Dorothy House Hospice Care

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

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

This service scored 83 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Patients in the inpatient unit received at least daily nursing and medical assessments. The hospice held weekly consultant ward rounds and weekly MDT meetings where each patient was discussed and their condition and symptoms reviewed. The ward used the integrated palliative care outcome (IPOS) for symptom tracking. IPOS isa standardised questionnaire used in palliative care to assess a patient's symptoms and concerns, including physical, psychological, social, and spiritual needs, from the patient's, family and/or staff's perspective.

All clinical staff were trained in recognising the signs of changing needs or a clinical deterioration, as well as the use of assessment tools and documentation systems to ensure continuity of care and consistency in monitoring.

Staff reviewed treatment plans on an ongoing basis and updated and adjusted these as patients improved or deteriorated. The community team conducted regular caseload reviews with clinicians to highlight patients whose clinical needs were changing.

We reviewed five patient records during the inspection and found them to be completed appropriately with reviews undertaken with the support and guidance of specialist staff.

The hospice had rolled out the Oliver McGowan training to all clinical staff. Leaders told us they considered this to be a priority for understanding and proactively managing any additional needs for people.

Patients’ needs were assessed by a range of specialist staff, including a team of allied health professionals. This included a speech and language therapist (SaLT), who carried out assessments of communication and swallowing, and worked closely with a specialist dietitian to support safe eating and drinking, even where there were high levels of complexity and risk. These assessments were supported by the hospice’s nutrition policies.

The hospice also provided monthly training on nutrition and swallowing difficulties in palliative care for registered health and care professionals. Catering staff received training to ensure patients were provided with the correct food consistency to support nutrition and maintain quality of life where swallowing difficulties were present. When necessary, the hospice had a waiting list which was prioritised in order of patient needs need by the consultants and MDT at the daily SitRep meeting. At the time of inspection, the hospice did not have any patients on the IPU waitlist.

The evidence showed a good standard. 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.

The hospice ensured staff delivered care in line with current evidence by providing access to a range of up-to-date information sources, including a weekly journal club and regular bulletins from the local acute trust library on newly published palliative and end of life care research.

Staff were supported through ongoing education and training, including both internal and externally funded courses. Practice was also aligned with national guidance and standards, including Medicines and Healthcare products Regulatory Agency (MHRA) alerts, National Institute for Health and Care Excellence (NICE) guidance, and other relevant policies, to ensure care remained evidence-based and up to date. The hospice undertook a comprehensive programme of audits and analysed the trends and shared this with all staff with follow up of actions presented at the clinical audit and quality improvement group. Audits were completed annually, every six months and at an ad hoc frequency. The hospice used the audits as a quality improvement process to improve patient care and outcomes through systematic review of care against explicit standards. Each person admitted to the hospice had an individual assessment of their personal care, level of pain, nutrition, moving and handling, Venous Thromboembolism (VTE) and pressure area care needs.

Audits the service undertook included missed medication audit, care of dying adults, nutritional audit and management of pressure ulcer audit. We reviewed the inpatient unit nutritional assessment audit from July to August 2025 which reported an overall compliance of 94% with an action plan in place.

The hospice participated in local and national audits in order to benchmark themselves with similar services to improve patient care and treatment. The hospice provided us with the national audit that they had participated in, which showed a score of 100%.

We reviewed care plans and found these to be detailed with important information which linked with current good practice on how to support people with their health conditions. These included interventions staff had made, and advice sought when required.

In addition to the specialist allied health professionals (AHP) services, the hospice provided complementary therapies which included massage, reflexology and aromatherapy in order to create a calming and healing environment for patients and their families.

Staff also had access to a range of specialists for advice and support, these included dieticians, motor neurone disease specialist practitioners and speech and language therapists.

The hospice demonstrated a systematic approach to ensuring care remained evidence-based by reviewing NICE guidance on a weekly basis and responding to central alerting system (CAS) alerts promptly. Changes to policies and procedures were made in line with this guidance.

Oversight and assurance were maintained through regular reporting to the Clinical governance committee and the clinical audit and quality improvement group (CAQIG), as well as through quarterly updates to commissioners.

The evidence showed an exceptional standard. The service always worked well across teams and services to support people. They shared thorough assessments of people’s needs when they moved between different services, so people only needed to tell their story once.

Staff reported an excellent working relationship with all staff within the service.

The hospice held weekly multidisciplinary team (MDT) meetings where information was shared and next steps discussed regarding the transition of care and treatment. Discussing the transition of care for hospice is critical for improving the quality of life for both patients and their families as they navigate the final stage of a life-limiting illness.

We attended an MDT meeting which demonstrated a proactive governance of the hospices services and individual packages of care delivered by other providers. Information was shared including safeguarding concerns, new patients and concerns with existing patients. For example, an 80-year-old resident with safeguarding concern who was in a local care home was discussed during the meeting and actions included escalating to provider, safeguarding lead and continuing healthcare (CHC) fast track to ensure the safe transfer between services.

To support MDT reviews, staff could access patients notes electronically which allowed real-time oversight of care including medicine charts and medicines administered.

Additionally, the hospice held daily SitRep meetings which reviewed staffing levels, admissions and safeguarding and was attended by the multidisciplinary team.

