The Shakespeare 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 looked for evidence 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. We also looked for evidence that people could access care in ways that met their personal circumstances and protected equality characteristics.

Services were tailored to meet the needs of individuals and delivered to ensure flexibility, choice and continuity of care.

People and communities were always at the centre of how care was planned and delivered. The health and care needs of people and communities were understood, and they were actively involved in planning care that meets these needs. Care, support and treatment was easily accessible, including physical access. People could access care in ways that met their personal circumstances and protected equality characteristics.

This service scored 86 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider 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.

Staff worked with patients when their needs changed to consider the care and treatment options which best met their changing needs. The service offered experienced nursing care for patients approaching the end of their lives, who wished to remain at home, surrounded by those who were important to them. This included specialised care and advice to prevent hospital admission, and emotional and psychological support for patients and their families and carers. Registered nursing staff had expert knowledge in assessment and management of physical symptoms, including administration of medications.

Patients had access to a physiotherapist and an occupational therapist. The occupational therapist assisted people to use their strengths to prevent deconditioning. People could have a block of 8 occupational therapy appointments to assist them in maintaining or gaining strength and confidence to meet as many of their own needs as possible. For example, using the toilet unassisted, or having a wash without support. If a patient was referred immediately prior to their death and it was identified they would benefit from occupational or physiotherapy an urgent referral to a community therapy team could be made.

The service offered complimentary therapy to patients and their family members to help reduce stress and anxiety, improve sleep and an overall sense of wellbeing. The clinical aromatherapist made patients bespoke aromatherapy products including lip balms to assist with mouth care, and balms and sprays that could be used to help improve sleep and reduce anxiety. These products could be safely used alongside prescribed medicines.

Staff provided appropriate support to maximise people’s involvement in decision making and care planning, so it genuinely reflected their needs and preferences. This included making reasonable adjustments and enabling involvement from people that mattered to the person using the service. Staff told us they asked patients about the people who were important to them to make sure that the right people were listed as their next of kin. They recognised that some people may prefer not to openly discuss aspects of their personal relationships, and they approached these conversations with tact and sensitivity. They were able to demonstrate to us the types of conversation they might have to help people feel comfortable identifying important people.

Staff received training to support them to communicate with a range of people with additional support and communication needs. For example, staff received training to help them support patients with a learning disabilities and autistic people. They also received training and ongoing support from a specialist dementia team to assist them to work with patients with dementia.

A variety of sessions were held at the hospice to support patients and their relatives. Sessions included the living well course, a lunch club, a gardening club, and music and singing sessions. These sessions were designed to provide a sense of community and mutual support. They were spaces for people to be able to talk openly about their experience of living with a life limiting or terminal illness, to share their thoughts and feelings and know they were not alone.

The physiotherapy and occupational therapist ran inclusive exercise classes that could be enjoyed by wheelchair users. These included tai chi, circuits classes and guided mediation sessions.

People could access counselling services. Patients could access counselling to explore their feelings about living with life limiting and terminal conditions. Relatives could access counselling to explore their feelings around bereavement. Children and young people could access bereavement counselling. These could be individual sessions or group support sessions that were designed to allow children to speak openly together about their feelings about the death of a parent or other relative.

The provider had an exceptional understanding of the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

The service understood the diverse health and social care needs of the patients that used their service and the local communities and tailored its support to meet those needs. This included understanding the needs of people most at risk or of a poorer experience of care. For example, elderly and socially isolated people, people living in rural communities, and people with caring responsibilities. Staff described a proactive approach to meeting the care needs of the local community and working with other healthcare professionals to ensure continuity of care. They worked as part of multidisciplinary teams with patients from broad diagnostic pathways including cancer, cardiac, respiratory, neurological, dementia, and frailty.

The provider offered patient and carer well-being services to help people live as independently as possible in their own homes and communities. When the patient or family were being supported by more than one service or by unpaid carers, staff worked in a transparent, collaborative, flexible and open way to make sure care was joined up for people.

Continuity of care was enhanced through a shared electronic patient records (EPR) system. The EPR was used by most of the other teams involved in patients care, including the district nursing team, the community palliative care team, and most GP surgeries. This gave staff access to accurate and up to date information about patients.

Staff and leaders understood the importance of continuity for people reaching the end of their life and for their family members. Whenever possible the same staff members would carry out visits. This was so they felt familiar to the patient and family and people did not think they needed to retell their story to somebody new. Relatives gave the following feedback to the service, “The last few days of [patient’s name] life were particularly difficult for many reasons. The care and attention from the hospice team was professional but very personal. It meant a great deal to me that at a time when I needed additional support to continue to care for [patient’s name] at home. It didn't feel intrusive or that I was being cut out. I am especially grateful that in the final 24 hours [name of staff member] was able to see [patient’s name] morning and night, and then the following morning after he had passed. This was a very upsetting time for my son and I and knowing that the same person was there with us on that journey was invaluable. While all of the team are amazing and we got to know all of them, the continuity at that end stage was comforting and made the situation a little bit more manageable. The care and compassion for [patient’s name] even after he had passed was especially comforting, and to be able to allow his parents and sister to say a final goodbye at home was very special, none of which would have been possible without [name of staff member].

