St Barnabas Hospice - Specialist Palliative Care Unit

Updated 7 November 2019

St Barnabas Hospice (Lincolnshire) is operated by St Barnabas Hospice Trust. The service opened in 1989.

St Barnabas Hospice is a local independent charity offering palliative care to people with life limiting conditions living in Lincolnshire. The service is situated in Lincoln

The hospice has had the same registered manager in post since 2015.

We inspected the provider at short notice on Thursday 08 August May 2019.

The hospice primarily serves the communities of Lincolnshire and the local area.

Updated 7 November 2019

St Barnabas Hospice is operated by St Barnabas Hospice Trust (Lincolnshire).

St Barnabas Hospice is a Specialist Palliative Care Unit which provides a wide range of services for adults who have advanced, progressive illnesses and where the focus is on palliative and end of life care. The services are provided within four settings; an eleven-bed in-patient unit, day therapy centres, hospice at home services and a palliative care co-ordination centre. Holistic services are delivered by a team of medical, nursing and social work staff, occupational and physiotherapists, counsellors, volunteers and chaplains.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service.

Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The registered manager had been in post at St Barnabas Hospice since 2015.

The service was registered to provide the one regulated activity of Treatment of disease, disorder or injury (TDDI) to people over the age of 18 years.

We inspected this service using our comprehensive inspection methodology. We carried out the inspection on the 08 August 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 hospice improved. We rated it as Outstanding overall because:

We found outstanding practice in relation to the hospice:

• There was a very strong, patient-centred culture from all staff. Staff were motivated and inspired to offer care for patients with kindness, compassion, dignity and respect through supportive relationships with patients and their families, care givers and loved ones.

• We observed all staff members speaking to patients and their relatives and care givers with compassion and we observed sensitivity being shown during those conversations.

• We heard patients being offered food and drinks in an encouraging and caring way and observed staff and volunteers to always be doing as much as they could to help patients.

• One of the patients told us, “The staff are all fantastic”. another patient told us. “I simply cannot fault them”. Another patient told us, “The care here is second to none”

• Staff ensured that patients and those close to them were partners in decisions about their care and treatment. People’s individual needs and preferences are central to the delivery of tailored services.

• There are innovative approaches to providing integrated person-centred pathways of care that involve other service providers, particularly for patients with multiple and complex needs. For example, at the time of our inspection, the hospice was delivering two projects to reach out to the homeless community and to a local prison, offering bereavement care to both communities. The projects included education to support staff to provide palliative care to those who do not normally have access hospice care counselling and provide bereavement counselling to the inmates of a local prison

• The Hospice hosts the PCCC, a commissioned service, with a single point of access. The PCCC was available to health professionals, patients, their families and care givers who need advice and support regarding palliative and or end-of-life care

• The PCCC centre facilitated referrals, organised care packages and worked in partnership with the clinical teams and the wider health community to enable care delivery within that community.

We found Good practice in relation to the hospice:

• The service provides mandatory training in key skills to all staff and made sure everyone completed it.

• Staff understand how to protect patients from abuse and the service works well with other agencies to do so. Staff had training on how to recognise and report abuse, and they knew how to apply it.

• The service-controls infection risk well. Staff keep equipment and the premises clean and used control measures to prevent the spread of infection.

• The service has suitable premises and equipment and looks after them well.

• Staff complete and update risk assessments for each patient. The records are clear and updated regularly

• The service has enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment.

• Staff keep detailed records of patients’ care and treatment. Records were clear, up-to-date and easily available to all staff providing care.

• The service follows best practice when prescribing and giving medications and patients receive the right medication at the right dose at the right time

• The service manages patient safety incidents well. Staff recognise incidents and reported them appropriately. Managers investigate incidents and share lessons learned with the whole team and the wider service. When things went wrong, staff apologise and give patients honest information and suitable support.

• The service provides care and treatment based on national guidance and evidence of its effectiveness. Managers check to make sure staff follow guidance.

• Staff give patients enough food and drink to meet their needs and improve their health. They use special feeding and hydration techniques when necessary. The service adjusts for patients’ religious, cultural and other preferences.

• Staff assess and monitor patients regularly to see if they were in pain. They support those unable to communicate using suitable assessment tools and give additional pain relief to ease pain.

• Managers monitor the effectiveness of care and treatment and use the findings to improve them. They compare local results with those of other services to learn from them.

• The service make sure staff are competent for their roles. Managers appraise staff’s work performance and hold supervision meetings with them to provide support and monitor the effectiveness of the service.

• Staff of different kinds work together as a team to benefit patients. Doctors, nurses and other healthcare professionals support each other to provide good care.

• The service delivers a full inpatient service for patients receiving palliative care seven days a week.

• Staff understand their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. They know how to support patients experiencing mental ill health and those who lack capacity to make decisions about their care.

• The service plan provides services in a way that meet the needs of local people.

• The service takes account of patients’ individual needs.

• People can access the service when they need it. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients are in line with good practice.

• The service treats concerns and complaints seriously, investigates them and learns lessons from the results, and shares these with all staff.

• Managers at all levels have the right skills and abilities to run a service providing high-quality sustainable care.

• The service has a vision for what it wants to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community.

• Managers across the service promote a positive culture that supports and values staff, creating a sense of common purpose based on shared values.

• The service has effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected risks

• The service collects, analyses, manages and uses information well to support all its activities, using secure electronic systems with security safeguards.

• The service engages well with patients, staff, the public and local organisations to plan and manage appropriate services as well as collaborating with partner organisations effectively.

• The service is committed to improving services by learning from when things go well and when they go wrong, promoting training, research and innovation.

Services we rate

Our rating of this. We rated it as outstanding overall

• Staff cared for patients with compassion, empathy and respect. Feedback from all patients confirmed that staff treated them exceptionally well and with kindness and told us that staff went over and above what was expected of them. People were truly respected and valued as individuals and empowered as partners in their care, practically and emotionally, by an exceptional and distinctive service.

• The trust responded to people’s individual needs and preferences which were central to the delivery of tailored services. There were innovative approaches to providing integrated person-centred pathways of care that involved other service providers, particularly for people with multiple and complex needs. The services were flexible, provided informed choice and ensured continuity of care.

• There was an embedded and extensive team of volunteers who helped support the service. There was a separate volunteer induction and training programme.  Volunteers were valued members of the service who were provided with support and who felt part of the hospice team.

We also found areas of good practice:

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

• Staff provided good care and treatment, gave patients enough to eat and drink. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.

• Staff treated patients with great compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided exceptional emotional support to patients, families and carers.

• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.

• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work.  Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

Heidi Smoult

Deputy Chief Inspector of Hospitals (Central Region)

Updated 7 November 2019

The hospice had an 11 bedded inpatient unit providing care for complex symptom management and terminal care. This was the main activity for this service. The hospice also provided a Hospice at Home Service community service providing specialist palliative care to patients in their usual place of residence, as well as day therapy centres, hospice at home services and a palliative care co-ordination centre.

We rated this service as outstanding overall because we rated caring and responsive as outstanding, but safe, effective and well led as good.