Bury Hospice

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We assessed 1 quality statement in the responsive key question and found areas of good practice. The scores for these areas have been combined with scores based on the rating from the last inspection, which was good. People who use the service and those close to them spoke positively about care being well co-ordinated. They said the service worked well with other agencies to meet their individual needs. Staff considered the needs and preferences of different patients, including those with protected characteristics. Staff shared examples of how patient care and treatment was based on their assessed needs and was joined-up with other services in a co-ordinated, timely and responsive way. Partners we spoke with were very positive about how the service delivered care that was joined-up, flexible and supported choice and continuity. Partners said that they and the hospice were aware of the need to ensure the service had a mix of patients that reflected the ethnicity of the area. The service involved relatives and carers in planning care and support. They had developed resources to help educate relatives on how they can support oral care. The service piloted and evaluated new services to support known gaps in provision such as respite support at night. The service held events to raise awareness of the service provision.

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 Person-centred Care during this assessment. The score for this quality statement is based on the previous rating for Responsive.

People who use the service and those close to them spoke positively about care being well co-ordinated. They told us that staff had involved them and their family with advance care planning and that they felt listened to and valued. They said the service worked well with other agencies to meet their individual needs. Positive feedback included ‘it was good that family can visit at any time’ ‘staff took into account personal preferences’ ‘discharges and outreach care was seamless’ ‘the communication with our GP and joint home visits were very good’ ‘staff really listened’ and ‘my family member felt heard’. People who use the service and those close to them shared examples of when they were given palliative care options and had chosen the hospice as their place of care. Communication was clear on what the end of life pathway was and the plan going forward. They said that staff had created special moments for them to enjoy as a family and supported them to attend special occasions such as weddings.

Staff told us that the services available were very good however cuts in funding after COVID-19 meant that some services were no longer available. For example, the use of day services stopped due to social distancing and services held there such as the motor neurone disease (MND) clinic moved to a monthly outpatient provision rather than a group. The chronic obstructive pulmonary disease (COPD) support group was replaced by community respiratory hubs which the hospice was involved in to support appropriate patients. Staff considered the needs and preferences of different patients, including those with protected characteristics. Staff shared examples of how patient care and treatment was based on their assessed needs and was joined-up with other services in a co-ordinated, timely and responsive way. Staff had used language interpreters, sign language interpreters and communication boards to help facilitate discussions with patients and their families. Staff also shared examples of when they had made adaptions to meet different religions which allowed patients and their family to continue their religious and cultural practices. Staff worked with families and their children to create memory boxes and other memory orientated keepsake items. They also told us that they adapted rooms with cuddle beds to allow family to sleep close and brought social activities to the inpatient rooms to enjoy with family and friends.

Partners we spoke with were very positive about how the service delivered care that was joined-up, flexible and supported choice and continuity. Partners said that the weekly MDT meeting promoted joined-up and in depth care planning for patients with transitioning or shared services. Partners told us that there had been many great examples of best place of care and choice with patients over the previous years. They said that the outreach support service had a flexible approach when prioritising patients which supported them to achieve preferred place of care (PPC) or preferred place of death (PPD). For example, staff had provided responsive and timely respite at night to those in need. Partners told us that all palliative services were committed to supporting patients achieve their PPD. However, the small capacity of the inpatient unit meant this was not always achieved. Partners said that they and the hospice were aware of the need to ensure the service had a mix of patients that reflected the ethnicity of the area. They said they wanted to ensure the diversity of the local population was supported appropriately when palliative or end of life care was needed. They told us that the service shared patient stories with them to demonstrate joined up care and highlight areas of improvement. Pathways of care delivery were reviewed to identify the highest standard of care and what changes or improvements were needed. Partners praised the service for their integration with the wider system. They said that collaborative working and support from the hospice had helped patients have the support they required without the need for a hospital admission.

The service involved relatives and carers in planning care and support. They had developed resources to help educate relatives on how they can support oral care. We observed information such as advance care planning, PPD, family and social circumstances and comprehensive discharge plans in patient records. The service piloted and evaluated new services to support known gaps in provision such as respite support at night. They had secured recurrent funding and this was available three times a week. The service also had a new advice line available weekdays to support with symptom management and end of life care. Performance indicators were monitored by the service and showed average waiting times for admission to the inpatient unit had reduced from 2 days in 2022 to 1 day throughout 2023/2024. The average number of referrals and admissions to the inpatient unit had increased each year from 2022 to 2023/2024. Bed occupancy had also increased from 60% to 80%. Patients ethnicity had been captured for 100% of patients and they monitored the reasons for patients not being admitted. Data for the outreach and bereavement service for the same time period showed that referrals, caseloads, face to face contacts and phone calls had increased each year. Patients could attend the hospice instead of a hospital twice a week for blood tests and infusions. This was led by a consultant from a specialist cancer hospital. Patients were also able to attend a monthly Motor Neurone Disease consultant-led clinic at the hospice. Bereavement groups were available for adults and children in different settings such as walking, the onsite café or virtually. The service held events to raise awareness of the service provision. They had visited local carer hubs, hospitals, cancer support groups, supermarkets and had welcomed visits from groups to see the facilities and what could be offered.

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

We did not look at Listening to and involving people during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Equity in access during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Equity in experiences and outcomes during this assessment. The score for this quality statement is based on the previous rating for Responsive.

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