Hospice rated 'good' - but leadership 'requires improvement'

The Care Quality Commission (CQC), which rated St Leonard's Hospice 'outstanding' after visiting it in 2016, has published a new report following an inspection in April.

It says the hospice is 'good' in response to the questions are services safe, effective, caring, and responsive to needs? However, it says it 'requires improvement' in response to the question: Are services well led?

The report hails staff and managers' work for patients, saying: "Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it.

"Managers monitored the effectiveness of the service and made sure staff were competent.

"Staff worked well together for the benefit of patients, supported them to make decisions about their care, and had access to good information.

"Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions."

The report said patients said staff treated them well and with kindness, and had gone out of their way to support people.

"This included arranging a wedding for a patient who wished to marry their partner at the hospice and a Viking style funeral was organised for another individual," it said.

"Staff arranged an afternoon tea for a patient and their family who loved a particular teashop. Staff collected a hamper from this shop and held the tea party on the patient’s balcony."

However, the report said many staff did not feel 'aligned to the service’s vision and values' and did not understand the long-term strategic view.

"Many staff told us that they did not feel respected, supported and valued and this affected the overall culture within the organisation,"it said.

"Unlike our previous inspection, we did not find substantial evidence of outstanding practice in care and treatment or how the leaders managed the service.

"However, we did not identify breaches of regulation in the safe, effective, caring and responsive domains."

The report said the hospice had a 'divided culture' following changes to the services offered and because of disciplinary processes in the previous year, which meant some staff left the service.

"We received a significant amount of feedback from staff and other stakeholders, with most sharing concerns about the culture of the hospice.

"Some staff described the culture as ‘toxic’ and described a disconnect between teams and between staff and managers. Some staff spoke of feeling fearful of raising concerns with leaders.

"There was a perception that speaking out would have unfavourable consequences. Managers were aware of the cultural issues in the hospice and acted to improve relationships, including introducing external support for the service."

HOSPICE chief executive Emma Johnson said she was'thrilled' to have received an overall rating of good under a new and revised CQC inspection framework for hospices and acute hospitals.

"We are proud of the care we deliver, particularly how responsive we have been during the past two years, adapting our services to meet the changing needs of the community and caring for more people than ever before," she said.

“Like our partners across the NHS, we have been thoroughly tested by the pressures of working in a pandemic and I want to thank all our staff for their hard work and commitment to providing high quality, safe and compassionate care to help local people achieve a good death."

“We recognise the ongoing improvements we need to make as an organisation and had already identified some of these with the CQC prior to the inspection.

"We had also introduced measures to address some of the areas and this was recognised by the inspectors."

She added that the hospice was in a period of culture change as it recovered from the last couple of years and looked at how it could adapt, and potentially remodel, some of its services in order better serve the needs of the wider community.