Ellenor Gravesend

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.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s care and outcomes were consistently positive, and people’s feedback confirmed this.

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 service always made sure people’s care and treatment was effective by thoroughly assessing and reviewing their health, care, wellbeing and communication needs with them.

People told us staff discussed their needs with them and those close to them. They were involved in how care and treatment was planned and were confident they were listened to and their needs understood.

The hospice had clear assessment processes for identifying and monitoring patient’s individual needs. They used nationally recognised assessment tools, including those that helped to identify and monitor risk, and those that were focused on identifying and meeting care needs. We saw examples of assessments relating to patient needs such as the risk of falls, pain management and activities of daily living. The Integrated Palliative Outcome Scale (IPOS) was used to assess people’ needs and measure the physical, psychosocial, social and spiritual impact of illness. In addition, an SBAR (situation, background, assessment and recommendation) approach was used to assess people in relation to their individual needs and identify actions to improve care.

We saw examples of staff continuously assessing people’ needs and adapting care to meet those changing needs. Care records included evaluations of the effectiveness of care against agreed objectives. We observed staff assessing and evaluating a patient in relation to their symptoms. We saw this included a holistic assessment incorporating pain, nausea, appetite and further discussion of what mattered to the patient and their preferences.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. Staff did this in line with legislation and current evidence-based good practice and standards.

Staff followed up-to-date policies to plan and deliver high quality care according to best practice and national guidance. Care related policies took account of relevant national guidance, for example National Institute for Health and Care Excellence (NICE) Quality Standard 13 End of life care for adults and NICE guidance 31 Care of Dying Adults in the Last Days of Life. People had personalised care plans and assessments took account of people’s emotional, spiritual and social needs. Care in the last days and hours of life delivered the Five Priorities for Care of the Dying Person.

Care plans were developed with input from the patient and those close to them. They included support for patient’s psychological, social and spiritual support needs. Recommended summary plans for emergency care (ReSPECT) forms were completed in line with national guidance.

Advance care plans were developed with people and those close to them, outlining preferences for future care and support. This process was based on recognised approaches to ensuring people received the care they want at the end of life, confident their care was focused on what matters most to them.

The service worked well across teams and services to support people. Staff made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

People told us they believed staff worked well together and they didn’t have to explain the same thing to everyone. Services were coordinated and there were good communication mechanisms in place. Multidisciplinary meetings were held for both community and inpatient services. These involved staff from different departments and services meeting to discuss care, therefore ensuring a smooth transition between services.

The hospice was well positioned within local and regional health and care services and there were clear communication links that enabled information to be shared seamlessly when people moved between services. Staff were able to access appropriate expertise when they needed it. Multidisciplinary conversations involved medical, nursing, community, physiotherapy, occupational therapy and psychosocial support services.

The hospice used an electronic patient record system that was shared with patient’s GPs. This enabled key professionals involved in care to have up to date information. Plans were in progress to expand the system across local community teams.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to promote the best quality and end of life possible.

The service had relevant information promoting health and support for people. Patient information was available, providing advice and guidance on issues such as sleep. Members of the multidisciplinary team provided health promotion advice and people had access to dietetic and nutrition advice.

Staff assessed each patient’s health when admitted and provided support for any individual needs to live as well as possible. Assessments were holistic and included emotional and social support needs. The support needs of those close to people were also assessed and staff took action to meet the needs both within the hospice and community service.

People were encouraged to eat and drink what they wanted and we observed hospice staff adapting food choices to meet individual needs.

There was a strong focus on health and wellbeing and maximising this for people with palliative care needs and frailty. Rehabilitation services supported people to live as well as possible. The aim of the wellbeing service was to nurture wellness and embrace life, providing support for physical, emotional, social, spiritual, educational and financial wellbeing. Examples of specific support sessions included exercise, complementary therapy, art and talking therapies, advance care planning, making memories, life skills, occupational therapy, physiotherapy, falls prevention, money matters and living well with dementia.

The service routinely monitored people’s care and treatment to continuously improve it. Staff ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Outcomes for people were positive, consistent and met expectations. The use of the Outcome Assessment and Complexity (OACC) measures was well-established. These included the Integrated Palliative Outcome Scale (IPOS) to measure the physical, psychosocial, social and spiritual impact of illness, including self-reported patient outcomes. The Australian Karnofsky Performance Score (AKPS) helped to provide a clinical picture of a patient’s health, phase of illness and activities of daily living. Outcome measures were collected on admission and then weekly in the community and every 3 days during an in-patient stay. This data was viewed and discussed as part of multidisciplinary meetings and handover discussions. The regular evaluation of the outcome measures as a tool supported staff in identifying changes in individual’s health, enabling them to adapt care in a way that best supported people.

Other outcome measures were used for specific services. This included the use of the Rockwood frailty scale as part of the frailty quality improvement project. For example, evaluation data showed there was on average a 47% increase in the strength and balance of people participating in the project.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff supported people to make informed decisions about their care and treatment. They followed national guidance to gain people’s consent. They knew how to support people who lacked capacity to make their own decisions or were experiencing mental ill health.

Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. Mental capacity assessments were carried out routinely as part of assessment processes across the hospice. Staff understood the principles of best interest decision making where people were assessed as not having the mental capacity to make certain decisions. Where appropriate, family members and those close to the individual were involved in discussions about decisions.

Staff gained consent from people for their care and treatment in line with legislation and guidance. When people could not give consent, staff made decisions in their best interest, taking into account people’ wishes, culture and traditions. This included following advance care plans that had previously been developed with input from the patient and those close to them.

Staff made sure people consented to treatment based on all the information available and took time to ensure people understood the information.

Staff clearly recorded consent in the people’s records. This was routinely audited to identify any gaps and improvements required.