St Joseph's Hospice Association

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

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

St Joseph’s Hospice maintained a patient-centred approach. Patients were assessed on admission, and personalised care plans were developed. Multidisciplinary team meetings (MDT) supported holistic care and adherence to national guidance. Risk assessments and pain monitoring were sometimes inconsistently documented, but staff responded promptly to patient needs, including complex cases such as tracheostomy care.

Teams worked collaboratively to meet patients’ physical, emotional, and nutritional needs, while families were actively involved in care planning, consent, and decision-making. Feedback was collected via the “I Want Great Care”.

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.

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

St Joseph’s Hospice had a non-medical prescriber (NMP) nurse who was trained to manage patients’ symptoms. All patients were assessed on admission, and an appropriate care plan was developed to meet their individual needs. The initial assessment included a review of the patient’s medication and symptoms to ensure that the hospice had all necessary resources in place to provide the highest standard of care and support to patients and their families.

The IPOS (Integrated Palliative Outcome Scale) tool was used to document and monitor evidence-based care and treatment. The completed IPOS form then generates a discussion at the MDT meetings, which is formally documented in the MDT booklet for each patient.

Food, including pureed meals, was of good quality and adapted to meet patients’ individual needs to ensure optimal nutrition. Meals were often homemade and incorporated home-grown produce.

The clinical service was inspected twice yearly by the trustees.

However, we had some concerns regarding patient risk assessments and the frequency of completion. They were to be completed on admission and then every following month. There was a diary in place to alert staff members when risk assessments were due for review for each patient. However, there were no examples of risk assessments that had been repeated earlier due to clinical changes and/or deteriorations. There was a risk to patients that their risk assessments and subsequent recommendations were not reflective of their individual need.

The application of risk assessment tools, including Waterlow score (This Waterlow score calculator predicts the risk of developing pressure ulcer or sores), MUST (Malnutrition Universal Screening Tool), and the Abbey Pain Scale, was inconsistent. While staff were observed responding to patients’ pain, there was no clear evidence of how pain was monitored systematically. This raised concerns about how non-verbal patients communicated pain and whether it was being effectively tracked.

There were initial concerns that repositioning was not being carried out within the required timeframes. However, the provider later supplied information indicating that repositioning had taken place, although this was not consistently documented. While patients appeared well cared for, it was not possible to clearly determine the care that should have been provided compared with the care that was delivered. Care records were disorganised, which limited assurance.

We scored the service as 3. The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well

Staff ensured that care was provided in line with national guidance. The multidisciplinary team (MDT) discussed patient care with the palliative care consultant, and staff were supported to remain up to date with national guidance, NICE guidance (National Institute for Health and Care Excellence), the palliative care formulary, and the IMPaCT team. The palliative medicine consultant delivered sessions on managing deteriorating patients, and staff presented their own patients during MDT meetings.

The MDT used tool and frameworks to monitor outcomes which included IPOS (Integrated Palliative Outcome Scale) which captured the patient’s perspective on psychological, emotional, spiritual, and practical symptoms and PPS (Palliative Performance Scale): assessed functionality, including ambulation, activity level, self-care, intake, and consciousness.

When staff were unsure about patient management, they discussed concerns with the consultant, who was present weekly on Wednesdays and was always contactable for support. Staff training on medications, and formularies were regularly reviewed to ensure compliance with best practice.

The hospice ensured that staff followed guidance when a patient was admitted for a short period with a tracheostomy. A strict care regime was implemented, and all relevant staff completed the required training to manage the patient safely. Staff reported feeling confident to manage care going forward. A clear care plan was drawn up, consumables were prepared, and guidance on tracheostomy management was provided and followed by all staff.

No cancer-specific pathway was followed, as the hospice cared for patients with a variety of conditions and diagnoses. Person-centred care was provided, and care plans had been cooperatively written with patients and staff to meet individual needs.

During 2024/25, two patients requiring more complex care, were transferred to a neighbouring hospice, representing 0.99% of admissions. Between April and August 2025, eight patients (9% of those cared for to date that year) were discharged because Continuing healthcare (CHC) funding had been withdrawn.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

The hospice maintained a good working relationship with partner hospices.

Staff rotated teams every six months, with registered nurses (RNs) rotating first, followed by healthcare assistants (HCAs) once the RNs had become familiar with patients. This rotation was neither viewed as wholly positive nor negative.

The inpatient unit manager (IPUM), and ward sisters attended every unit at 8am to ensure safe staffing levels and adequate patient care. Staff were moved between units if required to maintain appropriate staffing levels, particularly during periods of staff sickness or high patient dependency. The ward sister or IPUM on shift assessed patient needs and redistributed staff accordingly.

RNs checked the nurse diary daily to identify tasks, including prescription requests or patients requiring a review by the doctor. All staff, including HCAs and RNs, were familiar with all units due to regular rotation. Full handovers were provided each morning at 8am and each evening at 8pm detailing patients’ histories, nutritional needs, and required staffing levels.

Ward sisters or IPUM conducted daily walkarounds to check staff wellbeing and address any patient concerns. Where necessary, issues were escalated to the doctor, and ward sisters or IPUM remained on the unit to support staff. Staff communicated effectively throughout the day and sought guidance from the IPUM, or ward sister as required. Family support was provided by all staff.

