Warwick Myton 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

We reviewed 7 quality statements for effective, 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.

Staff assessed the physical and psychosocial needs of patients.

Staff provided care and treatment based on national guidance and evidence-based practice.

Staff worked together as a multidisciplinary team to benefit patients. They supported each other to provide good care.

Staff gave patients practical support and advice to lead healthier lives.

Staff monitored the effectiveness of care and treatment. They used the findings to make improvements for patients.

Staff supported patients to make informed decisions about their care and treatment.

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.

People told us their need for hospice support was generally formulated from a multi-disciplinary assessment by their healthcare providers in the community. One person on respite care told us, “It was district nurses and the GP who referred me.” This person told us they had a full discussion when they arrived about their expectations and what the service could offer them.

Staff told us they used an individualised and holistic approach to assessing patient needs. This was to ensure patients received care and treatment that was specific to their individual needs and took the whole person into account; their psychological health and wellbeing, practical and social needs, as well as their physical health.

Staff on the inpatient unit had daily handover meetings (huddle) at the start of each shift so they knew what changes there had been in patient’s psychological and emotional needs, as well as their medical and nursing needs, since they had last cared for them. As well as these structured meetings staff told us they had frequent informal meetings so they could flex to the changing needs of patients. A member of the inpatient team said “There are debriefs that go on spontaneously, we will go into a huddle and share information because we need to adapt as things are changing.”

Staff in the hospice at home team had a daily handover from staff who worked the previous day, sometimes this was a written handover but staff told us they would sometimes ring in from home so they could give a verbal update if there had been significant changes to patient’s care needs.

All staff, including those in the wellbeing service told us they work as part of a multidisciplinary team to continuously assess the changing needs of patients.”

Patients referred to the inpatient unit with complex palliative care needs who were in the last 6 weeks of their life were assessed for their suitability by external healthcare professionals including community palliative care teams, and doctors working in local hospitals. The provider was reviewing the process of assessment to see if they could improve the referral process to ensure the right people were being referred at the right time. Patients using the inpatient unit for a respite stay had their admission suitability assessed by a clinical nurse practitioner using a standard admission criteria. Patients could refer themselves for respite care. They could also be referred by a health care professional or relative.

The service had employed an admission and discharge coordinator who was about to take up this new post. Part of this new role was to talk to patients, their loved ones, and health care professionals about discharge from the point of referral. This was to ensure people understood that their referral to the hospice might not mean they were in the last weeks of their life, and they might need to be referred to an alternative place of care. This was to ensure patients and their loved ones were not shocked and upset if the idea of an alternative placement was brought up. The admission and discharge coordinator also coordinated care with other services to ensure there was a holistic approach to the care provided once patients were discharged.

Hospice at home patients were assessed for their suitability for this service by the hospice at home staff. The assessment included looking at the needs of the patient to understand if they could be met by the team or if they may need to be met by or in conjunction with additional domiciliary care service providers, within the inpatient unit, or by an alternative health care provider.

Staff followed up-to-date policies to plan and deliver high quality care according to best practice and national guidance. They followed patient care plans devised by the multidisciplinary team and ensured care plans were up dated as patient’s needs changed. For example, they followed guidance from the National Palliative and End-of-Life Care Partnership and the National Institute for Health and Care Excellence (NICE). Staff told us they had regular opportunities to ensure they were using up to date guidance through supervision, attendance at multidisciplinary team meetings, and through a journal club. The journal club gave staff the opportunity to read recently published end of life research findings and to discuss these findings with their peers to explore how new or improved treatment options could benefit their patients.

Staff told us if a care plan was not helping to improve a patient’s needs, for example their level of pain or psychological functioning, they would work as a multidisciplinary team to reassess the patient’s care needs to look at how they could improve their outcomes.

The service provided care and treatment based on national guidance and evidence-based practice.

The provider was a member of local multidisciplinary end of life specialist, and expert, palliative and end of life care groups. These groups worked together to produce evidence-based guidance on clinical care, care pathways, and service provision.

