The Shakespeare Hospice

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked for evidence that safety was a priority for everyone, and leaders embedded a culture of openness and collaboration. We checked that people were safe and protected from bullying, harassment, avoidable harm, neglect, abuse and discrimination. We also checked people’s liberty was protected where this was in their best interests and in line with legislation.

The service had a good learning culture and people could raise concerns. Managers investigated incidents thoroughly. People were protected and kept safe. Staff understood and managed risks. The facilities and equipment met the needs of people, were clean and well-maintained. There were enough staff with the right skills, qualifications, and experience. Managers made sure staff received training and regular appraisals to maintain high-quality care.

This service scored 78 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

There was a culture of learning from events that had either put people and staff at risk of harm or caused them harm, to improve the service. Staff described an open culture where incidents were seen as opportunities to learn and improve patient safety.

Safety incidents were appropriately investigated and reported. Staff recognised and reported incidents and near misses in line with policy. For example, they reported when a clinical incident occurred and when a clinical incident was narrowly avoided, this was to ensure learning could be shared to prevent a future occurrence.

A route cause analysis approach was used to investigate incidents so people could be given an explanation of an incident and an apology when things went wrong, and an action plan could be developed to improve processes, which included any learning requirements.

Managers investigated incidents and shared lessons learned with the whole team. Patient safety incidents were also shared with partnership agencies working in end-of-life care so learning could be shared as widely as possible. Staff gave us an example of an incident that arose when a patient chose to be discharged from hospital without having their nasogastric tube reintroduced despite it being used to administer their medicines. The team raised this as an incident after experiencing resistance from the prescribing doctor to change the medicines from oral to injectable. The incident was then discussed with the local end of life network, this resulted in a new standard operating procedure (SOP) being developed by the acute trust to give confidence as well as guidance to staff across the local end of life network.

Staff told us as well as reporting when things went wrong or near misses, they also incident reported additional demand on the service as a way of monitoring this. For example, if the team were requested to support with a syringe driver for a patient not open to the service, whether or not they could help, they would record this incident so it could be monitored to help identify how resources were being used and if there was a specific need within the end of life network for additional resources. In January 2026 thirteen clinical incidents were reported, all of which reflected the times the teams had been asked to support a home visit to a patient by an external team.

Staff attended end of life conferences, learning events, and formal meetings hosted by partnership agencies to share learning and best practice. Staff attended weekly specialist palliative care multidisciplinary team (MDT) meetings as part of their learning and development about end of life care and new developments in treatment, including changes to best practice. The meetings were held to discuss patients receiving care and treatment, and also to review recently deceased patients to identify if there was any learning that could be taken forward.

Safety and continuity of care was a priority throughout people’s care journey. This happened through a collaborative, joined-up approach to safety that involved patients, along with staff and other partners in their care. This included where people were moving between or accessing multiple services.

People could be referred through their GP, hospital, district nurse or any other health professional. They could also self-refer. The provider worked in partnership with the GP and district nurse team in the management of each patient.

Patients underwent a comprehensive assessment of their needs. Patients were asked what their understanding of the illness was so staff had a point to start discussions from. As part of the assessment staff asked about symptoms, and what aspects of their care needs they felt they needed support with and what they could do for themselves. Staff carried out assessments mostly in patients own homes. They recognised some patients felt overwhelmed by the volume of questions and needed more time to answer and reflect. Therefore, staff offered more than 1 assessment visit where required to ensure patients felt comfortable during the visits.

If staff felt the complexities of a patient’s illness could not be managed at home, or if the family were not coping well, staff would discuss the option of inpatient hospice care. However, other options, like support from a domiciliary care agency would also be discussed with the family.

To ensure patients were managed safely, for example when being moved during personal care, staff completed hospice at home visits in pairs. Staff reassessed patients’ symptoms on each home visit. Staff carried sphygmomanometers (blood pressure monitors), oxygen saturation monitors, and thermometers so they could take and record patient observations to help them monitor signs of clinical deterioration.

The provider worked with people and partners to establish and maintain safe systems of care, in which safety was managed, monitored and assured. Staff ensured continuity of care, including when people move between different services. Patients referred from hospital, on the discharge home to die pathway, were monitored by staff through daily phone calls to the hospitals for updates on the patient’s condition and their expected discharge date. Staff worked in partnership with an NHS team who could provide round the clock care to ensure people who were discharged from hospital outside of the hospices opening hours could receive a home visit on the day of their discharge.

Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date, stored securely and easily available to all staff providing care. The hospice used the same electronic patient record (EPR) system as other community services including GPs, district nursing teams, other local hospices, and the community palliative care team. This enabled staff to see changes in patient care, including MDT discussions, and referrals to other healthcare providers, so they did not have to ask patients or their relatives what had happened since their last visit. Staff used an end of life template on the EPR to record information specific to the patients end of life care plan.

