Saint Catherine's - Scarborough

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 looked for evidence that patients and communities had the best possible outcomes because their needs were assessed. We checked that patient’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring patients 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 patients’ outcomes were consistently good, and patients’ 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 made sure patients’ care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

We reviewed 4 patients’ care plans which all showed evidence that the patients’ physical, health, wellbeing and communication needs were fully assessed and reviewed as required. Care plans showed that carers were involved in the assessment and agreement of patients’ needs.

Staff shared patients’ care plans and how to record information in them such as when patients’ needs changed. Care plans were holistic and complete, were reviewed at the end of each shift by the staff who had cared for them.

Patients’ notes identified they had been asked about advanced care planning and whether they had the capacity to make decisions. Patients and carers said that they felt well supported, were involved in planning their care and that all their caring needs were met.

Staff used symptom management guidelines which included guidance on pain management. The guidelines were produced by the regional Palliative and End of Life Care Group of Yorkshire and the Humber. The hospice had also adopted the Scottish Palliative Care Guideline to manage patients pain levels as this tool offered guidance for people over the age of 18 years.

Additional guidelines informed staff within their clinical practice, for example, pressure area care, bedrails, moving and handling, nutrition.

Mouthcare matters was introduced to ensure patients mouthcare needs were met.

Documentation audits reviewed patients records to ascertain the quality of the documentation. Where shortfalls where identified recommendations resulted.

The service planned and delivered patient’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.

We reviewed 15 evidence-based hospice policies and procedures. Please refer to the well led section of the report governance, management and sustainability for further detail. Patients’ care plans showed care, and treatment was evidence based and person-centred.

A retrospective review of 10 patient records who died in Saint Catherine’s Hospice Inpatient Unit in April 2024 was carried out using the National Audit of Care at the End of Life (NACEL) audit tool to ascertain whether they had met the 5 priorities of care. The audit outcome identified five priorities and four recommendations.

Staff told us how they ensured they were aware of what was important and mattered to the patient and family. Patients could celebrate weddings and anniversaries whilst at the hospice. One example was when a candle-lit meal was provided for a couple.

Non-pharmaceutical herbal teas were introduced to help patients with their nausea.

Kitchen staff were aware of the need to provide nutritional meals to patients and described the process which ensured meals met patients’ needs. A dietitian is provided by a community provider.

Kitchen staff visited patients daily to ascertain their daily choices and any requests and completed a white board in the kitchen area which identified patients’ nutritional needs, preferences and status. The hospice said it provided a nutritionally balanced three-week menu, which included vegan, halal and pescatarian options. Staff collected feedback from patients, carers and families through the comment forms. Patients praised kitchen staff who visited them daily to confirm their nutritional needs and meal choices. We observed snack, treats and drinks available on the inpatient area.

Staff told us a new kitchen had been built in the inpatient areas so that the kitchen staff could come to the area to assist staff with presenting the food to the same standards as a restaurant to ensure it looked appetizing. New cutlery and bowls were introduced so patients could eat their meals independently.

The service worked well across teams and services to support patients. Staff made sure patients only needed to tell their story once by sharing their assessment of needs when patients moved between different services.

The service used an electronic palliative care coordination system which included partners and services from the NHS Trust, GPs, District nurses and other hospices. This system ensured the coordination of patients’ end of life care. Leaders confirmed that due to the Yorkshire and Humber care inter-functionality systems staff could look at patients’ records.

Band 5 and 6 staff completed competency-based training which included communication skills training to ensure that they could maintain communication with people about difficult matters and / or in difficult situations. The training guide which was taken from a local NHS Trust identified expected behaviours for individual staff in this area.

Inpatients and community patients care records, management plans and what was important to them were discussed at the two-consultant led multi-disciplinary team (MDT) meetings. Patients’ records were updated by the MDT. MDT input was received from health and social care professionals which meant that all aspects of the person’s needs could be discussed, actioned and support identified.

A respite service was to be introduced.

Staff met at designated handover times to share information about patients who used the service. The information was captured from patients’ electronic records so that staff were kept informed of patients’ latest needs. The multi-disciplinary team (MDT) huddle was attended by members of the MDT.

The medical team and clinical lead met at 9am for the inpatient ward round.

The hospice attended and received minutes from the Mental Health, Learning Disability and Autism Collaborative Newsletter.

Leaders kept staff informed of changes at the hospice through the staff newsletters and during staff engagement sessions.

The service supported patients to manage their health and wellbeing to maximise their independence, choice and control. The service supported patients to live healthier lives and where possible, reduce their future needs for care and support.

Patients and carers confirmed they had been supported to manage their health and wellbeing. Patients could access support through the limited-service provision at the hospice wellbeing centre.

Patients were signposted to local services to improve their health, for example, smoking cessation, obesity, drug and alcohol dependence services.

Physical activity was encouraged through initiatives, for example, a walking group had recently been set up for patients who wanted to walk outside within the local area.

