St Helena Hospice

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We did not look at this key question during this assessment. The score below is based on the previous rating for this key question.

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 Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

Patients' reported being asked of their preferences, religious beliefs, and choices on admission. They were supported to live as they wished and care was coordinated with staff working to support patient choice. For example, we saw a patient who was at risk of falls being encouraged to use the call bell to allow staff to supervise the patient whilst walking. Patient’s told us they did not have to repeat information, all staff knew how and when to deliver their personalised care and treatment. One patient reported the experience had surpassed his expectations.

The service monitored people’s care and treatment continuously to improve it. The Integrated Palliative Care Outcome Scale (IPOS) was completed on admission and on discharge by service users. This data captured their most important concerns, both in relation to symptoms, as well as practical concerns, anxiety or low mood, family anxieties and overall feeling of being at peace. This data was reviewed by senior leaders and fed back to staff through governance meetings, monthly ward meetings, as well as newsletter briefings. Working groups reviewed performance in relation to tissue viability, medicines management and falls, feeding back results to staff through meetings and staff bulletins. Continuous monitoring had led to service improvements such as improved access for heart failure patients and end of life outcomes in areas of deprivation. IPOS was completed by the caseload holding clinical nurse specialist team, not by the rapid response hospice at home service. Leaders reviewed data from their dashboard to review the effectiveness of the service in line with expected key performance indicators. For example, how quickly they responded to calls within the assigned timescale. Staff told us clinical updates were shared at monthly staff meetings and included within the weekly newsletter email. Audit results for IPC, falls and wrist bands were shared with staff on a regular basis via email and monthly meetings so staff were aware of performance. There was a staff suggestion box where staff were able to make suggestions on improvements to the service. All staff we spoke to were aware of how to raise concerns and knew of the freedom to speak up guardian, they felt confident in raising concerns with managers and senior leaders. Informal feedback from service users was shared with staff via email.

Staff holistically assessed people’s needs, and delivered care and treatment in line with legislation, standards and evidence-based guidance. Staff monitored the effectiveness of care and treatment. They used the findings to make improvements and achieved good outcomes for patients. The service participated in local and national clinical audits and benchmarked itself against other services in the area and nationally. They took part in the Hospice UK programme for benchmarking pressure ulcers, falls, and medicines errors, against the average for participating hospices of comparable size. Staff carried out a comprehensive programme of repeated audits to check improvement over time. We saw evidence of completed audits and actions taken to make improvements. For example, a recent falls audit found patients were more likely to fall with a declining functional impairment score. As a result, the policy was changed and improvements were noted. The service collected performance and outcome data. Key performance indicators (KPIs) included, but were not limited to, average length of stay, average wait for admissions, and deaths in preferred place of care. In addition, the service used a range of dashboards to measure outcomes and to support addressing inequalities. Examples included, hosting the local electronic palliative care coordination system (EPaCCS) on behalf of the local ICB Alliance. The internal dashboard demonstrated the inequality of access to advance care planning for people with conditions other than cancer. As a result, a collaborative quality improvement project was launched with the local hospital frailty team in which the hospice embedded a palliative clinical nurse specialist. This resulted in a positive impact on the number of referrals for people with frailty. We also saw positive impact of the inequalities dashboard following a project which supported access to hospice services for previously underserved groups.

We did not look at Consent to care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.