The Treehouse

Updated 7 April 2020

The Treehouse is a dedicated children's hospice, operated by East Anglia's Children's Hospices (EACH). It is one of three hospices operated by EACH, along with The Nook hospice in Norfolk and the Milton hospice in Cambridgeshire. EACH provides support for children and young people with life-limiting or life-threatening conditions, and their families and carers, across the counties of Norfolk, Suffolk, Cambridgeshire and Essex.

The Treehouse is a custom-built facility, which opened in 2012. It has five bedrooms for children and young people, and accommodation for their families. In addition to the bedrooms, the location includes an outdoor play area with woodland walks, a sensory garden, a music room, an art studio, a hydrotherapy pool, a sensory room, a faith and reflection room, a refreshment and kitchen area, and dedicated play areas.

The hospice delivers several services, including end of life care, day care, overnight accommodation, emotional support, counselling and well-being services, occupational therapy, physiotherapy, hydrotherapy, specialist play support and symptom management. The hospice provided additional services in patients’ homes, including a long-term ventilation outreach service.

The location has had a registered manager in post since July 2015.

The service is registered to provide the following regulated activities:

• Treatment of disease, disorder and injury.

We have inspected The Treehouse four times since its registration with CQC in 2011. Our last inspection was in June 2015, where we rated the service as good overall. We did not issue any requirement or enforcement notices following the inspection.

Updated 7 April 2020

East Anglia's Children's Hospices (EACH) operates The Treehouse - a dedicated children's hospice with five beds. Facilities include an outdoor play area with woodland walks, a sensory garden, a music room, an art studio, a hydrotherapy pool, a sensory room, a faith and reflection room, a refreshment and kitchen area, and dedicated play areas.

The Treehouse provides hospice care for children and young people. We inspected all services provided by the hospice.

We inspected this service using our comprehensive inspection methodology. We carried out a short-notice announced inspection on 14 January 2020.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

Services we rate

Our rating of this hospice improved. We rated it as outstanding overall.

We found areas of outstanding practice in relation to hospice care for children:

• There was a truly holistic approach to assessing, planning and delivering care and treatment to all children and young people who used the service. The service provided care and treatment based on national guidance and evidence-based practice, and managers checked to make sure staff followed guidance. Staff protected the rights of children and young people subject to the Mental Health Act 1983.
• Staff consistently treated children, young people, and their families with compassion and kindness. Staff respected and maintained children and young people's privacy and dignity throughout their care. There was a strong patient-centred culture, and staff were passionate about meeting the holistic needs of each child, young person and their families.
• Staff provided emotional support to children, young people and their families to minimise their distress. Staff recognised and respected the totality of people's needs, and their personal, cultural and religious needs. Staff went the extra mile to meet people's emotional needs, and saw these as important as their physical needs.
• Staff supported children, young people and their families to understand their condition, make decisions about their care and treatment, and become active partners in their care. Staff ensured a family-centred approach to care, and were fully committed to working with people to make this a reality. Staff encouraged and empowered the people who used the service to have a voice and realise their potential. For example, we saw the service had developed a model and approach to care planning that firmly placed the child or young person at the centre. Staff and managers proactively undertook a comprehensive and regular review of the needs of all people who used the service, through the development of the holistic needs assessment process.
• The service planned and provided care that met the needs of local children, young people and their families. Staff worked with other healthcare providers to deliver care, including community providers and local organisations. Staff were passionate about meeting the needs of local children and young people, and were proactive in the development of flexible and tailored pathways for each service user. For example, we saw the service had developed a comprehensive transition programme with a local adult hospice to support the transition of young people from children’s and young people’s services into adult services.
• Staff went the extra mile to understand the needs of each child and young person who used the service, as well as the needs of their families and those close to them. The service was inclusive, and staff took a proactive approach to make adjustments to allow all children and young people to access hospice services. The service coordinated care with other healthcare organisations and providers. For example, we saw the service had developed a comprehensive long-term ventilator community outreach service, staffed by experienced nurses, who provided children and young people with dedicated and specialist advice within their own home and within the hospice.
• Leaders and staff actively and openly engaged with children, young people, families, staff, equality groups, the public and local organisations to plan and manage services. They collaborated with partner organisations to help improve services for children and young people. For example, we saw the service had developed a comprehensive network of local volunteers, which helped the organisation to meet the needs of local people, particularly with the development of their 'Help at Home' volunteer service.
• The service had a vision and a mission statement for what it wanted to achieve, developed with all relevant stakeholders. The vision was focused on sustainability of services and aligned to local plans within the wider health economy. Leaders and staff understood and knew how to apply them and monitor progress. For example, we saw the service had formed strong and lasting working relationships with other care providers and community organisations, and had taken a leadership role in the local healthcare environment to meet the needs of the local population.

We found areas of good practice in relation to hospice care for children:

• The design, maintenance and use of facilities, premises and equipment kept people safe. Staff received training to use them. Staff managed clinical waste well. When providing care in patients’ homes, staff took precautions and actions to protect themselves and patients.
• The service managed patient safety incidents well. Staff recognised and reported incidents and near misses. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave children, young people and their families honest information and suitable support. Managers ensured they implemented and monitored any actions from patient safety alerts.
• Staff gave children and young people enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary. The service adjusted for patients’ religious, cultural and other needs.
• Staff assessed and monitored children and young people regularly to see if they were in pain, and gave pain relief in a timely way. They supported those unable to communicate using suitable assessment tools and gave additional pain relief to ease pain.

​Heidi Smoult

Deputy Chief Inspector of Hospitals

Updated 7 April 2020

Hospice services for children was the main service offered at The Treehouse.

We rated the service as outstanding overall, because the service was outstanding in caring and well-led, and good in safe, effective and responsive.