St Michael's Hospice (North Hampshire)

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

This means we looked for evidence that the service met people’s needs. At our last assessment we rated this key question as good. At this assessment the rating has changed to outstanding. This meant services were tailored to meet the needs of individuals and delivered to ensure flexibility, choice and continuity of care.

The hospice delivered a responsive service by adapting its care and protocols to meet the specific needs of its community. Evidence showed staff acted on feedback to change sensitive procedures, the organisation expanded its Hospice at Home service and launched outreach projects to support the local Nepalese community. These proactive adjustments helped to ensure patients received timely, culturally appropriate support, which directly improved the quality of life and dignity of patients and their families.

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

The hospice provided a good standard of person-centred care by putting patient preferences at the heart of all medical decisions. Staff held detailed discussions with patients and families about their wishes, such as choosing to decline hospital transfers or deciding on their preferred place of death. This approach was supported using ‘About Me’ profiles and ‘Patient Passports’, which helped to ensure every individual maintained control over their care and felt their personal values were respected.

The hospice invested in cuddle beds (designed to allow patients and their loved ones to lie together comfortably) and provided overnight facilities like Z-beds and sofa beds so families could remain close to each other. These actions created a supportive atmosphere where families felt cared for, and patients were treated with compassion and respect.

The team used personalised tools to support the diverse and emotional needs of their patients. We observed each room with featured whiteboards for sharing personal likes and dislikes, alongside dementia friendly clocks to help people stay orientated. Staff also adjusted clinical routines, such as wound care, to prioritise a patient’s comfort over standard schedules when necessary. These tailored adjustments helped to reduce patient anxiety and ensured that care was always adapted to the specific needs of the individual. This holistic focus extended to the Living Well Service, which offered a variety of programs such as the ‘Living Well Together’ 7-week course. This included a dedicated week on emotional care led by the chaplain, allowing patients to explore the physical and psychological impacts of their illness while introducing the benefits of the complimentary therapy team.

The hospice fostered a supportive community environment through specialised groups designed to build connections and reduce isolation. The ‘Living Well Living Better’ group provided a secure space for patients to engage in activities like crocheting, gardening, and card making, while a dedicated Men’s Group offered a similar environment for men to share experiences through woodwork and board games. Additionally, the ‘Well with Your Symptoms’ 5-week program empowered patients to develop strategies for managing symptoms at home, while the ‘Stories for Life’ initiative focused on personal legacy. These tailored adjustments and social opportunities helped to reduce patient anxiety and ensured that care remained individualised.

Support for families remained a priority throughout the care journey and beyond, with a range of bereavement services. All bereaved relatives were invited to access a wide network of support, including bereavement coffee mornings and ‘Walk and Talk’ sessions. The hospice also provided specialised support through the ‘Young and Widowed’ group, the ‘Bereavement Journey’ program, and formal bereavement counselling. By providing these resources alongside practical guidance and compassionate clinical care, the organisation ensured that both patients and their families were supported with sensitivity from their first contact with the hospice through to their long-term recovery from loss.

The hospice delivered high-quality clinical care by maintaining daily oversight of all patient needs. Senior nurses and consultants led multidisciplinary meetings every morning to review referrals, pain relief requirements, and levels of urgency for both inpatient and home-based patients. This clinical focus helped to ensure that staff identified medical risks immediately and provided timely treatments to keep patients comfortable. This reach was further extended by the Living Well Service (LWS), which provided a dedicated Motor Neurone Disease (MND) clinic and community outreach in collaboration with acute hospice colleagues, ensuring specialised clinical support was accessible across all care settings.

The service built good working relationships with partners and regional healthcare providers. For example, staff worked closely with hospital palliative teams, district nurses, and specialist services including haematology and microbiology departments through weekly coordination meetings and shared on-call systems. These professional links were strengthened by input from the Multiple System Atrophy Trust and the Progressive Supranuclear Palsy Association, alongside support from local acute trusts. Additionally, the hospice collaborated with charities to assist patients and families in managing the financial impacts of life-limiting illnesses such as cancer and heart disease. These professional links across different organisations meant patients received expert, joined-up support from a wide range of services.

The organisation ensured reliable continuity of care by planning effectively for patient transitions and potential emergencies. The therapy teams worked across both the Inpatient Unit and the Hospice at Home service to keep equipment and symptom management consistent. The 24/7 on-call system provided constant access to doctors and pharmacy advice. The provision of backup paper records meant the hospice could guarantee patient support remained uninterrupted in the event of an IT outage.

Holistic support was centralised through the Progressive Neurological Condition Group, which provided quarterly sessions for both carers and patients to encourage social interaction and peer support. These sessions offered access to multidisciplinary staff and were supported by a consultant neurologist. For those unable to attend the hospice in person, the service provided home visits. Looking forward, the hospice was expanding this support through workshops covering practical topics such as self-care, will-writing, and financial guidance, often delivered in partnership with guest speakers and volunteers.

