Great Oaks Hospice

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 the service met people’s needs. At our last assessment we rated this key question as good. At this assessment the rating has remained good. This meant that people’s needs were met through good organisation and delivery.

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.

We scored the service as 4. The evidence showed an exceptional standard. 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.

Staff demonstrated a strong commitment to person‑centred care, ensuring patients and their families were meaningfully involved in planning and making decisions about treatment. We observed staff engaging with patients and carers throughout the end‑of‑life journey, clearly explaining procedures, responding to concerns, and tailoring their approach to meet individual needs. One service user commented, “Staff are always focused on ‘service user’ and involve them and ‘service user’ in care and planning.”

Teams worked collaboratively across disciplines to create care plans that addressed physical, emotional, and social needs. The hospice’s flexible and responsive approach meant patients received care aligned with their personal preferences, circumstances, and priorities. An example shared with us involved a patient who wished to take one final holiday to listen to the sea. Staff supported the patient to plan the trip, liaised with the local care team at the destination, and coordinated with the GP and district nursing services to make this possible. Spiritual needs were considered at the initial assessment and the service had contacts with local spiritual leaders to enable patients to access this care as and when required.

Staff encouraged patients to make their own choices about their care and treatment. They worked with individuals to understand their preferred place of death and collaborated with partner organisations to help honour these wishes. Patients were also supported to participate in activities that promoted wellbeing and connected them with others living with life‑limiting illnesses, offering peer support and reducing social isolation.

The service had a volunteer workforce which was an integral part of the hospice. We spoke with a volunteer who expressed how a loved one had been helped by the charity and that now they were loving the opportunity to give back. Volunteers helped with admin, running groups such as the men’s group and offering complimentary therapies.

We scored the service as 4. The evidence showed an exceptional standard. 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.

The service had referral and assessment pathways which supported the service to react responsively to a patients changing care needs. We were given several examples of the provider providing hospice at home services to a patient, for which funding was not immediately available, which enabled the patient to achieve their wish of dying at home and avoided unnecessary hospital admissions. The medical director of the service was a general practitioner. He stated “When I was a GP I referred someone and had a response from Great Oaks Hospice within 20 minutes. The patient died the next day. I was impressed at the speed the hospice responded”. Feedback from other service providers also positively mentioned the service ability to respond to emergency end of life care requirements.

The service worked collaboratively both internally and with other healthcare providers, ensuring patients transitioning between various stages of their care journey received joined up and well-coordinated treatment. We saw there were effective multi-disciplinary team meetings between other service organisations such as district nurses and the local hospital. The hospice’s main philosophy was to support people from the start of their diagnosis of a life limiting illness until their death. People could access activities, therapies and support groups at the hospice and when it was near the end of their support in the home with end of life care. The service had made the decision to recruit permanent staff rather than relying on bank staff to ensure patients had continuity of care. Working closely with the primary care network, this service allowed them to engage with families early in their diagnosis, offering tailored support at home. The hospice then connected them with the Wellbeing Service to help them live well with their condition and support their carers. When end-of-life care is needed, the hospice at home team stepped in, ensuring continuity, compassion and choice throughout their journey.

The hospice recognised the diverse needs of its patient population, ensuring services were tailored to meet individual requirements, including those with protected characteristics under the Equality Act. Staff made reasonable adjustments for patients with additional needs, ensuring care was delivered in a way that respected personal, cultural, and medical considerations.

We scored the service as 3. The evidence showed a good standard. The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

People were provided with a wide range of accessible information about their care and the support that could be offered. The hospice had a community support service which helped to create a personalised care and support plan to meet patient’s needs. This enabled adults with life-limiting conditions, their carers and families, to adapt, manage and understand their diagnosis in a holistic manner. The service provided signposting and guidance for future planning to families to make it easier to know what administrative processes would support the family when their loved one was deceased. One patient stated “When ‘staff member’ got involved, they understood all the issues we were struggling with and made it their mission to help us”.

We saw people were provided with a wide range of accessible information about their care, treatment, and support. This included information about their life limiting illness and the different support options available, such as bereavement counselling. There was clear information to people and their families on how to make a complaint. The service provided easy read documents which included its complaints policy.

