Regulators have described as “striking” the extremely high standard of care routinely found in the hospices they have inspected.
An exchange programme where hospice and hospital nurses spend time in each other’s settings to expand their skills is just one example of innovative practice highlighted in a new report from the Care Quality Commission on the state of hospice care.
“It is striking that hospices have an extremely high standard of care”
Much can be learned from the sector, said the report published during Hospice Care Week, with hospices offering more “outstanding” care than any other services regulated by the CQC.
The CQC’s report – titled State of Hospice Services in England 2014 to 2017 – shows that a quarter of all hospices – 51 services in all – have achieved the regulator’s top “outstanding” rating.
This compares to around 6% of NHS acute services, 4% of GP services and 2% of domiciliary care agencies, nursing homes and residential homes.
A further 70% of hospice services – 142 services in all – are rated as “good” overall, noted the CQC.
Andrea Sutcliffe, the CQC’s chief inspector of adult social care, described the consistently high ratings as a “remarkable achievement, which the staff and leaders in hospices can be proud of”.
“Hospices are demonstrating that it is possible to deliver expert care with compassion”
In particular, CQC inspectors found hospice managers and frontline staff displayed a strong commitment to providing truly person-centred, compassionate care as well as developing good relationships with other local services.
The regulator emphasised there was still more to be done to ensure everyone, regardless of their background or circumstances, could access high quality end of life care but found top-rated hospices were often leading the way when it came to reaching out to different groups and sharing best practice.
Three quarters of hospices rated as “outstanding” in 2016-17 had carried out some work on equality for disabled people, while 88% had carried out some work around equality for people of different religions and beliefs.
“Partnership working was also a key factor in terms of delivering excellent care – particularly having strong links with professionals, services and the local community,” said the report.
One example it highlighted was an “exchange programme” for nurses run by St Ann’s Hospice in Salford via a partnership with Central Manchester University Hospitals NHS Foundation Trust.
The scheme offered nurses a five-day placement on haematology, gastroenterology, respiratory or cardiac wards at the trust.
Meanwhile, nurses from the trust could do placements St Ann’s “which enabled both sets of staff to learn new skills and experience what it is like to work in the different care settings”, noted the CQC.
One nurse quoted in the regulator’s report highlighted that the exchange experience had been a “huge benefit to me and my personal development”.
“I’ve really enjoyed it and it is really good to see the journeys people have been on and the care they receive,” the nurse said. “It has really helped with referrals and I’ve learnt things I had never encountered here, which can only be a good thing.”
The hospice in Greater Manchester was also praised for work with the local transgender community, which led to training about this group of people at the end of life and when living with dementia.
Meanwhile, the CQC noted that Dorothy House Hospice Care, based near Bath, was working with local partners to support homeless people to access better end of life care.
For example, the report described how its homeless project nurse had helped a man with terminal liver disease, who was living in his car, access hospice services.
“The nurse worked with different services to make them aware of his situation. There were improved outcomes for this man as he went on to live in a hostel with district nurse support after a short stay at the hospice,” said the report.
Hospices offer more ‘outstanding’ care than other services
Dorothy House had also worked with Royal United Hospital in Bath on projects to support people to leave hospital more quickly, added the CQC.
“People with ongoing care needs could be discharged into the care of the hospice, which provided palliative treatments for certain blood and breast cancers with their trained staff and specialist nurses,” said its report.
“This meant people would not need to attend hospital outpatient departments but could receive their care in a more relaxed environment, as well as having access to all the additional support and services the hospice could offer.”
Ms Sutcliffe suggested there was a lot that other care providers could learn from the hospice sector.
“It was clear from our inspections that the vast majority of hospices have the needs of people and their families at the centre of their work,” she said.
“It is particularly encouraging to see services committed to continuing improvement reach out to groups they had little contact with in the past to understand the obstacles they have faced and how they can support them better now and in the future,” said Ms Sutcliffe.
“To see dedicated staff have such careful consideration of the whole person and their needs was a privilege for inspectors and something I would encourage other services to learn from,” she added.
Jonathan Ellis, director of policy and advocacy at the charity Hospice UK, said the report reflected the “expertise, passion and commitment of hospice staff and volunteers and the strong leadership and positive work culture within the sector”.
“At a time when there is growing public concern about the quality of care that people receive in the health and social care system, hospices are demonstrating that it is possible to deliver expert care with compassion,” he said.
He added: “Many hospices are working in partnership with other local services to help make sure that everybody gets the care they deserve and need, wherever they may be cared for.”