The Shakespeare Hospice

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 people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people 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.

People were involved in assessments of their needs. Staff reviewed assessments taking account of people’s communication, personal and health needs. Care was based on the latest evidence and good practice. Staff gave people information to support healthy living. They made sure people understood their care and treatment to enable them to give informed consent. Staff involved those important to patients to make decisions in people’s best interests where they did not have capacity.

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.

People’s needs were comprehensively assessed and included consideration of their physical, mental health, social and communication needs.

Assessment was done as soon as possible after referral. This was typically months before palliative end of life care was expected. However, patients on a discharge home to die pathway were assessed as soon as possible after their referral was received. This was normally the same day or the following day if they were not discharged until the evening. The assessment included looking at the needs of the patient to understand if they could be met by the team or if they may need to be met by or in conjunction with additional domiciliary care service providers, an inpatient hospice, or by an alternative health care provider.

Staff told us they used a person centred and holistic approach to assessing patient needs. This was to ensure patients received care and treatment that was specific to their individual needs and took the whole person into account, their psychological health and wellbeing, practical and social needs, as well as their physical health. Where appropriate, families, carers, advocates, and other professionals working with the patient were meaningfully involved in the assessment process.

Physiotherapy and occupational therapy assessments were typically done at home to ensure patient’s environment was taken into consideration when developing a treatment plan.

Handover meetings took place at the start of each shift, so staff knew what changes there had been in a patient’s psychological and emotional needs, as well as their medical and nursing needs, since they had last cared for them. Staff worked as part of a multidisciplinary team to continuously assess the changing needs of patients.

Assessments were regularly reviewed and updated to make sure the information was current, and care, support and treatment was meeting people’s needs and individual outcomes as expected. The needs of family members were also assessed so the team could identify what support carers might need to continue to participate in providing care to people using the service. For example, counselling services or respite care.

Staff kept clear and comprehensive care records to support reviews and evidence of appropriate action taken in response to changes were noted.

Staff and leaders understood the current legislation, national standards and evidence-based good practice guidance relevant to their service, and they applied these effectively. They had good systems for ensuring they kept up to date and embed this in their service.

The provider was a member of local multidisciplinary end of life specialist, and expert, palliative and end of life care groups. These groups worked together to produce evidence-based guidance on clinical care, care pathways, and service provision.

Patients receiving end of life care in their own homes were visited by staff twice a day. At those visits patients received personal care and symptom management. Staff worked as part of a multidisciplinary team to assess and reassess patient’s treatment needs and consider how they could improve their treatment outcomes (reduce symptoms). Staff asked patients questions about their symptoms so they could provide symptomatic relief. Symptomatic relief could be administered through the range of medicines, including anticipatory medicines, that had been prescribed to the patient.

Staff used tools to help them assess patients end of life care needs including the Karnofsky Performance Scale (KPS) and the Integrated Palliative care Outcome Scale (IPOS). The KPS is a tool to assess a patient's functional ability and need for care and monitoring of disease progression. The IPOS is a tool to assess a patient's symptoms and their physical, psychological, social, spiritual wellbeing. It is used to improve care, monitor effectiveness, and can help capture what truly matters to the patient.

Staff used other nationally recognised tools to assess and monitor risk. For example, of pressure ulcers.

Staff, teams and services worked together with patients and their relatives to effectively deliver coordinated, timely, consistent, person-centred care, support and treatment.

People benefited from a multi-disciplinary approach where staff communicated effectively to ensure their needs and preferences were met. Staff told us there were regular multidisciplinary meetings to discuss people and improve their care and outcomes.

Information was effectively shared between teams and services working together to deliver patients care. This meant all relevant staff understood people’s needs, how they would be met and by who, for example when clinical tasks were delegated or when people were referred between services. The team were responsible for being a single point of access (SPOA) for referrals for end of life hospice care in South Warwickshire. A SPOA is a streamlined system for accessing services through a single contact for referrals to get patients the right support faster and ensure no referrals were overlooked. The SPOA worked with their system partners to prevent hospital admission and support discharge from hospital for people in the last 4 to 6 weeks of their life. The SPOA ensured all referrals for hospice care for people who were in the last weeks and days of their life were reviewed at a daily meeting that included other local teams working as part of the end of life network. Other teams included, local hospices, the palliative care nursing team, local hospitals, the clinical outreach team and the district nursing team.

