St Richard's Hospice

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

We rated caring as outstanding

We reviewed all 5 quality statements for caring: kindness, compassion and dignity, treating patients as individuals, independence, choice and control, responding to patients’ immediate needs and workforce wellbeing and enablement.

Patients received care and support that was exceptionally compassionate and kind.

Staff cared for patients and each other in a way that exceeded expectations and fully respected their privacy and dignity. Staff demonstrated genuine empathy for the patients cared for.

The service was exceptional at helping patients to understand their rights and express their views so that staff and managers at all levels understand their views, preferences, wishes and choices.

Staff demonstrated genuine empathy for the patients they cared for and were able to act creatively to uphold these rights, even in challenging situations. The embedded culture of kindness and respect extended to colleagues as they were treated in the same manner.

Staff had a strong understanding of patients’ human rights to dignity and respect, and were able to act creatively to uphold these rights, even in challenging situations.

Staff went to great lengths to make sure that patients’ needs, views, wishes and comfort were their utmost priority. They went above and beyond to anticipate patients’ needs and take steps to ensure preventable discomfort, concern or distress for patients.

Staff were able to anticipate when someone needed urgent end of life care or support and offered this immediately, using the most up to date tools as required.

At our last inspection we rated this key question good. At this inspection, the rating has changed to outstanding.

This service scored 95 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Patients received care and support that was exceptionally compassionate and kind. All people we spoke to said they or their loved one were treated with kindness, compassion and dignity in their day-today care and support. Leaders and staff were motivated and inspired to offer care for patients with kindness and compassion.

Staff cared for patients and each other in a way that exceeded expectations and fully respected their privacy and dignity. We saw staff did not rush patients or their loved one and listened to them and gave them comfort and reassurance. Patients told us how they were reassured staff gave their loved one time and a listening ear. All people we spoke with agreed staff were kind and compassionate. The hospice leaders promoted and supported its staff to ensure dignity and privacy were central to the care they provided. At every opportunity, curtains were drawn, and blinds were closed on bedroom doors by staff when they provided intimate care. We saw signs on bedroom doors saying patients did not wish to be disturbed as they were resting. Patients told us staff closed blinds to give them privacy when they were distressed.

Staff demonstrated genuine empathy for the patients they cared for. Patients felt staff listened to them and communicated with them appropriately, in a way they understood.

Patients felt staff knew and understood them, including their preferences and wishes. Information about patient’s wishes were recorded. Managers told us they supported and had facilities for deceased patients to remain longer within the hospice to enable their loved ones to come and say their goodbyes properly without urgency before they were taken to the funeral directors.

Patients said staff responded to their needs quickly and efficiently, especially if they were in pain, discomfort, or distress. Relatives told us: “I’ve never felt we had to wait for any staff to come.”

Patients were assured information about them was treated confidentially and they know staff respected their privacy. Staff followed policy to keep patient care and treatment confidential. The service had an information governance policy and staff were compliant with it. Conversations between staff and patients were kept private and sensitive information was never shared in the presence of those not authorised to hear it. Patients and their loved ones were able to share their fears for the future and were confident their concerns would not be shared with their loved ones.

The hospice and its staff had a strong patient centred culture with patients’ individual needs and preferences understood and reflected in their care. Staff had a strong understanding of patients’ human rights to dignity and respect and were able to act uphold these rights, even in challenging situations.

Patients’ personal, cultural, social and religious needs were understood and met.

Information about what was important to the person were clearly identified. This included information such as how to share bad news with their loved ones and their interests.

Staff supported patients to take part in activities they had been unable to for some time such as gardening within the specialised adapted garden with catered for their needs. There were many examples of caring and compassionate staff supporting patients for example pets stayed with their owners on the inpatient ward. There were special beds called cuddle beds.

Staff supported patients to enjoy “pamper” sessions in one of the “spa” bathrooms with spa lighting, jacuzzi bath, where they could enjoy their favourite music. One person told us staff had kindly agreed for them to bring bottles of wine in for a Cheltenham Festival Day with friends. Staff arranged movie nights with popcorn and arranged for takeaways to be brought in when requested. In fact whatever patients identified was important to them staff would endeavour to enable them to experience it.

