Sue Ryder - St John's

Updated 28 November 2019

Sue Ryder – St John’s is operated by Sue Ryder, a national charitable organisation which offers specialist palliative care and treatment for adults living with life-limiting conditions. The hospice is located in a quiet rural setting in the village of Moggerhanger, near Bedford. It primarily serves the communities of Bedfordshire and Cambridgeshire.

The hospice has had several registered managers in post since 2011. At the time of the inspection, a new manager had recently been appointed and was registered with the CQC in August 2019.

The registered manager is the hospice’s accountable officer for controlled drugs.

Updated 28 November 2019

Sue Ryder – St John’s is operated by Sue Ryder, a national charitable organisation which specialises in providing palliative and neurological care to people living with life-limiting conditions. The hospice has 15 inpatient beds. Facilities include an inpatient unit, day therapy unit, palliative care hub, lounge, multi-faith and spiritual room, conservatory and garden.

The hospice provides end of life and palliative care for adults. We inspected all services provided.

We inspected this service using our comprehensive inspection methodology. We carried out a short-notice announced inspection on 27 September 2019. We gave staff two days’ notice that we were coming to ensure that everyone we needed to talk to was available. We also inspected on the 3 October 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.

Services we rate

Our rating of this service improved. We rated it as Outstanding overall.

We found outstanding practice in relation to:

• Staff treated patients and their families with compassion and kindness, respected their dignity and privacy, and went above and beyond expectations to meet their individual needs and wishes. Staff were devoted to doing all they could to support the emotional needs of patients, families and carers to minimise their distress. Staff helped patients live every day to the fullest.

• Services were delivered in a way to ensure flexibility, choice and continuity of care and were tailored to meet patients’ individual needs and wishes. The service planned and provided care in a way that fully met the needs of local people and the communities served. It also worked proactively with others in the wider system and local organisations to plan care and improve services.

• It was easy for people to give feedback. Concerns and complaints were taken seriously and investigated, and improvements were made in response to feedback where possible. Patients could access services when they needed them.

• Leaders ran services well using best practice information systems and supported staff to develop their skills. Staff understood the vision and values, and how to apply them in their work. Staff were motivated to provide the best care they could for their patients. There was a common focus on improving the quality and sustainability of care and people’s experiences. Staff were proud to work at the service and felt respected, supported and valued. Leaders operated effective governance processes and staff at all levels were clear about their roles and accountabilities. The service engaged well with patients, staff and the local community.

• The palliative care hub service worked collaboratively with partner organisations to ensure patients received the best care possible at the end of life, in their own homes. Feedback from relatives and carers who had been supported by the palliative care hub was overwhelmingly positive, and staff were often described as “angels” and having gone above and beyond what was necessary.

• Staff were involved in an innovative project to support patients to choose their own care home. The palliative social worker recognised that patients discharged from a hospice to a care home often had their choice and control compromised because they had to rely on others to choose a home on their behalf. To address this, staff visited all nursing homes who agreed to participate in the project and photographed the bedrooms. This meant patients who were not able to view nursing homes themselves were given more choice and control regarding where they would like to go. The photograph folders were also used by staff to open up discussions with patients about what to expect in a nursing home.

We found good practice in relation to:

• Despite some staff vacancies, the service had enough staff to care for patients and keep them safe. Staff had training in key skills and understood how to protect patients from abuse. The service controlled infection risk well. Staff assessed risks to patients and acted on them. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve services.

• The service provided care and treatment based on national guidance and best practice. Staff gave patients enough to eat and drink and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, supported them to make decisions about their care and had access to good information. Key services were available seven days a week.

We found areas of practice that require improvement:

• Patients preferred place of death was not always documented.

• The real-time patient feedback rate was significantly below the Sue Ryder target.

• Two ‘aroma steam’ machines required electrical safety testing.

Following this inspection, we told the provider that it should make some improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals (East)

Updated 28 November 2019

We rated this service as outstanding for caring, responsive and well-led, and good for safe and effective.