St Richard's Hospice

On this page

• 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 rated responsive as outstanding. We assessed all 7 quality statements within responsive:

person centred care, care provision, integration and continuity, providing information, listening to and involving patients, equity in access, equity in experience and outcomes and planning for the future.

The hospice was exceptional at ensuring patients were at the centre of their care and treatment choices. Staff decided, in partnership with patients, how to respond to any relevant changes in their needs.

Services were tailored to meet the needs of individual patients in a way that ensured flexibility, choice and continuity of care.

The hospice provided appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The service was exceptional at enabling patients to share feedback and ideas, or raise complaints about their care, treatment and support.

The hospice was exceptional at ensuring patients could access timely care, support and treatment, whilst promoting equality and protecting their human rights. Patients did not experience discrimination and staff worked hard to provide equity in access to care and treatment. Staff made reasonable adjustments where required and listened to patients’ concerns to improve the service.

Staff and leaders actively listened to information about patients who were most likely to experience inequality in experience or outcomes and tailored their care, support, and treatment in response to this.

Staff gave patients exceptional support to plan their care and treatment, so they could make informed decisions about their future.

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

This service scored 93 (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 was exceptional at making sure patients were at the centre of their care and treatment choices and they decided, in partnership with patients, how to respond to any relevant changes in their needs.

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

Patients 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. Patients understood their condition, care and treatment options (including any associated risks) and any advice provided. Recent examples shared by St Richard’s Hospice of how staff had supported patients social needs included arranging a visit of a footballer from the club the patient supported, arranging a film and sleepover for the patients two daughters, arranging a visit by a horse for a patient who loved horse riding, arranging a visit from a champion jockey for a patient who loved horse racing, arranging a pilot to draw a smile in the sky for an inpatient who loved aeroplanes.

Patient feedback the Living Well Team had received identified 10 am was too early for some patients. The, Living Well team have changed the start time to 10.30 am.

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

Services were tailored to meet the needs of individual patients 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 provided support to manage fatigue. Multidisciplinary therapists supported patients in the living well therapy centre of the service. People we spoke with were consistently positive about the care and treatment them and their loved ones received.

People we spoke with during the inspection told us how valuable the specialist nurses, family support practitioners, specialist palliative care social workers and specialist palliative care cognitive behavioural therapists had been in supporting them through their journey even after their loved one had died. Dedicated community teams supported patients and families in their home over sometimes lengthy periods of time to ensure continuity of care and treatment. One person told us, “My wife and sons can have a bespoke carers support session when its needed and my wife has been offered counselling sessions.”

Patients benefited from a warm and welcoming environment. Patients had their own bedroom space and access to various communal areas. This included quiet areas where patients could spend time with their family members, a faith room and areas for children and younger visitors and support to the patient and their loved ones. Relatives told us about the holistic care they and their loved one had received as a family. This included a Hospice at Home service, availability of bereavement counselling and strategies to manage the challenges of their loved ones disease.

The service took a proactive approach in understanding the needs and preferences of different groups of patients 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 patients individual needs and preferences were central to the delivery of tailored services particularly for patients with multiple and complex needs. We saw examples of communication tools used to support neurodiverse patients and specific staff training in how to support autistic patients or people with learning disability with their grief and bereavement.

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, a symbol based language and picture boards to aid communication with patients and relatives.

We saw how the service collaborated across the healthcare network to provide timely access to medication, equipment. We saw how the service collaborated across the healthcare network to provide timely access to medication and equipment.

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.

Care provision was all inclusive and complexity of care was a key consideration of the service. The service demonstrated this by providing a metastatic breast care service, intravenous therapy, tracheostomy care and feeding support to patients within the wider community as well as training and education to support local primary care colleagues. Work undertaken with the Integrated Care Board and local health economy considered the care needs of the local area. A rise in patients living with mental health conditions, dementia and frailty had been identified. In response the service had implemented professional health telephone lines, clinical outreach, and learning and education for the upskilling of key professionals such as GP's, community nurses and paramedics.