Beyond clinical treatment, the hospice remained committed to community education through the Hawthorne Schools Project. This initiative aimed to educate the younger generation about palliative care to help reduce the fear and stigma often associated with hospices. By engaging pupils and patients in collaborative projects, the hospice fostered a better understanding of its work, encouraging students to pass their knowledge and experiences on to others in the community.

The hospice delivered information with transparency and sensitivity, ensuring patients and families understood their clinical journey. Staff held discussions about prognosis timelines to manage expectations for everyone involved. This honest approach allowed families to prepare emotionally and practically for the future. This commitment to accessibility was reinforced by a 24/7 telephone advice and support service available to all patients and families. Notably, this service extended beyond those directly under hospice care where patients and families supported by NHS clinical nurse specialist teams were also encouraged to contact the hospice for advice and signposting.

The service complied with the Accessible Information Standard by adapting communication to meet individual needs. Staff used understandable language when interacting with patients and their families and translation services were in place for non-English speaking patients to ensure clarity during difficult conversations. Staff had access to a communication box resource and received expert guidance from the occupational therapy and speech and language therapy teams. The hospice also demonstrated a high level of technical ability by supporting patients who used eye-gaze technology to communicate their needs and wishes.

The organisation maintained good communication with families, providing updates in line with each patient’s wishes. Where consent was in place, the Community Hub and Hospice at Home teams conducted follow-up calls to discuss progress and schedule appointments. This constant flow of information helped to reassure relatives their loved ones were safe and continually monitored.

Staff supported families through the dying process by providing clear, written guidance on physical and behavioural changes at the end of life. The hospice issued a booklet that explained natural symptoms such as changes in breathing, skin temperature, and reduced appetite. This resource helped relatives distinguish between natural end-of-life stages and signs of distress.

The organisation ensured a smooth transition after death by giving families practical information about legal and administrative requirements. The team explained the roles of the Medical Examiner and Coroner and provided instructions on how to contact funeral directors and how to return medical equipment. This guidance helped to simplify a complex process, allowing families to focus on their grief rather than administrative burdens.

The hospice prioritised emotional wellbeing by signposting families to a wide network of specialist bereavement services. Staff shared contact details for various charities, including those for children, young adults, and people who lost partners. These referrals helped to ensure families received long-term, specialised support that was suited to their specific circumstances.

The hospice demonstrated a commitment to listening by changing core protocols based on family experiences. For example, the service ended the practice of moving deceased patients to the chapel of rest after relatives reported it made them feel rushed. Instead, staff allowed patients to remain in their rooms. This change allowed families to say goodbye at their own pace in a familiar, private space. This culture of listening was formalised using a Hospice User Group (HUG), which involved people who have recently or previously used services to ensure they have a voice in service development. This group contributed directly to identifying areas for improvement, such as reviewing and updating patient information publications to ensure they are clear and helpful.

The leadership team took active steps to address communication gaps identified by people who used the service. After receiving feedback about a lack of clear information about the dying process, the hospice refreshed its patient documents and launched a virtual tour on its website. These improvements helped to ensure families felt better informed and less anxious about what to expect. To capture real-time feedback, the hospice also displayed posters throughout the facility featuring Quick Response (QR) codes, allowing patients and visitors to provide direct digital feedback about their immediate experiences.

The service effectively supported the diverse cultural and personal backgrounds of its community. Staff used professional translators to facilitate complex medical discussions and ensure people were able to express their views. By acknowledging these needs, the hospice helped to create an environment where people were listened to and involved in their care. This inclusive approach extended to service improvements where the HUG was involved in selecting the hospice’s cuddle beds, ensuring that the equipment met the emotional and physical needs of families.

To maintain high standards, the hospice used the 15 steps challenge, a toolkit developed by the NHS that explores healthcare settings through the eyes of patients and relatives. This challenge was completed annually to identify risks and environmental improvements. The resulting reports were shared with the leadership team, and the Chief Executive Officer provided a direct response back to the HUG, ensuring that identified actions were implemented and leaders remained accountable to the people they served.

The hospice’s leaders took action to remove cultural barriers for groups of people who historically struggled to access care. To do this, the Chief Executive teamed up with local NHS health bosses (the Integrated Care Board) to secure funding for a project with the local Nepalese community. The project aimed to reach over 1,000 homes by training ‘community champions’ – trusted local people who can offer advise – and by making health information available in Nepalese through videos and audio clips. Instead of waiting for people to come to them, the hospice went out into the community to try and build trust. This helped to ensure that from the very first day of care, a patient’s religious and cultural traditions were respected and understood.

