St Michael's Hospice (North Hampshire)

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• 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

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last assessment we rated this key question as good. At this assessment the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this. The hospice delivered a good standard of effective care by consistently using evidence-based frameworks to assess and meet patient needs. Clinicians employed gold standard tools to monitor physical decline and incorporated a strong focus on patient comfort, dignity, and autonomy when people were nearing the end of life. This helped to ensure any medical intervention was timely and accurate, while allowing the most vulnerable patients to remain safe and pain-free. .

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.

The service maintained a good standard of clinical safety by identifying medical risks quickly and monitoring them using standardised tools. Staff told us they assessed every new patient immediately to understand both how unwell they are and how comfortable they feel. This helped staff act quickly to ease any pain or distress. During our inspection, we spoke with a patient who had just been admitted, and the patient reported they were in pain. During this conversation, nurses were already in the process of preparing pain relief. Staff told us they regularly monitored patients’ pain, including those who could no longer communicate their needs. For those unable to communicate their needs, staff used support tools such as communication boards, iPads, translation devices, and interpreters, or consulted with Speech and Language Therapists (SALT). This meant the most vulnerable patients could be kept comfortable and pain free.

Inpatients benefitted from a schedule of clinical oversight, which included daily nursing and medical assessment reviews. This was supported by twice-weekly consultant-led ward rounds and a weekly multidisciplinary team (MDT) meeting where every patient’s condition and symptoms were reviewed. Additionally, staff monitored nutrition and hydration through food and fluid charts, using this data to provide supplements or adjusted support when a patient’s intake declined. We saw the use of food and fluid charts for patients whose intake had declined for staff to monitor this change. This meant the team had information which could be used to support patients and altered care plans when needed.

Staff protected patients from avoidable pressure injuries by carrying out regular skin assessments. We were told they conducted regular checks and documented this on body maps which described the placement and status of wounds. Our review of 5 sets of patient notes found that 2 hourly repositioning, body maps, and wound care plans were completed to a good standard. Beyond skin health, these checks also ensured patients’ hygiene, mouthcare, and comfort needs were met. This consistent monitoring meant safety and dignity were built into the everyday routine for every patient.

For patients nearing the end of life, the team used the Achieving Priorities of Care (APOC) framework to guide care decisions. This is a clinical framework used in palliative care to ensure a patient’s final days of life are managed with comfort, dignity, and respect. By breaking down care into key areas, such as physical comfort, hygiene needs, food and fluids, spiritual needs, and communication, staff could focus on the immediate needs of the dying person. Staff compliance for the completion of this paperwork achieved a 92.3% rate across April, May and June 2025 which meant these assessments provided a continuous oversight of a patient’s condition.

The service embedded guidelines from the National Institute for Health and Care Excellence (NICE) into their daily routines, to ensure patients approaching the end of life were identified early and supported effectively. Following NICE guidelines, clinical leaders held daily meetings to review patient stability and identify those who might be entering the final weeks or days of life. This approach allowed the team to conduct holistic needs assessments, looking beyond medical symptoms to address emotional, spiritual, and social concerns. By identifying these needs early, staff ensured care was tailored to the individual. Beyond clinical care, the hospice promoted a calming environment through complimentary therapies such as massage, reflexology, aromatherapy, and reiki. To evaluate these services, the team used a questionnaire which allowed patients, carers, and bereaved relatives to track improvements in their specific areas of concern and overall wellbeing.

Staff implemented advance care planning to ensure treatment remained aligned with patient’s wishes as their condition changed. We saw evidence that staff regularly reviewed treatment plans, stopping unnecessary medications or interventions that no longer benefited the patient. Using the ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) process, the team documented clear preferences for emergency care, ensuring that transitions between the hospice and other care settings were handled safely. As these plans were shared with out-of-hours services and GPs, patients received consistent care across different care settings. For psychological support, the service used outcome measures within its pre and post bereavement counselling sessions. This tool provided a broad snapshot of psychological wellbeing and helped clinicians identify specific risks and treatment targets beyond general symptoms of distress.

