KEMP 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 rated effective as good

We assessed all 6 quality statements for effective, assessing needs, delivering evidenced based care and treatment, how staff, teams and services work together, supporting patients to live healthier lives, monitoring and improving outcomes and consent to care and treatment. We found:

Staff assessed and reviewed patients’ health, care, wellbeing, communication needs and their mental health needs with them.

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 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.

However,

The results of monitoring was used to improve the quality of interventions given to individual patients. However, more work was required to demonstrate overall effectiveness of the service and interventions being provided.

At our last inspection we rated this key question good. At this inspection, the rating has remained good.

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.

There was a consistent and high-quality approach to assessing, and reviewing patients’ health, care, wellbeing and communication needs with them. All patients attending the day hospice on the day we visited had undergone an initial health assessment. The health assessment included looking at specific risks such as falls, incontinence, risk of malnutrition, tissue viability, frailty and breathlessness. Patients’ individual needs were appropriately assessed, and staff ensured the care provided met their needs. The assessment considered the patients’ health, social, emotional, communication and spiritual needs. The patient’s stage of illness was also recorded as well as advanced care plan discussions such as resuscitation status and individual wishes. During our site visit we observed a health assessment and reviewed 6 patient records. We found the initial assessment was detailed, person centred and clearly documented the patient wishes and risks.

The hospice used personalised care plans and goal setting and included both patient and their families in patients’ assessments. Patients knew what their goals were and told us ‘I’m involved in my care planning’. Staff actively encouraged patients to maintain their interests and participate in activities at the hospice. A patient told us ‘I have some mobility difficulties, but staff support me to be as independent as I can be whilst here’.

Patients were routinely re-assessed every 12 weeks, and they were reviewed at each visit to the day hospice. Staff used the Karnofsky score which is a national recognised assessment tool to assess patients’ ability to perform daily activities to determine how they were managing. They also used IPOS (Integrated Palliative care Outcome Scale) to assess patient needs on each visit. IPOS measured patient’s symptoms and concerns that mattered to them to help staff to provide the best care. These were reassessed at each visit to the day hospice to gauge how the patient was and how effective the interventions were. The most up to date scores were reviewed during daily handover meetings to help staff assess the patient condition.

Pain was assessed using a pain assessment tool which was recorded on the electronic system. All records we reviewed showed staff reassessed the pain score on each visit. The hospice offered patients holistic support to manage pain to support pain relief prescribed through their GP. For example, patients were assessed by an occupational therapist and attended an exercise group and complementary therapy to support effective pain management. Patients told us staff supported them to manage pain whilst they were at the day hospice.

Patients’ communication needs were assessed by staff. This was incorporated into care plans. Staff had access to communication tools within the hospice. Staff told us they would seek training where required to support patients with assistive technology. There was a hearing loop system in the day hospice to support patients with impaired hearing whilst using a hearing aid. We observed through the handover, staff discussing patients’ communication needs and changes. Staff made referrals to speech and language therapy where there were unmet needs or additional support was needed. Access to translation services were available should they be required.

Patients with mobility needs were referred to the occupational therapist who undertook a mobility assessment and provided patients with specialist equipment to use at the day hospice and whilst at home. The occupational therapists worked closely alongside community teams to ensure patients had equipment they needed in the community. The day hospice had access to a standing and mobile hoist and wheelchairs to support patients to mobilise around the day hospice. Staff using the equipment had been trained and were supported by the therapy team when in use.

Staff assessed and discussed the needs of relatives and loved ones. This supported their health and well-being in their carer roles and helped them to provide safe and effective care to their loved ones they supported.

Patient’s care and treatment was planned and delivered with them, including what was important and mattered to them. This was carried out in line with legislation and current evidence-based practice and standards.

KEMP Hospice delivered holistic, person-centred palliative care that supported patients and families whilst maintaining quality of life. Patients had personalised care plans and assessments took account of patients’ emotional, spiritual and social needs. Patients told us they were fully involved in the assessment process and staff supported them to take part in activities which they preferred and supported them to manage their symptoms and improve their quality of life. Staff had conversations with patients about their wishes and decision making about the future. We observed conversations about advanced care planning were done sensitively, respecting the patient’s wishes.

People were told about current good practice that is relevant to their care and were involved in how this is reflected in their care plan. Care plans were developed with input from the patient and their loved ones. They included support for patients’ psychological, social and spiritual support needs. Recommended summary plans for emergency care (ReSPECT) forms were completed in line with national guidance.

People received care, treatment and support that was evidence-based and generally in line with current good practice standards.

