Ellenor Gravesend

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, 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 outstanding. At this assessment the rating for this key question remains outstanding.

This service scored 93 (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 was exceptional at making 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.

People’s care plans fully reflected their physical, mental, emotional and social needs, including those related to protected characteristics under the Equality Act. People and those close to them were regularly involved in planning and making decisions about their care and treatment. Staff took the time to get to know people and those close to them, to support them in identifying what was important to them and make the right decisions about their care and treatment.

We observed examples where staff enabled people to take a lead role in their care. For example, we observed a discussion between a nurse and a care home resident that was centred on what was a priority for them. The staff member actively encouraged the person to think about what was important to them and then sought ways to ensure those activities were incorporated into their care. We also viewed care plans and records where people’s preferences were clearly recorded. This included preferences in relation to activities, food choices and preferred place of care at the end of life.

The hospice ‘this is your life’ project supported patients to reflect and reminisce on their lives, using crafting and creativity to capture past experiences and focus on future goals. This approach was used to support patients to prioritise what was important to them, particularly at the end of life.

People received the most appropriate care and treatment for them and the service made reasonable adjustments where necessary.

The service 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.

There was continuity in people’s care and treatment because services were flexible and joined-up. Care and treatment were coordinated and responsive and delivered in a way that met people's assessed needs. Patients accessing one part of the service were routinely signposted to other parts of the service as part of regular assessment using the palliative care outcome scale.

Staff and leaders worked collaboratively with other providers to ensure that services were responsive to the needs of the local community. Hospice leads were active within local networks that were focused on integration and continuity of care for the community. These networks included a regional Ageing Well Board, South East hospice quality group and a South East directors care network.

The hospice responded in a supportive and collaborative way during the Covid 19 pandemic. They supported people from the local community and worked in an integrated way with statutory services through the provision of 10 emergency step down beds. Staff worked quickly to provide this service within days to the local community. The additional beds were initially commissioned for a period of 3 months but the project was later extended to cover a period of 4 years. The partnership received national recognition in 2022 for an outstanding contribution to healthcare from the Health Service Journal.

The hospice recognised their work providing exercise sessions to build strength and balance had the potential to benefit patients with frailty, not just those with life limiting conditions. As a result, a frailty project was developed where staff worked with local care homes to provide support for residents with general frailty. The aim was to start working with people with more moderate frailty to prevent further deterioration.

Delivering and co-ordinating services considered the needs and preferences of different people, including those with protected characteristics under the Equality Act and those at most risk of a poorer experience of care. The hospice was actively working with the local communities to promote effective engagement with the services they provided. This was enabling the hospice to provide supportive care in an integrated way.

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

People had access to information and advice that was accurate, up-to-date and provided in a way they could understand and that met their communication needs. Individual needs for information in an accessible way were identified and shared. These needs were incorporated into care plans in line with the Accessible Information Standard.

When needed information could be tailored to individual needs. This included reasonable adjustments and the use of different written information formats, interpreting and translation services. We observed patient information was translated into Punjabi to meet the needs of the local community. Relevant information was also available specifically adapted to the information and communication needs of children.

Hospice staff worked within relevant policies to protect people’s information and confidentiality. The hospice had clear information governance processes in place in line with relevant legislation.

The service was exceptional at enabling people to share feedback and ideas, or 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.

People we spoke with knew how to give feedback about their experiences of care and support including how to raise any concerns or issues. There were clear guides on how to complain and provide feedback. Complaints were dealt with promptly and in an open and transparent manner. We observed complaints records that showed there was clear ongoing communication with the individual and that complaints were investigated and people given the opportunity to meet with hospice leads to discuss their concerns and a resolution.

People were encouraged to complete feedback questionnaires about their experience of the services. These were collated and evaluated by staff and leaders and opportunities for improvement identified. We also saw that staff and leaders regularly engaged with people about changes and developments to the service, including changes to facilities and the development of the newly opened wellbeing centre. We also saw that staff engaged with local organisations representative of the local community to gather views and input on changes made. This included engaging with services supporting people with protected characteristics about changes to the building and environment to ensure their needs were considered and addressed.

Staff routinely engaged with different groups within the local community to ensure that services were accessible. They listened to people’s needs and encouraged sharing of views and information. We saw examples of engagement with representatives from Sikh, Gypsy Romany Traveller and LGBTQ+ communities to ensure services met people’s needs.