Care delivery was consistently aligned with what mattered most to patients and families. Staff worked to ensure care was joined-up, flexible and supported choice and continuity. A medical professional who worked alongside the team gave the following feedback, “As someone who has worked alongside the Paediatric team for many years, I have heard the fear experienced by families and witnessed the challenges faced when patients move from paediatric to adult services. The support that your teams have been able to provide is an example of exemplary care and a standard that is difficult to achieve in any other setting”.

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

Staff understood and applied the policy on meeting the information and communication needs of patients with a disability or sensory loss. Staff, including volunteers, told us they were informed about people’s communication needs so they could interact more effectively with them.

Staff appropriately identified people’s individual communication needs to make sure information was always provided in an accessible way. This included making reasonable adjustments for disabled people, interpreting and translation for people whose first language was not English, including people who used British Sign Language. People who had difficulty with reading, writing or using digital services were supported to access information.

If patients had communication aids staff used these to ensure patients were partners in their care and treatment. If staff thought patients could benefit from communication aids they made a referral to the external team best suited to support with the assessment and implementation of necessary aids.

The provider’s website contained a range of information for patients and relatives, including what services the hospice provided, and how to make a referral. The website had a recite function so people with a sight impairment, or people who could not read English could listen to the information on the website. Text size could be altered, and the screen could be magnified to make browsing the website easier for people with sight impairments. The website could also be viewed as text only. The website could be accessed in 105 languages.

Patients and families receiving hospice at home care were given a booklet so they understood the care that was being offered, and so they could look at some answers to the frequently asked questions. Staff used a space at the back of the booklet to write the telephone number of the nurse in charge so they could contact the team by phone between 8.30am and 10pm. Staff gave leaflets to relatives about what happens after death, so they understood what steps they needed to take, for example, to contact a funeral director, and register the death.

People and relatives told us staff took time to ensure information was being delivered in a way they understood. We heard staff being friendly and reassuring when they provided information to patients and their families and carers. Staff gave people time to ask questions.

Staff checked with patients to establish if they had understood all of the information provided. They also checked patients understood why they had been referred to the service. Staff were open and honest with the discussions held, providing patients with relevant information regarding their condition. They explained to patients and relatives they did not mind how many times people ask the same question, staff reassured them that they had time to answer questions and they would always be happy to do this.

Staff made sure patients living with mental health problems, learning disabilities and dementia, received the necessary care to meet all their needs. They achieved this by working collaboratively with people and specialist support services.

The provider enabled people to share feedback and ideas, and raise complaints about their care, treatment and support. Staff always involved people in decisions about their care and told them what had changed as a result.

Staff collaborated with partner organisations to help improve services for patients. The team used a patient led approach to design their motor neurone disease (MND) clinic. By listening to and involving patients and their relatives in the design of the clinic they created a multi-disciplinary service that reduced the burdens and challenges expressed by patients with MND and their families. The service enabled people to avoid travel to acute hospitals, access care closer to home, receive a holistic assessment in one place, gain early introduction to hospice services, and experience personalised and coordinated care.

Staff described a culture of active listening, responsive and personalised care. We observed how this impacted on the experience and dignity of patients and their family. Staff were alert to immediate needs and took the time to involve patients in decisions about their own care. Families were treated as active care partners and were involved in decision-making and kept informed of clinical progress. A quote from a relative on the provider’s website illustrates the value of this approach, “The support I received from the Hospice nurses was invaluable. They took the time to listen and really worked hard to ensure my husband did things his way right up until the end.”

Patients and their relatives and carers understood how to give feedback, share ideas or complain about care, support and treatment. They could do this in a way that met their needs. There were posters about providing feedback in patient areas. The posters included a quick response (QR) code that could be scanned using a mobile phone so people could leave feedback quickly and easily. There was a suggestion box in the reception and pens and paper so people could leave feedback for people who could not or did not want to use a mobile phone.

In the 12 months before we inspected the service had not received any complaints. However, staff told us they saw concerns or complaints as an opportunity to improve the service and the quality of care people received. Staff gave positive examples of how they incorporated learning into their work.

The provider ensured people could access the care, support and treatment they needed when they needed it.