Following our site visit we reviewed policies and procedures sent to us by the provider. In general, they reflected most up to date best practice. For example, the sepsis policy, advanced care planning policy and falls policy generally reflected national best practice standards. However, we found some were not fully compliant. For example, the resuscitation policy was reviewed in 2024 but did not incorporate the most up to date guidelines from the resuscitation council from 2021 and 2023. Furthermore, the nutritional care policy did not have a review date and did not fully reflect the most up to date NICE guidance CG32 Nutrition support in adults.

Staff followed up-to-date policies to plan and deliver high quality care according to best practice and national guidance. Care related policies took account of relevant national guidance, for example National Institute for Health and Care Excellence (NICE) Quality Standard 13 End of life care for adults and NICE guidance NG108 decision making and mental capacity in relation to advanced care planning.

Senior managers and leaders were responsible for routinely reviewing policies and procedures to ensure they reflected the most up to date legislation and best practice guidance. They were signed off at the hospice and quality and safety subcommittees before being sent out to staff to review.

The provider’s systems generally ensured that staff were up to date with national legislation, evidence-based good practice and required standards. The service had an audit programme in place. Audits included reviewing compliance with re-assessments, ReSPECT forms, mobility reviews, phase of illness reviews, activity of daily living measures, personal evacuation plans, occupational therapy assessments and IPOS scores. Outcomes were generally positive. For example, from June to October 2025, on average 86% of patients care had been reviewed in line with policy. There was 100% compliance with occupational therapy assessments over this time, and most patients had an up-to-date IPOS score (87%), Karnofsky score (88%) and up to date phase of illness (89%) documented.

The service also had daily, weekly and monthly checks in place to ensure policies and procedures were effectively implemented in relation to the environment, medicines management, fire safety, and infection prevention and control. We reviewed the checklists during our site visit which in general showed good compliance with actions to address any areas of concern.

People’s nutrition and hydration needs were met in line with current guidance. Staff used a nationally recognised screening tool to monitor patients at risk of malnutrition. The Malnutrition Universal Screening Tool (MUST) was used to assess a patient’s risk of malnutrition. A MUST was undertaken and regularly reviewed in all 6 patient records we reviewed. Patients’ fluid and nutrition in take whilst at the day hospice was documented in the electronic patient record.

There was a robust oversight of patients at risk of choking due to difficulty with chewing or swallowing. Patients requiring special diets for clinical reasons were assessed. Nutritional needs were assessed and documented in records. Where there were concerns with diet, staffed referred patients to dietitians or speech and language therapy services for assessment.

Staff and leaders are encouraged to learn about new and innovative evidence-based approaches can improve care delivery. Staff shared information about service developments during their meetings. For example, work had been carried out to develop and embed a breathlessness group. This was shared with the multidisciplinary team to improve their understanding and increase referrals. Managers ensured staff had time to attend conferences and training to maintain up to date knowledge in palliative care.

Staff had access to the information they need to appropriately assess, plan and deliver people’s care, treatment and support. The whole staff team worked collaboratively to make sure patients' healthcare needs were met. The team included nursing staff, nursing assistants, occupational therapists, complementary therapists, administrative staff, and a range of other support staff.

There was effective working across teams and services to support people. People only need to tell their story once as their assessment of needs is shared when they move between different services. KEMP Hospice had access to the shared patient record which meant they had access to up-to-date medical information to support patients and meet their needs.

Staff worked in partnership with community services including inpatient hospices, palliative care teams, speech and language therapy, GPs, district nurses, and other community teams delivering care to patients in their homes.

Plans for transition, referral and discharge consider people's individual needs, circumstances, ongoing care arrangements and expected outcomes. KEMP Hospice held monthly multi-disciplinary meetings with local palliative care services including a palliative care consultant and other services to review patients using the day hospice. Staff referred patients to the MDT for support in reviewing their care where the patients' needs were changing, their phase of illness was changing, and they needed more input. Furthermore, the KEMP clinical nurse specialist attended the community specialist palliative care MDT meeting to discuss shared patients.

When people are due to move between services, all necessary staff, teams and services are involved in assessing their needs to maintain continuity of care. The hospice staff worked with other health and social care providers to ensure patients complex palliative care needs were met. The 2025 patient survey showed that 97% of respondents felt attending KEMP Hospice had a positive impact on their wellbeing.

Information was shared between teams and services to ensure continuity of care, for example when clinical tasks are delegated or when people are referred between services. When people received care from a range of different staff, teams or services, it was co-ordinated effectively. All relevant staff, teams and services were involved in assessing, planning and delivering patient's care and treatment and staff worked collaboratively to understand and meet their needs. For example, staff worked with district nursing teams to maintain daily monitoring and dressing of wounds on days patients were at the day hospice. Furthermore, the service worked alongside local palliative care services to offer more holistic care and support. They shared information with other services to improve continuity. KEMP Hospice had an information sharing agreement to enable staff to access local shared patient record systems. This included accessing wider information from GP'S, Hospitals, community services, mental health services, ambulance services and some social care providers.

