The Prince of Wales 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

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.

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.

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

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

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 service carried out assessments to identify and meet people’s needs. Patients received an assessment on admission, which identified key risks such as frailty, delirium, falls, tissue viability and continence needs. These assessments considered physical, psychological and social requirements and informed care planning. They were reviewed and updated as people’s conditions changed.

There were clear pathways for recognising and escalating reversible deterioration. Staff knew when and how to escalate concerns, and senior clinical review was available when needed. As patients approached the last days of life, a further holistic reassessment was undertaken, with a focus on recognising dying and aligning care with the patient’s priorities. Wherever possible, patients were involved in these discussions; when this was not possible, families and those important to the patient were included.

Nutrition and hydration were assessed and monitored. Care plans included pain management plans, and staff considered the need for regular or anticipatory analgesia. Pain and comfort were reviewed regularly, and patients appeared comfortable. We observed a patient having increased frequency of pain observations as they were not receiving pain relief. This helped staff to closely monitor changes in people’s comfort levels and respond promptly if pain increased or new symptoms developed.

Communication needs were assessed. Staff had access to interpreters, accessible information and communication aids where needed to support understanding and involvement in care. We heard of a recent example from staff where a patient had communication difficulties and a communication board was successfully used to communicate their needs.

Staff told us that as a person’s condition changes and they become more dependent on nursing support, their care was reviewed and adjusted. This included increased support with repositioning, pain management and personal hygiene. Staff explained that the level and frequency of intervention increased in response to people’s individual needs, helping to ensure care remains responsive and personalised.

Patients were screened for mental health needs, and referrals were made when concerns were identified. Where there were concerns about capacity to consent, staff followed Mental Capacity Act guidance. Legal authority, such as lasting power of attorney, was checked where relevant.

Carers and family members were involved in assessments and reviews where appropriate and with the patient’s consent. The needs of unpaid carers and dependants were considered and signposted to additional support where required.

The service delivered care and treatment in line with current evidence, national guidance and best practice. Staff had access to up‑to‑date policies and clinical guidelines, which included review dates and references to relevant national standards. There were governance arrangements to ensure policies were regularly reviewed and updated in response to changes in legislation and guidance, and staff were informed of updates. The service was supported by links with clinical networks and specialist teams, which helped staff remain up to date with best practice.

Clinicians followed National Institute for Health and Care Excellence (NICE) guidance relevant to the service, including guidance on acutely ill adults in hospital: recognising and responding to deterioration and care of dying adults.

Patients identified as approaching the end of their life had timely discussions about their care preferences. Advance care planning was encouraged and recorded, and ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) plans were in place to guide decision making in the event of deterioration. We reviewed 10 ReSPECT forms, all were well completed with the wishes of the patient clearly documented and discussion with families recorded, when the patient lacked capacity.

There was a clinical audit programme in place that covered key areas of care and supported implementation of NICE guidance. Audit findings were reviewed through governance meetings, and action plans were developed where improvements were needed.

There were arrangements for managing acute, potentially reversible conditions alongside palliative care, with senior clinical oversight. Protocols were in place for managing significant clinical events, such as major haemorrhage and sepsis. Staff understood escalation processes and how to access specialist support when needed.

The service had a nutrition and hydration policy and used recognised screening tools to identify patients at risk of malnutrition. We saw a red tray system was in place, where patients at risk of under nutrition were identified and supported. Fluid and nutrition charts were completed where required and used to inform care planning.

Food provision was personalised and took account of clinical, cultural and individual preferences, a patient told us; “it’s a very good food menu, gives lots of choice”. Staff supported patients to eat and drink, protected mealtimes where possible and ensured food and drink were available outside standard mealtimes. Menus for visitors were available in people’s rooms, which supported family dining and promoted the social aspects of nutrition and hydration.

The service worked with other teams and services to meet people’s needs and support good outcomes. There were clear arrangements to access emergency and specialist interventions through established networks, including out‑of‑hours provision.

We observed a multidisciplinary team (MDT) meeting and saw contributions from different professionals and that information was shared clearly to ensure a consistent approach to care. The outcomes of MDT discussions were reflected in care plans and, where appropriate, shared with patients and their families to support involvement and understanding.

The service worked with external partners and services to plan and manage transitions of care. Plans were in place to support safe transfer to community services, care homes or other settings when required.

We were told that hospice staff were invited into local care homes to provide training on topics such as recognising deterioration and advance care planning. This was described as a positive and effective way of strengthening relationships between the hospice and care homes. This approach supported care home staff to develop their skills and confidence and helped to improve outcomes for people and their families.

Each patient had clear clinical leadership throughout their care. Discharge planning took account of individual needs, circumstances and ongoing support requirements. Where appropriate, discharges were planned with community health and social care services to ensure continuity and safety.

