We carried out a review of the data available to us about St Christopher's Hospice on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about St Christopher's Hospice, you can give feedback on this service.
St Christopher’s Hospice is operated by St Christophers Hospice. It has 38 beds and provides hospice care for adults including inpatient care, outpatient clinics and community services. We inspected all of these areas.
We inspected this hospice using our comprehensive inspection methodology and carried out the unannounced inspection on 11th and 12th December 2019.
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.
The main service provided by this hospice is palliative care and care of the dying.
Services we rate
Our rating of this hospice stayed the same. We rated it as Outstanding overall, because:
Staff and volunteers proactively kept patients safe from avoidable harm and abuse. Staff regularly completed thorough risk assessments to tailor care.
Patient care was accurately recorded, and these records were available to staff when required including to consultants off site when on call.
Staff and volunteers had appropriate training to care for patients. Training needs were regularly assessed, and staff told us they were able to access learning to improve the level of care they were able to offer.
Services were designed to meet patients changing, and often complex, needs.
Staff cared for patients with compassion and treated them with dignity and respect. Staff saw each patient as an individual and involved them in decisions about their care goals.
The hospice had a range of bereavement support to allow relatives and carers to access the support they needed.
The hospice actively reached out to groups that were hard to reach, to enable them to use their services.
There were clear processes for recording and responding to complaint and concerns, these had been strengthened in the past year.
Leaders had the skills and abilities to run the hospice and were passionate about the care they delivered. They were aware of the potential risks facing the service and planned to minimise these risks.
Staff were engaged with the service and told us there was an open, honest and caring culture.
The hospice actively involved patients and staff in decisions about changes to services.
The hospice had a clear vision of what it wanted to achieve and a strategy to make this happen.
However, we also found the following issues that the service provider needs to improve:
The infection control policy, after death, was not fully being adhered to, therefore potentially putting staff at risk.
Nigel Acheson
Deputy Chief Inspector of Hospitals (London and South)
St Christopher’s Hospice has charitable status and provides palliative and end of life care to a population of approximately 1.5 million people living in the five South East London Boroughs of Bromley, Croydon, Lewisham, Southwark and Lambeth. The hospice accepts referrals from anyone in the community who knows a child or an adult with a life threatening or life limiting condition. Care, treatment and support is provided to people with a life threatening/life limiting illness, their families, carers and friends by a range of multi-disciplinary health and social care professionals including doctors, nurses, health care assistants, physiotherapists, occupational therapists, dieticians, social workers, complementary therapists and volunteers. The hospice plays a key role at a local, national and international level by offering information, advice, education/training and research opportunities to individuals, groups and institutions wanting to know more about end of life and palliative care matters.
Although the hospice has two different sites located at Sydenham and Orpington in Bromley, St Christopher’s considers itself a single provider with people in the local community, their families/carers, staff and volunteers visiting or working at both sites. This report relates specifically to the Sydenham site which has 48 beds divided into four wards named Nuffield, City, Alex and Rugby wards. Each ward includes a mix of single occupancy bedrooms and four bedded bays, a kitchen area and small sitting room or conservatory. The Sydenham site also includes the Anniversary day centre and cafe that is open to the public, the Pilgrim multi-faith room, the Pavilion Gardens meeting room and art lodge, a fully equipped gymnasium, a mortuary, various complementary therapies clinics, a conference room and the education and training centre. The hospice is surrounded by well-maintained gardens.
The specialist community palliative care team operates in collaboration with local primary health care teams to provide people, their families and/or carers with end of life care and support. Its primary task is to manage symptoms associated with people’s illnesses and to support them and their families through the illness and into bereavement. The team also offers an advice and visiting service for patients throughout the 24hr period. New patients can be admitted in to the community or inpatient service at anytime.
St Christopher's provides pastoral and counselling/bereavement services for children, adults and families. The hospice has three distinct bereavement services for adults following the death of someone under the care of the hospice, for anyone who is bereaved and lives in Bromley and the Candle project for children and their families.
People in the local community can also access a range of group and social activities at the hospice’s day care unit and Anniversary Centre where individuals, families and carers can relax, socialise, support each other and make use of a range of creative and complementary therapies, which includes a rehabilitation gym. St Christopher’s creative arts and complementary therapy team also work with staff, in care homes and with related projects in the local community.
At the time of our inspection there were 38 patients staying on the wards at the Sydenham site. The community palliative care team supports around 500 people in the community at any one time and offers advice and a 24 hour consultancy hotline for over 100 care homes in South East London. Nearly a thousand people used the facilities at the Anniversary centre in 2015/16. Approximately 120 people access physio sessions in the gym weekly and 20 young adults with life limiting conditions regularly attend social groups run by St Christopher’s.
The service had a registered manager in post who is also the director of nursing. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.
People and their families told us staff and volunteers looked after them in a very kind, respectful and compassionate way. Feedback we received from people, their families and community professionals supported this. We saw staff and volunteers built good working and caring relationships with people and their families and always treated people as individuals’ and with the utmost respect and dignity.
