Farleigh Hospice

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• 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 routinely monitors people’s care and treatment to make continuous improvements. They ensure that outcomes are positive and consistent, and that they meet both clinical expectations and the expectations of people. Treatment options and preferred place of care was were discussed with families. In-patient outcome scale (IPOS) is a scale where patient's assess their symptoms, emotional well-being and spiritual needs to inform staff of their perspective on treatments. It is completed weekly, or when the needs of the patient change, or they enter a new phase of illness.This is carried out at time of referral and at regular intervals to look at any decreasing score to inform multi-professional meetings. IPOS is completed weekly or sooner depending on the patient needs or if care delivered is not meeting expected outcomes. The data produced shows how effective care is for the patient. The IPOS is also used for improvements in care and education required. The service is aware that obtaining feedback from relatives can be very difficult at such a sensitive time. The provider has paper forms and a website with electronic feedback forms. The Rapid Assessment and Discharge Team (RAD) helped patients make informed decisions about place of care options for end of life care and facilitation of discharge. For those whose condition was deteriorating rapidly and likely entering the terminal phase on care and provides patients and families with information on what is and is not available to them. Complaints, concerns and compliments are reviewed and logged to address any themes. The provider responded to feedback and implemented a Admissions and Discharges Navigator to support admission and discharge to the inpatient unit to improve hospice home transition. The provider monitored risk with the use of a risk management framework tool. This identified the three most common incidents reviewed as falls, pressure injuries and medicines.

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 Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

Families felt informed about the care journey of their family member. They were clear on what to expect from the provider. Families felt able to raise concerns if needed. Patient’s had visits from doctors every day to discuss care with family included in those discussions to make informed decisions. Treatment options and preferred place of care was discussed with families and documented. The patient survey showed the following detail: “Staff paid attention to detail at all times and all treatments were discussed and explained to ensure appropriate care was provided at all times.” “We always feel we are heard, and that any decisions which are made take into full account our views and everything we say.” “Everyone is so helpful if I need to speak to staff they contact us on a regular basis to check how I am doing, and asks about my wife to see if she wants to join the carers call - and the Financial help towards things we may need is a great relief. We will have had help with two mini break holidays away to live life to the fullest while we still can. Staff also helped us access small grants we knew nothing about which helps with the bills.”

The introduction of the rapid access to discharge from hospitals has seen an improved service for patients such as getting the patient to their preferred place of choice. Leaders told us the national tool IPOS was used to access physical and emotional symptoms which is patient led. This is carried out at time of admission and at regular intervals when the needs of the patient changed. IPOS was used to monitor outcomes and identify areas of improvement and learning as well as demonstrate the effectiveness of care. The Clinical Quality report was created during a review of Ward to Board Governance undertaken by the Director of Care in 2022/23. This involved embedding a local risk framework, building strength, resilience and accountability in teams. Risks are managed and reviewed at Clinical Quality Group and reported by exception to Clinical Governance Committee and Board of Trustees. This allowed the service to identify emerging risk alongside themes and trends to produce actions plans to address any patient risk. Leaders told us that current quality improvement projects included training for staff to improve patient care outcomes and shared learning. Monthly local risk meetings with service leaders to build local accountability. The provider had a clear clinical governance structure, producing quarterly quality reports. The RAD team helped patients make informed decisions on care providing patients and families with information on what resources were available to them. Complaints and compliments are reviewed to address any themes. The provider responded to feedback and implemented a flow co-coordinator to improve hospice to home transition. Falls, pressure injuries, medication, safeguarding and MCA are discussed at monthly meetings, with Infection Prevention and Control as an agenda item now reduced to quarterly in line with reducing covid rates. Mental Capacity training is provided face to face and online, with audits to measure compliance with legislation.

The provider is engaging with their local Integrated Care Board around the Patient Safety Incident Response Framework (PSIRF) implementation and policy. This provider has a patient safety incident response plan, which sets out how the service will respond to patient safety incidents and how learning will occur within the organisation. The provider has an After-Action Review process (AAR) which is a structured, facilitated discussion on an incident or event to identify a group’s strengths, weaknesses and areas for improvement by understanding the expectations and perspectives of all those involved and capturing learning to share more widely. Safe space, invitees only (those involved in incident, agreed by PSIRF team). AARs can be used after any activity or event that has been particularly successful or unsuccessful. It is also often used at the end of a project to help populate a lessons learnt log. It is important to disseminate learning widely so that good practice can be shared and others can learn from mistakes. Patient Safety Incident Response Policy: This policy supports the requirements of the NHS England Patient Safety Incident Response Framework (PSIRF) and sets out how Farleigh Hospice will approach the development and maintenance of effective systems and processes for responding to patient safety incidents and issues for the purpose of learning and improving patient safety. The provider has a “ward to board risk framework”. Local risk groups were set up with terms of reference to build accountability and responsibility in team leaders and managers, and training was provided to enable staff to understand risk management and how to mitigate and form action plans. The provider has a clear risk register format, triaging and rating the risk to be actioned and escalated accordingly. This includes looking at financial and clinical risks.

We did not look at Consent to care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.