The SPOA assessed patient’s clinical priority, ascertained capacity within the network, and identified which team could meet patients care best. For example, if someone was waiting to be discharged home from hospital to die but their closest hospice did not have capacity for a new patient, they would identify which team had capacity and could provide care from the point of discharge. This might involve 2 teams, like a hospice and district nursing team, working together to ensure 2 visits to deliver care could be made to the patient each day. The team had a strong focus on keeping community patients out of hospital whenever possible especially when patients planned place of death was at home or in a hospice.

The whole staff team worked collaboratively to make sure people's healthcare needs were effectively treated and met. The team included medical and nursing staff, nursing assistants, occupational therapists, physiotherapists, complimentary therapists, administrative staff.

The hospice at home team worked in partnership with, doctors from acute NHS Trusts, GPs, district nurses, and other community teams delivering care to patients in their homes, and domiciliary care agencies.

After death, staff sent the GP a bereavement form and let other teams know working with the patient that they had died. Staff also let their counselling team know about the death so they could offer bereavement support to relatives that wanted it.

One healthcare professional working alongside the team told us, “The Hospice team have been superb with me and with the family. The communication has been outstanding, and their range of skills are outstanding”. They went on to say, “Staff are approachable and friendly and accepting of me”.

The service identified risks to people’s health and wellbeing and prioritised support to prevent deterioration as much as possible. For example, supporting people to remain as active and mobile as possible.

At support visits to patients’ staff gave information about health and wellbeing including information about diet and nutrition, supplements, and sleep. They also spoke to patients about receiving support from the therapies team and community-based teams for example, the speech and language team. We saw staff give patients, relatives, and carers advice on mouthcare, and on preventing pressure ulcers.

The complimentary therapists told us about the natural treatments they provided that could help treat nausea, pain, and improve sleep.

The service ran a 7 week ‘living well’ course. The course gave patients access to the therapy team including a dietician, occupational therapist and physiotherapist as well as the nursing team. Sessions were used to discuss topics such as advanced care planning, pain management, and managing stress.

The service understood what expectations and positive outcomes looked like according to legislation, national standards and evidence-based good practice guidance relevant to their service.

People and their relatives told us staff were good at monitoring them to ensure they received the right pain relief when they needed it. They also said they were given support to meet their psychosocial needs.

Staff, including the therapy team, measured patient outcomes using the IPOS and the KPS. The IPOS was used at the initial assessment to gain an understanding of the patient’s baseline satisfaction with the physiological, emotional, and social wellbeing. It was used again at different points in a patient’s treatment journeys to gain an understanding of changes and where more intervention might be required. However, staff said not all patients were well enough to have an IPOS completed. At the time of our inspection the service did not have the software required to analyse the IPOS and KPS data and convert this into demonstrative information. However, despite this lack of software staff were still able to identify trends (declines or improvements in individual patient scores) and act on them, which demonstrated they were still maintaining patient care through manual monitoring.

Staff spoke at length about the importance of working to ensure patients were not in pain and told us how they worked as part of a multidisciplinary team to monitor patients and review their care to provide relief from pain and to improve psychological functioning.

The service ran an ‘I want great care’ survey to measure patient and relatives’ satisfaction with the service. Outcomes were shared with staff every 2 months. People could give a satisfaction score of up to 5. The hospice was consistently scored 5 stars based on peoples’ 100% positive experiences, including their overall experience, dignity and respect, involvement, information, caring, trust, and the level of support from staff. The feedback for the hospice at home service showed consistently high levels of satisfaction from both patients and their relatives. The team was scored 5 stars in August 2025, 5 stars in October 4.99 stars in December 2025.

Patients’ rights and decisions around consent were understood and respected by staff and the service.

Patients and their relatives told us treatment options were discussed with them so they could understand what they were consenting to.

Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent. They knew how to support patients who lacked capacity to make their own decisions.

When patients could not give consent, staff made decisions in their best interest, taking into account patients’ wishes, culture and traditions.

Staff spoke of patients and their relatives as partners in decision making.

During assessment staff asked patients for their written consent to share their information with the GP and other healthcare providers. Consent for care at home was given verbally at the point of care. Staff recorded consent after the care episode on the electronic patient record (EPR). For example, we saw staff asking for verbal consent to photograph a pressure ulcer. They explained the photograph would be used as part of their monitoring and to formulate any changes required to the treatment plan. The patient gave consent and this was recorded in their EPR.