Staff reported positive relationships with external partners such as the local learning disability team and the NHS Swallow/Speech and Language Therapy (SLT) teams who specialised in diagnosing and managing dysphagia (swallowing difficulties) caused by stroke, neurological conditions, head/neck cancer, or dementia.

The community palliative care team (CPCT) worked closely with other health and social care professionals in the community and attended local meetings across Somerset, Wiltshire and Bath and Northeast Somerset (Banes).

Medical staff within the hospice worked alongside the local acute hospital palliative care team to support people and shared assessments when they moved between services. The motor neurone disease clinical specialist also linked in with an acute trust and met regularly to discuss caseloads and share information.

The hospice worked with other local hospices, community providers and acute trusts with patient safety incidents and shared learning from these to improve patient care.

The hospice also worked alongside physiotherapists and occupational therapists and referred patients to the physiotherapy team to help manage symptoms of pain, mobility, balance and coordination.

Additionally, the hospice worked with citizens advice bureau (CAB) service to provide benefits advice and through partnership working with CAB, helped patients and families with advice and guidance with finances.

The evidence showed an exceptional standard. The service always supported people to manage their health and wellbeing to fully maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

Staff had access to the nutrition and hydration policy which outlined the principles, procedures and guidance to be followed in assessing and meeting the nutritional and hydration needs of patients and to enable, with appropriate interventions, holistic individualised management of a patient’s nutrition and hydration needs.

Specialist support from staff such as dietitians and speech and language therapists was available for patients and families who needed it.

The hospice provided a number of activities through the day hospice and community groups. These included the allotment group, coffee connection, peer support pottery group and walking through grief.

Additionally the family support services team which included social workers, counsellors, children’s workers, therapists and spiritual staff helped patients and their families adjust emotionally, spiritually and practically at any stage of illness. This also included the bereavement groups and children and young people’s services, spiritual care and the creative arts team who supported patients and families extensively in innovative, creative and comprehensive support, enabling people to open up and express and discuss emotional concerns through art therapy. The hospice also partnered with innovations such as a wellbeing app to support families and children to learn and understand their emotional state.

Some of the feedback received on I want great care (IWGC) from patients who had used the family support services read, ‘the support I received from my counsellor was exemplary and helped me become whole again and to face the world after a traumatic few years, enabled me to face the future without fear.’ IWGC is the world's largest independent, secure, and trusted patient data and insights platform, allowing patients to rate the care they receive from the clinical workforce. It enables users to share, thank staff for care, or report issues, helping others make informed health decisions.

Additionally, the hospice had created specialist reablement facilities including a gymnasium which was overseen by specialist physiotherapists and an exercise practitioner who was a frailty specialist. A patient who had used the complementary therapy offered by the hospice fedback ‘I enjoyed the treatment and always left feeling relaxed and restored.’ Another read ‘ I am grateful for the opportunity that my gym and therapy sessions have given me in my cancer journey and it keeps me going and is so good for my mental health, so thank you for everything.’

The evidence showed a good standard. 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 hospice used outcome data to monitor and improve care, with results routinely reviewed and shared through performance dashboards across teams. This ensured that reviewing outcomes and measuring impact was embedded in day-to-day practice and informed service improvement.

Outcome data was also reported through the hospice’s impact report to trustees, commissioners and external partners, demonstrating how the service focused on delivering measurable outcomes against its key organisational objectives.

The hospice used outcome measures called the Outcome Assessment and Complexity Collaborative (OACC) to measure patient outcomes. OACC is a validated suite of measures used in UK hospice and palliative care to assess patient clinical outcomes, including Phase of Illness (POI) and the Integrated Palliative care Outcome Scale (IPOS). We saw good use of tools like IPOS and the OACC suite of resources for measuring patient outcomes.

In the inpatient unit and community settings, IPOS was completed on admission and prior to weekly MDT meetings. The measures were part of the nursing and medical handover and staff used it to trigger re-assessment of other nursing assessments.

Additionally the hospice used Australia-modified Karnofsky Performance Score which assesses a patient's functional status and ranks their functional impairment on a scale of 100% (normal) down to 0% (dead), in 10-point increments.'

For patient experience data, the hospice used ‘I want great care’ feedback to capture patient feedback and complaints which was routinely shared with individuals and teams and reported quarterly to their clinical governance and the board. This information formed the annual report for complaints which the hospice used to learn and improve. In addition to this, the hospice also sought feedback from the local community and their own staff to measure the effectiveness of care and treatment.

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

Staff carefully explained to people what their rights around consent were and ensured they fully understood them. People’s right to consent was fully respected when delivering person-centred care and treatment.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

Staff had received Mental Capacity Act 2005 (MCA) training and were able to explain the main principles. Staff understood the importance of giving people choice in the support they received, and we observed staff always sought people's consent before providing any support.

Consent was obtained, recorded and reviewed in line with a clear, up‑to‑date consent policy that reflected the MCA 2005. Staff enabled people to understand their options, choices, risks and benefits, using accessible communication and involving those important to them where appropriate. Where people lacked capacity, decisions were made lawfully and in their best interests, with appropriate involvement of family members or legally appointed representatives. Practice was routinely monitored through audit and supervision to ensure consent processes were effective, proportionate and consistently applied.

In addition to the consent policy staff also had access to the MCA and deprivation of liberty safeguards policies and practice guidance.