Willow Burn Also known as Maiden Law Hospital, Maiden Law Hospital,DH7 0QS

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

At our last assessment we rated effective as good. At this assessment the rating has remained good.

This meant people consistently experienced positive outcomes that met or exceeded their individual goals and care needs, and people’s feedback confirmed this.

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support, and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

Staff followed a consistent and high-quality approach to assessing, and reviewing patients’ health, care, wellbeing, communication needs, and their mental health needs.

The service planned and delivered patients’ care and treatment with them, including what was important and mattered to them. Staff did this in line with legislation and current evidence-based good practice and standards. Staff monitored patients’ care and treatment to continuously improve it.

Staff worked together and with others when assessing patients’ needs and shared information to maintain continuity of care.

Staff gave patients practical support and advice to improve the quality of their life and lead healthier lives.

Staff told patients about their rights around consent. Staff respected these rights when person-centred care and treatment was delivered.

This service scored 79 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

We looked at 4 patient records during the assessment. All records showed clear planning and assessment of needs prior to admission through communication with referrers. Handover documents showed patients’ individual needs were appropriately assessed, and staff ensured the care provided would meet their needs. Willow Burn is a small service and there were clear admission and exclusion criteria and staff ensured referrers were given clear information and guidance on any restrictions to provision of safe care.

Staff assessed patients’ needs on admission and throughout their care using a range of assessment tools to ensure their needs were identified and understood. The hospice used personalised care plans and goal setting and included patients and their families in these assessments. Staff actively encouraged patients to maintain their interests and participate in activities. Willow Burn processes ensured staff understood their patients’ holistic needs. Staff showed a consistent and high-quality approach to assessing, and reviewing patients’ health, care, wellbeing and communication needs with them to enable them to receive care or treatment that had the best possible outcomes.

There was a creative and person-centred approach in ensuring patients’ communication needs were met to maximise the effectiveness of their care and treatment. Staff asked patients what name they preferred to be called by and if they had difficulty with any particular form of communication. There was a range of communication tools available to offer.

All patients on the inpatient unit were under the care of their own GP and patient’s needs and treatment were reviewed by a doctor on site as necessary, and up to 4 days a week. There was a palliative care consultant ward round once a week.

Staff on the inpatient unit had twice daily handover meetings at the start of each shift so they knew if there had been changes in patients’ physical, psychological and emotional needs.

All staff worked as part of a multidisciplinary team to continuously assess the changing needs of patients. Staff also assessed and discussed the needs of relatives and loved ones. A family liaison officer supported their wellbeing and with administrative or financial advice and support in their carer roles and helped them to provide safe and effective care to their loved ones.

The service always planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation. They worked to develop evidence-based good practice and standards.

Willow Burn planned and delivered patient’s care and treatment with them, including what was important and what mattered to them. They did this in line with legislation and current evidence-based good care and standards, which was referenced in the policies. Staff asked patients what mattered to them and recorded the responses in patient records to ensure everyone was aware of their wishes. Patients and their loved ones participated in the assessment and staff provided support where needed to maximise their involvement. Staff could offer support in accessing spiritual or religious materials. There was a quiet room that could be used as a prayer room or simply for quiet contemplation. Religious items could be stored away if not needed or wanted.

The lead nurse managed an annual audit programme utilising recognised validated tools by Hospice UK that ensured all aspects of care, cleanliness, safety and patient outcomes were checked and considered by the hospice team and the wider multidisciplinary community palliative care team. The service used audit as a tool to highlight good practice and to identify any missed priorities or failings requiring actions. Immediate required actions were shared via shift handovers, email, and circulation of a “red top” staff communication flyer. Audit outcomes and updates were shared at staff and service quality meetings as standard agenda items. All clinical staff were involved in completing audits to maintain and promote standards. Clinical lead link roles provided focus, developed self-awareness, knowledge and skills, and took ownership of the environment and patient care. Quality and performance information was shared in quarterly (3 monthly) reports to the board and the review cycle had oversight by the Quality and Compliance Sub-committee. External expert support could be sought and provided where required.

Staff assessed and met patients’ needs for food and drink and for specialist nutrition and hydration. There was a varied menu that accommodated most tastes. Staff spent time with patients and listened and encouraged them to make choices from the menu. The hospice chef visited patients to find out what their favourite meals were. Staff, patients, or families could order a takeaway, or families could bring in food to suit patients’ wishes. Staff offered patients specialist products including “air with flavour” to create a sensation of a liquid to ease a dry mouth but without making the need to swallow.

Staff participated in clinical audit, benchmarking and quality improvement initiatives. Staff had clear and individual audit responsibilities from completion of audits and following up on actions arising from them.

The team included or had access to the full range of specialists required to meet the needs of patients in the service. As well as doctors and nurses, occupational therapists, social workers, pharmacists, speech and language therapists, dieticians.

The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff held regular and effective multidisciplinary meetings, led by a GP with specialist interest in end-of-life care. There had not been an MDT meeting for 2 months prior to this assessment but these were due to reconvene.

The inpatient team worked in partnership with GPs, district nurses, and other community teams delivering care to patients in their homes. They had effective working relationships, including good handovers, with other relevant teams within the organisation such as day services, counsellors, bereavement support and family liaison co-ordinators.

Staff shared information about patients at effective handover meetings within the team before every shift, and when patients were due to move between services, all necessary staff, teams and services participated in assessing their needs to maintain continuity of care.