The clinical governance team, in conjunction with a consultant,were responsible for reviewing changes to national guidance, for example, from the National Institute for Health and Care Excellence (NICE). This task was completed monthly, and policies were updated accordingly in partnership with the medical and clinical teams. For example, in January 2024 the bed rails policy was updated to reflect updates in guidance from the National Patient Safety Agency.

Managers monitored if staff followed policies through guided conversations in supervision sessions.

Staff used a recognised tools to monitor patients, for example the ‘Australia-modified karnofsky Performance scale’ (AKPS) to assess patients' day-to-day functioning. This assisted in assessing if care needed to be adjusted as a patient neared the end of life.

Staff were supported by a clinical education teamand a learning and development team who provided professional development, evidence-based education and training in palliative and end of life care. The team also provided education and training opportunities to professionals providing palliative and end of life care who were working in the community.

People benefited from a multi-disciplinary approach where staff communicated effectively to ensure their needs and preferences were met.

Staff told us there were regular multidisciplinary team (MDT) meetings to discuss people and improve their care and outcomes. Members of the therapy team described how this resulted in better outcomes for people. One therapist told us, “The doctors do their tweaking and get patients pain under control, and we will be alongside asking how we can optimise this person. The exciting bit of our role is seeing a difference. In some care settings these can be seen as small wins but for us they can be really big wins.” Another therapist told us, “There is a daily handover at 8.30am and we all attend that. We have a MDT on Wednesday morning when we discuss all the patients on the unit. It is a powerful meeting and there is a lot of excellence in the room. It is one of the best places I have worked for teamwork. I feel listened to, it is a real level playing field, the different expertise is really appreciated. It is place where we are all listening to each other.”

Throughout our inspection we witnessed staff working as a team for the benefit of patients. For example, we saw nurses and care assistants discussing a patient to identify if there was anything additional that could be done to optimise their care.

We saw evidence of MDT working in patients records.

A request by the hospice at home team for a GP to prescribe a patient a syringe driver was not fulfilled. This meant the patient was potentially in more pain and discomfort than they might have been. When staff arrived to see the patient they had to administer additional medication straight away to relive the patient’s pain. At the end of the visit staff contacted the district nurse to ascertain why the driver had not been prescribed by the GP. We followed this incident up after the inspection was over and found the team had worked in partnership with the community rapid response team to get the prescription set up rather than continue to rely on the GP. Details of the incident were shared with partners from the wider system so learning could be shared, including with the GP practice.

The whole staff team worked collaboratively to make sure people's healthcare needs were effectively treated and met. The team included medical and nursing staff, nursing assistants, occupational therapists, physiotherapists, complimentary therapists, administrative staff, and a range of other support staff.

The hospice at home team worked in partnership with domiciliary care agencies, GPs, district nurses, and other community teams delivering care to patients in their homes.

People and their relatives told us they were regularly offered drinks throughout the day. One relative told us how staff encouraged their family member to eat saying, “the chef comes in to [name] and says, 'come on [name] what do you fancy today'. She gives him what he wants. If [name] feels he wants something, they will get it for him." This person described the food as “great.”

There was a visitors food menu that contained a range of meals relatives could eat from while they were staying at the unit.

Staff made sure people’s nutrition and hydration needs were met. They talked to patients about their food preferences so they could offer meals they knew they would enjoy and met their religious or cultural needs. Staff could access speech and language therapists and dieticians for people who had dysphagia (difficulty swallowing) or other conditions that made eating and drinking difficult. A volunteer told us how they were given a written daily handover, so they knew people’s nutritional and hydration needs. This ensured any risks around patient’s eating and drinking were known to them before offering them drinks and snacks.

Therapy staff told us they gave patients practical support and advice to lead healthier lives.

Staff spoke at length about the importance of working to ensure patients were not in pain and told us how they worked as part of a multidisciplinary team to monitor patients and review their care to provide relief from pain and to improve psychological functioning.

