End of life care at the Royal London rated 'good'
The CQC has announced that the Royal London Hospital is now rated as ‘Good’ in all areas of End of Life Care services. This is an enormous achievement, given that in 2015, the report determined all criteria in this category either ‘required improvement’ or were deemed ‘inadequate’.
Over the last four years, the staff at the Royal London have worked hard to improve the services offered and provide patients and their loved ones the best support possible in their time of bereavement. Ros Butterfield, Bereavement Lead at Barts Health, explains, “[an improved service] is what we strive for every single day.”
During the recent inspection, Ros reflected on how far they’ve come since the previous report, “I wanted the team to be prepared to say all the good things we are doing; I think they really got that across.”
One of the ways in which End of Life Care has improved at the Royal London is through the Bereaved Carers Survey, which is given to families whose loved ones have died. The surveys are part of an approach called ‘experience-based co-design’, which looks at how it felt to experience the loss of a loved one at Barts Health.
The surveys were first put into place in 2011, but were initially much more satisfaction based, and mainly just included box ticking. “I personally don’t feel that we got people’s feelings [or] experienced the true essence of what they felt,” Ros remembers. Two years ago, however, a new model was introduced.
This new survey allows bereaved families to rate the their overall experience, as well as give more specific feedback across the different aspects of their time in our hospital: care; staff; beliefs (spiritual, religious, cultural); at the time of death; return of personal Items; viewing; bereavement officer. The experiences shared in the surveys are then given to the End of Life Care group where the feedback can be disseminated to the team.
This allows for quick reaction to those areas that families feel require improvement. “A family wrote down recently that they went to see their loved one and everything looked lovely but mattress was still buzzing, though the beds can be made static…all the care had been done just as it should be but with the buzzing going on it took away from their experience.” This feedback was then able to be mentioned in the Monday morning huddle as something to look out for.
Ros has also seen a change in the way staff on the wards think about spiritual care, not just for the patient but also for their loved ones in this difficult time for them. “We are looking after the patient more holistically than before.”
She goes on to explain, “We really need to be thinking for our bereaved families. When families don’t feel they have to be constantly approaching staff for information, and that information comes directly to them, they really appreciate it.”
In reaction to feedback from the surveys, the Bereavement Officers now offer the option to electronically book death registry appointments for the families, and are also purchasing a kettle and tea cups to offer to families.
Ensuring that small details like this are offered impacts the way that patients and their families view their care at the Royal London, and this is reflecting positively in the surveys:
“We’re finding that not only was the patient offered support, but the family were too. And that makes such a difference to the family. We’ve had an influx of really positive feedback and it’s important to shout about it! We recently had two batches of carers surveys come to us, in which all experiences were reported good or excellent (none were rated poor, fair or very poor). A lot of people wanted the opportunity to say thank you; they really appreciated the care.”
Moving forward, the team at the Royal London continues to work towards ‘outstanding’ service. Following feedback from a patient panel, the surveys now include the option for people to fill in their contact details, which allows for follow up and further conversation if needed.
In May, the bereavement team will be going across all the different sites to work with the palliative care team for Dying Matters week, focusing on ‘death is the last taboo.’ There will also be a Barts Health Bereavement Conference held on the 17th June. Please visit the 'events' page on WeShare for more information.
Ros is positive about the future, “I believe we do a good job in the bereavement office every day and I think we do across the hospital. These surveys are showing that. What we do now is continue to learn from the feedback from the carers survey.”