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

People could access care, treatment and support when they needed to and in a way that worked for them. Triaging processes were in place to ensure that care was prioritised based on need. Access to the inpatient ward was reviewed by the multidisciplinary team to ensure people with the most urgent need were prioritised. People referred to and accessing support from community services such as hospice at home were triaged by clinical nurse specialists (CNS’) and prioritised based on need.

The average waiting time for the inpatient ward was 2.4 days, a slight increase on the previous waiting time of 2 days. Referrals had increased from 84 to 98 in the last year. Within the community service there had been 540 referrals in the last 12 months. The average wait from referral to contact was 4.7 days which was a reduction from 6.6 days the previous year despite an increase in referrals for this period.

Staff and leaders were aware of potential discrimination and inequality that could disadvantage different groups of people in accessing care, treatment and support, whether this was from wider society, within organisational processes and culture or from individuals.

Leaders prioritised and allocated resources and opportunities to tackle inequalities and achieve equity of access. They were proactive in seeking ways to address barriers and improve access. They had recruited an inclusion and diversity officer who worked across the hospice to look at ways to improve access to underrepresented communities and there was a goal to increase this by 10% by 2027.

We saw examples of engagement and awareness activities with local communities to ensure the care provided and access reflected the needs of different populations. This included the development of engagement with the local Sikh community, the LGBTQ+ community and the Gypsy Romany travelling community. The hospice undertook specific activities that included offering counselling services to young people in the local Sikh community. Staff regularly attended the local gurdwara and community events and invited representatives of the Sikh community to engagement events at the hospice with a view to ongoing partnership working. Staff told us their work with local communities had increased the footfall of patients from diverse ethnic groups accessing services from 4% to 7% over the last 2 years.

The hospice had undertaken work to develop an LGBTQ+ equality and inclusion culture. Staff made use of a regular podcast to raise awareness of hospice service targeted to specific communities. This included a 2 part podcast with a representative from the LGBTQ+ community to discuss specific needs in relation to hospice and end of life care. An audit and gap analysis had been carried out to find out what was and was not working in relation to equality, diversity and inclusion. This work was referenced within the Hospice UK innovation hub that published examples of innovation in hospice care.

The facilities provided space to care for people with physical disabilities, therefore, ensuring that services were accessible. This included a changing places bathroom that was available to members of the public to provide changing facilities that increased the ability of people with disabilities to get out and about and enjoy activities.

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 proactively sought ways to address any barriers to improving people’s experience and worked with local organisations, including within the voluntary sector, to address any local health inequalities. Staff understood the importance of providing an inclusive approach to care and made adjustments to support equity in people’s experience and outcomes.

Staff and leaders were alert to discrimination and inequality that could disadvantage diverse groups of people using their services. They regularly engaged with local communities to understand the specific issues around palliative and end of life care with a view to improving their understanding and people’s experience. For example, staff within the inclusion and diversity team had met with local support groups to understand after death care and rituals. This helped them to identify specific learning, such as the belief of gypsy Romany travellers that mirrors should be covered after death, and that beard trimming was against the Sikh communities beliefs. This enabled them to provide specific training for staff.

The care home support team provided support to care homes caring for patients with palliative and end of life care needs. This included patients with dementia and those with learning disabilities. Staff had completed training in supporting patients with dementia, learning disabilities and autistic people.

People were given exceptional support to plan for important life changes, so they could make informed decisions about their future, including at the end of their life.

We observed staff speaking to people about their wishes. Staff had been trained in advanced communication skills and were skilled in conducting conversations about future care. This was integrated into assessment conversations as part of normal practice across the hospice teams. Staff were creative about how they worked with people to think about the future, including a ‘this is your life’ project where people worked with staff using scrapbooking to reflect on their lives and think about their priorities for their remaining life.

Care plans were personalised and shared with other professionals involved in the individual’s care. People were supported to share their wishes about cardiopulmonary resuscitation and their desired level of treatment. There was a clear focus on maximising quality of life and comfort for people at the end of life. They were supported to make decisions about fewer care interventions when these were less likely to benefit them.

Feedback from hospice engagement processes included a comment from one person that they ‘feel empowered to make decisions around my care, and how I want to die.’