People received care and support from a multi-disciplinary team of highly qualified health and social care professionals who were well trained and supported by their co-workers, senior staff and managers. There was a very proactive approach to the personal development of staff and the acquiring of new skills and qualifications. A system of competency based assessments ensured staff had the required knowledge and skills to meet people’s needs and wishes and effectively. Systems were in place to support staff and volunteers to enable them to reflect on their own practice and that of their co-workers. This provided staff and volunteers with the knowledge, skills and confidence they required to meet people’s needs and wishes in an outstanding and personalised manner.
The provider demonstrated a strong commitment to providing people with good outcomes and high quality care, and to continually improve, extend and develop the service to reach as many people as possible. The hospice had developed a number of innovative approaches to reaching more ‘harder to reach’ groups in the local community. This included young people with a life limiting condition and individuals who did not previously receive any specialist palliative care services because they did not have a primary diagnosis of cancer. The hospice had responded to these challenges by setting up the Bromley Care Coordination (BCC) team and a therapeutic/social day every other Saturday for young people with life limiting conditions. This is held at the Anniversary Centre on the Sydenham site.
The service worked collaboratively with other professionals and agencies. Staff worked in partnership with a wide range of external health and social care professionals and other organisations to improve the services St Christopher’s offered to patients, people in the community and their families. Staff were encouraged and supported to undertake research and act as education facilitators to share best practice and ensure high quality outcomes for people with life-limiting conditions and those closest to them.
People received a personalised service. People were supported to make informed choices about their end of life care and to have as much control as possible about what happened to them before and after their death. Person centred care plans reflected people’s specific needs and preferences in respect of how they wanted to be cared for, treated and supported. Staff ensured people received all the necessary information in a way and at a pace they could understand. This enabled people and their families to make more informed decisions about the end of life care, treatment and support they wanted. Consent to care was sought by staff prior to any support being provided.
Robust systems were in place to enable people to receive support and advice whenever they needed it. This included a 24 hour advice line and visiting service aimed at helping people to manage their symptoms. People and their families/carers were able to access a wide range of group and individual social activities and educational classes at the Anniversary centre. People also told us staff understood their emotional needs and focused on their wellbeing as well as the wellbeing of their family member. There was a family support team which provided pre and post bereavement counselling for children, adults, their families and friends. There were no restrictions on visiting times at St Christopher’s and families could stay overnight.
People’s cultural and spiritual needs were respected and care and support was provided in line with an individual’s faith and customs. Staff had received training and were aware of different religious and cultural practices at the time of and after a person’s death. There was also a chaplaincy service to support people and their families with their spiritual needs.
There was strong emphasis on the importance of eating and drinking well and a commitment to providing people with what they wanted to eat and drink in a flexible manner. There was an excellent choice of meals, snacks and drinks, and staff went out of their way to buy people specific food if it was not available at the hospice. People were supported to receive good health care from the hospice’s and other external community health and social care professionals. People received their medicines as prescribed and staff knew how to manage medicines safely.
The management team demonstrated a strong commitment to delivering people with high quality care in a well-managed environment. The management structure showed clear lines of responsibility and leadership. The provider regularly reviewed their performance and where further improvements were identified appropriate actions were taken. Managers used learning from near misses, incidents and inspections to identify improvements that would positively enhance the lives of people receiving a service from St Christopher’s.
People said they felt safe on the wards or receiving care and support in their own home from the palliative community teams. Staff knew what action to take to ensure people were protected if they suspected they were at risk of abuse or
People who were in-patients at the hospice and their relatives told us they were very happy with the care they received. One relative could not praise the staff enough, they said "the staff do it for pure love, and there is lots of laughter'. Another relative told us 'mum is being looked after very well'. One person told us 'the staff are doing their bit, and they always respond to the call button'. People also told us their thoughts about the food. One person told us 'the food is not bad' and another said 'the food is ok". Overall people were very happy with the care and support they and their family members received.
We found people's needs were assessed to ensure they received the most appropriate care and support. People's care was delivered to promote their comfort and we found they received appropriate nursing and medical input. People were protected against malnutrition and dehydration and they were able to make choices about their mealtimes. We found improvements had been made with infection control practice, and the management of medicines was safe. People were cared for by adequate numbers of appropriately skilled care and medical staff.
We found the provider acted to seek appropriate consent from people, and would act in people's best interests if they lacked capacity to make their own decisions. Appropriate consent practice was followed. People's care and support needs were assessed and care was planned to meet their changing needs. People's care was reviewed on a regular basis to ensure it was appropriate to meet their needs. Staff knew what abuse was and how to report concerns. We found safeguarding adults and children's procedures had been followed in the past when concerns had been raised. The provider's recruitment procedures were sufficient to ensure staff were suitable. The provider acted in accordance with their complaints policy to ensure complaints were investigated and responded to adequately.
People felt that they were involved in and consulted about their treatment and care, informed of changes, and that their dignity and privacy were well-respected.
People using the service and those supporting them who we spoke to at our inspection praised the all the care services they received and the staff. They told us that they 'could not speak more highly of the care provided by the staff'. One family member said she 'could sleep easy' because of the quality of care.
During our visit we observed that care was provided in a compassionate and appropriate manner. Staff were friendly, professional, caring and respectful with people using the services and their supporters at all times.
Everyone we spoke with said that they felt safe and well looked after. People felt that if they did have a concern they would be able to raise it with staff, and that they would be listened to and appropriate action would be taken. People knew there was a complaints procedure and how to access it.