The service worked hard to understand and reflect the diverse health and care needs of patients and local communities. This included working with the homeless population at specialist day centres providing bereavement support to both staff and homeless people. The service had recognised patients with reading and writing challenges were less able and unlikely to communicate wishes and needs and as a result an art group had been set up to support advance care planning.

Feedback from patients who had used the service indicated that they sometimes felt that facilities could be intimidating “a place to die” where they may not be welcomed. Managers had introduced community engagement in response to feedback received. An Equality, Diversity and Inclusion forum was in place. Members of this forum linked with lesbian, gay, bisexual, transgender, queer, questioning, intersex, or asexual (LGBTQIA+) groups in the community to ensure the voice of the community was heard and services reflected their needs and choices. After liaising with local LGBTQIA+ community group Out2Gether,they changed some of the terminology on the hospice website to recognise a person’s biological family might not be the people they were closest to. On the Family Support pages of the website, it now says: “We also support the people important to our patients, which may include their biological or chosen family and carers.” This has demonstrated the hospice was inclusive to people whose loved ones were their chosen family, rather than biological relatives. Lunch and learn sessions helped overcome cultural and social barriers of older generations of LGBTQIA+ patients. The hospice had cared for several people from the LGBTQIA+ community and felt comfortable to share their sexuality with staff.

Staff representing the hospice attended Malvern Pride in 2024 and hosted a stand as part of the celebrations. The team shared information and resources about hospice care.

Clinical staff undertook mortality reviews which also considered whether spiritual care needs had been met. Staff used Makaton and easy read documents to support patients with learning disabilities.

The service had a psychological care facilitator within the Hospice at Home and community palliative care services. Managers looked at the local population to see if any particular groups of people were missing out on the service. Managers provided training in understanding Gypsy, Roma and traveler community people to all staff having recognised these as patients who experience barriers to accessing services. Managers also offered transgender awareness training to all staff to support better service delivery.

The hospice service worked to continually improve care, treatment and safety for patients and their loved ones. A palliative knowledge programme, family support, ‘my wishes’ document, what matters to me assessment and safeguarding advocate roles had all been created.

The hospice had sent out questionnaires about services the hospice provided to community groups. Feedback received identified some of the groups were unaware of services the hospice provided and did not realise they were free of charge. As a result of subsequent work undertaken community groups had been able to give more information to their communities and more patients had attended from these groups and benefited from services the hospice provided. In addition people from those community groups had become volunteers within the hospice.

The hospice provided appropriate, accurate and up-to-date information in formats that were tailored to individual needs. Patients 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.

Patients had information which met their individual needs. This included making reasonable adjustments for them, interpreting and translation for patients who do not speak English as a first language and for deaf patients who used British Sign Language. Information was also available in Easy Read for people who had a learning disability.

Staff provided support for patients who had difficulty with reading, writing or using digital services with accessible information. The service worked within the Accessible Information Standard.

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

Patients and their loved ones said staff took time to ensure they had the information they needed, and they understood it. The hospice provided a helpline 24 hours a day. During office hours the helpline was separately staffed, evening and weekends 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 benefits.

The service was exceptional at enabling patients to share feedback and ideas, or raise complaints about their care, treatment and support. Staff always involved patients in decisions about their care and told them what had changed as a result.

People we spoke with knew how to give feedback about their experiences of care and support including how to raise any concerns or issues. There were clear guides on how to complain and provide feedback. Managers dealt with complaints 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.

Patients and loved ones were encouraged to complete feedback questionnaires about their experience of the services. Staff collected the responses and evaluated these. Staff used the feedback to identify opportunities for improvement. Managers had reviewed systems for feedback and had made it easier for people to share their feedback. Patients could leave feedback either in writing or electronically. The electronic system provided immediate feedback to managers to enable them if needed to make immediate changes.