The service supported patients to maintain their health, wellbeing and quality of life in ways that were meaningful to them. Staff took a holistic approach to care, recognising that living as well as possible, including planning for a good death, was an important part of supporting health.

Patients were supported to understand and manage their health in line with their abilities, wishes and stage of illness. The hospice wellbeing and community services promoted wellbeing through social interaction, therapeutic activities and opportunities to maintain independence. Sessions such as complementary therapy, exercise groups and craft groups were on offer as well as bereavement support, family and career support and counselling.

We were told about the hospice bathing service, which was available to members of the local community. People could attend the hospice to use the accessible bathing facilities with support from staff. This service helped people to maintain their dignity, comfort and personal care needs and supported their wellbeing at a time when this may have become difficult at home.

Staff encouraged movement and activity in line with patients’ abilities and wishes. Patients were supported to remain as active as possible, including getting dressed, mobilising safely and participating in activities.

The service recognised the importance of mental health and emotional wellbeing. Staff provided emotional support from admission through to the end of life, and patients could access additional support, including counselling or spiritual care services. Staff supported patients to plan and take part in activities that were important to them, helping them maintain a sense of purpose and identity.

Spiritual and cultural needs were respected and supported. Patients were encouraged to maintain links with family and friends, and staff supported visits and the celebration of important life events wherever possible. We heard multiple examples of hospice staff helping patients and their families to celebrate important events, one patient told us about a birthday party staff had organised for their family member, where decorations, balloons and pizzas were provided.

Staff focused on understanding what mattered most to patients and used this to define meaningful outcomes, including comfort, dignity, symptom control, emotional wellbeing and achieving preferred place of care.

Patients’ expectations and experiences were explored through direct conversations, care reviews, feedback and complaints. We reviewed the lymphoedema clinic outcome audit for March 2026, which asked patients whether, since attending the clinic, they felt their lymphoedema had improved and whether they were better able to manage their daily activities. Both questions received 100% positive responses.

The service used a range of resources to help monitor and measure patient outcomes. This included discussions at MDT meetings about deaths and discharges, focusing on what had gone well, whether outcomes had been achieved, and any learning that could be taken forward to improve care.

A programme of clinical audits monitored patient outcomes against agreed standards, including end‑of‑life care. The hospice compares and analyses data from other hospices to see their performance relative to peers, to inform improvements and help with planning.

The hospice used a recognised outcome scale to support holistic assessment and ongoing review of people using the service. The scale was used on admission to identify symptom burden, psychological distress and overall wellbeing. It was then repeated weekly, and scores were discussed at the multidisciplinary team (MDT) meeting.

Staff told us that full and consistent adoption of all elements of the scale, including ability and independence and phase of illness, had not yet been embedded across the service. Staff described this as work in progress, with systems and practice continuing to develop. They had initiateda quality improvement project to address this. Inaddition, they had recently appointed a data lead whose role included improving the extraction,analysisand presentation of data, to better evidence patient outcomes anddemonstratethe impact of hospice care.

The service had arrangements in place to support informed consent and shared decision making. Staff who obtained consent were trained and competent to do so, and were able to explain the purpose, risks, benefits and alternatives to investigations and treatments in a way patients could understand.

Consent documentation was clear, legible and completed appropriately. Records showed that risks and benefits were documented.

Staff understood when and how to assess a person’s capacity to make decisions about their care and treatment. Staff knew how to recognise when a person might lack capacity and how to access advice from senior clinicians or safeguarding leads if required.

Where patients had reduced capacity, staff took appropriate steps to support them to make decisions for themselves wherever possible. This included using interpreters, communication aids, hearing support and involving family or carers with the patient’s consent.

When patients lacked capacity to make a specific decision, staff followed Mental Capacity Act principles. Best interest decisions were made with appropriate involvement from family members, carers or advocates and considered the patient’s wishes, beliefs, values, culture and traditions. Where a Lasting Power of Attorney was in place, staff checked and verified that documentation was valid and registered before accepting decisions.

Staff were trained in consent, the Mental Capacity Act and Deprivation of Liberty Safeguards, both with 97% training compliance. They knew how to access policies and guidance and described confidence in applying this in practice. Leaders had assurance through audits, training records and supervision that consent and capacity processes were being followed.

We reviewed 10 patient records and found all forms were completed well with wishes clearly documented and discussions taking place with the patients or their legal representatives.

Patients told us they felt involved in decisions about their care and treatment and understood the risks and benefits of treatment options. Staff sought verbal consent before delivering care and involved patients in everyday decisions wherever possible. One patient told us, “I am always involved in my care conversations, here they really care for me, you could use every interaction as a staff training video”.