Hospice in the Weald

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

This meant 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 their 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.

At our last assessment, we rated this key question good. At this assessment the rating remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

The service involved people in assessments of their needs. Staff reviewed assessments and took account of people’s communication, personal and health needs. Staff based care on the latest evidence and best practice. Staff ensured people always had enough to eat and drink to stay healthy. Staff worked with all agencies involved in people’s care to achieve the best outcomes and support smooth transitions when people moved between services. They monitored people’s health to support healthy living. Staff made sure people understood their care and treatment to enable them to give informed consent. Staff involved people’s families and others important to them in decision-making in their best interests if they did not have capacity.

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 thoroughly assessing and reviewing their health, care, wellbeing and communication needs with them.

The hospice’s patient feedback survey included positive feedback about the support provided to people’s families. The hospice reported that responses showed staff recognised and responded to the needs of those close to the person, not just the individual receiving care. One person told us, “The support was for everyone, not just the patient.”

People told us, “My wishes and opinions were listened to.” and “My husband’s wishes were heard and respected.” Another person said, “I can confidently say that all my needs are being met here.”

The service had clear processes to assess, identify and monitor people’s individual needs using nationally recognised tools. Staff completed assessments before admission to understand each person’s needs, which supported safe and personalised care planning. We reviewed 5 patient records and saw examples of falls risk assessments, pain management assessments and dietary needs assessments. These were reviewed and updated regularly by all members of the multidisciplinary team.

The service used the Integrated Palliative Care Outcome Scale (IPOS) to assess people’s needs, including the physical, psychological, social and spiritual impact of illness, as well as support needs. Staff reviewed IPOS weekly and discussed outcomes at multidisciplinary team (MDT) meetings to make sure care plans reflected people’s changing needs.

We attended a multidisciplinary team meeting, where staff discussed people’s individual physical, medical and social needs. We saw staff regularly assessing people’s needs and responding as these changed. Care records showed updates that reflected changing needs and the effectiveness of the care provided.

Staff made discharge plans with people and those close to them. We observed staff creating plans that included arranging weekday discharges to ensure appropriate support was available. Plans included a safety net enabling people to return to the hospice or make other arrangements if the people or their family found it too challenging to manage symptoms at home.

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. Staff did this in line with legislation and current evidence-based practice and standards.

Staff assessed and reviewed people’s care plans accordingly. The service used a formal tool to assess and to provide a picture of a patient’s health, phase of illness and ability to manage daily living activities.

The hospice’s patient survey showed positive feedback about pain relief and symptom support. One person said, “They explained what they were going to do to treat my pain and how they would do it.”

A multidisciplinary team met daily to review people’s needs and make sure care was based on evidence. The team included nurses, doctors, allied health professionals and social workers, who considered symptoms, mental wellbeing and social circumstances to develop clear assessments and plan care.

Staff developed care plans in collaboration with people and those close to them, considering not only physical but psychological, social and spiritual needs. Staff assessed people’s nutrition and hydration needs as part of holistic care planning.

Staff discussed preferred place of care with people and those close to them, and this was clearly documented for 92% of patients in March 2025. The service audited the outcomes and reported that in March 2025 90% of people received end of life care in their preferred place of care.

Staff followed local policy to plan and deliver high-quality care. We reviewed 5 care plans and found these contained detailed assessments and individually tailored care plans. Staff recorded all interventions, including people’s responses to medicines, for example, pain relief.

However, the service did not consistently assess people for the risk of venous thromboembolism (VTE), as staff only completed VTE assessments when a person had a known risk, rather than routinely for all people using the service.

At a leadership interview we were told that leaders had not benchmarked falls data against similar services through the national hospice comparison programmes, which compared hospices of similar size. They told us this was an aspiration. Following the assessment we were supplied with evidence that told us they had been submitting falls data for benchmarking. Leaders identified falls as an area for improvement after analysing incident trends, which showed falls were among the most common issues. The service implemented a prevention and management of falls improvement plan and leaders were updating the falls policy at the time of our assessment to include the latest guidance.

