Bury Hospice

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We assessed 4 quality statements in the safe 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 said they were involved in advance care planning and felt listened to and valued. People who use the service and those close to them were very positive about the care they received. Staff we spoke with felt listened to, well supported and gave examples of when their views had been taken into account. Partner feedback was consistently positive about safety and continuity of care. The service provided care that followed best practice and national guidance and had processes in place to identify and manage risks. People who use the service were cared for in an environment that was suitably designed to meet their needs. The service had effective arrangements to monitor the safety and upkeep of the premises. The service assessed patient to staffing ratio daily to plan any bank or agency staff to ensure safe staffing. The service had a mandatory training assurance framework that covered a range of modules that included learning disability and autism. Overall staff mandatory training compliance was 98.5%. Areas were clean and had suitable furnishings which were clean and well-maintained. Equipment used to deliver care and treatment was suitable for the intended purpose, stored securely and used properly. The service performed well on infection, prevention and control audits.

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 Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

People who use the service and those close to them said they were involved in advance care planning and felt listened to and valued. People who had received care from both the inpatient unit and the community outreach team reported good continuity of care when they moved between the different services. People who used the service and families told us they had confidently chosen the hospice as their preferred place of care (PPC) and/or preferred place of death (PPD). They reported a good collaborative approach between the hospice and their GP. The views of people who use services, partners and staff were listened to and taken into account. The service asked people if they felt informed, involved and supported by staff. We looked at feedback data from July 2024 for 18 people across the inpatient unit, community outreach, bereavement support and complementary therapy. The feedback data showed 100% positive experience reported across all these services. The service collected responses from 702 visitors between May and July 2024 based on their experience that day at the hospice. The results showed that 92% reported a ‘very good’ experience and 8% said ‘good’. People who use the service and those close to them were very positive about the care they received.

Staff we spoke with felt listened to, well supported and gave examples of when their views had been taken into account. Senior leaders provided opportunities for staff to express any concerns including through one to ones, the freedom to speak up guardian and team meetings. The most recent staff survey dated October 2023 showed that 95% of staff said if family or friends needed treatment at the hospice they would be happy with the standard of care. All staff reported good multidisciplinary team (MDT) working within their service and with the local NHS trust. MDT hospice meetings were held weekly and clinical meetings were held daily. They were attended by internal health professionals from the hospice and external professionals such as district nurses and the hospital specialist team. Staff we spoke with told us these meetings were valuable and shared information about complex patients, new referrals, discharges and transfers. Staff told us that morning safety meetings for the inpatient unit took place every morning. We observed meeting minutes that showed the meetings discussed staffing, medical cover, patient phase of illness and risks such as falls or pressure ulcers. Community outreach staff told us they also had regular meetings and that the clinical leads met monthly. They said that information from these meetings were shared via email to all relevant staff. We spoke with staff from the kitchen department who spoke about the contingency plan they had in place to provide food if staff were sick. The plan was implemented this year with a local NHS hospital and they told us it had been used on one occasion.

We collected feedback from external partner services that worked collaboratively with the hospice. Partner feedback was consistently positive about safety and continuity of care. They told us they worked well collaboratively with the hospice to support the system, maintain patient safety and ensure patients are placed where they are best cared for. Partners we spoke with told us that daily MDT communications with the inpatient unit and outreach was excellent. The hospice had supported the recruitment of a consultant in palliative care a year ago and partners said that this had led to further improvements such as more in depth discussions about patients and provided more continual learning. They told us that medical staff were readily available to discuss patients when needed. Partners spoke about the benefits of the system wide meetings that took place daily with senior leaders and system partners such as the local NHS trust and commissioners. The meetings discussed the current Bury operational pressures escalation levels (OPEL) position and hospice capacity for potential admissions. Partners shared many positive examples of working with the service and staff. They told us that the service was focused on innovation and improvement and they were confident in the managerial and clinician leadership.