The service created formal structures to ensure diverse groups had a direct say in how services were designed. The hospice established the Hospice User Group (HUG), an open forum for patients, carers and families, that met 4 times a year. This group allowed service users to identify areas for improvement and influence the future development of palliative care services. By giving people a voice, staff helped to ensure its service developments were shaped by the real-world experiences and desires of the local community.

The service used effective partnerships with local organisations to bridge gaps in healthcare inequality. The hospice collaborated with groups such as the Basingstoke Nepalese Society and the Eastleigh Gurkha Association to host workshops and engagement events. Staff also planned visits to local religious centres to better understand the spiritual needs of different groups. Working with partners allowed the hospice to reach people who were previously unaware of the services available, leading to a better quality of life for a wider range of patients.

The hospice actively worked to eliminate practical obstacles that prevented people from receiving timely support. The service expanded its Hospice at Home programme to a 24/7 operation and organised voluntary transport for patients who were not independent, and unable to access onsite clinics. Additionally, the hospice covered the costs of care when external funding teams were unavailable after hours, ensuring that financial paperwork did not delay patient treatment. These actions helped to ensure a patient’s location, mobility, or financial situation did not limit their access to specialist palliative care, especially during evenings and weekends.

The hospice’s patient group generally reflected the local population, though data indicated that most people accessing hospice care came from more affluent areas. While the hospice was available to everyone, residents from lower-income neighbourhoods remained under-represented. The service was actively working to bridge this gap by improving awareness and ensure more equitable access for these underserved communities.

The service proactively identified and removed barriers to care to ensure equitable outcomes for all patients. Leaders used population data to identify groups that were less likely to access hospice services, such as those from lower-income backgrounds. By recognising this gap, the service was able to tailor its outreach and admission processes. This meant that a patient’s background or diagnosis did not limit their access to specialist end-of-life care, ensuring that the local community had equal opportunity to receive support.

The multidisciplinary team addressed socio-economic barriers to ensure patients had an equal choice in their place of death. For example, hospice staff provided practical support by assisting families with navigating financial hurdles. By providing this targeted assistance, the service ensured that a patient’s financial situation did not dictate their end-of-life choices, resulting in a more equitable experience for the entire family.

The hospice created a welcoming environment by providing a multi-faith room stocked with various religious books, allowing patients and families to pray or reflect in a peaceful, private space. Staff made sure care was respectful by asking patients about their religious needs (like special diets or prayer times) when they arrived and recorded these details in their files. When a person wanted specific religious support, such as a blessing or a traditional ceremony, the team contacted local faith leaders and chaplains to visit. This teamwork ensured that everyone, no matter their religion, received the spiritual comfort they needed to feel at ease.

Leaders built a culture of learning to support vulnerable groups, such as those with learning disabilities or autistic people. For example, the leadership team arranged specialist training around communication styles and introduced a ‘champion’ role to improve how they assessed patients with a learning disability or neurodiversity. This meant hospice staff were working hard to ensure they provided an equitable experience for all patients.

The hospice staff prioritised patient choice by using clear clinical documents for future emergencies. They updated ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) forms and the Inpatient Unit whiteboard to show whether a patient wanted resuscitation or a ceiling of treatment. These actions gave healthcare workers a clear summary of what mattered most to the patient, ensuring people received only the medical treatments they wanted when they could no longer speak for themselves. This commitment to planning was further supported by the Living Well Service through its ‘Living Well Together’ programme. Specifically, the ‘Looking Ahead’ session in week 6 introduced patients to advance care planning, helping them navigate difficult conversations and make informed decisions about their future care.

The team acted to prevent future pain by using ‘anticipatory prescribing’. For example, during daily meetings, doctors and nurses ensured ‘just in case’ medications were already prescribed for patients both at home and in the hospice. This meant patients did not have to wait for a doctor to be present when symptoms such as breathlessness or pain escalated, allowing for a more peaceful and controlled end of life experience.

Patient wishes often extended beyond clinical care to include personal milestones. For instance, the Inpatient Unit team coordinated a wedding in 1 day and arranged for registrars, a photographer, a cake from the chef, and decorations, to fulfil a patient’s final wish to marry their partner. The team further transformed the patient’s room into a honeymoon suite using an additional bed, ensuring their last conscious hours were spent in accordance with their final wishes.

The team created a smooth pathway for patients leaving the hospice by organising home support in advance. Occupational therapists visited homes to fit hoists and mobility aids, while nurses coordinated funding to pay for packages of care in the community. To ensure these transitions were safe and successful, the hospice held regular discharge planning meetings involving both the patient and their family. These meetings provided an opportunity for relatives to raise any concerns they had about future care. This meant patients could return home safely and stay there comfortably, reducing the risk of an emergency return to hospital.