Pilgrims Hospice Ashford

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

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

There was a consistent and high-quality approach to assessing, and reviewing people’s health, care, wellbeing, communication needs and included their mental and needs.

Care and treatment provided was evidence based, measurable and monitored for outcomes which enabled continuous improvement. People's needs were assessed using a range of assessment tools to ensure their needs were reflected and understood.

Staff demonstrated a good understanding around the importance of capacity to consent.

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 good practice and standards.

Staff worked together and with others when assessing people’s needs and shared information to maintain continuity of care.

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.

Staff treated patients as individuals and involved them and their families in care and treatment decisions. They were invited to attend care and treatment reviews. Patients were involved, listened to, and everyone involved worked well together.

Patients’ needs were thoroughly assessed prior to them using the service to ensure their needs could be safely met. Staff completed an Integrated Palliative Care Outcome Scale (IPOS) form on admission with patients and their families. The IPOS is used to measure patient’s physical symptoms, psychological, emotional and spiritual, and information and support needs. This was reviewed every week and presented at MDT meetings.

Handover and MDT included a holistic approach to care, assessing physical, medical, emotional and social needs and included the use of recognised tools to identify changes in a patient’s condition and potential deterioration. The use of the Integrated Palliative Care Outcome Scale (IPOS) guided staff in identifying changes to patient illness and ability to function. Doctors utilised the IPOS form as well as pain scores, memory assessment tools, delirium screening and other validated screening tools depending on the situation.

There was a consistent and high-quality approach to assessing, and reviewing people’s health, care, and wellbeing needs with them. People’s individual needs were appropriately assessed, and staff ensured the care provided met their needs. The hospice used personalised care plans and goal setting and included both patient and their families in patient’s assessments. Staff actively encouraged people to maintain their interests and participate in activities.

There was a creative and person-centred approach in ensuring people’s communication needs were met to maximise the effectiveness of their care and treatment. For example, we saw that there was big screen at Pilgrims Hospice, used for connecting patients with loved ones via video calls, and was part of theirvirtual reality (VR) system.This system was introduced after the Immerse Your Senses Appeal raised funds.It's used across various settings, including inpatient units, therapy centres, and even in patients' homes, to help ease anxiety, breathlessness, fatigue, and pain.

Patients were reassessed daily both face to face and in multidisciplinary conversations with colleagues. All patients were seen on weekly consultant rounds and were reviewed by a senior doctor within 24 hours of admission.

Staff told us daily assessment of symptoms was made using observations and physical examinations based on The Palliative Care Handbook. For example, the fears and concerns of the patient, which may be associated with pain and its management or with the dying process.

Communication was assessed by doctors and nurses and reviewed regularly. Tools such as communication boards, iPad, interpreters and speech and language therapists (SALT) input was used for communication difficulties.

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 good practice and standards.

Care needs were assessed and reviewed and management plans adjusted accordingly. This included nutrition and hydration needs for the patient. The service monitored people’s care and treatment, and staff used the Karnofsky Performance Scale to provide a clinical picture of a patient’s health, phase of illness and ability to cope with daily living activities. The Karnofsky Performance Status (KPS) scale is a standardised tool used to assess a patient's functional status, particularly in those with serious or terminal illnesses.It provides a numerical score from 0 to 100, with higher scores indicating better physical function and the ability to perform daily activities

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.

We reviewed 5 care plans and found these to be detailed with important information which linked with current good practice on how to support people with their health conditions. These included interventions staff had made, and advice sought when required.

In addition, to occupational therapy, the hospice provided complementary therapies which included massage, reflexology and aromatherapy to create a calm and healing environment for patients and their families.

People had personalised care plans and assessments took account of people’s emotional, spiritual and social needs. Care in the last days and hours of life delivered the Five Priorities for Care of the Dying Person. These priorities emphasise a person-centred approach, focusing on individual needs and preferences during the end-of-life process.

We reviewed recommended summary plans for emergency care (ReSPECT) forms which were completed in line with national guidance.

