Damning report finds Leeds hospice 'inadequate' and puts it in special measures

The Care Quality Commission (CQC) rated Sue Ryder- Wheatfields Hospice in Headingley inadequate and placed the service into special measures to protect people. It follows an inspection in March and May which found issues of “understaffing and low morale” and instances where patients were put at risk due to inadequate care.

The publication of the damning report comes two weeks after whistleblowers told the Yorkshire Evening Post that end-of-life patients had been moved suddenly over “unforeseen staff shortages”.

In summary, the CQC said that it found:

• Leaders didn’t ensure staff had the right skills, qualifications and experience to meet people’s needs.
• Leaders failed to support and supervise staff to ensure they were competent in their roles.
• Leaders didn’t always consult with staff and people when there had been significant service reductions such as the closure of the day centre and the loss of palliative care social workers and nurse-managed beds.
• Staff didn’t always work well with people or health system partners to establish and maintain safe systems of care.
• The service didn’t always follow infection prevention control measures to keep people safe from infection.
• People requiring additional support or needing referrals to external services experienced delays in receiving appropriate assistance.

A spokesperson for Sue Ryder has said that it is seeking legal advice over what has described as a “shockingly inaccurate assessment” that is “misleading and unnecessarily alarming”.

The CQC undertook the inspection after concerns were raised about the quality of care being provided.

Linda Hirst, CQC deputy director of operations in the north, said: “When we inspected Wheatfields, it was disappointing to see how ineffective leadership had directly contributed to poor care. Staff were kind and worked hard to provide compassionate care but were let down by leaders who hadn’t investigated when things went wrong. Leaders didn’t respond effectively to concerns about understaffing and low morale, which impacted on people’s care. Staff also said they were frequently unable to take breaks as it placed people at risk due to their being no cover.”

She said that staff dissatisfaction led to many leaving the service and that leaders continued to put pressure on teams to take new admissions despite the issues, which “placed people at further risk of harm”.

Ms Hirst said that people didn’t always receive their medications on time due to only one nurse being on shift, which meant delays in rounds and “some people (sic) in pain whilst waiting”. She continued: “Additionally, leaders didn’t listen to people’s preferences, and care delivery was very task-focused with little consideration of people’s values, aspirations or goals. Staff wanted to spend more time with people but didn’t have time due to excessive workloads.”

The Grove Road hospice provides adult inpatient and community specialist palliative care services for people with life limiting conditions where curative treatment is no longer an option and people are approaching the end of their life.

Following this inspection, CQC has rated the areas of safe, effective and well-led, as inadequate. Caring has been rated requires improvement, and responsive has been rated good. The hospice was previously rated good overall and for all five domains.

CQC has also placed the service into special measures which involves close monitoring to ensure people are safe while they make improvements. Special measures also provides a structured timeframe so services understand when they need to make improvements by, and what action CQC will take if this doesn’t happen.

Ms Hirst said: “We have told leaders where we expect to see rapid, and continued improvements and will continue to monitor the hospice closely to keep people safe while this happens. We will return to check on their progress and won’t hesitate to use our regulatory powers further if people aren’t receiving the care they have a right to expect.”

CQC has also begun the process of taking regulatory action to address the concerns which Sue Ryder has the right to appeal.

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In response to the report, the chief executive at Sue Ryder, James Sanderson, said: “Sue Ryder is very disappointed with the CQC report into Wheatfields hospice, which we believe is misleading and unnecessarily alarming.

“The hospice is in an ongoing period of improvement, but we challenge a significant number of the CQC’s findings as factually inaccurate. In addition, the process of the inspection, the behaviours of the inspector and the lack of context and selectivity have created serious concerns over the report’s integrity.”

Mr Sanderson said that the charity carried out a comprehensive internal review last year and identified areas of improvement after the decision to temporarily close the hospice.

He said that the CQC was informed of the findings, adding: “Those included poor behaviours amongst some staff and concerns regarding their clinical practice, which resulted in a formal investigation and several employees at all levels of the service leaving the organisation.

“A new leadership team was appointed and the improvements led by that team over the last 12 months demonstrate Sue Ryder’s staunch adherence to our responsibilities as a responsible provider and our commitment to a significant development programme at Wheatfields, focused on patient care.

“At no point have we found evidence to suggest that any patients received unsafe care. The safety of our patients is paramount and when we were unable to secure safe staffing levels last year we temporarily closed the inpatient unit. We would not hesitate to do the same again if we felt it necessary.

“The CQC report mentions understaffing of the inpatient unit, but during the period referenced, there were four shifts out of 453 (0.88%) where we were one staff member down due to last minute sickness. Mitigation plans were put in place, including the leadership team stepping in to support colleagues.

“Sue Ryder has had a strong working relationship with the CQC for many years and respects them as our regulator. However, despite attempts to work constructively with them during this inspection process, we have sadly been left with no choice but to seek legal advice in relation to this report and what we feel is a shockingly inaccurate assessment of Wheatfields hospice.”