Nottinghamshire 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

People, care givers and loved ones had good outcomes. During our assessment, we observed that people’s care, support and treatment reflected these needs and protected equality characteristics, ensuring people were at the centre of their care.
As part of our assessment, we reviewed evidence that showed people were encouraged to live healthier lives leaders and that consent to care processes were undertaken appropriately. Staff worked to ensure that current outcomes and exploring best practice was part of their everyday work. However, we could not always identify the outcomes measures and action plans on a number of different audits.
At our last assessment we rated this key question good. At this assessment the rating has remained the same. This meant people’s needs were met through good organisation and delivery.
 

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff used appropriate assessments to identify patient need and levels of deterioration of physical, emotional and psychosocial needs of patients.

Patient needs were escalated appropriately, within the context of the service.

Staff provided care and treatment based on national guidance and evidence-based practice.

Staff worked together as a multidisciplinary team with the district nurses, GP’s and other partners in their care, to benefit patients and provide the best outcomes for them.

All new members of staff and volunteers underwent a structured and comprehensive induction training programme appropriate to their role. For example, one staff member told us about their privacy and dignity training, which was part of mandatory training, and how they put that training into practice when caring for people.
The service had a mandatory training and competency framework, compliance was monitored through the service’s training database. All mandatory training and competencies were reviewed on a regular basis to ensure that they met current guidelines and procedures.
The service set a target of 90% for mandatory training compliance. Data showed for the period January 2025 there was a mandatory compliance rate of 93%, thereby exceeding the target.

Leaders and staff were aware of their responsibilities for reporting and recording incidents and accidents.
Staff were confident to report incidents and were supported when things went wrong. Staff knew what they should report and when they should report it and to whom. The formal reporting system was easy to use, and staff were knowledgeable when using it.
Staff told us they felt comfortable raising concerns with leaders and felt they would be listened to.
All senior staff were knowledgeable about the duty of candour, there was a standard operating procedure that provided guidance to the requirements of duty of candour.

QS Score:
Score: 2
During a hospice at home visit, we observed that staff used a recognised pain score tool to assess pain. Patient records we reviewed evidenced appropriate pain relief medicines were given to patients to manage symptoms.
Patients and their relatives told us staff were good at monitoring them to ensure they received the right pain relief when they needed it.
The service incorporated the Integrated Palliative care Outcome Scale (IPOS) which is a measure of symptoms and concerns which matter to a patient and helps staff provide patients with the best care. There are 10 questions scored on a scale of 1-4, which assess a patient's symptoms and needs with regards to physical, social, psychological and spiritual preferences and needs.
Loved ones were asked to complete a bereavement survey approximately 6 weeks after the death of a patient. This was to measure people’s experience before they died. For example, had the patient been treated with dignity and respect, had they felt listened to and did they consider the staff supportive.
The response to the survey from January 2024 to January 2025 showed 100% positive experience by those who completed it.
We saw evidence in patient care records that relatives were involved decisions about patients’ care and treatment and in developing their care plans. Relatives told us staff answered questions about care and treatment openly and in plain English they could understand.

The service participated in relevant national clinical audits, for example for the hospice at home team, mental capacity assessments showed an 80% compliance, record keeping showed 100% compliance and pressure area care showed a compliance of 78%. However, we could not identify the outcomes measures and action plans on a number of different audits. For example, for the hospice at home handover, the audit showed a compliance of 29%, for handovers, 36% for a registered nurse first visit and 78% for hand hygiene all audits were against the hospice target of 90% for the period September to December 2024,
Policies and processes about safety were aligned with other key partners who are involved in people’s care journey to enable shared learning and drive improvement.

Staff supported patients to maintain healthy choices and healthy lifestyles. Patients were given advice on how they could be involved in monitoring their own health and wellbeing to maximise their independence and comfort.

A healthy diet was promoted, and wellbeing sessions were part of the provision including various forms of relaxation and alternative therapies.

We saw the malnutrition universal screening tool (MUST) being used in addition to the national screening tool, to help staff support patients nutritional needs.

Leaflets were available in the hospice on subjects such as living positively with cancer and managing breathlessness. As well as supporting patients the hospice worked to identify the needs of families and care givers and part of this was to ensure they were supported to remain healthy.

QS Score:
Score: 2
During a hospice at home visit, we observed that staff used a recognised pain score tool to assess pain. Patient records we reviewed evidenced appropriate pain relief medicines were given to patients to manage symptoms.
Patients and their relatives told us staff were good at monitoring them to ensure they received the right pain relief when they needed it.
The service incorporated the Integrated Palliative care Outcome Scale (IPOS) which is a measure of symptoms and concerns which matter to a patient and helps staff provide patients with the best care. There are 10 questions scored on a scale of 1-4, which assess a patient's symptoms and needs with regards to physical, social, psychological and spiritual preferences and needs.
Loved ones were asked to complete a bereavement survey approximately 6 weeks after the death of a patient. This was to measure people’s experience before they died. For example, had the patient been treated with dignity and respect, had they felt listened to and did they consider the staff supportive.
The response to the survey from January 2024 to January 2025 showed 100% positive experience by those who completed it.
We saw evidence in patient care records that relatives were involved decisions about patients’ care and treatment and in developing their care plans. Relatives told us staff answered questions about care and treatment openly and in plain English they could understand.

The service participated in relevant national clinical audits, for example for the hospice at home team, mental capacity assessments showed an 80% compliance, record keeping showed 100% compliance and pressure area care showed a compliance of 78%. However, we could not identify the outcomes measures and action plans on a number of different audits. For example, for the hospice at home handover, the audit showed a compliance of 29%, for handovers, 36% for a registered nurse first visit and 78% for hand hygiene all audits were against the hospice target of 90% for the period September to December 2024,
Policies and processes about safety were aligned with other key partners who are involved in people’s care journey to enable shared learning and drive improvement.

Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent. They knew how to support patients who lacked the mental capacity to make their own decisions or were experiencing mental ill health. They used agreed personalised measures that limit patients' freedom and liberty.
Staff told us consent was gained before any sharing of patient information, both internally and with other primary care services.
Relatives and patients, we spoke with told us staff did not provide any care without first asking their permission. We looked at 5 sets of patient care records and saw consent was appropriately recorded on all of them as well discussions about their holistic and care needs, as well as preferences.