The Rowans Hospice

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

We found the care and treatment provided by the hospice was effective. The correct processes, equipment and assessments were in place. Care and treatment provided was evidence based, measurable and monitored for outcomes which enabled continuous improvement. People's needs were assessed using a range of assessment tools to ensure their needs were reflected and understood.

Staff demonstrated a good understanding around the importance of capacity to consent.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff treated patients as individuals, and involved them and their families in care, and treatment decisions. They were invited to attend care and treatment reviews. Patients were involved, listened to, and everyone involved worked well together.

Care needs were assessed and reviewed and management plans adjusted accordingly. This included nutrition and hydration needs for the patient. Doctors utilised the IPOS form as well as pain scores, memory assessment tools, delirium screening and other validated screening tools depending on the situation.

The hospice used the Australia-modified Karnofsky Performance Score (AKPS), Barthel and Phase of illness to assess needs, including activities of daily living. Patient specific care plans were generated on admission, depending on patient needs and reviewed, updated regularly to reflect change in needs.

Patients were reassessed on a daily basis both face to face and in multidisciplinary conversations with colleagues. All patients were seen on weekly consultant rounds and were reviewed by a senior doctor within 24hr hours of admission.

Staff told us daily assessment of symptoms was made using observations and physical examinations. symptoms assessment based on The Palliative Care Handbook.

Communication was assessed by doctors and nurses and reviewed regularly. Tools such as communication boards, iPad, interpreters and speech and language therapists (SALT)input was used for communication difficulties.

Staff evaluated treatment plans on an ongoing basis and updated and adjusted as patient improved or deteriorated.

Staff supported patients to understand their treatment and had good knowledge of the communication resources, and options available to them.

The provider 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 and current evidence-based good practice and standards.

We reviewed five care plans and found these to be detailed with important information which linked with current good practice on how to support people with their health conditions. These included interventions staff had made, and advice sought when required.

In addition to occupational therapy, the hospice provided complementary therapies which included massage, reflexology and aromatherapy in order to create a calming and healing environment for patients and their families.

The hospice undertook audits and analysed the trends and shared this with all staff. The service adhered to guidance set by the National Institute for Health and Care Excellence (NICE).

The hospice linked with Hospice UK national benchmarking programme for falls, medicine incidents and pressure ulcers. These were reported quarterly and benchmarked nationally and against those hospices of similar sizes.

The hospice also supported external and internal research projects reporting into the Rowans Ethics Advisory Group whichconsidered and discussed ethical issues for example The Assisted Dying Bill and implications for the hospice, staff, volunteers, patients and families.

The hospice worked well across teams and services to support people. Patients care was well coordinated, and everyone involved in their care worked well together.

The NHS clinical nurse care team were based at the hospice and staff reported an excellent working relationship with them.

The hospice at home team work together with community and hospital teams and supported patients discharged from hospital into the community, ensuring a smooth transition.

Staff worked closely with the social work team who were based at the hospice with discharge planning, liaising with local authorities and signposting to other services and agencies.

Patients were referred to the physiotherapy team to help manage symptoms of pain, mobility, balance and coordination.

Staff from all disciplines attended an MDT meeting where information was shared and next steps discussed regarding the transition of care and treatment.

As part of discharge planning, future planning and current care within the hospice, the team linked with community partners, other providers, nursing homes as appropriate and if needed were invited to join the care review or discharge planning meeting especially for those who had more advanced complex needs. This supported continuity of care for the patient and their family during any transition from one care provider to another.

Staff supported patients to live healthier lives and where possible supported people to manage their health and wellbeing to fully maximise their independence, choice and control.

Patients and their relatives told us they had enough to eat and drink and were complementary of the food and choice available.

Staff promoted the importance of good nutrition and hydration. People had nutrition and hydration assessments and plans, which were up-to-date and where necessary recording of people's intake had been completed.

Patients had access to dieticians within the NHS if required. We reviewed patient notes and saw evidence of staff gathering information in order to establish what the patients liked to eat.

The hospice provided a number of activities through their living well service which included a chair based age and dementia friendly exercise called Love to Move. The exercise engaged participants with simple hand movements set to music, and had been shown to help improve their mobility, strength, and flexibility.

The living well service also provided many other programmes and support groups such as the veterans group, coffee morning for the motor neuron disease association, sleep clinic and many more that supported healthier living.

Patients spoke positively about these activities and told us how they enjoyed not only the activity but the social aspect of meeting up with others.

Patients and family members were referred as deemed appropriate to psychology service of which offered emotional and psychological support. The hospice had a rehabilitation team comprising of physio and occupational therapy to support mobility, independence and living with a life limiting illness. This service also supported the inpatient unit and living well services.

The hospice sought the views from patients, families and staff to pilot the Introduction of "No smoking" across the hospice sites and grounds and continued to monitor the impact for their patients through the satisfaction questionnaires. This supported healthier living but also demonstrated service user involvement to gain their thoughts. For those patients who smoke, support was offered to help them manage their admission without smoking.

The hospice monitored all people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they fully met both clinical expectations and the expectations of people themselves.

The service also monitored complaints, concerns, compliments and satisfaction feedback. Follow up contact/care was made once patient was discharged or transferred to another care facility.

Staff continuously monitored people’s health conditions where appropriate. Evidence based tools were used to support this practice. The Outcome Assessment and Complexity Collaborative (OACC) was used to measure, demonstrate, and improve care for patients and families.

Phase of Illness was used as a measure to reflect changing care needs which described the urgency of care needs for a person receiving palliative care and captured additional clinical information.

The hospice used the AKPS to measure the patients overall performance status or ability to perform their activities of daily living. Evidence based tools were used at the MDT meeting to support, inform the team in assessing the patients changing needs.

The hospice was part of the Hospice UK benchmarking group and submitted data on a quarterly basis, learning from other hospices and sharing information that could improve care.

The hospice always carefully explained to people what their rights around consent were, made sure they fully understood them and always fully respected these when delivering person-centred care and treatment.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

Staff had received training in relation to the Mental Capacity Act 2005 (MCA) and were able to explain the main principles. Staff understood the importance of giving people choice in the support they received, and we observed staff always sought people's consent before providing any support. People were supported to make their own decisions where appropriate, in accordance with the MCA.

One patient receiving care in the inpatient unit told us ‘If I don’t want something, then I won’t have it. I’m very independent and determined. Staff always follow my choices’.

Staff had access to the consent guidelines which provided staff with information on how to record consent and when this was not necessary.

The service had made appropriate Deprivation of Liberty Safeguards (DoLS) applications and monitored the progress of the applications, where conditions were in place these were followed and monitored.

Staff discussed treatment escalation plans, involving the patient in decisions of their preferences in the event of deterioration, symptom management in a way that they would want it to be where possible. Patient preferences were discussed on admission, this included their preferences for place of care, death, who we could discuss and share information with ensuring consent was obtained.

Advance planning of care was discussed with patients who attend the living well service.