Pilgrims Hospice Ashford

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We assessed 7 quality statements: person centred care, care provision, integration and continuity, providing information, listening to and involving people, equity in access, equity in experience and outcomes and planning for the future.

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

The hospice worked well with external partners, patients and families when planning and delivering patient care and treatment and planning for the future. People's care plans fully reflected their physical, mental, emotional and social needs including those related to protected characteristics under the Equality Act.

The hospice understood the diverse health and care needs of people and their local communities to ensure care was joined up, flexible and supported choice and continuity. People received information and advice which was accurate and up to date. The hospice encouraged people to share feedback and ideas or raise complaints about their care, treatment and support and used this as an opportunity for learning and improvement.

The hospice was accessible to all, and anyone could access their services at any time. Every morning there was a Multidisciplinary Team (MDT) meeting where all admissions and urgent community activity was discussed, and patients were prioritised. If there was no capacity in the inpatient unit patients would be offered other Pilgrims sites. If there was a lack of capacity in the community the MDT will look at utilising resources from the other sites.

The hospice supported people to plan for their future and encouraged patients to complete their personalised future planning document. To better support patients and their families, the hospice trained staff in advanced communications skills for having end of life conversations.

This service scored 100 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Patients and their families received personalised care that was responsive to all their needs through a wide range of services provided by the hospice. These included all aspects of physical, spiritual, social, emotional and psychological care.

People received the most appropriate care and treatment for them as the hospice made reasonable adjustments where necessary. The hospice was accessible for all, promoting people’s independence whilst acknowledging they may require assistance.

We spoke with 1 patient who was now an outpatient but had been an in-patient for an extended stay, who had been transferred from a local NHS Hospital. The patient told us that they felt safe staying in the hospice. Staff always explained everything to them and checked that they understood. The patient said that they never felt rushed by staff, and they always protected their privacy and dignity. Relatives and families were welcomed and included. The patient said they completely trusted everyone and told us staff felt like a second family. They were gentle, caring and nothing was too much trouble.

The patient went on to tell us that when they were first admitted they hadn't been able to eat or drink for 4 weeks and didn't feel like eating, but staff told them that they ‘’could ask for anything’’ and had given them some iced water which felt amazing.

The patient said that they had a craving for an ice-cold chocolate milkshake which staff managed to make up very quickly and they said it was the best one they had ever had.

The patient told us staff were very gentle and interacted with their grandchildren. They knew how to respond and talk to them and made them feel safe and included and welcome.

We spoke with the chef who told us that they catered for changing needs and preferences. They confirmed that records were maintained concerning people's likes and dislikes as well as important information about dietary needs such as allergies, and whether people required soft diet.

The kitchen received feedback if meals were not eaten and the chef told us that this made them curious to see if they could offer something different or something special. They also catered for special occasions such as birthdays, anniversaries, weddings and christenings. The chef said that “no ask was too big”.

A skin awareness leaflet was included in all admission packs which was discussed with patients and their families so that they may be fully informed to understand the risk and causes of pressure ulcers and their cooperation sought in maintaining their skin integrity through repositioning, skin care and mobilisation.

All patients had a wide range of pressure relieving equipment available including investment in new profiling beds and dynamic mattresses, which were serviced, updated and replaced, and support wedges and cushions for offloading vulnerable areas.

People’s care plans fully reflected their physical, mental, emotional and social needs, including those related to protected characteristics under the Equality Act.

People and their loved ones were regularly involved in planning and making decisions about their care and treatment, to ensure it was centred around them and their needs. People understood their condition, care and treatment options (including any associated risks) and any advice provided.

Patients could pick and choose from a wide range of activities and exercises. Some of these included: arts and crafts, carers education and future planning.

All patient areas were on the ground floor with accessible access throughout. There was access onto the garden which had raised flower beds to enable people an opportunity to take part in gardening if they wished. There was also access direct from people's bedrooms onto a patio area outside their room. People who were too ill to get out of bed could be wheeled outside in their bed if they wished.

The inpatient bedroom doors were wide. Beds were wider and known as cuddle beds suitable for loved ones to lie (including pets) to lie alongside them. Bedrooms all had ensuite facilities with a ceiling lifting hoist.

There were overnight relatives’ rooms, an onsite coffee shop, drinks machines and family meals when required making it easier for loved ones to stay close by.