Staff told us they measured patient outcomes by the level of pain or discomfort patients were experiencing. They measured patient outcomes using the integrated palliative care outcome scale (IPOS) and the AKPS. Outcomes were measured jointly for both the inpatient unit in Warwick and the unit in Coventry. The aim was to have a baseline IPOS measurement for all patients on admission. Staff told us not all patients were well enough to have an IPOS completed. Of the 104 admissions in July, August, and September 2024 an IPOS was completed for 71 patients at admission and 52 of these patients completed a second IPOS enabling outcomes to be measured. All patients reported a reduction in their symptoms including in pain, anxiety, depression, and psychosocial problems including worrying about loved ones and practical problems. Most patients described a significant or major improvement in their physical and psychosocial symptoms. Patients also reported an improved sense of peace and spiritual wellbeing. The IPOS results also showed, in the last three days before death 80% of patients had little or no pain, and 75% of patients felt at peace most or all of the time.

Loved ones were asked to complete a bereavement survey after the death of a patient. This was to gauge, amongst other things, if people had been in pain during their inpatient stay, if the person had died in their preferred place, what people thought about staffing levels, and if loved ones had been provided with regular updates about the patient’s care and treatment. The response to the 2024 survey showed most respondents thought patients had received exceptional or excellent care (100%), had their pain well managed (99%), had died in their chosen setting (97%), there were enough staff (100%), and that they themselves had always or usually received enough information from staff (95%).

Audits were completed to ensure patients were receiving a high standard of care. For example, a tissue viability, and a mouth care audit. The last mouth care audit was completed in January 2024. The audit showed that while patient’s oral hygiene needs were consistently assessed by staff at admission, when mouth care was being carried out it was not consistently documented and did not form part of their care plans. The audit looked at the mouth care of 21 patients, however, it had only been possible to speak to six patients, only three of whom required support with their mouth care routine. The three patients who required support said staff were helping them to manage their concerns. There was an associated action plan to help improve staff compliance with documenting mouth care so future audits could capture the experience of more patients.

Audits to monitor if staff were following processes to improve patient outcomes were also routinely undertaken. They included audits for pain management, symptom control, physical wellbeing, and end of life care planning.

People and their relatives told us treatment options were discussed with them so they could understand what they were consenting to.

Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent. They knew how to support patients who lacked capacity to make their own decisions. They used agreed personalised measures when they needed to limit patients' liberty.

When patients could not give consent, staff made decisions in their best interest, taking into account patients’ wishes, culture and traditions.

Clinical staff received and kept up to date with training in the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). Staff implemented DoLS when they were required and in line with approved documentation. If patients under DoLS required restraint, for example from leaving the unit against medical advice, they used the least restrictive practice. This might mean a patient had round the clock supervision from a member of staff to help them remain calm and stay in the unit. DoLS applications were submitted using a central email address to ensure the response was received and acted upon swiftly. This meant if the member of staff who submitted the application was not at work when the DoLS was agreed or refused it would always be acted upon by the team to ensure people were not having their liberty deprived unlawfully.

Staff spoke of patients and their relatives as partners in decision making. Nursing associates told us if they had any concerns about people’s capacity to consent to an intervention, they would report it to the nurse in charge. One staff member told us how they would not hesitate to advocate for a person to ensure any decisions were made in the person’s best interests.

Staff followed a process to produce, and record treatment escalation plans including a Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) form. Sometimes the forms had already been completed before the patient arrived at the unit. If patients did not already have a ReSPECT form a new one was completed through a conversation with the patient, their families, and their health and care providers to understand what mattered to the patient and what was realistic in terms of their care and treatment. The plan was used by staff for making decisions in an emergency when the patient had lost capacity to participate in making that decision. One of the items recorded on the ReSPECT form was a shared recommendation about whether cardiopulmonary resuscitation (CPR) was recommended or not.

An audit was completed in December 2023 to explore if the ReSPECT forms in patient files were valid (had been correctly completed), the audit included ReSPECT forms that had been completed prior to admission to the inpatient unit. The outcome showed 7% of doctors had not consistently completed their section of the form which invalidated them. There was an action plan which included details how of this problem could be rectified.

There was a clear process for staff to follow when patients did not have capacity to consent to treatment. Staff followed a process to apply for and implement a DoLS.