Kirkwood 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

Effective – 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. Kirkwood Hospice effectiveness inspection, previously rated good, has remained good, reflecting outcomes better than expected compared to similar services.

Feedback from people using the service described care as exceptional and individual. The service adopted an outstanding holistic approach to assessing, planning, and delivering person-centred care, supported by robust processes driving continuous improvement. Handovers and multidisciplinary team (MDT) meetings effectively prioritised patient outcomes, emphasising psychological and emotional needs. Staff were well-trained in managing complaints and incident reporting, with learning actively promoted through multiple channels to enhance services. Regular audits and Hospice UK benchmarking underscored a commitment to evidence-based practice. Policies on volunteer involvement and innovative practices were proactively updated, with volunteers improving outcomes. Discharge, transfer, and transition planning was holistic and initiated early to ensure care continuity. Staff told us that they saw positive changes in care provided to people.

This service scored 79 (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 delivered an effective, person-centred approach to assessing and meeting the needs of people. Staff consistently treated people as individuals, actively involving them in decisions about care and treatment. People were invited to participate in care reviews, ensuring their voices were heard and integrated into care planning. Staff engaged effectively to deliver cohesive care. Clinical staff employed a range of validated tools and accessible resources to support individualised care planning.

Care needs were regularly reviewed, with management plans adjusted to reflect changes. This included comprehensive review of nutrition and hydration needs. These were supported by a visual dashboard within medical records, enabling the MDT to monitor progress and tailor care effectively. All staff completed training in the International Dysphagia Diet Standardisation Initiative (IDDSI) and demonstrated awareness of dysphagia diets.

Clear signage, such as ‘please ask staff for help’ displays, enhanced accessibility, and patient engagement.

Daily reassessments were conducted through face-to-face interactions and MDT discussions, with people reviewed by a senior doctor within 24 hours of admission. Staff undertook daily symptom assessments using observations and physical examinations, ensuring responsive care delivery. Communication needs were regularly evaluated by doctors and nurses, with tools such as communication boards, iPads, interpreters, and input from speech and language therapists (SLT).

Although the service did not conduct a DNACPR audit, we saw evidence that this was documented within all patient records and reviewed appropriately. The service did conduct a preferred place of death audit, involving 16 patient records with nine patients achieving preferred place of death, three had the choice of home, three were not recorded and one person had not decided. Additional audits included, appropriate anticipatory medication, where 100% of patients reviewed resulted in a peaceful death and recognising a deteriorating person. These audits demonstrated that people had a comfortable death, were peaceful in their last hours of life and all patients were content to be in Kirkwood Hospice.

The service provided bereavement support, including counselling services. This included telephone calls, a structured six-week weekly group addressing grief stages and a café-style drop-in bereavement support group facilitated by volunteers. Additionally, one-to-one counselling was available.

Care and treatment at Kirkwood Hospice is guided by evidence-based practice, combining available research, national guidance, and clinical expertise. Staff followed recognised protocols, including National Institute for Health and Cre Excellence (NICE) and professional body guidance for symptom management, medication administration and holistic care planning. Validated assessment tools were used to monitor pain, breathlessness and cognitive changes ensuring interventions are tailored to patient need.

Nursing staff had implemented a needs assessment tool informed by the latest research and current best practice guidelines with evidence provided during the inspection.

We reviewed care plans and saw these were detailed and reviewed regularly, they documented staff interventions and instances where specialist advice was sought, ensuring responsive and tailored care delivery.

The service conducted regular audits to analyse trends, with findings shared across all staff teams to drive continuous improvement. A Care Plan Audit completed in September 2024 found not all care plans were personalised, following this, a collaborative working group was established to enhance care plan personalisation, with evidence of improvement observed during inspection and verified post-visit. An audit carried out in April 2024 confirmed that people experienced high levels of comfort, with symptoms promptly and appropriately managed.

A nurse and a volunteer with specialist nursing experience established a training and education working group dedicated to tissue viability and improving outcomes, with data and trends analysed and shared with all staff. Staff told us they had been supported through tissue viability training and collaborated closely with external partners to refine procedures for managing pressure ulcers. Pressure ulcer pathways ensured skin assessments were conducted within six hours of admission, with evidence in clinical records confirming adherence to this standard. Clear processes for reporting and addressing pressure ulcers were in place, supported by electronic systems. Systems included a new safety module, enhancing reporting capabilities.

The service proved a highly effective approach to cross-team and cross-service collaboration. Staff involved in care worked cohesively to deliver person-centred support throughout the care journey.

The service benefited from co-located community nursing, social work, occupational therapy, physiotherapy, allied health professional (AHP) and medical teams, creating strong working relationships with the IPU. Staff consistently reported excellent collaboration, which ensured people received holistic support at every stage of their care.

The social work team played a pivotal role in discharge planning. They liaised with LA to signpost people to relevant services and agencies. An assessor agreement with the LA enabled the team to arrange care packages. Additionally, social workers processed Care Act assessments, contributed to Community Healthcare Checklists (CHC), supported with benefits applications, and conducted carers' assessments. Their strong links with the local safeguarding team further enhanced their ability to provide comprehensive support.

