Marie Curie Hospice and Community Services North West and Cumbria Region

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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 assessed 3 quality statements from this key question. We have combined the scores for this area with scores based on the rating from the last inspection, which was good. Our rating for this key question remains good. We found staff involved people in decisions about their care and treatment and provided them advice and support. Staff regularly reviewed people’s care and worked with other services to achieve this. Staff followed best practice guidance and patient care pathways to ensure appropriate care and treatment was delivered.

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.

Patients told us that staff explained their care and treatment options in a way they could understand, and that staff knew and understood them and their needs and requirements. We were told that staff responded to their needs quickly and efficiently, especially if they were in pain, discomfort, or distress. Patient’s felt hat their privacy and dignity were respected and upheld at all times. Nutrition and hydration needs were met in line with current guidance. Patients told us they had been offered nutrition and hydration.

Staff completed and updated risk assessments for each patient. Staff identified and quickly acted upon patients at risk of deterioration. Staff conducted a formal assessment to prioritise patients for admission to the inpatient ward so that patients requiring end of life care would be prioritised for admission over patients requiring respite care or psychological support.

Risk assessments for each patient were completed using a recognised tool, and these were reviewed regularly, including after any incident. The staff we spoke with understood how to identify patients with suspected sepsis. Staff explained that any patients with suspected sepsis would be immediately transferred out to the local NHS acute hospital by emergency ambulance. There had not been any instances in the past 12 months where a patient required transfer to hospital for suspected sepsis. Staff used a nationally recognised tool to identify deteriorating patients and escalated them appropriately. Staff knew about and dealt with any specific risk issues.

Patients could access the specialist palliative care service in a way and at a time when they needed it. Waiting times from referral to achievement of preferred place of care and death were in line with good practice. There were processes in place to ensure urgent admission and rapid discharge when needed. Staff gave patients enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary. Staff used a nationally recognised screening tool to monitor patients at risk of malnutrition.

Policies and procedures were based on national guidance from The National Institute for Health and Care Excellence (NICE), Royal Colleges and other bodies such as the North West Palliative Care Audit Group. Patients had an individualised care plan which, if the patient was at end of life, was supported by the individualised care and communication record for a person in the last days or hours of life. This was in line with NICE guidelines and quality standards, such as QS13 (End of life care for adults) and NG31 (Care of Dying Adults in the Last Days of Life).

We did not receive information from patients regarding how staff, teams and services worked together.

Patients could access the specialist palliative care service when they needed it. Waiting times from referral to achievement of preferred place of care and death were in line with good practice. There were processes in place to ensure urgent admission and rapid discharge when needed. There were routine team meetings that involved staff from the different specialities. The patient records we looked at showed there was routine input from nursing and medical staff and allied health professionals. There were daily safety huddles to identify and resolve any issues relating to the patient risks and admission, discharge, and death of patients. Staff told us there was weekly community interface meetings. They stated there had been a merger of services to stop duplication, which promoted integration of teams which improved the service’s resilience in patient care.

The service had a Service Level Agreement with a local NHS trust for pharmacy, for the provision of planned preventative maintenance for equipment, for laundry services, and for waste disposal.

The hospice had menus with options available for patients with specific requirements, such as vegetarian, halal and kosher meals. Staff also offered to cook food for patients that was not on the menu, if required. We saw there was effective team working and communication between staff across all disciplines within the service. Staff worked with other agencies when required to care for patients. Staff held regular multidisciplinary meetings to discuss patients and improve their care. Handover meetings took place during shift changes and ‘safety huddles’ were conducted on a daily basis.

Processes were in place for the management of documentation and records of patients’ care. Records were clear, up to date, stored securely and easily available to all staff providing care. Policies and procedures were based on national guidance from The National Institute for Health and Care Excellence (NICE), Royal Colleges and other bodies such as the North West Palliative Care Audit Group. Staff protected the rights of patients subject to the Mental Health Act and followed the Code of Practice. Patients and their relatives were supported by the counselling team for psychotherapy and emotional support. Patients could also be referred to local specialist NHS mental health services for advice and support.

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.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

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.