The hospice understood the diverse health and care needs of people and their local communities. Pilgrims Hospice formed an east Kent-wide Compassionate Community network connecting with individuals, community groups, faith groups, organisations, schools that worked together to develop an inclusive community that inspired, supported and celebrated care for one another through collaborative and compassionate action.

The hospice offered courses and training for local health and social care professionals to facilitate education around end-of-life care. For example, Principles and Practices in Palliative and End of Life Care, for Registered Practitioners. This course provided registered nurses and allied health professionals with the foundations of end-of-life and palliative care, to support their patients and families, in any setting during their final months, weeks and days.

The service relaunched collaboration with Porchlight, supporting the homeless community in east Kent following the pandemic ; this had become business as usual now. Pilgrims Hospice was committed to addressing health inequalities affecting the delivery of its services and established the Equality, Diversity and Inclusion (EDI) group to deliver this commitment. The EDI group had developed a Service User diversity monitoring form, launched in April 2024. This form enabled the service to understand who they were caring for and highlighted any healthcare inequalities for those accessing the hospice services. Equality Impact Assessments were now embedded for use when developing new policies and practices to ensure that groups holding protected characteristics were not disadvantaged

Pilgrims was invited to the Marshes Integrated Neighbourhood Group to advise and assist on an issue in the Marshes with identifying and supporting patients in the last year of life (The North Kent Marshes are in the far north of the county of Kent). Pilgrims agreed to work with them to provide Think, Talk, Act to two GP surgeries and be commenced in 2024-25.

Services were tailored to meet the needs of individual people in a way that ensured flexibility, choice and continuity of care. We saw examples of individual therapy sessions for patients or their loved ones. Specialist groups providing support to manage fatigue and multidisciplinary therapists supporting patients in the living well therapy centre of the service.

The service took a proactive approach in understanding the needs and preferences of different groups of people and delivered care in a way that met those needs. The service had bespoke menus and multifaith sacred spaces. Staff we spoke with gave examples of how peoples individual needs and preferences were central to the delivery of tailored services particularly for people with multiple and complex needs. We saw examples of communication tools used to support people living with neurodiversity and specific staff training in how to support autistic people or people with learning disability with their grief and bereavement.

The community palliative care team were based in the same building and worked in collaboration with the hospice team to ensure patient care was joined up and coordinated well. The hospice also worked alongside other services and partners and involved them in discussions and decisions around future care of the patient including transfer to another care provider.

The hospice had a dedicated social support team who took part in care planning meetings and supported with discharge planning. Hospice at home staff worked alongside district nursing services in the area to provide 24/7 care to people in their own homes.

A large proportion of volunteers at the service had lived experience of the service when their loved ones had been cared for by the hospice. They had returned as volunteers due to how well their loved ones were cared for.

The hospice provided appropriate, accurate and up-to-date information in formats that were tailored to individual needs. People could get information and advice that was accurate, up-to-date and provided in a way that they understood, and met their communication needs. Staff had access to communication aids to help patients become partners in their care and treatment.

People had information which met their individual needs. This included making reasonable adjustments for them, interpreting and translation for people who did not speak English as a first language and for deaf people who used British Sign Language and met the Accessible Information Standard.

Staff provided support to people who had difficulty with reading, writing or using digital services with accessible information.

Staff told us how they would ensure that patients glasses were clean so they could see properly, use various communication approaches such as whiteboards and pens, widget symbols (a symbol-based language) and picture boards to aid communication with patients and relatives.

Staff made sure patients living with mental health illness , learning disabilities and dementia, received the necessary care to meet all their needs.

The hospice provided a helpline 24 hours a day. During office hours the helpline was separately staffed, evening and weekend callers were put through to the inpatient unit. Staff on the inpatient unit would either answer their questions or contact a doctor or specialist nurse to call them back. The helpline provided a wide range of advice from symptom management to signposting for people benefits.

We looked at patient feedback on the hospice’s website and saw comments, for example, "Right now, Pilgrims is a lifeline for us, it’s the only consistent support we get. We know we can call the 24-hour advice line if we need anything, or if xxx deteriorates; the staff are so caring and attentive, we can’t fault them."