People were routinely referred to the physiotherapy team to address pain, mobility, balance, and coordination challenges. Feedback highlighted the positive impact of this service. One person told us, "I cannot thank the physios enough; they are so understanding and have helped me no end with my day-to-day living."

Regular MDT meetings facilitated the sharing of information and collaborative decision-making regarding care transitions and treatment plans. Staff from all disciplines actively participated, ensuring a coordinated approach.

The service maintained effective partnerships with other healthcare providers and nursing homes. For people with advanced or complex needs, external partners were invited to care reviews or discharge planning meetings as appropriate. People using the service and their families told us this collaborative, integrated approach supported continuity of care and smooth transitions between providers.

Kirkwood Hospice evidenced a consistent approach to supporting people lead healthier lives. Staff adopted a targeted strategy for health promotion and ill-health prevention, maximising every interaction to enhance independence, choice, and control.

People using the service and their relatives consistently reported high satisfaction with the quality and variety of food and drink provided, describing the choices as both appealing and well-suited to their needs. Information leaflets on health and wellbeing were readily available to support informed decision-making. Emotional wellbeing was promoted through initiatives such as afternoon tea and seasonal garden events, which supported social connection and encouraged people to spend time outdoors. Where individuals chose to smoke or consume alcohol, staff carried out individual risk assessment to ensure this was managed safely and proportionately, while also providing support and guidance to help people make informed choices.

Staff placed a strong emphasis on the importance of good nutrition and hydration. Comprehensive nutrition and hydration assessments and plans were in place and regularly updated. Kirkwood Hospice utilised fresh, seasonal produce grown in the garden onsite, prioritising organic ingredients wherever possible. Staff and volunteers held an annual meeting to establish a ‘Grow Calendar’ to plan cultivation, ensuring a steady supply of fresh produce.

Catering staff actively shared their expertise, presenting best practices in food preparation and dietary management at local care homes, supporting a culture of continuous improvement and collaboration within the wider care community.

All meals were prepared fresh on-site, allowing the team to accommodate diverse dietary requirements and cultural preferences effectively. People using the service had access to dieticians and SLT team when needed. A review of care plans confirmed that staff gathered information on food preferences to deliver individualised care.

Kirkwood Hospice promoted a culture of continuous learning, with systems to share best practices and improve outcomes. Managers facilitated knowledge dissemination through emails, team meetings, handovers, and information boards. We saw evidence of regular and comprehensive audits to ensure clinical compliance in critical areas such as pain management and infection prevention, driving ongoing improvements in care quality. Information systems ensured accurate, reliable data for reporting and care delivery.

People using the service and staff expressed confidence in raising concerns when needed. MDT meetings were observed, where outcomes, performance, and family support were discussed. These meetings involved a range of clinical and non-clinical staff who were encouraged to contribute insights, ensuring comprehensive care planning. During handover meetings, staff consistently addressed the psychological and emotional needs of people, discussing improvement.

Kirkwood Hospice maintained a proactive approach to monitoring care and treatment to ensure positive and consistent outcomes that met both clinical standards and expectations. An audit that looked at response times to advice line calls, confirmed calls were answered within appropriate timeframes by relevant professionals and clear management plans were established or updated to guide ongoing care, demonstrating effective and timely responses. Timescales ranged between zero and 14 working days based on a traffic light system that considered urgency and patient need.

The service systematically monitored complaints, concerns, compliments, and satisfaction feedback. Follow-up contact or care was provided within one to two days of discharge or on transfer to other facilities, ensuring continuity of support and ongoing service input. We saw the positive impact of this highlights in the Integrated Transfer of Care (ITOC) Model Pilot 2024, feedback included ‘very pleased to speak to someone from Kirkwood in the hospital – very fond of the Kirkwood and expressed many thanks all staff.’ Another said, ‘very grateful for re-admission on to the IPU so quickly’ and ‘Family very grateful to hear that Kirkwood could then support family member back in the care home.​’

Inspection evidence and data confirmed that The Kirkwood had effective processes to audit, implement, and monitor actions for service improvement, with continuous checks to sustain progress.

People were fully informed about their rights regarding consent, with clear explanations provided to support understanding. Staff delivered person-centred care and treatment while respecting these rights.

The Mental Capacity Act 2005 (MCA) provides a legal framework for decision-making on behalf of individuals who may lack the capacity to make decisions themselves. All staff had received training on the MCA and demonstrated a clear understanding of its core principles. During observations, staff consistently sought consent before providing support, ensuring people were given choices in line with MCA requirements. Care plans reviewed reflected this.

Staff had access to comprehensive consent guidelines, which provided clear instructions on recording consent and identifying situations where consent was not required. Mandatory training for all staff included the Oliver McGowan Tier One online training module, as well as modules on learning disability education and Deprivation of Liberty Safeguards, ensuring a well-informed workforce.

Staff engaged people in discussions about treatment escalation plans. These discussions occurred upon admission and covered individual preferences with consent obtained and documented appropriately within care records. All records reviewed evidenced this. This approach ensured that care promoted dignity and autonomy.