Staff understood and respected the personal, cultural, social and religious needs of patients and how they may relate to care needs. The service respected the diverse nature of everyone. St Richard’s had a hospice chaplain who was available onsite to provide spiritual and bereavement support. The chaplain provided spiritual care to patients of all faiths and facilitated other leaders to come and meet the patient’s spiritual and religious needs. The hospice chaplain also attended and provided an active part in multidisciplinary meetings to ensure patients religious and spiritual needs were discussed. We heard examples of how the chaplain visited when difficulties or conflicts within families were identified. The “Sacred Space” was a room for patients to use for reflection and as a space to meet their cultural and spiritual needs, regardless of faith.

Patients’ communication needs were met. Staff could access translators in various languages including British Sign Language. This enabled patients to engage in their care, treatment and support.

St Richard's Hospice had a Carers Network which provided a forum to support carers and loved ones. Carers were invited to same wellbeing sessions as their loved ones.

Staff treated patients as individuals, considering any relevant protected equality characteristics. Staff respected the individual needs of each patient and showed understanding and a non-judgmental attitude when caring for or discussing patients with mental health needs. Staff received training in equality and diversity, so they understood, valued, and celebrated difference.

Staff received training on the ethos of the service so they had a clear focus on enhancing the lives of patients with a terminal illness to provide them with more quality time with their loved ones, and this meant finding out what mattered to them to promote their choices and give them control over what their care should look like.

The service was exceptional at helping patients to understand their rights and express their views so that staff and managers at all levels understand their views, preferences, wishes and choices.

The inpatient bedroom doors were wide enabling access for patients and visitors with mobility challenges who may require assistance whilst also promoting their independence. All bedrooms had direct access to their own patio area with additional accessible access to a large communal garden with several seating areas to enable people choice to be outside if they wished.

Patients were supported to have choice and control over their care and to make decisions about their care, treatment and wellbeing. Service user evaluation results showed more than 98% of patients and family members who responded felt they were involved in and had a choice about care. The survey also identified more than 98% felt they were listened to.

Specific feedback collated by the hospice, included “My husband did not want showering, being moved often for example his/ our wishes were quickly adhered to” and “I’m always listened to.”

Patients were supported to maintain their relationships and networks when being cared for in the inpatient ward. Friends and family were able to visit when the individual wanted them to and there were arrangements in place for overnight stays when required. Patients said staff always made them welcome.

There was a clear focus throughout the hospice on maintaining independence. Community support services were focused on maintaining health, wellbeing and daily living for as long as possible, to ensure the best possible quality of life. Equipment was available to promote patients’ independence, choice and control. One person said: “When I first came here, I was exhausted and could not cope and spent a lot of time in bed, I’m now stronger and able to get up and move around in a wheelchair.”

The service was exceptional at helping patients to understand their rights and express their views so that staff and managers at all levels understand their views, preferences, wishes and choices.

The inpatient bedroom doors were wide enabling access for patients and visitors with mobility challenges who may require assistance whilst also promoting their independence. All bedrooms had direct access to their own patio area with additional accessible access to a large communal garden with several seating areas to enable people choice to be outside if they wished.

Patients were supported to have choice and control over their care and to make decisions about their care, treatment and wellbeing. Service user evaluation results showed more than 98% of patients and family members responding felt they were involved in and had a choice about care.The service user evaluations also identified more than 98% felt they were listened to.

Specific feedback collated by the hospice, included “My husband did not want showering, being moved often for example his/ our wishes were quickly adhered to” and “I’m always listened to.”

Patients were supported to maintain their relationships and networks when being cared for in the inpatient ward. Friends and family were able to visit when the individual wanted them to and there were arrangements in place for overnight stays when required. Patients said staff always made them welcome.

There was a clear focus throughout the hospice on maintaining independence. Community support services were focused on maintaining health, wellbeing and daily living for as long as possible, to ensure the best possible quality of life. Equipment was available to promote patients’ independence, choice and control. One person said: “When I first came here, I was exhausted and could not cope and spent a lot of time in bed I’m now stronger and now able to get up and moving around in a wheelchair.”

Staff went to great lengths to make sure patients’ needs, views, wishes and comfort were their utmost priority. They went above and beyond to anticipate patients’ needs and took steps to ensure preventable discomfort, concern or distress for patients. We observed staff communicating and engaging with patients in discussions about their immediate needs. This included asking about their symptoms as well as what was most important to them at that point in time. Regularly checking how they and their loved ones were and asking about their pain, potential side effects such as nausea to ensure timely escalation would be made and ensuring they had the food and drink they wanted.