The hospice participated in the community out of hours study with Kings College London. For the interviews with patients, carers and bereaved carers 7 of 47 interviews were views and experiences of Pilgrims service users, from the 8 sites that participated. There was a journal article which included the service user interview phase of the study. In the article Theme 2 mentioned having a single number to call as an aspect of good quality care, through which a service would assess, triage and coordinate. Having one point of contact gave a feeling a reassurance and safety to patients.

Patients knew how to feedback on their care and were encouraged and supported to do so. The service sought feedback from people, their relatives, staff and community professionals using various methods, which was overwhelmingly positive. Staff always involved people in decisions about their care and told them what had changed as a result.

People were encouraged to complete feedback questionnaires about their experience of the services. These were collated and evaluated by staff and leaders and opportunities for improvement identified. Managers had reviewed systems for feedback and had made it easier for people to share their feedback.

There were clear guides on how to complain and provide feedback. Complaints were dealt with promptly and in an open and transparent manner. We observed complaints records that showed there was clear ongoing communication with the individual and that complaints were investigated and people given the opportunity to meet with hospice leads to discuss their concerns and a resolution. For example, we looked at minutes of the Nursing and Care Leadership Group Meeting for March 2025, and saw that the hospice had received 2 complaints that month. We reviewed these and found them to be appropriately addressed in a timely manner. Relevant information and outcomes were shared with the person raising the concern.

Staff and leaders regularly engaged with people about changes and developments to the service, including the new wellbeing café and changes to centre care provision around complex end of life and palliative care. Staff engaged with organisations representative of the local community to gather views and input on changes made. This included engaging with services supporting people with protected characteristics about changes to the service to ensure their needs were considered and addressed.

For example, the service were in the process of developing a formalised user involvement service for the organisation, which will be made up with volunteers who have a variety of lived experiences, some aligned to Pilgrims services (bereaved family members). Their views with regards changes and developments within the organisation will be regularly sought and valued and listened to.

As part of the development of the Stepping Stones Bereavement Support services for the people of east Kent, the service had worked with South Kent Cruse Bereavement Care and staff from the local NHS trust to develop the bereavement support café model now being used 6 years on, which was regularly evaluated by its service users to implement changes as required.

Staff routinely engaged with different groups within the local community to ensure services were accessible. They listened to people’s needs and encouraged sharing of views and information. Staff engaged with representatives from the Nepalese Community, Travellers and LGBTQ+ communities to ensure services met people’s needs.

The hospice was accessible to all the public and anyone could access their services at any time. Referrals were from GPs, community nurses or social prescribers.

For patients who couldn’t physically get to the service, the hospice at home team visited patients in their own homes which helped reduce hospital admissions for end-of-life patients. The hospice spiritual team also went out to visit people in their own homes.

Staff told us the doctor on call would see the patient at their home to admit when there were ambulance delays.

People (patients, their loved ones) were able to ring the hospice advice line and make a “self-referral.” Patients and their loved ones could also visit the “Wellbeing café” which was an informal drop-in session where they could come along and learn more about Pilgrims services, meet their Wellbeing Practitioner team, and identify which of the wellbeing programmes could support them and their family. The service could also help identify other groups and services in their community that could offer support.

The main advice line was open in normal office hours, existing patients and their loved ones could also ring evenings and weekends for advice. Patients and their loved ones in the community had a call from a clinician within 12 hours with arrangements if they needed to be seen in their own home.

People were referred as either urgent or non-urgent. Urgent cases were admitted either the same day or within 24 hours and non-urgent cases were usually admitted within 3 days of the referral. Managers told us priority was given to people in the community.

People received timely care, treatment and support in line with best practice, quality standards and legal requirements, including equality and human rights. This included accessing care and treatment, making reasonable adjustments for people, addressing communication barriers and having accessible premises.

All patient areas were on the ground floor and were fully accessible. In addition, the hospice had large outdoor gardens which were also accessible for wheelchair users and people with mobility difficulties. The onsite sanctuary and new designed garden provided areas to give peaceful reflection. There was free onsite (including disabled) car parking and pleasant landscaped gardens.

People were given support to overcome barriers to ensure equal access. Leaders and staff were alert to discrimination and inequality that could disadvantage different groups of people in accessing care, treatment and support. For example, the hospice had a “no barriers here initiative” they had adopted from Mary Stevens Hospice, a group running in conjunction with Learning Disabilities (LD) services and a local provider for residential care. Using an arts-based approach that had been co-produced with people with LD they ran a three-week group to make future care plans.