Advance care plans were developed with people and those close to them, outlining preferences for future care and support. This process was based on recognised approaches to ensuring people received the care they wanted at the end of life; confident their care was focused on what matters most to them.

The hospice linked with Hospice UK national benchmarking programme for falls, medicine incidents and pressure ulcers. These were reported quarterly and benchmarked nationally and against those hospices of similar sizes. The service found that the data was difficult to compare as hospices ranged so much in size and practice. We were told that Hospice UK were working to improve their data reporting.

We looked at tissue viability monthly data for February, March and April 2025 that highlighted most pressure ulcers were acquired before admission although the service proactively ensured pressure relieving mattresses were available on all inpatient beds and regularly reviewed people’s skin to avoid further skin deterioration.

We also looked at the hospice’s Annual Report and Strategic Plan for Tissue Viability, 2025. The report showed that skin integrity and the prevention of avoidable pressure ulcers continued to be a priority within the hospice, with all care and interventions in line with national best practice and guidelines. This annual plan outlined the achievements of the previous year in the care of patients identified at risk of pressure ulcers and set out the objectives and actions for the forthcoming year to further improve outcomes, maintain up to date best practice and improve patient care.

Pilgrims Hospice Ashford had a Tissue Viability Lead Nurse who had been delivering Wound Care workshops to Health Care Assistants (HCA) across all 3 Pilgrims sites to raise awareness and prevention of skin damage.

We looked at an end of year report to the Clinical Quality and Governance Committee Meeting on falls and saw that there was an increase in patients who had fallen, having their beds dropped to floor level and having crash mats added. Consideration had been given to how staff could be made aware of the appropriate times to use the beds at their lowest and when other methods of falls prevention measures were more appropriate. We saw that training had been rolled out around this.

We also looked at the end of year report to the Clinical Quality and Governance Committee Meeting for manual handling and saw that incidents remained low. We also noted that the community nursing teams had received role specific manual handling training. This would continue to be rolled out in the coming year to non-clinical, patient facing staff such as social workers and complementary therapists.

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

The hospice at home team worked in partnership with domiciliary care agencies, GPs, district nurses, and other community teams delivering care to patients in their homes.

The hospice provided telephone advice both in and out of hours for end of life or palliative care issues. This included providing support to other services and professionals, for example GPs, community nurses, hospital doctors, nurses, and paramedics.

The hospice had changed their IT system to align with the majority of GPs in East Kent who also had the same system. The hospice liaised with all GPs across East Kent to gain data sharing agreements so that they had joined up care for their patients. There were 2,328 phone calls for advice from outside healthcare professionals between January and July 2025.

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.

Staff supported patients to live healthier lives and where possible supported people to manage their health and wellbeing to fully maximise their independence, choice and control.

Staff promoted the importance of good nutrition and hydration. People had nutrition and hydration assessments and plans, which were up-to-date and where necessary recording of people's intake had been completed.

Patients had access to dietitians if required. We reviewed patient notes and saw evidence of staff gathering information to establish what the patients liked to eat.

Services focused on identifying risks to people’s health and wellbeing early to maximise their quality of life and including care at the end of their life. People could access information to improve the quality of life including managing breathlessness, tiredness and pain.

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

The hospice provided several activities through their Wellbeing Programme that was free to people who lived in east Kent and had been diagnosed with an incurable illness. It offered a range of therapeutic, creative, social and educational groups and activities designed to support people to live well, in both mind and body, for as long as possible. For example, Time to Create, a relaxing but stimulating group giving patients and their families an opportunity to develop new skills and rediscover long-forgotten ones; create art and crafts that reflected their unique interests and experiences that can be given as a lasting memory.

The hospice provided many other programmes and support groups such as the Wellbeing Café (an informal drop-in session where people could learn more about Pilgrims services), breathlessness management, living with fatigue and many more that supported healthier living.

