Marie Curie Hospice and Community Services North West and Cumbria Region

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We assessed 5 quality statements from this key question. We have combined the score 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 the provider had clear and effective governance processes, which supported the safe delivery of care. Staff were clear on their individual responsibilities and knew who was accountable for each aspect of the service. Leaders had the skills and abilities to run the service. They understood and managed the priorities and issues the service faced. The service had an open culture where patients, their families and staff could raise concerns without fear. Leaders operated effective governance processes, throughout the service and with partner organisations. Staff at all levels were clear about their roles and accountabilities.

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.

Nursing staff told us they were proud to work for the service and stated all staff “do a good job” and “the best we can.” They stated it was difficult to support each other due to staff depletion. And they were having to do more administrative tasks due to lack of support available because of shortages of administration staff. Staff stated they could access the strategy and vision document, and they were aware of its contents and that it had been discussed and circulated.

Leaders had the relevant skills and abilities to manage the hospice services effectively. They understood the risks to the services and had clear oversight of patient safety, governance and performance issues through daily involvement and quality monitoring. Staff stated they could access the strategy and vision document, and they were aware of its contents and that it had been discussed and circulated. We were told that wellbeing support offered by the hospice was “very good” and applied to both patients and staff. It included elements such as legal advice, and counselling.

Staff told us that leaders were visible and approachable. They told us there had been recent changes to the management team and managers were more approachable and sought to implement new ways of working to improve culture and effectiveness. Leaders we spoke with were knowledgeable about issues and priorities for the quality of services and could access appropriate support and development in their role. They reported there was effective support from senior management at national board level regarding implementation of the strategy and vision.

There were processes in place within the service to ensure that learning happened when things went wrong, and from examples of good practice. Leaders encouraged reflection and collective problem-solving. Weekly education sessions provided for clinical staff which was minuted.

Staff we spoke with knew about the service’s freedom to speak up policy. Staff at all levels told inspectors that they felt safe speaking up and had confidence in the processes which were in place. They gave examples of how they had previously used the process and that concerns reported had been dealt with to a satisfactory conclusion. Staff felt respected, supported, and valued. The service promoted equality and diversity in daily work and provided opportunities for career development.

The service had a freedom to speak up (FTSU) policy in place which was up to date. Staff had received training in FTSU. There were champions across the service and based at each hospice location. Staff we spoke with were aware of the policy and understood how to contact the freedom to speak up guardian if needed.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Staff at all levels were clear about their roles and accountabilities. However, some staff stated they did not have regular opportunities to meet, discuss and learn from the performance of the service. Staff stated HR were very supportive and gave good guidance regarding sickness management and disciplinary. There were processes in place for learning from incidents. Staff stated the service offered an employee assistance programme which was very useful. Staff stated that management were supportive overall and more nurturing of staff compared to previous management structures.

The hospice had a five-year operational plan in place to deliver high quality, safe, cost effective end of life care, delivered by supported and developed staff, plans were in place to work with an external organisation to help make the hospice facilities dementia friendly. In addition, there were plans to develop carers groups, ensure the allied health professionals workforce was future-proof, continue developing bereavement / pre-bereavement support, and to develop specialist palliative care rapid response, as some of the many ways to develop and achieve / maintain sustainability.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

There were processes in place within the service to ensure that learning happened when things went wrong, and from examples of good practice. Leaders encouraged reflection and collective problem-solving. Weekly education sessions provided for clinical staff and high level learning captured to share with all staff. Leaders operated effective governance processes, throughout the service and with partner organisations. Staff at all levels were clear about their roles and accountabilities. However, some staff stated they did not have regular opportunities to meet, discuss and learn from the performance of the service.

The Integrated Mersey Palliative Care Team (IMPaCT) offered a “one stop shop” for patients, families or health professionals who found themselves in need of palliative care services. The 24-hour telephone line staffed by specialist palliative care health professionals was aimed at getting the care, support or guidance the individual needs in and reduce the number of crisis admissions to A&E. The Enhanced Hospice at Home service was implemented due to the decision to “pause” inpatient admissions. The service offered support to those patients requiring specialist palliative care services in their own home, helping them remain at home. The Hospice Journal Club was developed by the hospice-based research team to improves collaboration, bring together professionals from various disciplines and locations to discuss and critically appraise research papers. The club enabled the team to review the latest research, develop evidenced based practice and foster collaboration working. The service also reached out to patients who would not otherwise engage with palliative care services. They used diagnostic imaging techniques to provide treatment to patients with liver disease.