St Luke's (Cheshire) Hospice

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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

At our last assessment we rated this key question Good. At this assessment the rating has remained Good.

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

Good: This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

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.

The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Staff completed a comprehensive health assessment of the patient in a timely manner at, or soon after, admission. The service used an electronic patient record that linked to the primary care and community service records.

We reviewed 8 care records which showed good documentation and appropriate assessments were completed within 2-4 hours of admission. We saw comprehensive records were kept with frequent entries from multidisciplinary teams.

We saw pain management was assessed in a timely manner. Syringe drivers were prescribed and documentation checks were completed to ensure pain relief was effective.

A modified National Early Warning Score 2 (NEWS2) was used. This is a standardised scoring system used across the NHS to quickly assess acutely ill patients for physical deterioration.

Patients’ communication needs were assessed on initial assessment and reviewed during their stay, including sensory loss. Interpreters were available if needed.

The evidence showed a good standard. The service 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.

Staff assessed and met patients’ needs for food and drink and for specialist nutrition and hydration. The service reviewed the malnutrition universal screening tool (MUST) following a Hospice UK conference. MUST is a 5 step screening tool used by healthcare professional to identify adults who are malnourished, at risk of malnutrition or obese. This screening tool is not always appropriate in a hospice setting and a patient led assessment of nutritional care option was under consideration.

The hospice delivered care and treatment in line with relevant legislation, standards and evidence-based guidance to achieve effective outcomes. Staff had access to policies and procedures. Polices contained a creation, review date, author, clear reference to current national guidelines and approval date. The policies had equality and diversity impact assessments to ensure the policy did not discriminate on the grounds of any of the nine protected characteristics under the equality Act 2010. The policies were approved by the relevant committee which ensured the policies reflected legislative and guidance changes.

Staff participated in clinical audit, benchmarking and quality improvement initiatives as part of the evaluation of the national care and the end-of-life case note review for hospices. The opiate doses at end of life care audit found opioids were used as part of holistic individualised symptom management. The controlled drugs audit found patch prescribing had improved since the introduction of a new prescription chart and the standard of controlled drug documentation was very good.

Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the patient group.

The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff held regular and effective multidisciplinary meetings.

Staff shared information about patients at effective handover meetings within the team.

The patient record system was used by primary care, community care and the service ensuring all staff had access to the same information and care records were updated in a timely manner.

The hospice worked with the local ICB and 3 local hospices to support symptom management and end of life care in Cheshire.

The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

Staff supported patients to live healthier lives and had links with the local community services.

Patients were supported to make decisions about their care and treatment and preferences. This included holistic treatments, counselling and signposting to other services.

The hospice team included a nurse led telephone consultation care service and complementary therapy sessions that offered a listening ear, help to understand life changing conditions, treatments and medication, practical advice, return to work advice and coping skills to support patients and their loved ones.

The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Staff used recognised tools to improve the detection and response to clinical deterioration in patients as a key element of patient safety and improving patient outcomes. For example using the integrated palliative outcome scale (IPOS). This is a tool used to measure a patient’s symptoms and concerns, such as physical, emotional, social and spiritual needs. It helps healthcare providers understand what matters most to the patient and ensures a more comprehensive, patient-centred approach in making timely and appropriate treatment decisions for advanced illness.

Day hospice services offered face to face meetings in a safe and comfortable environment and time to talk openly about patient’s wishes for the future.

The service completed a call bell audit to make sure relatives were aware how to use the call bell. The end of life care recognition audit found standards were currently met for recognising end of life care.

The hospice used a dashboard to monitor care quality. This included the number of falls, pressure ulcers, incidents and hospice activity. An annual quality account was reported. The quality account 2024-2025 report compared performance to the previous two years. For 2024/2025 84% of patients had a primary diagnosis of cancer and 65% of patients died at the hospice.

The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff took all practical steps to enable patients to make their own decisions

For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately.

When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history.

The focus of care was to ensure comfort, quality of life and wellbeing choosing the most appropriate method of support for individual needs at the time.