Hospice at Home West Cumbria

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 looked for evidence that the service met people’s needs and that people and communities were always at the centre of how care was planned and delivered. We checked that the health and care needs of people and communities were understood, and they were actively involved in planning care that met these needs. We also looked for evidence that people could access care in ways that met their personal circumstances and protected equality characteristics.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s needs were met through good organisation and delivery.

This service scored 79 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The evidence showed a good standard. The service made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

Staff identified and responded promptly to changing risks to patients. They were aware of and dealt with any specific risk issues, such as falls or pressure ulcers and care planned for these accordingly.

Emergency care plans were developed with patients and their carers and agreed, prior to being added to the care record.

Staff based patient care around individual needs and preferences. For example, visit times were negotiated in advance with the patient and their family. Staff also told us about how they delivered care for patients with mental health issues, by focusing on maintaining normal routines, encouraging engagement with treatment, and empowering patients to overcome their symptoms of anxiety, which might otherwise trigger challenging behaviour.

Staff received training to help them care for people with dementia and learning disabilities and linked with external specialist nurses if advice was required.

The evidence showed a good standard. The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

Care was delivered to a wide and sometimes remote population. Pain management and potential emergency situations requiring anticipatory medication, were all assessed and planned for at the initial referral stage.

In cases where established ceilings of care were nearing reach, such that the service would be unable to meet individual patient care needs (for example, tracheostomy care), the provider involved community services and other hospice providers, to maintain continuity of care.

The support at home service facilitated hospital discharge and ensured a wraparound support package was available for palliative and end of life patients who met the fast-track criteria. The service allowed patients to be at home in their preferred place of care and death with their loved ones.

The service offered up to 3 one-hour calls per day, and included personal care, medication, pressure care, and emotional and psychological support for the patient and their families. The teams also escalated symptom management to the relevant professionals such as district nursing, specialist palliative care teams and GP’s.

The evidence showed a good standard. The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The service complied with the Accessible Information Standard. For example, written information was available in easy read formats such as large print, audio recording or braille. In addition, the service website carried an accessibility statement which explained how as many people as possible should be able to use it. For example, users could change colours, contrast levels and fonts and navigate most of the website using speech recognition software. There was signposting to advice on making devices easier to use if people had a disability.

The website had separate sections for patients, carers and professionals to access relevant information. It had a comprehensive section for staff to access with their own login details, and included information, policies, templates, calendar of events and other resources.

Managers submitted data returns online for national audit activities and made notifications to external bodies as needed.

Information governance systems included confidentiality of patient records. All records were completed via an electronic application, and computers were password protected. Staff logged out of programs when they were not using computers.

Staff ensured carers and families were regularly updated about the patient’s progress and they ensured patients could obtain information on treatments, local services, patient rights, how to complain and so on.

The evidence showed a good standard. The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result.

The complaints policy was available on the provider’s website and upon request.

Patients and their families knew how to provide feedback, complain or raise concerns. The service had received 1 formal complaint in the last 12 months, which was responded to appropriately. Staff and leaders knew how to handle complaints and when patients complained or raised concerns, they received feedback.

Staff also received feedback on the outcome of investigation of complaints and acted on the findings. For example, following an incident where there was no reception staff and the patient left without being seen. This was discussed with staff and a new procedure whereby staff personally met patients at reception, was implemented

Friends and family feedback forms we saw for April to June 2025 indicated consistently high satisfaction scores and high recommendations of the service.

The service also received positive written feedback from other clinical stakeholders. For example, we saw recent feedback which said; ‘’ I would like to highlight that this gentleman and his family appeared to receive excellent holistic support in the last days of life which allowed him to die peacefully in his preferred place of care.’’

The evidence showed an exceptional standard. The service was exceptional at ensuring people could access the care, support and treatment they needed when they needed it.

Referrals were received from health or social care professionals, specialist palliative care providers, the patient or their carers and relatives.

Leaders recognised the need to access as many people as possible. Managers we spoke with explained they had received referrals but could not initiate care until an assessment was completed. They used a ‘traffic light tool’ to help prioritise referrals; this incorporated clear guidelines for patient referral and ongoing support.

The support at home service was initially set up with a team in the north of the area. However, in November 2024, due to increased demand, a team was set up to cover the south area and effectively doubled care delivery.

Leaders also made changes to the lymphoedema service, which resulted in improved access to care, and an increase in education and awareness about lymphoedema management. For example, clinics increased to 5 days per week.

Prevention clinics were also introduced. Staff worked with the breast care team and the head and neck team to identify the patients most at risk of developing lymphoedema post-surgery and intervened with education and treatment where required.

In addition, they provided educational sessions to external health care providers about lymphoedema management, to enable them to manage non-complex lymphoedema patients. This reduced the number of inappropriate referrals and improved efficiency of care.

The evidence showed a good standard. Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

Leaders and staff were trained in equality, diversity, inclusion and human rights, and promoted a culture in which the people using the service felt empowered to give their views.

The provider had undertaken equality impact assessments of their policies and procedures to ensure they did not place vulnerable people or people with protected characteristics at a disadvantage.

The evidence showed a good standard. People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Staff supported patients to make informed choices and decisions about their care and treatment and their future, for example they discussed and documented preferred place of care and preferred place of death.

Staff created personalised care plans to account for the patient’s needs, wishes and feelings and care for people nearing the end of their life was managed and communicated in a sensitive and dignified way.

Staff ensured all relevant healthcare professionals and other relevant bodies, such as GP’s and community services were involved in planning the care and treatment of people with complex needs. Senior hospice nurses were scheduled to visit or undertake joint visits with members of specialist palliative care teams as and when appropriate, when complex needs or home situations were identified.