Cheshire and Wirral Partnership NHS Foundation Trust

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

The trust was completing a service review at the time of the inspection. This included staffing, skill mix, job roles/responsibilities, training needs and service provision. We found patients were reviewed and escalated when needed. We reviewed patients clinical records and found anticipatory medicines were prescribed and documented appropriately. There were appropriate systems and processes in place to support patients preferences in their last days of life.

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 Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

Patients we spoke with told us they felt supported and listened to by staff. They felt their needs were met and appreciated the support from nursing teams during the difficult times.

Staff told us the trust was a great place to work and they loved working in their teams. Staff told us they felt supported by colleagues and leaders. Staff told us they missed their previous palliative care consultant and hoped the current vacancy would be filled soon. In the absence of a community palliative care consultant, staff told us they were supported by medical staff at the local hospice and hospital for specialist support and the patient's GP for routine review. Leaders told us a service review was in progress which included staffing, skill mix, job roles/responsibilities, training needs and service provision. Leaders had plans to support the specialist palliative care nurses with a nurse prescribing course to assist the community nursing teams with supporting patient care and reduce the burden on GP's.

We did not request feedback from partners for the end of life care service.

There were clear systems and processes to support patients preferred place of care and preferred place of death. We saw the service worked collaboratively with multidisciplinary teams to support patients needs in a timely manner. Staff were supported by the local hospice and hospital medical staff. However, there was no medical oversight of the service at the time of the assessment due to the community palliative care consultant vacancy.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Patients told us they felt staff were trained and qualified to deliver care which met their needs.

Staff told us they felt supported by colleagues and leaders. The community nursing teams told us they would like more support from the specialist palliative care team for anticipatory prescribing. The specialist palliative care team told us training had begun for anticipatory prescribing for the team. Leaders told us they had experienced staffing challenges but this had been addressed with a trust recruitment drive to support newly qualified nurses with community nursing training and supervision.

There were clear systems and processes for staff training, competency, appraisal and supervision. Training compliance and appraisals were reported monthly to the divisional leads. Protected time was given to staff to complete training. However, we found there was no competency review for syringe driver training after initial training. This was to be reviewed as part of the service review.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

Patients and their families we spoke with told us how difficult it was with their condition and managing symptoms and pain at times. Patients told us they felt supported by staff and were reviewed when the pain increased and there was any deterioration in their condition.

Staff and leaders told us and demonstrated there were systems and processes in place to support the safe prescribing of medicines. At the time of the assessment a specialist palliative care nurse was completing the nurse prescribing course. Prescribing and medicines management of patients were discussed with the team and escalated to a doctor for review when needed. The local hospital and hospice medical staff provided specialist support in the absence of a community palliative care consultant.

As part of the assessment, we shadowed some home visits to patients and reviewed patients' records and care provided. We found anticipatory medication was prescribed in line with best practice and national guidelines. Medicines were stored in patients' homes and self administered where possible. Syringe drivers were used when needed and checked and reviewed by the community nursing teams.

There were clear systems and processes to support patient care. Syringe drivers were kept with the community nursing teams who oversaw the maintenance/service of them. A patient record booklet which documented anticipatory medication was kept in the patients' home. We found the booklet review date had passed and had not been reviewed. No medicines were stored by the service as they were kept in the patients' home.