The hospice team used evidence-based tools and national benchmarking to ensure care remained safe and consistent. Staff employed the Fundamentals of Care (FoC) framework, which included the Malnutrition Universal Screening Tool (MUST) to identify nutritional risks early. The effectiveness of this approach was reflected in the service’s own FOC audit, which rose from 90% compliance in July to 100% in August 2025. Furthermore, the service participated in the Hospice UK national benchmarking programme for falls, medicine incidents, and pressure ulcers. This data was reviewed quarterly at the Clinical Governance Committee to compare performance against similar-sized hospices nationally. The service’s commitment to best practices was further supported by its active participation in the Wessex Research Active Hospice Development Group, ensuring that patient care was informed by the latest palliative research.

The hospice built strong relationships with outside healthcare services to ensure patients received smooth and continuous care. They worked closely with local hospital teams and specialist groups to manage patient needs across the region. For example, when the hospice’s own beds were full, staff contacted nearby hospices in other towns to find an available space for the patient. This coordination meant people received the help they needed quickly, even when the hospice was at full capacity.

The organisation made sure different types of staff learned the same skills to keep care standards high in all departments. The 2025 to 2026 training calendar included days and workshops where doctors, nurses, and therapists studied together on topics including autism, spiritual care, and managing pain. Staff also attended large conferences, such as the Oxford Advanced Pain and Symptom Management Conference, and shared what they learned with their colleagues. Sharing this knowledge internally helped to ensure the whole team remained at the forefront of palliative expertise, directly improving outcomes for patients with complex needs.

Internal teams used a ‘group talk’ approach to solve complex medical and emotional problems for their patients through multidisciplinary team (MDT) meetings. In September 2025, a large group including doctors, therapists, a chaplain, a pharmacist, and a hospice coordinator met to discuss a patient whose health was declining. The team reviewed advice from an outside brain specialist and an endocrine team to simplify the patient’s blood sugar monitoring and medication. This helped ensure the patient received the care and treatment they needed based on specialist advice.

The hospice combined medical care with emotional support to look after the family as a whole. In one case, the team worked closely with a specialist children’s service to coordinate support for a patient’s son, helping him navigate his parent’s illness. The staff spoke with the patient’s wife to see if the child needed extra counselling at school or if the family’s current supportive environment was enough.

The clinical team proactively pursued better health outcomes for patients by working with external specialists. In one instance, staff noticed an elderly patient admitted for end-of-life care following a stroke began to show unexpected signs of improvement. The team immediately brought in speech and language experts to help with their swallowing and consulted a specialist physiotherapist to design a recovery plan. This intervention changed their path from terminal care to active recovery, allowing them to move to a community hospital for rehabilitation.

Inpatient clinics improved the physical and emotional wellbeing of patients by bringing different experts together in one place. During a session for a patient with a progressive neurological disease, a team including a neurologist, a dietitian, and an occupational therapist (OT) assessed the patient at the same time. The OT identified mobility issues and immediately arranged for a foot splint, while the dietitian addressed nutritional health. This streamlined approach prevented the patient from having to repeat their story multiple times.

The hospice promoted the health of the entire family by reducing the heavy burden placed on caregivers. In one case, the team cared for a patient with a rare brain disease while their father-in-law was also struggling with chronic pain and dementia. To help the family cope, the hospice admitted both the patient and their father-in-law at the same time. This decision removed significant stress from the relatives and allowed them to spend quality time together.

The Living Well and BAFS (Breathing, Anxiety, Fatigue and Stress) programmes gave patients the tools to manage their own symptoms through education. Staff ran an 8-week course introducing patients to care options and a 5-week course focusing on managing breathlessness, anxiety, fatigue, and stress. The hospice also used simple reminders in patient areas; we observed posters for health screenings, to encourage preventative health. These initiatives helped patients handle their physical limits and mental stress.