The service user evaluations also identified more than 98% felt they were listened to.

Patients said staff always made them welcome.

For those patients who wanted additional or alternative management of pain, anxiety or distress staff arranged for patients and loved ones to receive alternative therapies such as massage and aromatherapy which were available within the hospice.

Patients told us their needs were met. We observed staff on the inpatient ward responding quickly to patients’ needs. One patient told us ‘The staff make sure I am ok. We have talked about the future, and we are taking it one day at a time.”

Staff were able to anticipate when someone needed urgent care or had entered the dying phase to provide timely and appropriate support. Managers and staff had worked hard to identify when patients were in their last hours of life this included a recognition of Death Audit and reviews of patient deaths which included whether staff had recognised the patient was in the dying phase and had taken appropriate action. Associated learning was shared across the hospice. Recognition that patients were in the dying phase not only ensured their ongoing comfort but also enabled loved ones to be alerted and be with the person if they wished when they died.

We observed a visit to an end of life patient in the community. The nurse discussed their needs and confirmed their pain was now controlled, planned for additional staff visits and fast tracked equipment to be available for them to die at home. The staff member ensured the patients relatives had the number of the hospice including out of hours contact should the relative need support overnight. The relative told us, “St Richard’s has been supportive and helpful, X (the nurse) sorted out the miracle to get oramorph (a strong pain relief) and control their pain.”

The embedded culture of kindness and respect extended to colleagues who were treated with kindness and respect. Patients received safe, effective and person-centred care as the hospice recognised and met the wellbeing needs of staff. These included facilities for safe working in a pleasant and comfortable environment, rest areas and regular breaks. All staff we spoke to from the chief executive to housekeeping staff said they loved working at the hospice, and it was a privilege to care for their patients.

Patients benefited from staff who had regular opportunities to provide feedback, raise concerns and suggest ways to improve the service or staff experiences. If necessary, leaders provided a timely and considered response. The hospice managers ensured staff were listened to. As part of the recent transition to the service managers consulted with staff and further changes had been made because of staff feedback.

There was a culture of kindness and respect between colleagues from other organisations. Patients were supported by staff who feel valued by their leaders and their colleagues. They had a sense of belonging and the ability to contribute to decision making. The staff survey in 2024 identified 86% (104 staff) who responded said they felt their manager was interested and supported their wellbeing.

The hospice provided wellbeing events for staff, such as Menopause support, yoga, Men’s Health Week, Neurodiversity Week drop ins, Brew Monday, wellbeing walks, move and take a moment week. Volunteers were able to access these events.

Twice a year the hospice ran a summer and winter event to thank volunteers for their contribution to the Hospice. These events were important to foster a feeling of inclusion and provided the opportunity for social interactions. The hospice also had a volunteer Facebook group which encouraged community and interaction.

There were clear policies that supported staff and managers by providing clarity, clear expectations and ensuring consistency which encouraged a healthy work life balance through flexibility and family friendly policies. Psychological safety was promoted by means of open communication, Freedom to speak up guardians, regular one to ones with managers, open door access to Senior Leadership and People Services Team.

The Volunteer coordinator had provided guidance and signposting to support managers in proactive and reactive welfare support of volunteers.

The Family Support Team offered informal de-brief/support sessions to staff and volunteers when something traumatic had happened, or a team had been particularly impacted by a situation (for example the death of a colleague).

Volunteers were also encouraged to have open conversations with their line managers. Some feedback from the annual volunteer satisfaction survey was they wanted a way to feedback. Managers had responded to this by implementing a feedback feature which had been embedded within the monthly newsletter.

Staff had easy access to personalised support that recognised the diversity of the workforce with proactive and reactive measures. The service had 9 Mental Health First Aiders (MHFA) at the hospice available to support staff who were or may struggle with their mental health. Posters were on display on noticeboards throughout the hospice to identify the team. Most Mental Health First Aiders also wore a pin badge to identify themselves. The MHFAs had recorded 37 contacts with staff members since March 2024 to April 2025. Information was anonymous.

Patients’ experience of a service was driven by a culture that normalised good wellbeing through inclusivity, active listening, and open conversations. This enabled staff to do their job well and to be well.