North Yorkshire Hospice Care

We rated it as good because:

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills and understood how to protect patients from abuse. The service-controlled infection risk well. They managed medicines well. The service managed safety incidents well and learned lessons from them. • Staff provided good care and treatment and gave patients 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. They provided emotional support to patients, families, and carers. • The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported, and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However:

• Checks of emergency medications were not always effective. • Staff were not always deployed in a way which enabled people to always access the service when they needed it.

Summary of findings

Our judgements about each of the main services

Service Rating Summary of each main service Hospice Good ––– services for adults

Summary of findings

Contents

Summary of this inspection Page Background to North Yorkshire Hospice Care 5 Information about North Yorkshire Hospice Care 5

Our findings from this inspection Overview of ratings 7 Our findings by main service 8

Summary of this inspection

Background to North Yorkshire Hospice Care Saint Michael’s Hospice is operated by North Yorkshire Hospice Care (NYHC).

North Yorkshire Hospice Care (NYHC) is an independent charity with a family of services, these included Saint Michaels Hospice, Herriot Hospice Homecare and Just ‘B’. The services span the Harrogate and Rural district, and the Hambleton and Richmondshire district in North Yorkshire.

The hospice provided a range of services including inpatient and community end of life care, symptom management, wellbeing services, a breathlessness outpatient clinic and lymphoedema management to people.

The service is registered to provide treatment of disease, disorder to people over 18 years of age. The service had a registered manager and controlled drugs accountable officer in place at the time of inspection.

How we carried out this inspection We inspected this service using our comprehensive inspection methodology. We carried out an unannounced inspection on 22 and 23 November 2023 as part of our routine inspection programme. The hospice was registered in October 2010 and was last inspected in October 2015. There was a registered manager in post during the inspection.

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? 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.

During the inspection:

• We spoke with a range of people working at the service, including 1 manager, 2 nursing staff, 2 doctors, 1 student nurse, 2 support staff, the medical director, 3 head of services managers, 1 trainee nurse associate, clinical practice educator, wellbeing lead, safeguarding and resilience lead, the chef and dietician. • We spoke with 3 patients and 1 family. • We reviewed 3 patient records. • We conducted 1 home visit. • We reviewed 7 staff, practising privileges and director files, including checking the service had completed fit and proper persons checks in line with the regulation. You can find information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/ how-we-do-our-job/what-we-do-inspection.

Outstanding practice We found the following outstanding practice:

Summary of this inspection • The service utilised and developed its relationships with external professionals to ensure patients received an exceptional service that proactively identified and addressed their needs such as implementing a service level agreement with the NHS dietitian to proactively review people using the service to identify if they could benefit from dietician support. • The hospice supported neighbouring services by taking a proactive approach in gathering the preferences of different patient groups with complex needs and/or approaching the end of their life to develop advance care plans, supporting as many people as possible to receive care in line with their wishes. • The service proactively sought and in schemes that would both benefit the service and support the local community, such as the kickstart scheme, in which the service gave placements to 16–24-year-olds without employment. • The service worked with stakeholders to identify the needs of the local community and surrounding areas and tailored its approach, including introducing new roles such as the care connector role, to meet this need and improve outcomes for people, particularly in rural areas. • The service actively sought to increase the accessibility of services to populations less likely to seek or receive healthcare, such as the homeless, and tailored care to meet their needs. • The service collaborated with partners to create service level agreements, such as with the Citizen’s Advice Bureau (CAB), to widen the scope of information and benefits available to patients. • The service worked collaboratively with other organisations within their integrated care system (ICS) to develop hospice services and offered the West Yorkshire grief and loss line, for people in their locality. • The service actively sought to engage with groups identified as having protected characteristics under the Equality Act 2010 to identify ways of minimalizing health inequalities and improve the accessibility and equity of services to these communities. • Consideration of people’s privacy and dignity and choices were consistently embedded in everything that staff do, including awareness of any specific needs as these are recorded and communicated. • People’s feedback consistently showed they felt cared for and that they matter, care given was described as excellent and invaluable.

Areas for improvement Action the service MUST take is necessary to comply with its legal obligations. Action a service SHOULD take is because it was not doing something required by a regulation, but it would be disproportionate to find a breach of the regulation overall