'˜Inadequate' South Tyneside hospice says overhaul is near complete as failings are published

St Clare's Hospice aims to re-open in the New Year - after being deemed inadequate by inspectors who raised concerns over safety and leadership.

St Clare's Hospice in Primrose Terrace, Jarrow.
St Clare's Hospice in Primrose Terrace, Jarrow.

The Care Quality Commission (CQC) drew up a list of 17 concerns over the way the centre, in Primrose Terrace, Jarrow, has been run - giving the damning verdict in four out of five areas it checked during an unannounced inspection in September.

The hospice, which has offered palliative and end of life care since 1987, closed voluntarily in the wake of the check after concerns were first raised by the CQC when it visited in September.

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Tracy Woodall, who is chairman of the trustees of St Clare's Hospice.

Now the findings of the autumn visit have been published, with only the care offered by staff being rated as good.

The safety of its services, their effectiveness and staff response to their leadership have each been given an inadequate rating.

Concerns include “significant safety” issues in areas including medicines management, identifying risk and incident investigation and subsequent learning.

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Managers were also singled out for criticism, with the report stating they did not “have the necessary experience, knowledge, capacity, capability or integrity to lead effectively.”

The report said: “Staff told us there was a culture of bullying and instances of conflict between individuals.”

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Last January, inspectors had warned its team it needed to improve its safety and leadership, with the other areas rated as good.

Today, its new chairman of trustees Tracy Woodall said a huge amount of work has already gone into turning around the service, with plans to relaunch the refurbished unit in the New Year.

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It had previously been hoped to reopen the hospice this month.

Ms Woodall, who is chief executive officer of Alice House Hospice in Hartlepool, said: “The care at St Clare’s has never been in doubt, it has always been rated as good and it has a fantastic team of nurses and staff who are invested in the patients and their families.

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“The problems have occurred because the hospice has never really had control of its own systems and processes. We are now working towards that.

“The building is owned by the NHS, so all its systems and processes go through them - finances, payroll, IT and housekeeping.

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“We are working with the Clinical Commissioning Group, the trust and the CQC, to make sure we get this hospice back up and running and get all the things that need to be in place, in place.

“The chief executiveis addressing this report and its required improvements.

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“We will reopen straight after the Christmas holidays, so it will be a New Year, new St Clare’s.”

Mr Paul Jones-King, acting chief executive officer, added: “While it’s heartening that our care is still ‘good’ under the new inspection framework, we have been working intensively to meet the shortcomings in other areas over the last three months and with the support of the board put a new management team in place.  

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“We have therefore made huge improvements to our processes and systems, working with the CQC and our other health partners.”

St Clare’s, which has en eight-bed inpatient unit and a day care facility for 15 day care patients, is a charity, with 40% of its funding given by the local CCG.

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The full report can be found via www.cqc.org.uk.

The issues

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The areas of practice found to be inadequate in relation to St Clare’s were:

*Significant safety concerns in areas such as medicines management, risk identification and incident investigation and subsequent learning.

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Safety is not sufficient priority and it saw patient harm had occurred as a result of this.

*There is insufficient attention to safeguarding. Staff displayed limited safeguarding understanding and the interim safeguard lead was appointed to the role without agreement or knowledge of doing so.

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*Staff were not supported with mandatory training and managers had no oversight of training needs required for the role.

*Patient records and assessments were incomplete and routine assessments were not completed for all patients, including those deemed to be high risk. Opportunities to prevent or minimise harm were missed.

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*Patients care and treatment does not reflect current evidence based guidance, standards and practice.

*None of the nursing staff had received an appraisal in the 12 months leading to inspection.

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*There is no formal process to monitor patient’s outcomes of care and treatment and there was little appetite by managers to drive improvement.

*Patients receive care from staff that do not always have the skills or training that is needed through regular completion of mandatory training.

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*Staff and teams work largely in isolation and do not seek support or input to actively improve services for

patients.

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*People are unable to access the care they need. Access and flow within the service was interrupted without due consideration for patients waiting for services.

*Complaints and concerns are not taken seriously and patients concerns and complaints do not lead to improvements in the quality of care.

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*Staff do not understand the vision and values and the strategy is not underpinned by detailed realistic objectives and plans.

*The governance arrangements and their purposes are unclear. Financial and quality governance are not integrated to support decision making.

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*Leaders do not have the necessary experience, knowledge, capacity, capability or integrity to lead effectively.

*Staff told us there was a culture of bullying and instances of conflict between individuals.

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*There is minimal engagement with people who use the service, staff and public.

*There is minimal evidence of learning and reflective practice.

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Action required

Five requirement notices have been issued to St Clare’s covering treatment.

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Areas it has been told it must improve include:

Action the provider MUST take to improve

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*It must ensure medicines are managed in line with national guidance and produce a medicines management policy

*It must ensure safeguarding processes are developed to ensure all staff fully understand how to report, investigate and learn from safeguarding alerts. They must receive training in line with Intercollegiate guidance

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*It must develop robust incident management processes, to ensure all incidents are reported, investigated and lessons learnt following incidents are shared.

*Ensure risks to patients are identified, assessed and monitored consistently and that action plans in assessments and care plans are updated and contain enough detail to enable staff to reduce those risks effectively. This includes environmental risk.

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*It must ensure care plans are individualised and person centred and reflect the needs and choices of each patient as an individual.

*Maintain an accurate record of the amount of fluids given and taken by all patients.

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*Ensure all staff have the necessary skills and training to enable them to be competent in their role.

*All staff must receive an appraisal every year.

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*All staff receive clinical competency supervision to ensure staff are providing care and treatment in line with national guidance and best practice.

*Improve the complaints processes, so that patients understand how to make a compliant and staff investigate and learn following complaints.

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*Improve governance processes to drive improvement. This includes the implementation of clinical auditing, review of all policies to ensure staff provide care and treatment in line with national guidance and best practice.