Sue Ryder - Manorlands 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

Effective Rating: Good

Effective- this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last assessment we rated this key question good. At this assessment the rating has remained good.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 75 (out of 100) for this area.

This service scored 75 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Processes enabled a holistic approach to assessing needs, planning and delivering care and treatment to all patients who used the service. This included addressing, where relevant, their nutrition, hydration and pain relief needs. Clear processes were in place to complete admission assessments and ensure care plans were person centred, kept up to date and reviewed regularly within multidisciplinary team meetings.

Care plans were personalised and holistic. They took into account peoples individual needs regarding symptom management and medication as well as ensuring wider emotional, social and wellbeing needs were identified and met.

Patient needs were assessed in a range of different ways. Assessments were comprehensive and kept the patients and their family or supporters central. A range of Multi-disciplinary Team (MDT) members were involved in the care planning process.

A review of 4 clinical records confirmed that assessments were accurate, with clear evidence of MDT working and up-to-date information on needs and preferences was present.

Care needs were regularly reviewed, with management plans adjusted to reflect changes. This included a comprehensive review of nutrition and hydration needs.

Daily reassessments were conducted through face-to-face interactions and MDT discussions, with 90% of people reviewed by a senior doctor within 12 hours of admission. These handovers ensured that each patient’s care plan was actively monitored and adjusted based on changing clinical needs. Staff undertook daily symptom assessments using observations and physical examinations, ensuring responsive care delivery.

We saw evidence of national early warning score (NEWS) calculations. However, a recent audit (treatment escalation, NEWS2 and antibiotic use) found, “where calculated, escalation to a doctor was not always clearly documented as linked to the score”, we saw key learning points and next steps were clearly documented in relation to this finding.

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

Staff told us they kept up to date with evidence-based practice through Journal Club, attending conferences and training. This allowed them to implement evidence based practice such as progressive muscle relaxation training.

The service conducted regular audits to analyse trends, with findings shared across all staff teams to drive continuous improvement.

Kitchen staff told us they spoke to patients directly when they were admitted, to understand their likes and dislikes and any nutritional needs they have. Staff had completed International Dysphagia Diet Standardisation Initiative (IDDSI) training. We saw pictures of pureed food, served in the shape of the food item, such as pureed pizza looking like a slice of pizza.

A patient led assessment for nutritional care was used, which supported patients’ nutritional needs to improve quality of life.

The delirium quality improvement project reviewed screening, assessment, documentation and management of delirium at the hospice. It was found that there was under-recognition and inconsistent documentation of delirium despite generally safe management. Using this evidence, the team put processes in place to improve care, such as an education programme with weekly spotlight teaching sessions with nursing/HCAs, and delirium training was included in doctor induction.

The Group Exercise Programme, facilitated by the day therapy team, used an outcome measurement tool for the programme. This provided the staff with data on individuals who improved, maintained or deteriorated within the areas. Upon completion of the programme, patients were asked to complete a feedback sheet. These approaches provided the hospice with useful data for quality improvement.

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

Manorlands Hospice provided care through three interconnected teams. The inpatient team, which offered support to those needing intensive symptom management or end of life care. The community services team which delivered palliative care in the patients home, and the living well team, which supported patients with wellbeing activities.

All three teams worked together, sharing information and coordinating care plans to ensure seamless transitions between settings.

The service worked well with external partners involved in patient care. A local General Practitioner (GP) told us “our partnership with Sue Ryder Manorlands Hospice, supported by our joint use of an electronic shared record, is a testament to the power of joined-up care. The hospice's commitment to seamless communication and coordinated support has a tangible, positive impact on the quality of life for our patients and their families”.

The day therapy team shared with us that during a wellbeing group session, a participant disclosed experiencing emotional distress. Hospice staff responded with compassion and ensured the individual felt supported, working collaboratively with external agencies to help coordinate appropriate care. The person later expressed feeling more connected and benefited from the opportunity to engage socially in a safe and supportive environment.

We were told about the good connection the hospice had with the local community, who did a lot of fundraising for the hospice. Many of the volunteers at the hospice were family members of local people who had received end of life care and support at the hospice and wanted to ‘give something back’.