In addition, the services told us that they were fortunate to have expert volunteers in a variety of support roles within the organisation, who not only had valuable lived experiences, but also some protected characteristics, both physical, cultural and diverse that brought a wealth of experience and expertise to their service users. The expert volunteer roles ensured the hospice were able to be inclusive with service providers as well as their service users.

The hospice complied with legal equality and human rights requirements, including avoiding discrimination, considering the needs of people with different protected characteristics and making reasonable adjustments.

Services were designed to make them accessible and timely for people who were most likely to have difficulty accessing care. When there were barriers, they were removed. The hospice used people’s feedback and other information to actively seek to improve access for people more likely to experience barriers or delays in accessing their care.

For example, the service has run a Nepalese project. They met with community leaders and using a strengths-based approach discussed what end of life looked like for them in their community. Spent time over several visits talking to various community elders, worked with them to understand an approach that would work for the community and presented to approximately, 80 elders about the hospice, followed by a question-and-answer session.

The hospice had worked hard to ensure people were aware care was free for all. There had been several initiatives to deliver this message which included to disadvantaged groups; this included work with health professionals and local community groups, work with local schools, and various fundraising initiatives advertised on local media and within Pilgrims Hospice’s shops.

Pilgrims Hospice Board of Trustees and the Chief Executive were accountable for equal opportunities, diversity and inclusion in both employment and service provisions. All line managers had a responsibility for ensuring that the Position Statement was applied effectively and fairly across all departments.

The purpose of the Position Statement was to provide equality and fairness for all in their service delivery and employment practices, and not to discriminate on grounds of gender, gender reassignment, gender identity, marital status (including civil partnerships), pregnancy and maternity, race, ethnic background, nationality, national origin, disability, sexual orientation, age, religion or belief.

Leaders proactively sought ways to address any barriers to improving people’s experience and worked with local organisations, including within the voluntary sector, to address any local health inequalities. Staff understood the importance of providing an inclusive approach to care and adjusted support equity in people’s experience and outcomes.

A member Pilgrim’s Social Work team attended the Transgender Healthcare Conference 2023: Tackling Inequalities and Providing Support , in particular a session entitled ‘Overcoming Barriers to High Quality Trans Healthcare: The Latest Guidance and Updates’. This focused on outlining and understanding the key factors that contributed to poor health outcomes for trans and gender-diverse patients. It included advice on improving the data collection and monitoring of gender identity to identify gaps in healthcare provision; Detailing plans to improve waiting times and the service experienced for transgender patients and measuring the impact of service improvements to understand successes and failures.

Staff and leaders were alert to discrimination and inequality that could disadvantage diverse groups of people using their services. They regularly engaged with local communities to understand the specific issues around palliative and end of life care with a view to improving their understanding and people’s experience. For example, staff within the inclusion and diversity team had met with local support groups to understand after death care and rituals. This helped them to identify specific learning, such as the belief of the travelling community that mirrors should be covered after death, and that beard trimming was against the Sikh community’s beliefs. This enabled them to provide specific training for staff.

The hospice provided support to other organisations and healthcare professionals who worked for other organisations care caring for patients with palliative and end of life care needs. This included patients living with dementia and those with learning disabilities. Staff had completed training in supporting patients with dementia, learning disabilities and autistic people.

The evidence showed a good standard. People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

The hospice provided specialist support to patients and their families at the earliest opportunity to consider their future care needs, including advanced care planning and preparing for the future to empower people to make informed choices based on their wishes and preferences. Patients had one to one appointments with the doctors to finalise their wishes and avoid unwanted treatment.

These conversations allowed patients to feel empowered, in control, have a sense of security and helped them focus on what mattered to them so they could live as well as they could for the time they had left.

Staff worked closely with patients and their families regarding their plans and encouraged patients to complete their personalised future planning document. To better support patients and their families, the hospice provided staff with advanced communications course for having end of life conversations.

We were given examples of when the hospice supported patients and families to celebrate significant events by bringing them forward. Staff at the hospice prided themselves in supporting families in personally caring for those at the end of life, including cultural and religious customs where indicated.

Staff completed recommended summary care and treatment forms (ReSPECT) during consultation with patients and in line with guidance which staff had access to.