Chief Inspector of Hospitals demands improvements at Prospect HospiceThe Prospect Hospice in Wroughton, which serves the wider Marlborough area and has an outreach base at Savernake Hospital, was inspected by the Care Quality Commission (CQC) in February. It was an unannounced inspection following concerns that had been raised with the CQC.
In its report published on Friday (June 8) the CQC has told Prospect Hospice that it must make 'significant improvements'.
We are publishing in full the statement put out by the CQC - and below that is today's response from Prospect Hospice.
CQC inspectors visited the service in Swindon unannounced in response to concerns about low staffing numbers, out of date staff competencies, increased safety incidents, low staff morale and allegations of bullying by senior staff.
Following the inspection CQC issued a Warning Notice requiring the hospice to improve its management oversight systems and to ensure that staff received appropriate training, support and appraisal to carry out their roles.
Inspectors found risks to patient safety as systems and processes for recording, monitoring and reviewing significant safety issues were ineffective. This was recognised by the provider but there was no evidence that the systems being implemented would improve their processes.
The inpatient unit had a high number of vacancies, and nursing staff described low morale and increasing levels of fatigue and sickness. In six months there had been 53 recorded medicine errors.
Although CQC did not observe unsafe practice during the inspection - staff training was out of date, and the provider could not demonstrate that all staff were competent to carry out all clinical procedures. There was no formal induction for temporary staff.
In response to a number of complaints about bullying the senior leadership instigated four workshops with staff. While these sessions were well-intentioned, staff said that the workshops made them feel uncomfortable and in some cases humiliated.
The board and senior leadership team did not always seem to be aware of what was happening within the inpatient unit. Key information on staffing and other risk areas were not reported regularly and the board was therefore unsighted and unable to support and challenge the leadership team. Omissions included information about delayed admissions and seven complaints about a member of the senior leadership team.
CQC’s Head of Hospital Inspection, Mary Cridge: “Prospect Hospice provides a much-needed service to people nearing the end of their lives. While there is clearly a commitment to provide a good service on all sides – it is troubling to report on the cultural issues and divisions that we found within the team as a whole."
“It is a real concern that patients are waiting for admission to the unit on a regular basis and also that this has not been actively monitored and reported. I am concerned that the trustee board did not receive regular information on key issues and so were unable to provide challenge and support to the leadership team."
“Since our inspection in February, the hospice has taken some steps to address our main concerns. The safety issues must be addressed as a priority. By the time we return to re-inspect, we hope to see a real improvement for the benefit of the patients and their families. In the meantime we are in regular contact with the leadership at Prospect Hospice and we will continue to monitor this service closely.”
The full CQC report can be read at: http://www.cqc.org.uk/location/1-117219570
Marlborough.news has received this statement from Prospect Hospice:
At Prospect Hospice, we take great pride in providing the very highest level of end-of-life care and we are naturally disappointed at the outcome of the inspection visit by the Care Quality Commission (CQC) in February 2018.
We acknowledge that some of our systems and processes do need updating in the areas of nurse training, induction, staffing levels and admissions, not least the manual collection and processing of our data. As a result of the lessons we have already learnt we have made significant progress in addressing the issues raised.
We are now confident that we are in a position to ensure the continued delivery of the very best standards of end-of-life care that our patients and their loved ones expect.
We are also sorry for any anxiety that the CQC findings may have caused our patients and their families but we would like to emphasise that no evidence was found to indicate that patient safety had in any way been compromised due to the issues that were highlighted.
Indeed our rating has been unaffected by the report and it highlights that our patients were extremely complimentary about the high standard of care, treatment and support that they have received – a testimony to the experience, professionalism and dedication of our colleagues. This is reinforced by our own patient experience surveys carried out between April 2017 and 31 March 2018 which reveal a 94.74% satisfaction score for the service we provide.
In terms of the workshop referred to in the report, we accept that it could have been run better. The intention was the right one in that we wanted to bring staff together to reflect on how we can best work together as we are conscious we operate in a very demanding and highly emotional environment looking after people with acute end-of-life care needs.
We have since met with our in-patient team about the workshop, taking on board their thoughts, and we will move forward as a better organisation as a consequence.
We have also made the CQC aware that a number of assumptions were made without, in our view, sufficient evidence being considered. As a result, some findings are simply inaccurate based on the information that we have to hand such as staffing levels where we are well above national guidelines.
However, we take the report findings extremely seriously and we remain fully committed to putting things right.
In addition the Swindon Clinical Commissioning Group - within whose area Prospect Hospice lies - have also issued a short statement:
Swindon CCG is aware of the Care Quality Commission's (CQC) focused inspection of Prospect Hospice in February 2018. We welcome CQC inspections as part of a process to continually check services and improve them where necessary.
The CCG will continue working, in partnership with Prospect Hospice, to drive improvements to the quality and safety of services for local people and address all recommendations raised in the report.