Staff attended a daily handover meeting where they discussed patients being cared for at home and the patients who would be coming in to use the hospice facilities that day. They discussed patients’ condition, updates from MDT meetings, as well as input from dietitians and speech and language (SALT) therapists. We saw all staff actively contributed to discussions.

There were clear safeguarding systems, processes and practices to protect people from abuse, neglect, harassment and breaches of their dignity. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse, and they knew how to apply it.

Staff understood their responsibility to report any concerns that could place people at risk of harm or abuse. Staff and volunteers were provided with level 3 training in safeguarding adults and level 3 safeguarding children. Staff told us as well as mandatory safeguarding training they had additional safeguarding training to help support their knowledge and confidence in recognising and reporting safeguarding concerns.

The service had a safeguarding lead, and safeguarding policies that reflected national guidance.

Staff said if they had a safeguarding concern, they would raise this with other healthcare teams working with the family to collect additional information and identify which team would progress the concern to a referral. One member of staff said, “I feel very supported by the teams because we have good documentation and good communication”. They also told us they met as a team to reflect on safeguarding referrals once they had been made. These meetings were used to explore if things could have been done differently that would have improved identification of concerns or other aspects of the referral process.

If family members were challenging staff would visit in pairs, this might be with another healthcare professional from another team, for example a district nurse. If staff identified there was a risk to the mismanagement of a patient’s medication they could install a safe for controlled drugs in the property.

Risks relating to people were assessed and managed appropriately, with the involvement of the person, so they understood any decisions about this. Patients and their relatives described regular and open conversations about risks around their health.

Staff told us they were informed about changes in patients risk profile during regular handovers. Hospice at home staff updated the risk assessment for each patient after every visit, and risks continued to be monitored throughout the day. Staff told us, the EPR was updated by all teams from the end of life network working with patients to ensure all staff were aware of any changes.

Patients were involved in their care planning, this included assessing and managing risks. If patients were too poorly to make new decisions, or they lacked the mental capacity to do this, people with responsibility for making decisions, including staff, made best interest decisions on their behalf. A best interest decision is a decision made for someone who lacks the mental capacity to understand information or make decisions about their life. The best interest decision must be made in the person’s best interest and by people who are authorised to make a decision on behalf of the person. This could be doctors, carers, relatives, or other people who were important to the person.

The environment was safe for staff to work in, including in people’s own homes. The hospice, equipment and technology were well-maintained, used for their intended purpose and consistently support staff to deliver safe and effective care.

Each home visited by staff had a risk assessment of the environment devised from initial and ongoing assessment. If the environment posed a risk, for example if someone in the home had a hoarding disorder, or had pets, this was added to the EPR so all healthcare staff providing home visits would be aware of the risk and take mitigating actions.

Staff had equipment to keep them safe when they were working out in the community. Each member of the team had a lone working device that was linked to a contact centre so they could report any problems, or they had or call for emergency help.

People had the equipment they needed to keep them safe, manage their pain and maintain their independence. We saw a member of the team arrange delivery of a hospital bed for a patient receiving hospice at home care. Hospital beds provide dignity, safety and comfort, and can help with pain management and easier caregiving.

Therapy staff told us they worked with people to ensure they had the right equipment to safely maximise their abilities and maintain their independence. For example, walking aids or wheelchairs, perching stools and rise and recline chairs.

The design, maintenance, use of hospice and equipment kept people safe. Equipment was clean and well maintained. Each room had been given a functional risk category score which reflected what the room could be used for and how frequently it required cleaning.

We saw information about fire safety and building evacuation displayed in staff and public areas. All staff and visitors to the hospice were asked to sign in. The names of staff who were a fire marshal or first aider were highlighted in yellow to enable other staff to quickly identify which staff to contact in the case of an emergency.

The counselling rooms for children and young people were on a separate corridor to counselling rooms and therapy rooms for adults.

The portable electrical equipment we looked at had been safety tested.

The provider used safe recruitment practices to make sure that all staff, including bank staff and volunteers, were suitably experienced, competent, and able, to carry out their role.

Staff were made up of registered nurses, health care assistants, a physiotherapist, an occupational therapist, a clinical aromatherapist, a complementary therapist, administrative staff and volunteers. The service used safer staffing processes to ensure staff and volunteers were safe to work with vulnerable adults and their families. There was a process to check nurses, and other health and care professionals maintained their registration with their professional bodies.

The service used bank staff to cover some shifts. The service had access to 3 nurses and 1 healthcare assistant who were all familiar with the service.

There were processes to quickly manage unplanned absence to ensure the service was safe. Staff described the staffing model for the hospice at home and main hospice services as “mobile”. They said it ensured care for hospice at home patients was always prioritised. The staff team used a mobile phone application to contact each other about work and would send messages to request if staff could work additional shifts to cover staff absence. Managers worked clinically when required to cover unplanned absence. In exceptional circumstances, the district nurse and community response team supported the service to visit patients when they were short staffed.