Access to patients’ GPs and dentists was available. Staff told us that dentists would visit the hospice to provide dental care for their patients.

Community groups had been set up to support local populations. One example was the positive potentials group in Bridlington. Staff managing this group had worked with local people, provided education and advice on financial support and signposted people to the professionals who could help to reduce their stress. As yet, this group had not been well received by the local population.

A cancer café took place every Tuesday in Scarborough and in Driffield at the local community hospital.Patients, carers and their relatives could access one to one discussions and were signposted to relevant guidance and services.

The lymphoedema service operated in Malton, Whitby, Scarborough and Bridlington. A business plan has been developed for York.

The hospice clinical nurse specialist (CNS) staff provided support, complex symptom control and advanced care planning to patients approaching end of life within the community and were also approached for advice by inpatient staff.

Patients could access a quarterly motor neurone disease clinic which was supported by a neurology consultant, a research nurse and clinical nurse specialist.

Fatigue and breathlessness management advice was provided. Patients were educated in energy conservation, the recognition of fatigue and how to manage fatigue.

Staff said they had completed training in learning disabilities, dementia and mental health needs which meant they could support patients’ health and wellbeing.

The service routinely monitored patients’ 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 patients themselves.

Saint Catherine's Hospice was the first hospice in the country to receive veteran’s aware accreditation and also the first hospice to sign the Armed forces Covenant.

The service was awarded bronze and silver accreditation for the veteran’s aware scheme.

The service completed a Quality Improvement initiative: Reducing Medication Errors on the Inpatient Unit. The initiative resulted in a reduction of medicine errors and recognised the factors which disturbed the medicines rounds. Actions resulted from the audit which included: ongoing monitoring, staff education and further discussion.

The Integrated Palliative Care Outcome Scale (IPOS) was used as a patient reported outcome measure in palliative care to assess symptoms and concerns, including physical, social, psychological, and spiritual aspects. The service had introduced outcome measures to monitor patients’ outcomes. Community staff completed this training in February / March 2025.

Medical staff were involved in the Australian-modified Karnofsky Performance Scale which identified the life expectancy of someone with a Karnofsky score.

The Hospice Audit Report – Chartered Society of Physiotherapy Charitable Trust (CSPCT) Pain Audit - June 2024 to May 2025 identified recommendations which included staff training, re-auditing and monitoring outcomes for patients with dementia and / or learning disabilities.

Staff and leaders described the national tools they used; their purpose was to deliver evidence-based care and treatment and monitor patients’ outcomes. Patients’ records confirmed completion of weekly risk assessments. Evidence-based tools in use included the Malnutrition Universal Screening Tool (MUST) and pain assessment tools. The Waterlow tool was used to identify individuals at risk of developing pressure ulcers in combination with Moving and Handling tools. The hospice monitored risk assessments weekly.

Mouthcare training had been provided to healthcare assistants and registered nurses to ensure patients mouthcare met their individual needs.

The service told patients about their rights around consent and respected these when delivering person-centred care and treatment.

The hospice had a consent policy and procedure. Staff described the consent process if a person did not agree to a procedure and how to ensure the person had capacity to make that decision. Staff said when patients’ capacity was limited, weekly discussions took place at the Tuesday multi-disciplinary meeting to ensure correct documentation of capacity and best interests. The hospice had adopted the ‘This is me’ document. This document informed staff and members of the multi-disciplinary team of what was important to the patient and to build a better understanding of who they were.

Patient care and risk records showed patients’ mental capacity was asked for, discussed and agreed. Staff recorded when patients lacked capacity and identified which family members, carers or advocate were consulted and involved in any decision making. Patients and carers said their needs and views were taken into account when decision making had taken place. The four patient notes reviewed identified that none of the patients lacked capacity.

When a patient did not have family or friends who were able to advocate for them, the hospice may refer them to the Independent Mental Capacity Advocate (IMCA). The local council had a single advocacy service in partnership with an advocacy agency who could access locally based advocates.

Electronic patient consent records were kept for each patient.

Advanced care plans were in place for those patients who needed them. We reviewed these and saw evidence of patients’ involvement in these plans. There was also a discussion recorded within the notes as to where the person would prefer to be at the last stages of life.

The Inpatient Unit consent audit (December 2024) reviewed 10 sets of electronic patient records. Some areas of improvement were identified. The action was to reaudit in 6 months, (June 2025) and increase the audit to include 20 sets of notes. A question was to be included in this audit in respect of asking for separate consent for additional clinical procedures.

The hospice had completed a Mental Capacity Act (MCA) audit for all IPU patients - 02/01/25 – 31/03/25. The audit included consent for admission, bed rails, syringe driver, catheter, discharge planning, Last Days of Life and any other decisions requiring consideration of mental capacity. The records of 53 patients were reviewed. The recommendations included education re the completion of the Last Days of Life documentation and the need to consider consent for end-of-life care in the hospice, particularly if the plan of care had changed This was also to be Included in new doctors training and face to face MCA training.