Ward sisters or IPUMs supported new admissions, introducing themselves to patients and families. If the doctor was unavailable during a new admission, the medication management assistant, ward sister, and non-medical prescriber worked together to check patient medications and commence MAR chart administration. The doctor then attended to prescribe any required medications. For complex cases, the palliative care consultant provided updated clinical letters and treatment plans.

Staff collaborated closely with the family support worker to address any patient or family concerns. Meetings were held with the ward sister, IPUM, and family support worker as needed. Patients and families were informed of formal complaint procedures if issues could not be resolved.

HCAs and RNs worked closely with catering staff to ensure patients’ nutritional needs were met, using the nutritional assessment tool. The team informed catering when a patient was on end of lifecare or had passed, allowing meals to be offered to families. After a patient’s discharge or death, RNs notified cleaning staff verbally or via the nurse diary that rooms required thorough cleaning.

Multi-disciplinary team (MDT) meetings were held most Wednesdays, attended by the consultant, doctor, family support worker, medication management assistant, registered nurses, and IPUM or ward sister. Patients were reviewed collaboratively, with the family support worker providing the IPOS score to represent the patient’s perspective. This score was evaluated to ensure appropriate care and support. The MDT focused on a patient-centred, holistic approach. Each case was reviewed individually to ensure a comprehensive care plan appropriate to the patient’s stage of illness.

All MDT members contributed actively to discussions and decision-making. The goals were to ensure patients received care aligned with their current needs and wishes, medication and clinical care plans were appropriate and up to date, safeguarding or capacity concerns were identified and acted upon, and tasks were delegated and followed up. This structured, collaborative approach maintained high standards of care tailored to each patient’s journey.

Score 3

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

Community engagement initiatives included the Hospices’ ‘Bake Box’ (bakery stall), footpaths, garden pods, and connecting paths, all of which were made accessible to the local community. Members of the community spent time on the hospice grounds, supporting a range of activities.

The hospice had 170 local volunteers who contributed across various areas, including the shops, hospice services, and gardening projects. A volunteer worked in ‘Mary’s Garden’ and collaborated with a local florist and garden centre.

Hospice beekeepers maintained the on-site beekeeping setup and sold the honey produced.

We scored the service as 3. The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Data was used to improve patient outcomes. The hospice routinely used the Integrated Palliative Outcome Scale (IPOS), which was undertaken weekly to capture patient issues. Discussions within the MDT and with patients allowed outcomes to be monitored and plans to be adjusted in response to deterioration. Escalation plans were in place, describing the approach in collaboration with registered nurses, senior staff, and family members when patients were responsible for decision-making. The out-of-hours service, provided by the IMPaCT team based at a neighbouring hospice was used as required. An example included managing a patient who refused a blood transfusion, where the patient was assessed as having full capacity.

The hospice used the online system “I Want Great Care” to review patient feedback. Themes and suggestions were analysed. Open forum meetings for staff were held every three months, and staff could also provide feedback anonymously via the system. Although attendance at meetings was sometimes low, anonymous submissions were used to resolve issues in real time while management were present.

Care files were reviewed monthly or sooner if any changes were made to a patient’s care or requirements. During each review, a monthly summary of care provided to the patient was generated, and a copy was given to the patient and their family. They were invited to read and agree or request amendments to the care plan. The nurse and/or patient and family discussed any required changes, and care plans were updated accordingly. The monthly summaries provided an overview of the care and support delivered, enabling patients, families, and staff to ensure agreement on the care provided. This process also supported safe and effective patient-centred care. All monthly summaries and care plans were kept in the patient’s care file, which staff could access at any time to remain informed about the patient’s needs.

The Integrated Palliative Outcome Scale (IPOS) was used weekly to ensure that patients’ holistic needs were met. It captured data on physical, psychological, emotional, spiritual, and practical needs from admission to the end of the patient’s hospice journey. It provided an overall profile score, detected changes in disease progression or priorities, and gave patients a voice in their care. The Palliative Performance Scale (PPS) was also used as a communication tool to describe a patient’s current functional level.

Preferred place of death was discussed with all patients on admission. Although no audits were conducted, all patients referred to St Joseph’s Hospice had a prognosis of a few weeks to a short number of months and were in receipt of fast-track funding. Patients with capacity received a full consultation with the doctor and nurse, while discussions for patients lacking capacity were held with the next of kin. These discussions reviewed whether the patient and family were comfortable with hospice admission and considered their preferred place of care or death. Home death was discussed where appropriate, noting that patient condition and required support could limit this. Patients were regularly reviewed, and preferences sometimes changed. Over the past six months, six patients chose to return home, while two patients were transferred to a nursing home because they had been admitted to the hospice earlier than desired and required more social input than the hospice could provide.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

The admissions booklet contained consent forms for the sharing of information and administration of medication. All risk assessment booklets and admission booklets included consent forms, which were signed by the patient or a family member on admission to the hospice or within the first 24 hours. These forms were audited monthly as part of the care file audits. There had been no requirement to undertake a separate audit specifically for consent, as this was incorporated within the care file audits.

Patients and their families were asked about the presence of Lasting Powers of Attorney, Advanced Statements, Advance Decisions, or an Advance Care Plan.

The Consent to Care Policy, Version 3, had last been reviewed in June 2023. The policy provided guidance on voluntary consent, obtaining consent, non-verbal and verbal consent, capacity and consent, best interest assessments, Advance Care Planning (ACP), Lasting Powers of Attorney, and Court-Appointed Deputies.

Appropriate mental capacity assessment forms and Best Interest decision-making forms were in place and were routinely used at the hospice.