All staff, including volunteers and bank workers, completed a range of mandatory training modules that reflected their role within the organisation. Mandatory training modules included basic life support level 2, sepsis, safeguarding children and safeguarding adults training. Compliance with mandatory training was mostly 100% against the organisations target of 85%. Compliance with appraisals was 100%.

Volunteers told us they received an induction when they started, completed mandatory training modules, and received other ongoing training to support them to carry out their roles. One volunteer told us senior staff were visible within the service and regularly checked in on them. They also told us they had a clear understanding of their role and responsibilities within the service.

Staff told us they had formal external monthly clinical supervision and regular team meetings. They also described regular opportunities to meet up to discuss patients and families, the efficacy of treatment, and ways in which care might be enhanced, for example through a referral to an external agency such as the SALT team.

People were protected as much as possible from the risk of infection because premises and equipment were kept clean and hygienic. Patients were supported to maintain their own personal hygiene in line with their needs and preferences.

The hospice was visibly clean and had suitable furnishings which were clean and well-maintained.

There was hand gel and cleaning wipes in every room. Sinks had handwashing signs, so people knew how to follow the correct handwashing technique.

Each room had a cleaning schedule. All the schedules we looked at showed evidence of regular cleaning in line with the schedule.

There were clear roles, responsibilities and procedures around infection prevention and control that meet current and relevant national guidance. The provider used up to date infection prevention and control (IPC) guidance from their local trust to introduce or step-down mandatory face mask use for staff and visitors to the hospice. The provider had a process for staff to follow if a patient had a communicable disease to help keep people safe.

Staff visiting patients at home took personal protective equipment (PPE) kits with them. Each kit contained disposable gloves, aprons, surgical face masks, and paper towels. Kits were carried in a small bag that could be used to safely contain used PPE prior to safe disposal. Staff also carried liquid soap so they could regularly wash their hands, and antibacterial hand gel to help keep their hands clean.

Staff conducting hospice at home visits also took sterile dressing packs with them so the contents could be used to create a sterile work surface if required. For example, to perform syringe driver maintenance on.

Each home visited by staff had IPC guidelines devised from initial and ongoing assessment of the environment. Staff reviewed the guidelines prior to starting each home visit. If there was nowhere for staff to wash their hands staff would add this information to the EPR so all healthcare staff providing home visits would be aware of this risk. We saw staff correctly donning and doffing PPE and we observed staff washing their hands regularly using the appropriate handwashing technique.

Annual handwashing training included the use of an ultraviolet light box. The use of ultraviolet light boxes is an effective, and evidence-based method used to improve hand hygiene compliance and handwashing technique.

The storage areas were clean and tidy. Stock was stored neatly so it could be checked and did not hamper cleaning.

Waste bins were clearly labelled and emptied regularly. Staff used portable sharps bins when they were visiting people at home. Sharps bins were stored securely and not overfilled prior to disposal.

Patients or their representatives were appropriately involved in decisions and reviews about their medicines and the level of support (including self-medication) they need to manage their medicines safely. People told us staff were very careful to ensure patients were on the right medicines and dosages to keep them pain free and control their symptoms.

Staff used appropriate tools to support patients with difficulty communicating to enable them to express their pain levels. This included tools for patients with dementia and people whose first language was not English.

Staff completed medicines records accurately and kept them up to date.

We observed staff providing hospice at home team care using the medicines chart from the consultant oncologist which showed what medications could be administered to the patient, in what dose and timeframe. The staff member completed the medicines chart with information to say what medicines they had given the patient.

Staff completed a stock check of patient’s controlled drugs each day. They updated the controlled drug record to show this had been completed.

Medicines were not prescribed by the hospice. Patients attending the hospice brought their prescription drugs in with them if they would be required during their scheduled activity. The medicines were signed into the hospice. The medicines were stored securely and administered by the nursing staff. When the patient left for the day, their medicines were signed back over to them.

All registered nurses were trained in syringe driver care. Syringe drivers are portable battery-operated medical devices used to deliver regular doses of medicines to patients with the aim of providing them with continuous symptom relief for pain, sickness, or agitation when oral medication becomes difficult to use. Syringe driver care included making sure the devices were clean and working correctly.

Staff made sure they had a clean and quiet area to perform syringe driver care. Staff told us they sometimes had to be creative in securing a quiet space and had performed syringe driver care in bathrooms and spare bedrooms. They carried equipment to ensure they always had a sterile workspace.

Staff recorded medicines incidents that were relevant to their mistakes and also the errors that were made by the teams they worked alongside. For example, as staff were responsible for administering medicines that had been prescribed and dispensed by external teams, they also incident reported errors made by other teams. From January to December 2025 staff recorded 9 incidents. One incident reported was an error made by internal staff, the remaining 8 incidents had been made by external teams. Themes of the incidents were documentation errors, pharmacy dispensing errors, and prescription directives not written up with the correct therapeutic dosage.