The hospice 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. Pilgrims Hospice’s services were all holistic, that meant they looked at each person’s physical symptoms and at their psychological and emotional symptoms.

The service also monitored complaints, concerns, compliments and satisfaction feedback. Follow up contact/care was made once the patient was discharged or transferred to another care facility.

Outcomes were positive, consistent, and met both clinical expectations and the expectations of people themselves. The service used the Integrated Palliative care Outcome Scale (IPOS) as a measure of symptoms and concerns which matter to patients therefore helping staff provide the best patient experience.

Staff continuously monitored people’s health conditions where appropriate. Evidence based tools were used to support this practice. For example, the ‘Australia-modified Karnofsky Performance scale’ (AKPS - a clinical assessment tool, that measures a patient's ability to perform daily activities, with a score from 0 to 100) to assess patients' day-to-day functioning. This assisted in assessing if care needed to be adjusted as a patient neared the end of life.

The hospice was part of the Hospice UK benchmarking group and submitted data on a quarterly basis, learning from other hospices and sharing information that could improve care.

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 ulcer risk score on admission, number of medication errors per 1000 bed days and the number of slips trips and falls were all monitored and benchmarked at clinical quality and management meetings.

Staff told us how managers completed audits to monitor and improve outcomes. Staff gave examples of actions, good practice and learning being shared with them. We looked at data for patients referred in the last year (23 May 2024 to 23rd May 2025) and saw that 100% had a preferred place of death (PPoD) recorded at first assessment. Of the 230 deaths, 155 (67%) patients died in their PPoD and 20% did not. Of the 230 deaths 32 patients had not been seen by the service and 5 patients were undecided on their PPoD. The service reviewed reasons for patients not dying in their PPoD to look where improvements could be made. Reasons for patients not dying in their PPoD included rapid deterioration of the patient, patients had actually died in their preferred location but proforma not correctly completed and died in the hospital.

We looked at The Hospice Outcome Measures Champion Group minutes for 2025 and saw that number of patients admitted to the ward, the age of patients admitted, length of stay on the ward and the percentage of patients discharged that said their stay made a difference to their quality of life were presented to the group.

Senior staff told us that the re-establishment of a dedicated Tissue Viability Lead Nurse in 2024 had significantly strengthened their approach to skin integrity and pressure ulcer prevention across all hospice sites. Focusing on staff training, robust risk and skin assessment protocols, patient education, and evidence-based practice. The Hospice’s 2025–26 plan builds on this progress, with clear goals for enhancing education, updating clinical policies, improving risk assessment tools, and evaluating the link nurse role.

The hospice always carefully explained to people what their rights around consent were, made sure they fully understood them and always fully respected these when delivering person-centred care and treatment.

The Mental Capacity Act 2005 (MCA) provided a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. 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 routinely as part of assessment processes across the hospice. Staff understood the principles of best interest decision making where people were assessed as not having the mental capacity to make certain decisions. Where appropriate, family members and those close to the individual were involved in discussions about decisions.

Staff understood the importance of giving people choice in the support they received, and we observed staff always sought people's consent before providing any support. People were supported to make their own decisions where appropriate, in accordance with the MCA.

Staff made sure people consented to treatment based on all the information available and took time to ensure people understood the information.

Practices around consent and records were actively monitored and reviewed to improve how people were involved in making decisions about their care and treatment. Staff clearly recorded consent in the people’s records. Records of consent were routinely audited and reviewed as part of a of patient’s death and care to identify any gaps and improvements required.

The service had made appropriate Deprivation of Liberty Safeguards (DoLS) applications and monitored the progress of the applications, where conditions were in place these were followed and monitored. DoLS ensures that any restrictions on a person's liberty are necessary, in their best interests, and carried out through a formal, legal process.

Staff discussed treatment escalation plans, involving the patient in decisions of their preferences in the event of deterioration, symptom management in a way that they would want it to be where possible. Patient preferences were discussed on admission, this included their preferences for place of care, death, who we could discuss and share information with ensuring consent was obtained.