The day therapy team told us about collaborative working with a local dementia support group. They put sessions on to give dementia carers the opportunity to meet and chat. We also heard about their work with a project, that helped people living with a terminal illness, to write and record their own song. Together they had developed a ‘Music and Memories’ session where people could listen to music and share special memories.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

Patients were supported on how to stay as well as possible. Patients could access complementary therapies which promoted good physical and mental health and wellbeing.

Wellbeing services offered by day services, included creative wellbeing sessions- wellbeing boxes, mindfulness, and activities around the senses. Staff also delivered living well and breathe better programmes, where there was some psychological support, as an anxiety and breathlessness session was facilitated by the clinical psychologist.

Staff supported patients to live healthier lives and encouraged patients where appropriate to participate in complementary therapies, which supported them alongside their treatments. Groups were provided by the living well service which promoted physical activities and were adapted to suit the mobility needs of the patient, chair-based activities were available.

We observed an exercise session started with a general chat about how everybody was. Before starting warm up patients were asked if anything had changed from last week that might impact their ability, and the importance of listening to your own body was explained. During the warmup staff were watching to make sure everyone was doing the exercises correctly.

Psychological support was available for patients. Inpatients were seen in their rooms on the unit, where a range of evidence-based interventions, dependent on the specific difficulty the patient was presenting with, were offered.

People using the service and their relatives reported satisfaction with the quality and variety of food and drink provided. One patient described it as “absolutely delicious”.

Staff placed a strong emphasis on the importance of good nutrition and hydration. Comprehensive nutrition and hydration assessments and plans were in place and regularly updated.

All meals were prepared fresh on-site, allowing the team to accommodate dietary requirements and cultural preferences effectively. A review of care plans confirmed that staff gathered information on food preferences to deliver individualised care.

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

The service checked themes and trends that were relevant to them, the patients they supported, and the service they provided. Action plans were formulated to address any issues or concerns, this drove improvement, promoted innovation, and enhanced knowledge and learning. The service completed audits, which were evidence based and measurable. The service learned lessons from the sharing of information, this helped them to drive improvement.

Manorlands Hospice promoted a culture of continuous learning, with systems to share best practices and improve outcomes. Managers facilitated knowledge dissemination through emails, team meetings, handovers and information boards. We saw evidence of regular and comprehensive audits to ensure clinical compliance in critical areas such as infection prevention and control.

Mortality reviews, where the quality of care patients received at or near the time of death were reviewed and we saw evidence that the main learnings and findings from these reviews were shared at the Quality Improvement Group and also shared with all staff.

Manorlands Hospice compares and analyses data from other hospices (Hospice UK) to see their performance relative to peers, to inform improvements and help with planning.

The service systematically monitored complaints, concerns, compliments, and satisfaction feedback.

We saw the user group 15 steps feedback- which mentioned the ‘room to reflect’ did not feel multi-cultural, it felt ‘like a church’. Listening to this feedback the service re decorated this room and made it a multifaith room, welcoming to all.

We saw multiple opportunities for people to give feedback- including 4 patient optional questionnaires asked 48 hours and 7 days after admission, share your feedback boxes, tell us about your experience QR codes and service user feedback forms for day services programmes.

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

The provider had policies in place relating to mental capacity assessment, best interest decision making and deprivation of liberty safeguarding which were found to be in date and subject to version control.

Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. Staff gained consent from patients for their care and treatment in line with legislation and guidance. Staff made sure patients were provided with all relevant information to make informed choices and consent to treatment.

We reviewed 4 patient care records and saw evidence that Do Not Attempt CPR (DNACPR) was discussed. A recent audit showed DNACPR discussions took place where possible with 90% of patients, with capacity assessments documented in all cases. Family and supporters were involved 100% of the time where appropriate, and best interests’ decisions recorded where patients had been assessed to lack capacity. Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) form completion was 100% for forms signed by a clinician.

The Mental Capacity Act 2005 (MCA) provides a legal framework for decision making on behalf of individuals who may lack the capacity to make decisions themselves. On the day of inspection, we found 60% of staff were compliant with Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS) training, which was significantly below the provider target of 95%.