The service played a system-leadership role in reducing inequalities across South Warwickshire through their role as the single point of access (SPOA) for hospice care. Staff used internal processes and nationally recognised tools to manage a structured and fair referral pathways. The tools ensured equitable decision-making, timely first contact, and responsive, needs-led visit frequency.

The team also responded to system pressures across the whole of Warwickshire to ensure patients were not disadvantaged by external service pressures. For example, when another local hospice within Warwickshire experienced a gap in service delivery, the team worked immediately with partners, including district nursing teams, to ensure all affected patients continued to receive uninterrupted care.

Leaders and staff were alert to discrimination and inequality that could disadvantage different groups of people in accessing their service. The team had a proactive approach to addressing variation and closing equity gaps. They actively tracked GP referrals to enable targeted engagement with practices with lower referral activity.

Staff worked with people from underserved groups who had traditionally faced barriers to hospice care, for example people from homeless, waterway, and travelling communities. This was achieved through outreach work and aimed to strengthen trust, build pathways into support, and reduce inequality at a community level.

Reasonable adjustments were made to ensure equal access to the service for everyone to remove barriers for people who may have found it hard to access services. For example, staff addressed communication barriers and the building had accessible premises and equipment.

Although there are regional variations hospices typically receive around 20% of their funding through the NHS and rely on donations and fundraising activities for the rest of the income required to operate at capacity. At the time of our inspection funding streams enabled the hospice at home team to provide personal care and symptom control for up to 3 adults with a terminal illness that no longer responded to curative treatment, and who were in the last 6 to 8 weeks of their life at the start of their hospice at home care. This also enabled them to provide support for the whole family, including emotional and psychological support as well as practical advice. The service was also providing day hospice services and support visits to 80 patients with life limiting or terminal illness, and psychological and practical support to their families and families of deceased patients.

However, the number of patients in the last weeks and days of their life the team worked with at any one time could be restricted by the location of patients. For example, if 2 patients requiring care were located at either end of South Warwickshire this might mean there was not enough time for a third patient to be supported at home. However, staff told us they ensured patients with the highest clinical need received the support they needed wherever they were located through their role as the SPOA for end of life care for people in their last 4 to 6 weeks of life in South Warwickshire. Their role as the SPOA meant they were able to identify other services in their local end of life network who had capacity to provide care if they could not. The network included teams from other local hospices, the palliative care nursing team, the clinical outreach team and the district nursing team.

The hospice at home staff worked from 8.30am to 10pm, 365 days a year. The hospice staff provided day hospital services to all the patients on their caseload, this could include group activities at the hospice or palliative support visits to patients in their home.

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

The provider recognised people could experience disadvantages because of the circumstances surrounding their ill health. For example, they recognised factors like homelessness, substance dependency, poverty, or lack of support systems created barriers to care. Rather than providing a one size fits all approach staff worked to ensure people were not disadvantaged by these circumstances and tailored the support they offered to meet individual needs. For example, by offering flexible visit times or introducing support for the patient of family through individual or group sessions, the companionship service, or introducing domiciliary care services.

People had good outcomes and experiences of the service regardless of their needs, backgrounds or protected characteristics under the Equality Act. Leaders and staff worked with partnership agencies to improve access to treatment for people with a learning disability, homeless people, people with dementia, and people from different faith backgrounds. For example, once a month a member of the team attended a day centre for people who were homeless. They ran a drop in for people to sit and discuss any questions they had about death and dying. This gave staff an opportunity to explain what the hospice could provide and the different ways they could support people in the last months and days of their life, to ensure the care provided met their individual needs and preferences.

After death relatives were sent a card offering the condolences of the team and proving information on the bereavement support offered by the hospice. Staff also rang the next of kin to follow up on the offer of bereavement support made in the card. The team sent a card to the family on the first anniversary of a patient’s death to show empathy and understanding on what was likely to be a difficult time for the family.

Staff supported people to plan for important life changes, including those relating to potential medical and psychological needs, so they had enough time to make informed decisions about their future, including at the end of their life.

Staff told us they attempted to engage with patients as early in their journey as possible to explore what helped them live well at home and what support they might need to do that. One of the ways they did this was through their ‘living well programme’ discussed above.

Staff spoke openly with patients about their illness to try and plan the last months, days and hours of a person’s life met with their wishes. Staff received training to support these conversations.

Staff spoke about how they planned care with patients, and how essential it was to take the time to help people recognise what was most important to them, to ensure they could continue to do the things that mattered for as long as possible until death. They gave an example of a father of young children who had been refusing pain relief despite his increasing painful condition. They spent time getting to know this man and finding out why he was reluctant to use medicines that could alleviate his pain. It transpired he was worried that he would not be able to read a bedtime story to his children if the medicine made him drowsy. Staff discussed the positive effect using pain relief could make on his quality of life and how timing the administration of his medication could ensure he was still alert for his children’s bedtime.