Douglas Macmillan 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 as good. At this assessment the rating has changed to outstanding.

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.

This meant people’s outcomes were consistently better than expected compared to similar services. People’s feedback described it as exceptional and distinctive.

This service scored 92 (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 an exceptional standard. The service always made sure people’s care and treatment was effective by thoroughly assessing and reviewing their health, care, wellbeing and communication needs with them.

Staff assessed patients’ needs using a range of assessment tools to ensure their needs were identified and understood. Assessments considered patients’ health, care, wellbeing, and communication needs, to enable them to receive care or treatment that had the best possible outcomes.

Patients told us how they felt that their pain was managed well. One patient told us how they had tried various pain relief options and how staff had acted fast to support them in this. They spoke of doctors input into managing pain and review and how they had nothing but praise for how they had been supported.

Various communication tools were available if patients were unable to communicate verbally. These included pictorial books which contained phrases patients could point to such as I am in pain, relating to personal care and feelings. Staff told us they also used the white communication boards in bedrooms and larger clocks.

The hospice used an external interpreting service. One staff member was able to share an example of how using the service had led to a positive outcome for a family member who was unable to speak English.

Staff assessed and discussed the needs of relatives and those close to them. This supported their health and wellbeing in their carer roles and helped them to provide safe and effective care to those close to them they supported.

Staff on the inpatient unit had daily handover meetings, so they knew if there had been changes in patients’ psychological and emotional needs, as well as their medical and nursing needs.

The service took actions to implement the ambitions for Palliative and End of Life; there was 6 actions in total and Douglas Macmillan Hospice had implemented all actions. The 6 actions included, (1) Each Person is Seen as an Individual, (2) Each Person Gets Fair Access to Care, (3) Maximising Comfort and Wellbeing, (4) Care is Coordinated, (5) All Staff are Prepared to Care, (6) All Communities are Supportive.

The evidence showed an exceptional standard. The service always 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. They worked to develop evidence-based good practice and standards.

One patient told us how staff would make them what they wanted to eat if they did not want what was on the menu; another told us how choices were offered. Water coolers were available on the inpatient unit to help with hydration needs.

We heard from a patient and their loved one who spoke about the honesty box in the kitchen so they could have sandwiches when they wanted and how the food was of good quality.

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 31 Care of Dying Adults in the Last Days of Life. Patients had personalised care plans and assessments took account of patients’ emotional, spiritual and social needs. Staff ensured they worked to the Five Priorities for Care of the Dying Person when giving care in the last days and hours of life.

Care plans were developed with input from the patient and those close to them. 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. We observed this during our inspection when attending home visits in the community, we found staff and patients had an open and honest conversation and included details of what matters most to everyone and these details were recorded in patients personalised care plans.

Staff attended multidisciplinary team meetings to ensure patients were receiving evidence-based care. These meetings provided a valuable opportunity for staff (across all disciplines) to share and develop their knowledge about end-of-life care and treatment options.

The evidence showed an exceptional standard. The service always worked well across teams and services to support people. They shared thorough assessments of people’s needs when they moved between different services, so people only needed to tell their story once.

We noted various multi-disciplinary team (MDT) meetings took place relating to the inpatient service including a meeting around discharge.

One patient commented to us that you could tell everyone was talking and working together.

All staff, including those in the community and wellbeing services told us they worked as part of a multidisciplinary team to continuously assess the changing needs of patients. Multi-disciplinary team meetings include doctors, nurses, therapists, and spiritual care staff to coordinate care.

Adult services currently use an electronic patient record system, and in March 2026 the Young Adult Unit will also begin using this system. This will enable joint Young Adult and Community MDT working, ensuring improved communication and collaborative care planning. The change has been implemented to support the seamless transition of young people from the Young Adult Unit into adult services whenever this is required, promoting continuity of care and a more integrated service across Douglas Macmillan Hospice.

The hospice worked collaboratively with local GP’s, local NHS trusts and ICB and communication was between all service providers was effective, with patient in the heart of all they do.

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.

Services focused on identifying risks to patients’ health and wellbeing early to maximise their quality of life and including care at the end of their life. Patients were asked about their goals and what was important to them.

Staff encouraged and supported patients to make healthier choices to promote and their health and wellbeing.

We saw some 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 also a volunteer/information hub at the main entrance of the hospice.

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

The service monitored its performance and benchmarked itself against other local and regional hospice providers. Data included number of admissions, deaths and discharges, percentage occupancy and length of stay, as well as average pressure injury risk score on admission, number of medication errors, the number of slips trips and falls were all monitored and benchmarked at clinical quality and management meetings. We saw December 2025 inpatient falls audit inspection report, 97% of falls risk assessment had been completed, with 94% of staff in adult community services completing the falls risk assessment.

The service had a clear and robust processes in place to support the timely recognition of patients who may be entering the dying phase. A validated assessment tool was used, included the outcome assessment and complexity collaborative (OACC) measures, the Australia modified Karnofsky Performance Status (AKPS), and was used routinely to identify functional decline and inform clinical decision-making. Patients were reviewed regularly to ensure changes in condition were recognised promptly and appropriate end-of-life care was initiated.

Patients with an AKPS score of

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.

We noted that posters were on display regarding the patients right to a chaperone.

Staff gained consent from patients for their care and treatment in line with legislation and guidance. When patients could not give consent, staff made decisions in their best interest, considering patients’ wishes, culture and traditions. This included following advance care plans that had previously been developed with input from the patient and those close to them. Electronic patient records include a box on consent for sharing of information to 3rd parties. We also saw that consent had been documented in a care plan.

Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. Mental capacity assessments were carried out if required, as part of assessment processes across the hospice. Staff understood the principles of best interest decision making where patients were assessed as not having the mental capacity to make certain decisions. Where appropriate, family members and those close to the individual participated in discussions about decision. People including families/carers were appropriately supported when they felt decisions had not been made in the person’s best interest.

To support patients with communication difficulties, the hospice had access to a specific tool, along with professional interpreters when needed, to ensure that communication was clear, and patients could fully express their wishes and ensured they understood the consent process.