The service had processes in place for monitoring clinical efficacy and patient experience. This helped the team identify gaps and implement targeted improvements to enhance the quality of palliative and holistic care. For example, the complementary therapy team monitored patient progress by using a questionnaire. Patients, carers, and bereaved relatives completed this assessment before and after receiving treatments such as massage, reflexology, or reiki. Outcomes demonstrated improvements in wellbeing, and feedback from patients highlighted an overall sense of improvement in relaxation and breathing techniques.

The team managed complaints, compliments, and incidents, reviewing them quarterly at the Clinical Governance Committee and within individual teams. This internal oversight was reinforced by participation in the Hospice UK national benchmarking programme, which allowed the service to analyse its performance against other hospices to drive quality improvements.

The service evaluated its performance against national standards through participation in the FAMCARE audit published in March 2024. This is a clinical quality tool used in palliative and end of life care to measure how satisfied family members are with the care provided to their loved ones. It supports providers to identify areas where they are succeeding or where they need to improve. The Inpatient Unit achieved a 53% response rate, exceeding the national average of 44.5%, while the Hospice at Home service had a lower engagement rate of 19% compared to the 29.7% national benchmark. The audit measures 4 domains of care; information provision, availability of care, physical patient care, and psychosocial support. Overall, hospice responses were either ‘satisfied’ or ‘very satisfied’ with all aspects of care. However, there were 2 responses showing dissatisfaction with communication and out-of-hours support. This data highlighted specific areas for improvement, such as the need for a 24/7 Hospice at Home service which is now in place. Additionally, the team used the Australia-modified Karnofsky Performance Status (AKPS) to measure patients’ overall performance status. This data was used during weekly multidisciplinary meetings to stay informed of and responsive to changing patient needs.

Ongoing safety and learning were prioritised through participation in regional initiatives and collaborative reviews. St. Michael’s Hospice hosted a monthly Interprofessional Meeting (IPM), where clinical teams and various healthcare professionals (including community specialists, social workers, and dieticians), discuss complex patient cases and review deaths to facilitate shared learning. These meetings support the management of patients after discharge and ensure that assessments and treatment plans are effectively transitioned between the inpatient unit and community settings. Furthermore, clinicians remained part of a regional initiative involving monthly morbidity and mortality meetings. These reviews have led to improvements, such as updated guidelines for supporting patients with spinal cancer and more effective medication protocols to ease restlessness and distress during a patient’s final hours.

Staff demonstrated patient autonomy, noting that seeking consent was an embedded practice. This person-centred approach prioritised individual wishes and treatment choices, which were proactively identified through advance care planning conversations. These preferences were formally recorded within clinical notes and on ReSPECT documents to ensure they remained central to the patient’s journey. In instances where patients lacked the capacity to consent, staff acted in their best interests while maintaining close and transparent communication with relatives.

The hospice updated their consent policy in October 2025 to meet legal standards, including the Montgomery ruling. This meant staff moved away from doctor-led decisions where patients became partners in their own care. People were treated as active decision-makers who were fully informed of all risks and treatment options. This policy update promoted people’s rights and upheld their autonomy.

The hospice followed the law to make sure they protected the rights and freedom of patients who could not make their own decisions. To do this, staff used a simple check called the ‘acid test’ to see if a patient’s care was too restrictive. If a patient needed extra supervision for their safety, the team always chose the most gentle and free option possible. The hospice’s managers took responsibility for following national safety rules, and they gave staff clear instructions on how to get official legal permission when needed. As a result, vulnerable patients were treated fairly, and their human rights were upheld while they received the care they needed.

The service had clear rules for patients who could not speak for themselves due to illness or conditions such as dementia. Staff assessed people’s mental capacity and used best interest decisions appropriately to guide care, involving their next of kin when a patient was close to death. These steps ensured the hospice met its legal duties under the Mental Capacity Act (2005). By following these rules, the service protected the most vulnerable patients from receiving unwanted treatment.