Butterwick Hospice Stockton

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

The service was effective and has been rated good. Patients fed back, through recent surveys, that they were involved in their care and treatment and they felt staff were competent and trained sufficiently to carry out their role. Staff handovers were comprehensive and the service had a clear admission criteria. The service had a positive partnership agreement with the local NHS trust and was an active member of the Hospices Network North East and North Cumbria collaborative. People's capacity and ability to consent was considered, in line with the Mental Capacity Act (2005) and staff we spoke with demonstrated full awareness of the procedure to follow regarding Deprivation of Liberty safeguards (DoLs).

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We saw evidence that patient’s needs were assessed using a holistic approach with formal assessment tools to ensure their needs were reflected and understood. For example, patients were asked about their individual dietary requirements. Staff used a support tool to enable person-centred care. For example, 'This is me' which was used to record details when a person could not easily share information about themselves.

We saw effective handovers between staff and a comprehensive exchange of information, between health care professionals. Assessments were up-to-date and staff understood patient’s needs, which were routinely reviewed. Staff we spoke with explained how they discussed pain scores with patients hourly and as required. There was a clear care plan to capture individual patient’s needs and preferences regarding end of life care. Staff we spoke with explained that all patients are potentially at risk of malnutrition, therefore they used the patient led assessment of nutritional care (PLANC) to record this.

There were now clear policies and processes in place to complete safe admissions. For example, we saw clear admission criteria and staff were clear about any treatments or interventions that could not be provided at the hospice. However, we saw ‘Care of the Dying Patient’ documents had not been fully completed. This was a concern, as the service’s acceptance criteria at the time of assessment stated these must be fully completed prior to admission.

The service was part of the Hospices North East and North Cumbria collaborative which shared best practice guidance. End of life care was well coordinated and enabled choice for individuals. Patients fed back through recent surveys that they were satisfied with the care they received from staff.

Staff we spoke with told us patient's needs were considered in accordance with best practice NICE guidance. For example, 'Care of dying adults in the last days of life'. We saw evidence that staff completed the care certificate which is a set of standards that defined the knowledge skills and behaviours expected at the service.

Staff now accessed policies which referenced evidence based best practice guidance, to support them to deliver care in line with the service’s purpose. The service, in collaboration with the local NHS trust, had developed clear admission and referral processes for the transfer of patients between services. This included a checklist to ensure key information and medicines were in place prior to transfer. However, the service acknowledged that further oversight was required to ensure all documents were completed prior to admission.

The service worked with the local NHS trust and accepted patients, following assessment by the trust’s specialist palliative care nurses. Staff received a verbal handover of the patients’ needs prior to their transfer. Three patient records we reviewed showed the ‘Care of the Dying Patient’ documents were mostly complete.

Healthcare professionals we spoke with explained how they worked together as a team to benefit patients. For example, patients were reviewed every day by the specialist nurse. They were able to contact the on-call consultant from the hospital. They supported each other to provide good care and we observed staff within the service demonstrated positive working relationships. We saw staff working well together as part of a team to meet the individual needs of their patients.

Feedback from stakeholders such as the Hospices Network North East and North Cumbria, provided evidence of effective team working. There was effective communication between different teams and seamless transition of care from, for example, the local NHS trust to the hospice.

We observed good quality interactions between staff to support their patients. For example, daily handovers and safety huddles. Staff were always present and available. Patient records we reviewed contained the 'All About Me' document. This meant information such as the patient's preferences, care requirements, diet, previous holidays and employment was recorded to facilitate person centred care and this was discussed at daily handover. Information was clearly displayed on notice boards relating to care, activities and feedback on care.

This was a nurse led unit and we saw a clear, documented process of the partnership working between the local NHS trust and the hospice. This included information on safety huddles and multidisciplinary meetings, including the review of potential patients for transfer to the hospice. We saw a clear admission process with defined ceilings of care.

We saw that patient’s health was regularly monitored and this was in a person-centred way. This included health assessments and checks and where appropriate, with input from required health and care professionals. The service hosted monthly 'Look Good Feel Better' sessions, which support women living with cancer by offering make up and skin care tutorials. They also host weekly Macmillan 'Craft and Chat' groups for people living with or impacted by cancer.

We spoke with staff who could explain clearly how they supported patients to make healthier choices. Staff received training on nutritional values and patients were given a range of healthy options at mealtimes using daily delivered, fresh, seasonal ingredients. Staff also received training in the International Dysphagia Diet Standardisation Initiative (IDDSI), which is an internationally recognised framework that provides standardised terms and testing methods for food textures and drink consistencies for individuals with swallowing difficulties.

Patients and families were able to access information on wellbeing, communication, healthy living and smoking cessation, from a range of materials displayed at the main entrance. We observed staff following processes to support people to live healthier lives.

The hospice recognised the importance of gaining feedback from patients, families and carers, to enable service improvement. They used a variety of methods to request feedback such as paper and digital questionnaires and feedback returns box. Returns were low due to the sensitive nature and timing of the requests. However, the service had received unprompted positive feedback in the form of cards or shared written feedback, which had been forwarded on by partnership services. Some of the feedback we saw included: ‘Your hospice is a wonderful, serene place and your staff are all so special’ ‘Not only was he given medical care of the highest standard, but everyone involved in helping my Father only showed him complete care and utter respect; this meant that he was able to maintain his dignity to the end – so important for such a strong and dignified man’ ‘I would like to thank all the nursing staff who looked after my Dad and brother, they went above and beyond for him’ Previous feedback was displayed on hospice notice boards.

Staff we spoke with explained that unlike other hospices, they did not use the Integrated Palliative Care Outcome Scale (IPOS) to measure outcomes. This was due to difficulties obtaining responses from patients nearing end of life. Instead, they used a simpler assessment tool, such as the Face, Legs, Activity, Cry, Consolability (FLACC) pain scale. This allowed more meaningful self-assessment of pain and symptoms where patients were unable to verbalise. The service acknowledged these scores were primarily for supporting care in the moment and did not easily translate into wider scale outcomes. Leaders shared with us how they planned to use more conventional tools, such as IPOS, to measure outcomes once patient admissions increased.

The service collated feedback from patients regarding their experience. However, staff did not always monitor the effectiveness of care and treatment or use the findings to make improvements to achieve good outcomes for patients. We saw evidence, however, that concerns were escalated immediately, and compliments were shared. We saw pain scores were recorded, for each patient, and effectiveness was evaluated. The service did not participate in relevant national clinical audits, such as National Standards. Therefore, it was not known whether outcomes for patients were positive, consistent or met expectations when compared with similar local services. We saw some evidence of local clinical audits, but these did not include monitoring of patient outcomes.

People's capacity and ability to consent was in line with the Mental Capacity Act (2005). We reviewed records of patients with fluctuating capacity and saw evidence that the patients and their carers were involved in planning, managing and reviewing of their care and treatment. People’s views and wishes were always taken into account when their care was planned. For example, their personal, spiritual, emotional needs or care after death.

Staff we spoke with demonstrated they were fully aware of the procedure to follow regarding Deprivation of Liberty safeguards (DoLS) and who to contact. DoLS is the legal procedure necessary to deprive a person of their liberty who lacks capacity to consent to their care and treatment in order to keep them safe from harm. At the time of our assessment there were no inpatients that were subject to DoLS authorisations.

Staff accessed a comprehensive policy regarding consent to treatment and care which referenced best practice guidance. Annual MCA and DoLS training was mandatory, according to the training matrix.