Butterwick Hospice Stockton

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

The service was responsive and has been rated good. The service admitted patients in accordance with the conditions we applied following our last inspection which restricted the numbers and complexity of patients admitted. Following this assessment, review of evidence and the assurances provided meant the conditions were now removed. Patient care was coordinated, and staff worked well together. Staff provided person-centred care, completed robust care plans and patient risk assessments. Patient’s individual preferences were considered and documented. Staff encouraged and supported patients to provide feedback on their care. Patients were encouraged to express their wishes about their care and future planning. Information was accessible with additional support provided for patients, as required. Senior leaders acknowledged that further work was required to address the needs of minority groups in the local community. This would be included in future development work, in accordance with their local strategy. Leaders were alert to discrimination and inequality. However, at the time of assessment and due to the conditions in place, admissions were agreed by the local NHS trust. It was therefore not evident how the service could ensure equality in access for hard to reach and minority groups as the service policy did not define this access.

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.

Staff treated patients with compassion and kindness and respected their privacy and dignity. Staff were discreet and responsive when caring for patients. Staff took time to interact with patients in a respectful and considerate way. We observed that staff all had good communication skills and had a caring approach when interacting and engaging with patients. We saw a display board with thank you letters and cards from patients and their families that demonstrated they had a particularly caring approach. Comments included that staff were caring and empathetic.

Staff we spoke with explained the hospice environment afforded them more time to provide quality care to their patients. The hospice accommodated patient’s carers overnight, when required. Staff clarified that friends and family were welcome at any time and the hospice did not have restricted visiting hours. Staff we spoke with could access medical help promptly by contacting ‘medic of the day’.

We observed patients needs were assessed individually and documented in care plans. Staff were clear how to assess patients’ suitability for the service.

The service admitted patients in accordance with the conditions we applied following our last inspection. The conditions restricted the maximum number of patients the service could admit according to complexity of need. This meant the service was unable to offer choice to the wider community. However, assurances subsequently received from the service meant the restrictions were now removed.

Senior managers we spoke with acknowledged that further work to assess the needs of the local community were required and would be included in future development work in accordance with their local strategy. Managers were considering ways of extending to difficult to reach and minority groups of patients.

We saw clinical leaders had visited other local hospice providers to share and seek best practice across the network. Partners told us Butterwick Hospice was a valuable and active member of the Hospices North East and North Cumbria collective. The service also participated in various regional subgroups and initiatives.

The service had developed and maintained positive working relationships with the local NHS trust. Provision to admit patients directly from the local hospital was in place and we saw clear criteria for admission to support these patients, who were approaching end of life. Educational support and training was provided by the trust clinicians and there were opportunities for clinical skill development for hospice staff.

Patients and their carers were provided with information that was accessible. We saw leaflets and posters displayed in the main reception area. In addition, they could access information about the hospice online via the service’s website and sign up to a newsletter. Information was also available via social media platforms. However, the service did not have a process in place to ensure written information could be provided in various languages.

Staff we spoke with explained how they assessed patient’s individual needs regarding giving and receiving information. Communication needs were discussed at staff handover and were documented in patient’s care records. Staff clarified they used white boards to assist patients who were non-verbal to communicate more effectively. Staff accessed interpreters or signers if they needed help with communication.

The complaints process was displayed in every patient bedroom and within the patient information packs, given to each patient on admission.

Patients and their carers knew how to give feedback about their experiences of care and support, including how to raise any concerns or issues and could do so in a range of accessible ways.

Managers we spoke with confirmed the service had not received any complaints. They were aware of the difficulties and sensitivities of requesting patient feedback and had considered introducing an anonymous feedback box to try and increase the number of feedback returns.

The complaints procedure was now displayed in the bedside folder which was located in each patient’s room, to ensure patients and carers could see this. In addition, we found contact details for submission of feedback on the service’s website.

Patients were individually assessed by a specialist palliative care nurse prior to admission to ensure services were appropriate to meet their needs. Referrals were accepted from the local NHS trust palliative care team for end of life care. The service was working to expand its scope of care and to increase the number of available beds. This service was available Monday to Sunday 9am to 5pm. Patients were accommodated in single bedrooms with ensuite facilities. The hospice and grounds were accessible for people who used a wheelchair or a pushchair.

Leaders were alert to discrimination and inequality that could disadvantage different groups of people in accessing care. Leaders clarified they were now considering ways to improve equity in access for hard to reach and minority groups. Trustees we spoke with told us they had attended a Hospice UK conference and were aware of the need to develop workstreams to promote care in hard to reach and minority groups. A strategy to achieve this objective was yet to be developed.

Staff accessed an up to date Equality and Diversity policy and attended Equality and Diversity training.

Staff accessed resource material which provided guidance on how to use inclusive language when communicating with patients. The service used the ‘Care of the Dying Patient’ document to capture individuals’ preferences to ensure equity in experiences and outcomes. Three records we reviewed were mostly complete.

Staff we spoke with told us that people would not be treated differently based on their sexual orientation or protected characteristics.

The service’s strategic plan described how it would work in partnership with local health and social care organisations to ensure a streamlined patient pathway, ensuring equity of service and responding to diversity and cultural need. Patient’s individual preferences were considered and documented on the ReSPECT forms we reviewed. ReSPECT stands for Recommended Summary Plan for Emergency Care and Treatment. The ReSPECT process. creates a summary of personalised recommendations for a person’s clinical care in a future emergency in which they do not have capacity to make or express choices. Care passports we saw, for example 'All About Me' demonstrated that staff considered individual's likes and dislikes regarding their treatment and care preferences. Leaders were alert to discrimination and inequality. However, at the time of assessment and due to the conditions in place, admissions were agreed by the local NHS trust. It was therefore not evident how the service could ensure equality in access for hard to reach and minority groups as the service’s policy did not define this access.

Patients were encouraged to express their wishes about cardiopulmonary resuscitation, and their preferred place of death. They were supported to do so and were able to change their mind, if they wished. When any treatment was changed or withdrawn, staff communicated and managed this openly and sensitively, so that patients had a comfortable and dignified death. They were supported to so and this was documented on ReSPECT forms we saw.

Staff we spoke with were clear about access to information regarding people’s future care preferences. They explained how professionals work together to support patients to reach their goals. People’s decisions and what mattered to them were delivered through personalised care plans.

We saw evidence that patients were involved in discharge planning, in collaboration with external stakeholders including social care providers and family members, where appropriate.