Archived: St Mary's Hospice Limited

Updated 17 December 2019

St Mary’s Hospice is operated by St Mary’s Hospice Limited. The hospice opened in 1979. It is a private hospice in Birmingham, West Midlands. The hospital primarily serves the communities of Birmingham and Sandwell. It also accepts patient referrals from outside this area.

The hospital has had a registered manager in post since April 2016.

Referrals received by the hospice include, but are not limited to, symptom management, psycho-social support, respite or terminal care.

Patients receive holistic care to support physical, psychological, social and spiritual needs. Patients have access to medical advice, social work and chaplaincy support, physiotherapy, occupational and complementary therapies.

A day hospice service is available which consists of two multi-disciplinary supported therapeutic days and a volunteer led “welcome group” and a multi-disciplinary breathlessness management programme. Therapies, including art and music, are available to patients and they also receive specialist palliative care interventions either on site or at outpatient appointments.

There is a community palliative care team consisting of clinical nurse specialists, a community palliative care consultant, occupational therapists and a family carer and support team.

The family carer and support team provide specialist counselling, spiritual and psychosocial support to patients, carers and family members, including children whose loved ones are ill. They also assist with concerns related to benefits, housing or other social needs, referring patients to other agencies as necessary.

The chaplaincy team provides spiritual support to those who request it and bereavement support is provided by highly skilled volunteers, all of whom are trained to support people during grief and loss.

Physiotherapy, occupational therapy and pharmacy services are provided by arrangement with a local NHS foundation trust.

Activity takes place at three GP surgeries, as hospice satellite clinics, run between the hours of 9.30am and 12.30pm by clinical nurse specialists who provide holistic assessment and advisory support to primary care. Between June 2018 and July 2019, the volume of clinic activity was 90 attendances.

Two designated registered nurses work closely with 21 care homes in the local area, supporting staff with education around end of life care based upon a six steps programme.

There was a focus on community, with a community development and partnerships lead, working externally, to identify opportunities for asset-based community development.

The hospice provided a community hub for patients and their carers (which has operated at various locations in South Birmingham) through their support at home service. Since inception there have been 20 group sessions with an average attendance of seven people per group.

Updated 17 December 2019

St Mary’s Hospice is operated by St Mary’s Hospice Limited. Facilities include a 15 bedded inpatient unit, which includes single rooms with en-suite facilities and small multi-bedded bays. The 15 beds included two home from home beds which were commissioned separately by the local clinical commissioning group. In the reporting period July 2018 to June 2019 there were 1,759 individuals cared for in the inpatient and day case services at the hospice.

There is a “family centre” where patients and their families can stay together. There is access to a peace room for prayer or quiet reflection, a dementia friendly conservatory and gardens. Other facilities include a lounge offering refreshments and information for patients and visitors.

The hospice provides inpatient, outpatient and community care to people aged 18 years old and above. We inspected all services provided by the hospice.

We inspected this service using our comprehensive inspection methodology. We carried out the unannounced part of the inspection on 17 and 18 September 2019.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

The main service provided by this hospice was inpatient and community care. Where our findings on inpatient care for example, management arrangements also apply to other services, we do not repeat the information but cross-refer to the inpatient service level.

Our rating of this hospice stayed the same. We rated it as Good overall.

We found good practice in relation to inpatient care:

• The service provided mandatory training in key skills to all staff and made sure everyone completed it.

• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

• The service controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean.

• The design, maintenance and use of facilities, premises and equipment kept people safe. Staff were trained to use them. Staff managed clinical waste well.

• Staff completed and updated risk assessments for each patient and removed or minimised risks. Staff identified and quickly acted upon patients at risk of deterioration.

• The service had enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed and adjusted staffing levels and skill mix, and gave bank, agency and locum staff a full induction.

• Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date, stored securely and easily available to all staff providing care.

• The service managed patient safety incidents well. Staff recognised and reported incidents and near misses. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support. Managers ensured that actions from patient safety alerts were implemented and monitored.

• The service used monitoring results well to improve safety. Staff collected safety information and shared it with staff, patients and visitors.

• The service provided care and treatment based on national guidance and evidence-based practice. Managers checked to make sure staff followed guidance. Staff protected the rights of patients’ subject to the Mental Health Act 1983.

• Staff gave patients enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary. The service made adjustments for patients’ religious, cultural and other needs.

• Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way. They supported those unable to communicate using suitable assessment tools and gave additional pain relief to ease pain.

• Staff monitored the effectiveness of care and treatment. They used the findings to make improvements and achieved good outcomes for patients. The service had been accredited under relevant clinical accreditation schemes.

• The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and development.

• Doctors, nurses and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care.

• Key services were available seven days a week to support timely patient care.

• Staff gave patients practical support to help them live well until they died.

• Staff supported patients to make informed decisions about their care and treatment. They knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health.

• Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.

• Staff provided emotional support to patients, families and carers to minimise their distress. They understood patients’ personal, cultural and religious needs.

• Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.

• The service planned and provided care in a way that met the needs of local people and the communities served. It also worked with others in the wider system and local organisations to plan care.

• The service was inclusive and took account of patients’ individual needs and preferences. Staff made reasonable adjustments to help patients access services. They coordinated care with other services and providers.

• 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.

• It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff. The service included patients in the investigation of their complaint.

• Leaders had the integrity, skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff. They supported staff to develop their skills and take on more senior roles.

• The service had a vision for what it wanted to achieve and a strategy to turn it into action, developed with all relevant stakeholders. The vision and strategy were focused on sustainability of services and aligned to local plans within the wider health economy. Leaders and staff understood and knew how to apply them and monitor progress.

• Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service promoted equality and diversity in daily work and provided opportunities for career development. 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 and had regular opportunities to meet, discuss and learn from the performance of the service.

• Leaders and teams used systems to manage performance effectively. They identified and escalated relevant risks and issues and identified actions to reduce their impact. They had plans to cope with unexpected events. Staff contributed to decision-making to help avoid financial pressures compromising the quality of care.

• The service collected reliable data and analysed it. Staff could find the data they needed, in easily accessible formats, to understand performance, make decisions and improvements. The information systems were integrated and secure. Data or notifications were consistently submitted to external organisations as required.

• Leaders and staff actively and openly engaged with patients, staff, equality groups, the public and local organisations to plan and manage services. They collaborated with partner organisations to help improve services for patients.

• All staff were committed to continually learning and improving services. They had a good understanding of quality improvement methods and the skills to use them. Leaders encouraged innovation and participation in research.

However, we also found the following issues that the service provider needs to improve:

• There were points during the reporting period when the service did not always use systems and processes to safely prescribe, administer, record and store medicines.

Heidi Smoult

Deputy Chief Inspector of Hospitals Midlands

Updated 17 December 2019

St Mary's Hospice provided hospice care to adults through inpatient, day hospice and community services. Bereavement and counselling services were also provided.

We rated the service good overall because the service was good in safe, effective, caring responsive and well led.