North London Hospice

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

The service had enough nursing and support staff to keep patients safe. Staffing levels were planned and reviewed to ensure there were sufficient staff for the number of patients on the unit. Managers could adjust staffing levels daily according to patient needs, using bank staff when required. On the day of our inspection, the number of nurses and healthcare assistants matched the planned numbers. The hospice ensured that all staff, including agency staff and volunteers, were suitably experienced, competent, and able to carry out their roles. Recruitment, disciplinary, and capability processes were fair and reviewed to avoid any disadvantage based on protected equality characteristics. The service experienced low rates of vacancies, staff turnover, and sickness, contributing to stability and continuity of care. Additionally, there was minimal reliance on bank and agency staff. Staff reported that medics were easily accessible and always attended the service when required. All staff we spoke with felt supported in their training. Staff also had opportunities to attend funded conferences and training courses relevant to their practice. Staff demonstrated a clear understanding of the safeguarding policy and knew how to identify and protect adults and children at risk of significant harm. They worked with other agencies to ensure patient protection. All staff knew how to make a safeguarding referral and whom to inform if they had concerns. We found staff occasionally did not complete a risk assessment for each patient on admission and assessments were not always reviewed regularly. We also found multiple items of out-of-date medications in the storage room. We saw a cupboard with medications for individual patients where labels were partially or completely removed. The chief executive officer and the director of nursing confirmed these medicines would be disposed of immediately and this practice would not continue.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

Staff felt supported in their roles through regular and relevant training opportunities. Leaders mentioned that training was appropriate to individual roles and it helped staff deliver safe care. Leaders stressed their commitment to providing learning opportunities and managing performance issues effectively. They ensured that staff at all levels had opportunities to develop and improve their skills.

Robust safeguarding policies and procedures ensured staff were knowledgeable about identifying and reporting risks to protect vulnerable patients. The hospice worked closely with the local NHS trust’s palliative care team, GPs, and other health and social care providers. This collaboration ensured a coordinated approach to patient care, facilitating seamless transitions and continuity of care. The hospice had a well-defined incident reporting system that encourages staff to report any safety concerns or incidents promptly. This system included clear protocols for reporting, investigating, and resolving incidents. However, staff did not always complete individual risk assessments for each patient on admission using a recognized tool, nor do they consistently review these assessments regularly. While incident reporting was robust, the process of learning from these incidents could be strengthened to ensure that lessons were systematically shared and applied across the organisation, further enhancing patient safety and care quality.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Patients at the hospice experienced a high standard of care, delivered by a team of qualified, skilled, and experienced staff. The hospice ensured that there were always enough staff on duty to meet the needs of patients, which contributed to a safe and supportive care environment. Patients felt well-supported, knowing that staff had the necessary skills and experience to manage their care effectively.

Staff reported that recruitment practices ensured new hires, including agency staff and volunteers, were suitably experienced and competent. They felt confident in the abilities of their colleagues. Leaders highlighted that recruitment processes were thorough and aligned with best practices, ensuring that only qualified individuals were hired. Staff were positive about the staffing levels, noting that there were always enough staff to provide safe, high-quality care. They appreciated the skill mix within teams, which ensured comprehensive patient care.

The hospice implemented thorough recruitment processes, including background checks and skills verification, to ensure all staff, including agency and volunteers, were suitably experienced and competent. They provided continuous training and professional development opportunities for staff. This ensured that they were equipped with up-to-date knowledge and skills to deliver effective care. Staffing levels and skill mix were planned and regularly reviewed to match patient needs. Managers could adjust staffing levels daily based on patient acuity and census. The hospice utilised bank staff as needed to maintain appropriate staffing levels without over-relying on agency staff, ensuring continuity and stability in care delivery.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

Despite the hospice's overall commitment to safety, there were shortcomings in the management of medicines, which posed risks to patient safety. A cupboard was found containing medications prescribed for individual patients with labels either partially or completely removed. This practice not only breaches guidelines but also risks medication errors, as it becomes challenging to verify if the correct medication is being given to the right patient. Staff reported that medications prescribed for specific patients were being used for other patients. This practice is against MHRA guidelines and poses significant safety risks, as it can lead to incorrect dosing, adverse reactions, and compromised patient care.