Staff had access to the information they needed to appropriately assess, plan and deliver patients’ care, treatment and support. The whole staff team worked collaboratively to make sure patients' healthcare needs were met. The hospice team included medical and nursing staff, nursing assistants, administrative staff, and a range of other support staff. The hospice staff worked with other health and social care providers to ensure patients complex palliative care needs were met. Staff accessed support for patients and their families from community staff including occupational therapists, social workers, physiotherapists, and complimentary therapists.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

Staff supported patients to live healthier lives – for example, through participation in smoking cessation schemes, healthy eating advice and screening for cancer.

There was a strong focus on empowering patients to manage their own health, care and wellbeing needs as much as possible. Patients participated in regularly reviewing their health and wellbeing needs to improve the quality of their life including their end-of-life care.

Services focused on identifying risks to patients’ health and wellbeing early to maximise their quality of life and including care at the end of their life. Patients were asked about their goals and what was important to them.

Patients and their loved ones could access information to improve their quality of life including managing breathlessness, tiredness and pain. The hospice had access to appropriate support to manage patients’ psychological health.

Staff encouraged and supported patients to make healthier choices to promote their health and wellbeing. There were health promotion materials throughout the service displayed on the walls, in the form of leaflets, helplines, and organisations to support ongoing health needs such as symptom control.

The service routinely monitored patient’s care and treatment and any necessary changes were made to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of patientsthemselves.

Patients told us staff regularly checked with them about their care and treatment and their loved one’s needs were also considered. Patients and their loved ones were given the opportunity to give feedback about the service during their care and after admission through a “How are we doing?” card and through commenting in the guest book in the family area. People could also give electronic feedback via the hospice website and by talking to staff in the inpatient unit. This encouraged patients and their loved to tell the service how they felt about the support they received. Many families fed back that their expectations were far exceeded.

Staff used recognised tools to improve the detection and response to clinical deterioration in patients as a key element of patient safety and improving patient outcomes.

Outcomes were positive, consistent, and met both clinical expectations and the expectations of patients themselves. The service used the Integrated Palliative care Outcome Scale (IPOS) as a measure of symptoms and concerns which matter to patients therefore helping staff provide the best patient experience. In addition, the service used Goal Attainment Score (GAS) to ensure patients had achieved desired goals.

Staff used recognised tools to monitor patients, for example the Australia-modified Karnofsky Performance Scale (AKPS) to assess patients' day-to-day functioning. This assisted in assessing if care needed to be adjusted as a patient neared the end of life.

Managers and staff completed audits using tools from Hospice UK to monitor and improve upon outcomes. Staff gave examples of actions, good practice and learning being shared with them. These included, quarterly (3-monthly) pain management audits and nutrition and hydration audits, as well as monthly infection prevention and control audits.

The service monitored its performance and benchmarked itself against other local and regional hospice providers. Results compared favourably with other similar providers. Data included number of admissions, deaths and discharges, percentage occupancy and length of stay, as well as the patient’s preferred place of death and whether this had been achieved. The number of medication errors and the number of falls were all monitored and benchmarked at clinical quality and management meetings.

Staff used the Outcome Assessment and Complexity Collaborative (OACC) evaluations were used for inpatients admitted for short say palliative symptom management and found these valuable in managing individual progress in achieving their goals or in managing their problems. However, staff recognised every patient had different needs and all were treated as individuals who were involved in their own care planning and in improving the quality of their own care. Managers and staff presented a range of audit results at the service quality meetings as standard agenda items. These included the capacity to consent, management of pressure ulcers, management of controlled drugs, self-administration of medicines, and care of deceased patients audits. The lead nurse and palliative care consultant provided updates and any changes to National Institute for Health and Care Excellence (NICE) guidelines which included end of life and palliative care patients. The service audited care provision in terms of meeting patients' individual needs. To support this, patient records captured details of patients' protected characteristics and communication needs.

The service told patients about their rights around consent and respected these when delivering person-centred care and treatment. Staff supported patients to make informed decisions about their care and treatment and took all practical steps to enable patients to make their own decisions. Staff followed national guidance to gain patients’ consent. Staff knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health.

Staff gained consent from patients for their care and treatment in line with legislation and guidance. When patients could not give consent, staff made decisions in their best interest, considering patients’ wishes, culture and traditions. They did this on a decision-specific basis with regard to significant decisions. This included following advance care plans that had previously been developed with input from the patient and those close to them.

Practices around consent and records were actively monitored and reviewed to improve how patients were involved in making decisions about their care and treatment. Staff clearly recorded consent in the patients’ records. Records of consent were routinely audited every other month to identify any gaps and improvements required.

For patients who might have impaired mental capacity, we found notes showed staff assessed and recorded capacity to consent appropriately. However, a clinical documentation audit from July 2025 showed 2 records reviewed did not record at every shift that patient capacity to consent or best interest decisions had been assessed. This was not in line with policy and actions had been taken to ensure all nursing staff completed these assessments in full. A later audit showed this had improved and all individual mental capacity and best interest decisions were documented.

Staff made sure patients consented to treatment based on all the information available and took time to ensure patients understood the information. Staff told us how they understood the principles of the Mental Capacity Act regarding consent to treatment and how they supported patients including their families to understand and make decisions about their care. Staff knew when to assess whether a patient had the capacity to make their own decisions.

We observed mental capacity assessments were carried out routinely as part of assessment processes across the hospice. Staff understood the principles of best interest decision making where patients were assessed as not having the mental capacity to make certain decisions. Where appropriate, family members and those close to the individual participated in discussions about decisions.