Marie Curie Hospice and Community Services North West and Cumbria Region

On this page

• 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

We assessed a total of 6 quality statements from this key question. We have combined the scores for these areas with scores based on the rating from the last inspection, which was good. Our rating for this key question remains good. We found safety was a top priority, and staff took all concerns seriously. When things went wrong, staff acted to ensure people remained safe. We received mixed feedback from staff relating to learning from incidents. Some told us more recently that the learning from incidents process had improved and learning was shared more widely, whilst others told us further improvement was required. Policies and processes relating to safety were aligned with other key partners who participated in people’s care journeys to enable shared learning and drive improvement. The areas we inspected were well maintained, free from clutter and suitable for providing safe care and treatment for patients. There was a service level agreement in place with a local trust NHS trust which covered the provision of pharmacy services. Challenges resulting from a shortage of nursing staff within the service was recognised and there was a process of ongoing recruitment for nursing staff. Patients and carers we spoke with told us they had no concerns about their care and treatment, and they felt safe.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff stated that risks were not overlooked or ignored and were dealt with willingly as an opportunity to put things right, learn and improve. However, some staff told us lessons were learnt from previous incidents whilst others stated that there were still concerns that areas identified were not sufficiently or effectively acted upon. Staff stated it was a refreshing change compared to previous management who imposed a more authoritarian approach, and it was a “blame culture” during that time. Staff reported that it was now a case of encouraging and nurturing staff under the present structure. Staff told us they were confident in the processes in place within the service and they knew how to report and escalate incidents and issues where required. However, there were also concerns reported by some staff that incidents and near misses weren’t dealt with effectively.

The service had processes and systems in place to learn from incidents and near misses and staff told us that learning was shared with them and lessons were learnt from safety incidents or complaints. The service had a patient safety incident requiring investigation policy which was in date and was clearly detailed. We were told that the Head of Talent and Development and Associate Director of Nursing planned to attend the hospice from May 2024 to July 2024 to complete 3 sessions with the whole hospice to undertake cultural work. The sessions would cover a 10-week period, and all hospice staff would be required to attend all 3 workshops. A six week programme of education and training was provided to all inpatient staff. The Patient Safety Incident Response Framework (PSIRF) approach launched Marie Curie wide in November 2023 continues to embed a systems learning non blame culture approach to enhance learning from incidents. Marie Curie have also developed a revised Just Culture guide to bring HR and patient safety functions to support this approach. There was a safety learning panel open to all staff which was held monthly to share learning from incidents and complaints. We were told about bi-weekly Multidisciplinary Education Meetings (MEMS), where all departments shared learning with the wider teams, and outside speakers attended to deliver relevant training for all staff.

We were told that staff were encouraged and supported to raise concerns, and they had no fear in reporting incidents. Staff felt confident that they would be treated with compassion and understanding, and would not be blamed, or treated negatively if they did so.

Policies and processes about safety were aligned with other key partners who participated in people’s care journey to enable shared learning and drive improvement.

The service had valid in date policies relating to areas such as Duty of Candour, serious incident, and deteriorating patients. The hospice had infection prevention and control policies which provided guidance for staff and the staff completed mandatory infection prevention and control training. The hospice had an infection control lead nurse in place.

Patients and carers we spoke with told us they had no concerns about their care and treatment, and they felt safe.

Staff told us the safeguarding policies were easy to access and to follow. Staff could give examples of how to protect patients from harassment and discrimination, including those with protected characteristics under the Equality Act. Staff had completed a number of mandatory training sessions which included safeguarding, mental capacity, human rights, and deprivation of liberty safeguards.

There are effective systems, processes, and practices to make sure people were protected from abuse and neglect. The service had valid in date policies relating to areas such as Safeguarding, Duty of Candour, serious incident, and deteriorating patients. Processes were embedded and easy to follow. The registered manager was trained to level 4 safeguarding. All staff both clinical and non-clinical had safeguarding adult and child training at level 2, which is repeated three yearly. Band 6 level and above staff were trained to level 3 safeguarding training.

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.

The layout of the hospice promoted accessibility in all areas. The areas we inspected were well maintained, free from clutter and suitable for providing safe care and treatment for patients

Some staff told us that the site was an older building and starting to show its age which could cause challenges to patient care. However, facilities, equipment, and technology were well-maintained and supported staff to deliver safe and effective care. Staff told us that any issues found were reported to the maintenance manager who was based on site and the issues would be rectified. If they couldn’t be completed by the service’s own staff, they would get the issue resolved using an external contractor.

During the site visit we observed maintenance of some equipment taking place. Equipment requiring repair was stored in a secure cupboard for safety.

There was a planned maintenance schedule in place with routine equipment servicing. External contractors conducted calibration and portable appliance testing, which was overseen by the hospice maintenance lead. The service had a Service Level Agreement with a local NHS trust Medical Engineering Department re provision of planned preventative maintenance for equipment.

Patients we spoke with said there were adequate staffing during their time at the hospice.

Leaders acknowledged there were challenges recruiting and retaining staff due to a shortage of specialist nursing staff and other opportunities available for these staff. The decision to voluntarily reduce the bed capacity was made at national level in consultation with management on site. Staff had opportunities to learn, and poor performance was managed appropriately. Staff told us there was a formal appraisal process in place. However, some stated they were not completed on a regular basis. They also stated a new mechanism had been implemented for appraisals which was more time consuming than the previous process.

The service had a staffing escalation process in place. To cover rota gaps, leaders had a process where staff would be offered overtime first to cover the gaps, and they then would be offered to bank staff. There was a process of ongoing recruitment for nursing staff. As a result of sickness levels and vacancies, the hospice had voluntarily reduced operational bed capacity in the inpatient unit to maintain safe care and treatment.

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.

People received their medicines as prescribed, and records demonstrated that associated physical health monitoring took place. The service had a process in place for people to receive medicines they may need for minor ailments. There was not a process in place for people to manage their own medicines if they wanted to. Staff told us they would be looking into how this could be managed.

The hospice had support from pharmacy staff who were on-site daily on weekdays. Staff could explain how they would access pharmacy advice and supplies out of hours and at weekends. Staff explained how medicines incidents had been investigated and managed appropriately. Registered nurses within the inpatient unit had all received medicines management training. We saw evidence that medicines were reconciled when people were admitted to the service. This ensured that people received the correct medicines.

Medicines were stored securely within the service. Temperature monitoring was being completed in areas where medicines were stored, however checks were not always completed daily as described in the service’s medicines policy. Oxygen was prescribed and recorded on medicines charts.

Allergies were recorded on all inpatient medicine’s charts; however, this information was not always recorded on the electronic patient record. Medicines reconciliation was completed by a member of the pharmacy team within 48 hours of a person being admitted to the service. Controlled drug stationary was stored and managed securely with a clear audit trail.