Patient referrals came from services including the NHS hospital, GP’s and district nurses. Patients were assessed in the community and supported to manage at home. If they needed more support to manage pain relief and medicines they were offered an inpatient bed. The hospice consultant led weekly MDT meetings to prioritise referrals for inpatient care and discussed complex needs and PPC or PPD. The service had 178 admissions to the inpatient unit between July 2023 and July 2024 and as of July 2024 there were 295 patients under the community outreach service. The service monitored reasons for patients not being admitted to the inpatient unit such as when patients were admitted to hospital or when their condition had improved. Data showed that an average of 2 patients a month were on the waiting list from April 2023 to March 2024 and this remained the same from March to July 2024. Patient records were completed and updated appropriately with evidence of discussions with patients, carers and internal and external partners. Records were stored securely on site. We observed in care records that staff carried out holistic assessments and risk assessments such as falls, pain scores, pressure ulcers. A nationally recognised tool was used to classify patients functional impairment and assess the prognosis in individual patients. The service provided care that followed best practice and national guidance and had processes in place to identify and manage risks. There were relevant up to date policies for staff to follow that included guidance on sepsis, hypoglycaemia, resuscitation and acute seizures. The service had an effective audit programme that included audits for pressure area care, oral care and patient records. Audit data showed what actions had already been taken and implemented since the last audit and recommendations for improvement.

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

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

People who use the service and their relatives told us the environment was safe, the design and condition of the rooms were good and met their needs. They told us that the ensuite bathrooms and access to the gardens from the inpatient rooms created a less clinical environment compared to a hospital ward. A family member we spoke with said the bathing service facility onsite had the provisions to play music and dim lights which made it a relaxing and therapeutic experience.

Staff told us they had no concerns regarding the building or equipment. They said that equipment needed for care and treatment was readily available and maintenance responded quickly to any reports of faulty equipment. Outreach staff told us that they liaised with social workers for equipment needed for those who were cared for at home. Staff were able to describe safety checks, safe storage and servicing for the environment and equipment. This included areas such as water storage, oxygen cylinders, the plant room, fire alarms, clinical waste and legionella flushing of water outlets.

People who use the service were cared for in an environment that was suitably designed to meet their needs. Rooms throughout the hospice were relaxing, homely and well furnished. This included a communal breakfast room, assisted bathroom, children’s bereavement room, 2 complimentary therapy rooms, a room for outpatient clinics and another room used for mindfulness sessions. All rooms in the inpatient unit had access to a large well maintained garden area which was therapeutic and accessible for those with limited mobility or using a wheelchair. The service had facilities that supported family members and were inclusive for all ages and cultures. There were 2 family rooms with a shower and beds, a sanctuary room with toys and activities for children and a quiet spiritual space to support a range of faiths. Equipment used to deliver care and treatment was suitable for the intended purpose, stored securely and used properly. Equipment that we looked at had stickers to show they had all been serviced such as the bath and hoists in the assisted bathroom. We also observed that the defibrillators had been checked weekly and oxygen cylinders were stored securely and had been checked daily for the previous 2 months.

The service had effective arrangements to monitor the safety and upkeep of the premises. We saw the service had a comprehensive clinical audit and monitoring plan in place. Daily checks were carried out on many areas such as oxygen levels, hoist battery levels, portable suction, lone worker devices, controlled drug balance and medicine room/fridge temperature. Weekly checks on the plan included glucometer checks, emergency medicine, resuscitation equipment and store room dates/stock levels. The service had completed checks which ensured the environment was safe and had procedures and protocols which detailed the associated risks. We observed a recent fire risk assessment with an associated action plan that showed the risks identified had actions already completed. We saw that there were personal emergency evacuation plans in place when required. The service provided copies of the gas safety certificates and evidence that that fire alarms, lifts and portable and fixed electrical appliances had been serviced. The service had a facilities manager who kept a maintenance schedule for all equipment. There was no equipment that was listed as being overdue for servicing. There were arrangements in place for the handling, storage, and disposal of clinical waste, including sharps. The service complied fully with the Control of Substances Hazardous to Health (COSHH) practices and had flammable storage cabinets

People who use the service and their relatives told us there was an appropriate level of staff and that nurses, medical staff, and domestic staff had all been visible. They also told us that staff at all levels had been professional, caring, compassionate and respectful. They said that staff were competent and had the appropriate skills to support them throughout their treatment journey ranging from pain relief and end of life care to bereavement support. The service provides palliative care for 8 patients on the inpatient unit. During the assessment we saw from the staffing rota and our observation that staffing on the unit was sufficient and safe. The staffing level establishment was an inpatient lead, 3 registered nurses (RGNs) and 3 healthcare assistants (HCAs) during the day shift and 2 RGNs and 2 HCAs during the late shift. Night shifts were staffed by 2 RGNs and 1 HCA. The community outreach service was staffed by HCA's, RGNs and a service lead. At the time of inspection there were no vacancies for RGNs or HCAs on the inpatient unit. The community outreach team were also fully established and staff told us that although they were a small team of 5 staff they were experienced and managed well. We saw that staff were available throughout the day to respond to patients in a timely manner. We observed that staff delivered person centred positive interactions with patients and worked efficiently together.

