People we spoke with were very happy with the services provided by Holy Cross Hospital. One person said; "This is better than most places I have been to." And; "It took me a while to get used to but now I can't think of a better place." Another person said; "I'm very happy here, I can't fault the place."

People said staff worked hard to make sure their needs were met and we were told that staff were attentive and helpful. One person commented; "Staff are brilliant." And another commented; "The staff are excellent, if you ring for them they come straight away and even if they are busy they will come and tell you they will come back as soon as they have finished with another patient."

We found there was knowledge and awareness of neurological care in the service. The management team were aware of good practice guidelines and the latest research relating to the care and treatment of neurological conditions and these were incorporated into the care provided by the hospital. We found staff were knowledgeable about how to care for people with neurological and associated conditions.

We found people's privacy and dignity were respected and staff involved patients as much as possible in decision making. We saw that the service went to great lengths, and with the use of new initiatives in technology and adaptations, assisted people to continue to interact with their surroundings.

Everybody we spoke with said they were fully consulted about their care and treatment. People told us continuity of care was very good. One person said;" It is a wonderful facility and communication is excellent." Another said; "I can't fault the care."

People’s health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in co-operation with others.

We saw there were sufficient staff to meet the needs of the people who required care and treatment.

People said they knew how to raise any concerns and were given the opportunity to provide feedback on the level of service received. Everyone we spoke with told us the staff were very helpful, kind and knowledgeable about their needs. One person said; "They are so thoughtful." And "The staff are brilliant."

We spoke with seven staff who worked at the hospital. They told us they enjoyed their work. Comments included; "We do our best to make people comfortable." Another commented; "There are excellent training opportunities." And; "We are encouraged to train and to further our personal development." Another person said; ”We work well as a team", "We get a lot of training and support, and I feel we are appreciated". Another said; "I look forward to coming to work, I really enjoy working here." All staff spoken with commented that they thought communication was effective. They said they felt involved and were consulted about changes in the hospital that were proposed through the hospital staff forum; "Have your Say."

All said they felt supported by their line manager to carry out their role. We looked at the records for the service, including quality assurance audits, staff meeting minutes and staff shift handover sheets and found them to be up-to-date.

At this inspection we spoke with three people who used the service and four relatives. They all spoke positively about the hospital and the care and treatment provided to them. People told us they were happy with the care and support they received. They told us that they received care in the way they had expected.

One person said, "This is a fantastic place. The staff have been great and really helped me to get better."

Another person told us that they were happy with how their personal and healthcare needs were met. They told us that they felt very reassured with how the staff provided support.

A relative said, “The care and support is excellent, nothing is too much trouble. I have total trust in the staff which comes from seeing how they have supported my family member”.

We also spent time observing the interactions between staff and people who use the service. We found this to be positive, friendly and caring. We saw staff explaining their actions and telling people about the day’s events especially those people who had highly complex needs and were unconscious.

We spoke with staff who told us that they were very happy working in the hospital. They felt supported in their work, had good training and felt the management was open and supportive.

The evidence we found supported the views expressed by people, relatives and staff.

Holy Cross Hospital is operated by The Congregation of the Daughters of the Cross of Liège. The hospital has 40 inpatient beds. Facilities include: 40 single bedrooms with ensuite and overhead hoists, an inpatient physiotherapy gym and a separate Physiotherapy Centre for outpatients, a hydrotherapy pool with hoist to assist transfers, a sensory room, an activity room with a therapy kitchen, a sensory garden, and a woodland trail. At the time of inspection, the hospital was in the process of building an Education Centre.

The hospital provides support for patients with long-term conditions within the specialisms of: disorders of consciousness; postural and physical management; complex respiratory management; swallowing disorders and nutrition as well as providing assistive technology.

Physiotherapy services are provided to outpatients at the integrated physiotherapy centre, as well as the gym and hydrotherapy pool.

We inspected this service using our comprehensive inspection methodology. We carried out an announced inspection on 28 and 29 March 2017.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

We rated this hospital as outstanding overall. We rated safe, effective and well led as good and responsiveness and caring as outstanding.

We found areas of outstanding practice:

• Patients were truly respected and valued as individuals an there was an emphasis on providing a care setting that patients could consider their home.There was an embedded culture of caring amongst all staff and we saw many examples of staff going the ‘extra mile’ to meet the needs of patients in ways that took account of their personal preferences. This included personal, cultural, social and religious needs.

• The hospital was at the forefront of care for people with long-term conditions. There was holistic approach to assessing, planning and delivering care and treatment to people who use services. The safe use of innovative and pioneering approaches to care and how it is delivered were actively encouraged. New evidence-based techniques and technologies were used to support the delivery of high quality care. Staff from the hospital had been invited to co-write Royal College of Physicians (RCP) guidelines regarding pain as well as to set up a patient group as part of a centre of excellence.

• When patients needed acute hospital care, there were arrangements for staff from Holy Cross Hospital to support patients in this environment, and also to support other professional staff in meeting the complex, individual needs of patients. Patients were welcomed when they returned. 

• Services were tailored to meet the needs of individual patients whose needs and preferences are central to the planning and delivery of tailored services. The services were flexible, provided choice and ensured continuity of care.  There were opportunities for patients and those close to them to experience a range of environments. There was a woodland trail outside the hospital that was wheelchair friendly and provided views over the countryside, a sensory garden included a fishpond with waterfall, plants of varying colour and scent and a terrace. Patients also had access to a holiday cottage in Selsey.

• The hospital had established “Special Interest Groups” covering a range of clinical areas such as infection prevention and control to ensure best practice and guidance was reviewed, considered, disseminated and managed throughout the hospital.

We found other areas of good practice.

• People were protected from avoidable harm and abuse.

• There were systems to report and investigate incidents, to control the spread of infection, to manage medicines in line with legislation and current guidelines and to report and investigate suspected abuse.

• There were sufficient numbers of staff with the necessary qualifications, skills and experience to meet patient’ complex needs.

• The leadership, governance and culture promoted the delivery of high quality person-centred care.

However, we also found the following issues that the service provider needs to improve. The hospital should:

• Expand information on duty of candour in the incident policy to indicate the practical application of candour as a point of reference for all staff.

• Have an auditable target in place for mandatory training completion.

• Follow through the chain of disposal external to the hospital for assurance at least annually.

• Document a rolling schedule of planned preventative maintenance for equipment used to enable easy reference.

• Conduct additional resuscitation scenario training.

• Establish key performance indicators within the pathology service level agreement setting out reporting.

• Review its arrangements for advanced care planning.

• Review the use of syringe drivers to support patients on an end of life pathway and to provide medication where appropriate.

• Ensure all staff have an annual appraisal.

• Ensure all staff know how to access professional translation services.

• Devise a risk register that is prioritised and gives the management team assurance of safety across the organisation.

Professor Ted baker

Deputy Chief Inspector of Hospitals