St Luke's Hospice -Turnchapel

There was a manager in post who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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. They held the post of head of quality and compliance and were supported by a leadership team that included the chief executive and directors and department managers.

The registered manager was open and transparent in their approach. They promoted the service mission of ‘Hospice without walls” providing and promoting high quality end of life care accessible to anyone. Staff demonstrated this vision in their practice and gave person centred, individualised care. All staff felt valued by the leadership team and supported to provide high quality care throughout the service.

The service provided outstanding end of life care which enabled people to experience a comfortable, dignified and pain-free death. The environment was accessible for people with disabilities. It was welcoming, well maintained and suited people's needs. Clinics, therapies and support groups were held in the unit and people, in wheelchairs or beds could enjoy the view looking out over Plymouth Sound. There were well maintained grounds which were also accessible for people to enjoy.

The service continuously looked at the local community to see how best they could provide the service and had done excellent work in identifying the needs of the local population developing services to meet those needs. This had resulted in the provision of a Crisis Team service in 2014. It was identified that at times people experienced unnecessary hospital or hospice admissions when they would have preferred to remain at home. As part of the service mission to provide a “Hospice without Walls”, the Crisis Team aimed to respond within an hour to provide a short 72 hour intervention to enable people to stabilise their symptoms and facilitate rapid discharge home from hospital or hospice.

The team of registered nurses and health care assistants operated 24 hours a day, 7 days a week. This assisted and supported families and carers to respond to people’s rapidly changing situations to enable them to continue supporting their loved one. The Crisis Team staff were employed by St Luke’s and worked closely with other health care professionals in the community.

St Luke’s Hospice staff also worked at Derriford Hospital, Plymouth where they provided a specialist palliative care service for any hospital patient with a progressive life limiting illness and working closely with an extended multidisciplinary team. Services included assisting hospital staff with people’s complex discharge arrangements to their preferred place of care. The hospice had also set up their own domiciliary care agency in response to community need and we inspect this separately.

Staff were exceptionally well trained and had excellent knowledge of each person and of how to meet their specific support needs. Staff commented on the positive culture and idea of teaching and sharing skills within the service and in the wider community. Staff went that extra mile to ensure people's needs were met in a holistic way including support for people's loved ones. For example, a project was in place to ensure people identified as caring for their loved one at home were supported. For example, by a named hospice social care contact, signpost information and staff ensured carers received their entitled support through national statutory assessment. Attention was paid to people’s individual social and psychological needs in a holistic way that included support pre and post bereavement for carers.

There was an excellent spiritual care service which was inclusive and their ethos was person centred regardless of belief. A spiritual care strategy was on-going to enhance the hospice spiritual chaplaincy team. This promoted spiritual wellbeing champions, specific training development and promoting the hospice vision that, “The spiritual wellbeing of St Luke’s service users, staff, volunteers and those connected to the organisation is everyone’s responsibility and is not the sole responsibility of the Champions.” A dedicated space ‘The Harbour’ provided somewhere for quiet meditation and thought for all.

The hospice had a comprehensive training department. A specialist computer learning management system (LMS) was used to ensure staff were up to date and competent in their roles and all staff had a ‘skills passport ‘of their knowledge and competencies. The department ran thorough orientation and mentorship programmes for new staff and focussed on personal development and quality. All members of care and support service staff received regular one to one or group supervision which ensured they were supported to work to the expected standards.

The service was particularly pro-active in offering training to a wide range of health professionals and those in contact with end of life care. For example, community specialist nurses and the education team had delivered training to hospice staff, school leavers, university, medical and paramedic students and community hospital staff. The service had also made links with projects supporting local homeless communities to ensure their staff were able to recognise end of life and so people accessed appropriate services.

An innovative project based on the nationally recognised ‘Six Steps to Success’ approach had delivered a programme of a series of workshops. These were tailored for care homes and domiciliary agencies in recognition of the challenges of providing high quality care. A ‘train the trainer’ approach was used to develop End of Life Care Champions in these settings along with a toolkit for learning and support. This programme also included additional workshops focussing on end of life care for people living with dementia and a learning disability focussed module. St Luke’s supported vulnerable communities and had launched an easy read future and end of life care plan designed with people with a communication or learning disability in mind.

A compassionate community project at the hospice was already improving care for people in the community. This was based on the national Dying Matters Coalition, led by the National Council for Palliative Care whose mission is to ‘support changing knowledge, attitudes and behaviours towards dying, death and bereavement, and through this to make living and dying the norm.’ The project aimed to build compassionate communities to facilitate more conversations about death, dying and bereavement and provide effective practical community support. [National figures showed around 70 % of people would prefer to die at home, but around 60% die in hospital. We heard examples of how the hospice was working with people to ensure they were able to die in their preferred place].

Another project had facilitated end of life care through training senior healthcare practitioners as champions in the community- the 3R’s project: Right place, right care, right time. A peer learning kit enabled these practitioners then cascade knowledge further. This project had directly led to service improvements, for example in the hospital, drug and alcohol team and prison, and was part of the hospice agenda of creating a ‘compassionate community’.

The service had identified a lack of local access to end of life care for people in prison. The locality included a Dartmoor prison community of over 650. An effective collaboration was in place with the prison and a ‘Living with and beyond Cancer’ group. This had resulted in prisoners being able to access practical end of life care from hospice staff, access appropriate information and support, including personal care in Dartmoor prison.

People's feedback was actively sought, encouraged and acted on. People and relatives were overwhelmingly positive about the service they received. They told us they were extremely satisfied about the staff approach and about how their care and treatment was delivered. Staff approach was exceptionally kind and compassionate. Relatives stated on an independent online feedback website ‘I want great care’, “The care the patient received was above and beyond anything I could of expected, I am not good at asking for help or putting on people but I was made to feel we deserved the help unconditionally!” Relatives told us, “This hospice is outstanding, nothing is too much trouble.” People's feedback about the caring approach of the service and staff was overwhelmingly positive and described it as, "It’s like a 5 star hotel. There is a wonderful garden view” and “I loved seeing my dog, an

Everyone said they were involved in their treatment plan and asked for their consent. People who were not able to make their own decisions were assured of being properly identified and assisted to make decisions in their best interest.

People's treatment needs were assessed carefully, and treatment was provided effectively by experienced and qualified staff. There were systems in place to ensure that information was shared appropriately between different agencies and organisations to provide continuity of care between providers, and that people were kept safe.

We found that measures were being put place to ensure staff were deployed effectively in sufficient numbers with the right knowledge, skill, qualifications and skills to support people.

The provider notified the care Quality Commission in a timely manner of any important events affecting people's welfare, health and safety.

We reviewed the arrangements for medicines at the hospice. Appropriate arrangements were in place in relation to the obtaining, recording and storage of medicines. The hospice has systems in place which monitor the administration of medicines.The hospice has an effective system of monitoring the quality of the service it provides. This includes questionnaires, suggestion boxes as well as formal audits undertaken in a number of areas. We saw that action was taken to address any deficits arising from these audits.

The provider has systems in place to provide support and training to staff. The hospice chaplain and an external consultant provide staff with the opportunity to discuss issues with them. A formal appraisal system is in place for all staff and training is offered to staff.