Hospices offering more ‘Outstanding’ care than other services regulated by CQC
Hospice care across England has the highest percentage of services rated ‘Outstanding’, according to a new report from the Care Quality Commission (CQC).
‘The State of Hospice Services in England, 2014 to 2017’ published during Hospice Care Week and ahead of World Hospice and Palliative Care Day (Saturday 14 October) has found that 25% of hospices are rated as Outstanding (51 services), with a further 70% (142 services) being rated as Good. This is in comparison to around 6% of NHS acute hospitals, 4% of GP services and 2% of domiciliary care agencies, nursing homes and residential homes being rated Outstanding.
In particular, inspectors found that hospice leaders and frontline staff displayed a strong commitment to providing truly person-centred, compassionate care and support to people using their services, and their loved ones, as well as developing strong relationships with other services in the area.
However there is more to be done to make sure that everyone, regardless of their background or circumstances, has access to high-quality end of life care. Hospice services rated as Outstanding were found to be striving to overcome such inequalities and share their expertise to drive better care in other services. For example, inspectors found that St Ann’s Hospice in Salford has engaged with its local transgender community to help understand their specific anxieties and concerns as well as operating an ‘Exchange Programme’ with its local NHS Foundation Trust so nurses from both can spend time in the other’s setting and expand their skills. Also, Dorothy House Hospice Care near Bath runs a dedicated partnership project to support homeless people at the end of life and worked with Royal United Hospital on projects to support people to leave hospital more quickly, if the hospice could offer them care away from the acute setting.
While there are only 217 hospice services registered with CQC in England, hospices across the UK care for around 200,000 people a year in hospices and the community with terminal and life-limiting conditions, and their families, as well as offering bereavement support to a further 40,000 people.
Andrea Sutcliffe, Chief Inspector of Adult Social Care at the Care Quality Commission, said: “People often access hospice care at a time when their complicated health and social care needs have to be met alongside compassionate emotional support. This is not a simple thing to do.
“It was clear from our inspections that the vast majority of hospices have the needs of people and their families at the centre of their work. It is particularly encouraging to see services committed to continuing improvement reach out to groups they had little contact with in the past to understand the obstacles they have faced and how they can support them better now and in the future.
“To see dedicated staff have such careful consideration of the whole person and their needs was a privilege for inspectors and something I would encourage other services to learn from.”
Jonathan Ellis, Director of Policy and Advocacy, at national hospice and palliative care charity Hospice UK, said: “We are delighted that more than nine in ten hospices have been rated good or outstanding by the Care Quality Commission, highlighting the remarkably high standard of care they provide. It reflects the expertise, passion and commitment of hospice staff and volunteers and the strong leadership and positive work culture within the sector.
“With its holistic, highly caring approach, hospice care can be transformative for dying people and their families, however we know there is no room for complacency and delivering good or outstanding care is an ongoing process.
“At a time when there is growing public concern about the quality of care that people receive in the health and social care system, hospices are demonstrating that it is possible to deliver expert care with compassion. Many hospices are working in partnership with other local services to help make sure that everybody gets the care they deserve and need, wherever they may be cared for.”
CQC embarked on a new approach to regulating hospice care in October 2014 after much consultation with the sector and other stakeholders. Between October 2014 and January 2017, CQC has been inspecting hospice services, along with other adult social care services, using clear standards of care and ratings which allow services to understand their responsibilities and help members of the public to easily see the level of care being offered by a provider.
In talking about Dorothy House, The State of Hospice Services report says:
Dorothy House Hospice Care: Example of person-centred care and leadership in a high-performing hospice
Dorothy House Hospice Care near Bath is registered for 10 beds and provides specialist palliative and end of life care for adults with life limiting illness or complex symptom management needs. It is run by a registered charity. After our inspection in September 2016, we rated the service as outstanding overall, with four out of the five key questions rated as outstanding.
A person who used the service said: “The nurses are attentive, and doctors are good at symptom control; there is time to talk and everyone is very very kind.” One relative said: “The care given to my dear husband was filled with love, respect, dignity, and empathy.”
Person-centred care and treatment:
• The homeless project nurse was very dedicated. She assisted a man with terminal liver disease to access hospice services. He was living in his car, often resisting and refusing support and could not access services through the normal routes as he was not registered with a GP. The nurse worked with different services to make them aware of his situation. There were improved outcomes for this man as he went on to live in a hostel with district nurse support after a short stay at the hospice. The nurse also worked in all aspects of the community, making links with Christian organisations and the YMCA. This promoted her role and what the hospice could offer, all with a view to identifying other people who could be referred.
• The hospice had an artist in residence who supported people to make ‘creative keepsakes’ – such as casting a hand in plaster or creating memory boxes. Sometimes people using the service did this with their loved ones, and at other times it was after the person had died that relatives came in. People found it very therapeutic, with people holding difficult conversations while they were being creative.
• When our inspector was on the ward, they saw a dying mother supporting their child. The young person was coming to terms with the situation and wanted to spend more time with their mother. She was, however, surrounded by other family and friends and the child lost their temper. A member of staff immediately intervened and supported the child to talk through their feelings and find time alone to spend with their mother.
Continuous improvement and leadership:
• Staff had ‘link roles’ that included skin care and prevention of pressure sores, falls prevention, nutrition and hydration and infection control. One of these told us about their tissue viability link role and said they attended a conference and visited other units to look at skin care. They had introduced a bespoke end of life pressure ulcer risk assessment tool, which helped staff identify factors that might make people more at risk of skin breakdown. They were involved in updating their local policy, and in purchasing moving and handling and pressure relieving equipment. They provided educational resources for other staff to read, shared information at staff meetings and supported and monitored skin care in the unit.
• Dorothy House continually sought external good practice – for example, reviewing CQC’s report into equalities in end of life care, A different ending, and taking part in a mock inspection by another hospice.
• A training needs analysis looked at the future training needs of hospice staff and identified additional skills needed, so that staff could take on extra roles – for example, clinical skills to support people to have more treatments in day services, such as blood transfusion, and prescribing for nurse specialists.
• Dorothy House worked with Royal United Hospital on projects to support people to leave hospital more quickly. People with ongoing care needs could be discharged into the care of the hospice, which provided palliative treatments for certain blood and breast cancers with their trained staff and specialist nurses. This meant people would not need to attend hospital outpatient departments but could receive their care in a more relaxed environment, as well as having access to all the additional support and services the hospice could offer.
• The provider was good at identifying where services were not efficient and therefore redirected resources. For example, the in-house respite service they were offering was demanding too much resource from the main inpatient unit. Since their aim is to invest in what will benefit the greatest number of people, they redirected their resources into other services, such as hospice at home and the palliative cancer treatments and outpatient services.