There was a strong focus on empowering patients to maximise their opportunity to manage their own health, care and wellbeing needs as much as possible. Staff fully understood patient’s needs, preferences and abilities, which enabled them to identify as many opportunities as possible for patients’ to be independent. The service provided a range of therapy groups which aimed to support patients to improve their health and wellbeing in general as well as reduce risks such as breathlessness and falls.

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

There was collaboration across staff, services and organisations to enable people (with their family and carers) to manage their health and wellbeing at home effectively and where possible, reduce their future needs for care and support. Patients and their loved ones could access information to improve the quality-of-life including managing breathlessness, tiredness and pain. The hospice had staff available to support their psychological health.

The results of monitoring was used to improve the quality of interventions given to individual patients. However, more work was required to demonstrate overall effectiveness of the service and interventions being provided. The service gathered information from patients to determine how they were managing. Staff used the Integrated Palliative care Outcome Scale (IPOS) as a measure of symptoms and concerns which mattered to patients therefore helping staff provide the best patient experience. They also used the Karnofsky score to assess patients' day-to-day functioning. These were reassessed at each visit to the day hospice. The outcomes of these were recorded on the electronic system and discussed at each daily handover. This helped the team to consider the progress of the individual patient and whether they had any additional support needs. Records we reviewed showed improvements in the IPOS and AKPS scores overtime for each patient. All patients we spoke to considered attending the hospice led to them feeling better. One patient told us ‘my mental health has improved coming here’.

Patient’s care and treatment was not always monitored regularly in a meaningful way or reviewed in detail. The service undertook audits of patient records to check that required assessments and documentation was present. For example, the service monitored the number of patients with an up-to-date assessment, mobility assessment and whether a ReSPECT form was in place. However, they did not check the quality of these assessments and whether interventions were in line with best practice, effective or personalised to the patient.

Managers undertook a programme of audits on a daily, weekly and monthly basis to check compliance with environmental, infection prevention and medicines management standards. We found these audits were regularly completed and where there was non-compliance, this was shared with staff in meetings with actions to improve.

Outcomes for patients who use services were not compared with similar services. We did not see evidence there were any benchmarking exercises to compare to other day hospices to determine how they were performing.

Staff received Mental Capacity Act (MCA) and DoLS training. They understood relevant consent and decision-making requirements.

Staff had a good understanding of consent procedures, and we observed staff explaining this to patients. Staff gained consent from patients for their care and treatment in line with legislation and guidance. Staff made sure patients were provided with all relevant information to make informed choices and consent to care and treatment.

The provider had policies in place relating to consent, mental capacity, best interest decisions and Deprivation of Liberty Safeguards (DoLS). These policies had undergone regular and recent reviews and were compliant with legislation and best practice. Staff had been updated on the most recent updates through team meetings. They knew how to access policy and advice on these topics.

The electronic patient system recorded where patients’ had consented to care planning, sharing information and using photographs. We observed staff seeking consent to share information with other professionals. Staff were observed to always ask consent before carrying out an intervention or task. For example, before weighing a patient, undertaking observations or supporting with mobility.

Patient records showed capacity to consent to care, and treatment were assessed at the first assessment appointment. Consent forms were on the electronic patient record. Consent forms we reviewed were clear and legible.

Staff took all practical steps to enable patients to make their own decisions. Patients told us they were given sufficient information to be able to make informed choices about their care in a way they understood. For example, staff gave patients information to support them to make decisions in relation to advanced care planning and their resuscitation status.

We reviewed 6 patient care records and saw evidence that advanced care planning and resuscitation status was discussed. Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) forms were completed in 4 records where the patient consented to advanced care planning. The records were fully completed and recorded the patient’s capacity status. The plan was used by staff for making decisions in an emergency when the patient had lost capacity to participate in making that decision.

Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. Staff understood the principles of best interest decision making where patients were assessed as not having the mental capacity to make certain decisions. Capacity assessments were carried out as part of the initial assessment and reviewed regularly or when there were any changes. Where appropriate, family members and those close to the individual participated in discussions about the patient’s capacity. For example, staff assessed a patient’s capacity to self-administer medicines whilst they were at the day hospice. Records we reviewed demonstrated they discussed this with family and carers and took actions where there were concerns about capacity and ability to self-administer safely.

The service did not routinely monitor for compliance with the MCA and consent policies. However, they did monitor compliance with ReSPECT documentation being confirmed and in place.