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.

The service kept clear and accurate records on its internal systems, which meant everyone involved in people’s care could access information about their needs and wishes. Staff shared information about care needs and treatment plans with the district nursing service and acute NHS hospital to support safe, high-quality care. This ensured the hospice worked in partnership with other teams to provide the best possible care for people.

The service recognised the need for holistic assessment and care planning for all patients. Multidisciplinary team meetings took place, involving doctors, nurses, physiotherapists, occupational therapists and social workers. These teams discussed the care needs of both inpatient and community patients. These discussions helped patients move smoothly between different parts of the service and helped ensure continuity of care. The hospice provided telephone support for patients and those close to them, both during and outside of regular hours.

The service based a hospice staff member within the acute NHS hospital, which improved communication and coordination. Leaders told us this initiative meant earlier identification and support for those who would benefit from hospice services, leading to better symptom control, outcomes and experiences and enabled timely discharge home with the right support.

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, reduce their future needs for care and support.

The service supported people with palliative care needs to maximise health and wellbeing and support quality of life at end of life. The service provided a Living Well Service, which included complementary therapies such as reflexology, reiki, yoga, qi gong and massage.

The service also offered craft and music sessions, which complemented more traditional approaches such as counselling. Specialist children and family therapists supported the children of people using the service, ensuring the needs of the whole family were considered, not just the patient’s.

People shared how the service genuinely inspired them to live their best lives. One person said, “You are truly encouraged to live the best life you can.” Another person told us, “This place makes me feel supported and uplifted.” People praised the personalised care, one said, “If I don’t like what’s on the menu, they’ll cook something else for me.” People told us they particularly valued the exercise classes, pottery sessions and reflexology.

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

The service regularly reviewed people’s decisions about their preferred place of care. We saw evidence of regular audits, with results reviewed and compared. The service aimed to discuss preferred place of death with at least 80% of patients cared for by the service and achieved discussions with 94% of people in March 2025. Further audits showed that 90% of people died in their preferred place during the same period.

The service monitored outcomes for people using the Outcome Assessment and Complexity Collaborative (OACC) measures. These are a nationally recognised suite of outcome measures used mainly in palliative and end of life care to assess people’s needs, monitor outcomes, and understand complexity over time.

These included the Integrated Palliative Outcome Scale (IPOS) measuring the physical, psychological, social and spiritual impact of illness. Staff reviewed data from these assessment tools and discussed them at multidisciplinary meetings and handovers. Staff developed care plans based on this information, ensuring these were tailored to meet the individual needs of each patient.

Staff reviewed inpatient care at least daily. Reviews covered falls risk, symptom management, dietary needs and any changes in pressure area risks. Staff updated care plans and shared information with the wider team during handovers to ensure continuity and responsive care, which helped ensure people received care that met their changing needs.

We reviewed an internal audit of medical records from May 2025, which showed staff used the IPOS assessment tool consistently at initial assessment. However, the audit found the assessment was not routinely reviewed afterwards. This meant opportunities to check progress and improve care were missed.

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 helped people make informed decisions about their care. We saw evidence in care records that staff discussed consent for personal care and documented this appropriately. Staff also explained how they obtained consent to share information with other services and recorded this.

The service monitored and audited consent practices. We reviewed a May 2025 audit of community medical records, which showed that 20 care records had been checked and 90% contained clear evidence that consent for care had been documented.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making decisions on behalf of people who may lack the mental capacity to do so for themselves. Almost all staff (98%) had completed training and knew how to assess whether someone could give consent. The service had a clear policy to guide staff when people lacked the mental capacity to consent, which followed up-to-date guidance and legislation.

Staff explored patient preferences both at the point of admission and throughout their care. These discussions included patients’ preferred place of care, preferred place of death, and consent regarding information sharing. Staff documented all preferences in patients’ healthcare records to ensure care was aligned with their wishes.