The service was able to access translation services. Patients could also call the service if required. One patient stated staff were “always at the other end of the phone, when needed. Advice and help was always good”.

We scored the service as 3. The evidence showed a good standard. The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result.

The service showed an open and honest learning culture, that actively enabled people to share feedback, ideas, and raise concerns or complaints about care, treatment and support. The service aimed to let people know about the outcome within 28 days. In the 6 months prior to the inspection the service had not received any complaints.

Complaints and feedback were analysed to see if there were any themes and trends. These were reviewed and discussed at the quality group meeting to see whether any action needed to be taken to improve the service offering. The hospice also attended the local ICB meeting where feedback and complaints from other organisations were also discussed.

The service provided advocacy support, whereby the hospice liaised with other organisations to support adjustments or to facilitate smoother and more timely transitions between the hospice services.

We scored the service as 3. The evidence showed a good standard. The service made sure that people could access the care, support and treatment they needed when they needed it.

Staff made reasonable adjustments for patients, for example, people with communication needs were given iPad and picture cards so they could communicate with staff effectively. The premises was accessible for disabled people.

The service served the area of the Forest of Dean, however it also provided support to patients outside of this area when urgently required and no other option is available. For example, the hospice at home lead was contacted by the palliative care team regarding a patient requiring discharge from hospital urgently. The patient was entering the end of their life. Their wishes were to be at home with their family. The patient lived outside of Great Oaks’ catchment area, however the patients nearest hospice wasn't able to provide the care. The palliative care nurse explained it wasn't appropriate for the care to go to a domiciliary agency due to the complex needs of the patient. Great Oaks accepted the discharge within a few hours, and discharge plans were put into place. The patient was able to go home the same day with support and care from the hospice at home team. They died peacefully with their family lying beside them.

There was access to post treatment support. There was an advice line people could call if they required help and information. There was support and bereavement counselling and advice available for family members following the death of a loved one. We spoke with a volunteer who stated, “the bereavement and complimentary therapy make a big difference”. The volunteer had received this following a bereavement and now they volunteered at the service.

We scored the service as 3. The evidence showed a good standard. 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.

Staff within the service and the wider organisation promoted a culture in which the people using the service felt empowered to give their views. At the initial assessment and throughout the patient journey, people were asked about what mattered to them.

The provider monitored the ethnicity, age and gender of people admitted to the service. The provider was trying to reach areas of the Forest of Dean, that were considered more deprived, by providing services in these locations so people didn’t have to travel to the hospice to be able to benefit from the services offered. For example, the service had started providing wellbeing groups in Newent once a month which was a 30 minute drive from the hospice.

Staff were trained to support people who required reasonable adjustments. Healthcare assistants and registered nurses received training in equality and diversity as well as learning and disability and autism awareness, dementia awareness and domestic violence and abuse awareness.

We scored the service as 3. The evidence showed a good standard. People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Staff supported patients to make decisions about their care and treatment and their future. For patients with life-limiting illness, the hospice sought to engage with these patients once they had been diagnosed. Clinical staff in the hospice could discuss attempts at resuscitation with patients and carers to ensure their preferences were factored into any actions that were carried out. These were written into ReSPECT forms. A ReSPECT form documents the emergency care and treatment preferences of a person and the clinical recommendations of their healthcare providers. The form isn’t legally binding but serves as a valuable guide for clinicians, especially in urgent situations. Staff then signposted patients to their GP and consultant to ensure the appropriate paperwork was completed. One staff member said they always tried to have conversation about ReSPECT forms as a family and they also respected the wishes of those patients that wished to discuss this in private. The hospice at home lead was responsible for ensuring all hospice at home staff were aware of the patient’s wishes prior to starting a shift and staff were responsible for reporting any changes to the patient’s wishes to the hospice at home co-ordinator.

Staff created personalised care plans to account for the patient’s needs, wishes and feelings. Families we spoke with said they felt involved in advanced care planning for their loved ones. Feedback provided by the hospice also indicated families and carers felt the hospice involved them in planning care for their loved ones. Care for people who were nearing the end of their life was managed and communicated in a sensitive and dignified way.