Staff told us that staffing levels were good across the inpatient unit and community outreach team. They said that staffing levels were safe and they used bank or agency staff to cover sickness and to meet the need of patients. Staff gave examples of this such as supporting patients with dementia or one to one care for patients with non-palliative additional care needs. The service had a full time consultant in palliative medicine who worked under practicing privileges. They worked collaboratively with staff on the inpatient unit and with the community outreach team to provide care for patients. There were 2 specialist grade doctors who covered day shifts seven days a week. The consultant contributed to ward rounds twice weekly; supported the on-call rota and covered sickness. The service had a GP onsite one day a week in addition to GP trainees and a junior doctor who worked part time. The service used the 'out of hours' doctor service if necessary and 24 hour medical cover was provided. Staff spoke highly of the education and hospice awareness training led by the education lead. They told us the service had developed an education group and collaborated with other education leads nationally and locally. A range of staff and partners, including the consultant and medical examiner, delivered clinical and advance care planning skills to GPs, district nurses and social workers. They had also promoted oral care study days. Staff told us they had completed an induction and training for their role; were supported with revalidation (where applicable) and received appraisals. Staff we spoke with told us they had completed mandatory training and managers monitored their compliance.

The service had a mandatory training assurance framework that covered a range of modules that included learning disability and autism. The framework listed the frequency of modules and outlined what staff groups were assigned to some or all of the modules. Overall compliance was 98.5%. All clinical staff undertook adult and children and young people safeguarding training to level 3. The safeguarding lead was trained to level 4. The service assessed patient to staffing ratio daily to plan any bank or agency staff to ensure safe staffing. The service provided data for staff sickness and turnover rates for the period of August 2023 to August 2024. The service had a total sickness rate of 5.8% and turnover rate of approximately 9%. The inpatient unit had a low rate of agency use to cover staff sickness (3%) and mainly used bank staff that already worked at the hospice (41%). There had been no bank or agency staff used for the community outreach team or other staff sickness. The service had safe recruitment practices to make sure all staff were suitably experienced, competent, and able to carry out their role. Recruitment processes were reviewed by checking records. We found they were complete and were up to date with revalidation and DBS checks. The service used a flagging system to alert managers when any requirements were expiring. New staff underwent induction and completed competency based training. This included volunteers who followed a volunteer training assurance framework. The service monitored appraisal compliance. The compliance with annual appraisals was 100% for both clinical staff and outreach support staff. Doctors and consultants working under practicing privileges had completed appraisals with their own organisations and recorded on the hospice checklist

People who use the service and their families told us they had no concerns with the cleanliness of the hospice. The service collected feedback from 606 visitors throughout June 2024 based on the cleanliness of the premises. Data provided by the service showed that 93.5% of visitors said that cleanliness was very good and 6.5% said it was good.

Staff were aware of the importance of cleanliness and hygiene and followed the service procedures when they identified concerns relating to infection, prevention, and control (IPC). Staff we spoke with were aware of hand hygiene audits and had no concerns regarding IPC. They knew who the IPC lead was to approach for support and guidance.

We observed all areas of the hospice including inpatient rooms, assisted bathroom, sluice room, cleaner room, clinic rooms and therapy rooms. They were clean and had suitable furnishings which were clean and well-maintained. We saw equipment with ‘I am clean’ stickers on them and cleaning records demonstrated that areas had been cleaned regularly. We observed that rooms including the sluice room and clean utility room had separate handwashing sinks. The service had a room for dirty linen and clinical waste and two rooms for clean linen. We observed hand hygiene posters, hand sanitiser points and posters reminding people to wipe down children’s toys after use.

The service completed IPC audits on a quarterly basis. These were done by the IPC lead and accompanied by an external IPC lead. The IPC audit was developed in line with IPC related national guidance and best practice. Audits covered 14 areas including policies, hand hygiene, inpatient rooms, waste management, cleaning equipment and communal bathrooms. Data provided by the service showed that the service performed well. In August 2024 the scores for each area ranged from 80%-100%. The hand hygiene score was 100% and the service scored 94% overall. We saw that the audit had clear actions and many were completed immediately where possible. The service had not reported any hospice acquired infections in the previous year.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.