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

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. They had created information about the hospice and hospice services in Easy Read to assist people. Staff had engaged with students from a school for children with special needs to ensure the documents were suitable and clear to understand. A version of our ‘what to expect: signs and symptoms of the last days of life’ document was translated into Polish for a patient who needed to access this information in their own language. This information can also be used by other Polish speakers who may benefit from this information.

The hospice was exceptional at ensuring patients could access timely care, support and treatment, whilst promoting equality and protecting their human rights.

Patients and their loved ones were able to ring the hospice advice line and make a “self-referral.” Patients and their loved ones could also come to the “Wellbeing café” which was an open access event every Wednesday. The main advice line was open in normal office hours. Patients and their loved ones could telephone during evenings and weekends for advice. Patients and their loved ones in the community had a call from a clinician within 12 hours if they needed to be seen in their own home.

Patients 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 patients in the community. Urgent admission to the inpatient unit from the community was always prioritised.

Patients 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 throughout. In addition, the hospice had large outdoor gardens which were accessible for wheelchair users and people with mobility difficulties. There was also access direct from patients' bedroom onto a patio area outside their room. Patients who were too ill to get out of bed could be wheeled outside in their bed if they wished. The large gardens had raised beds to enable patients an opportunity to take part in gardening if they wished.

The onsite onsite sacred space and newly designed garden provided areas to give peaceful reflection.There was free onsite (including disabled) car parking and pleasant landscaped gardens. The hospice had a contract in place with a community transport charity provider, to provide transport for patients and family members. There were arrangements in place for people who couldn’t afford to pay for transport to use the transport free of charge.

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. Bedroom 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.

Patients 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 patients accessing care, treatment and support. The hospice complied with legal equality and human rights requirements, including avoiding discrimination, considering the needs of patients with different protected characteristics and making reasonable adjustments

The hospice used people’s feedback and other information to actively seek to improve access for patients more likely to experience barriers or delays in accessing their care. When there were barriers, they were removed. After liaising with local LGBTQIA+ community group Out2Gether, they changed some of the terminology on the hospice website to recognise a person’s biological family might not be the people they were closest to. On the Family Support pages of the website, it now says: “We also support the people important to our patients, which may include their biological or chosen family and carers.” We hope this helps show how the hospice is inclusive to people whose loved ones are their chosen family, rather than biological relatives.

Staff ensured patients knew the service was completely free of charge. There had been several initiatives to deliver this message which included disadvantaged groups. This included work with health professionals and local community groups. In addition staff had provided an education session for staff from homeless hostels to highlight what the hospice did and how they could ensure people experiencing homelessness could access services. As part of this training staff identified a need for bereavement support (staff and those experiencing homelessness), this was now in place.

Staff and leaders actively listened to information about patients who were most likely to experience inequality in experience or outcomes. Staff tailored their care, support, and treatment in response to this.

The hospice attended Malvern Pride in 2024 and hosted a stand as part of the celebrations. The team shared information and resources about hospice care.

Leaders proactively sought ways to address any barriers to improving patients’ 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 patients’ experience and outcomes.

Staff and leaders were alert to discrimination and inequality that could disadvantage diverse groups 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 gypsy travellers that mirrors should be covered after death, and that beard trimming was against the Sikh communities 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 caring for patients with palliative and end of life care needs. This included patients with dementia and those with learning disabilities. Staff had completed training in supporting patients with dementia, learning disabilities and autistic patients.

Staff gave patients exceptional support to plan their care and treatment, so they could make informed decisions about their future.

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

Patients’ decisions and what matters to them were delivered through personalised care plans that were shared with others who may need to be informed.

When patients wanted to express their wishes about cardiopulmonary resuscitation, they were supported to do so and were able to change their mind if they wished.

When any treatment was changed or withdrawn, clinical staff communicated and managed this openly and sensitively, so patients had a comfortable and dignified death.

When patients’ future care preferences were for greater independence and fewer care interventions that were likely to benefit them, professionals worked together to support them to achieve their goals.