LIVES Headquarters

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• 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 found evidence that people and communities had the best possible outcomes because their needs were assessed promptly. People’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. Leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work

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 maximised the effectiveness of people’s care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them.

We reviewed 20 electronic patient records during the assessment. Staff completed a comprehensive health assessment of each patient. This assessment focused on physical, social and emotional aspects of their health and wellbeing. Assessments included past medical history, a physical examination, current medicines and treatments, mental capacity, social history and carer’s needs.

We saw care was planned using a personalised and holistic approach and focused on meeting the needs identified during the assessment. The service used technology to support assessment processes including ‘point of care’ blood testing and ultrasound scanning, where results were available straight away. We were told of examples where this additional use of technology helped support decision making on treatment escalation. This included examples where results helped to support decision making around patient’s requiring hospital care and those who could be safely cared for at home.

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 followed up to date policies that were based on evidence-based practice. They used recognised tools to support assessment and decision-making processes. For example, the falls team used an adapted frailty score to help determine people's level of frailty and functional ability.

Staff participated in clinical audit, benchmarking and quality improvement initiatives. This included work on clinical complexity scores. A clinical development group was in operation, where staff were involved in discussions about new technologies, evidence-based practice and innovations. We were given examples where staff were given dedicated time and had been encouraged to explore new ways of working that may improve care and outcomes for patients.

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.

Staff held regular internal clinical forum meetings to consider case reviews for service wide learning and escalation. Staff told us of one discussion related to the challenges versus potential benefits of providing beta blockers intravenously rather than orally. Outcomes of discussions and decisions were recorded in meeting minutes, with action plans outlined. The service also held regular Commissioned Services Advisory Group (CSAG) meetings, in which clinical staff members could raise issues, request further training or make suggestions to improve patient care.

LIVES staff worked closely with the local ambulance service and the local community hospital provider to ensure that patients’ situations and their treatment was accurately documented at handover. They also regularly liaised with the local hospices and other palliative care providers, as Lincolnshire tends to have a high number of elderly patients.

The CEMS teams worked closely with colleagues in local hospital A&E departments and as part of the local Major Trauma network. These teams had access to GP records systems to enable quick and effective communications with local surgeries. At the time of the assessment, the service was evaluating the work of the CEMS team to assess effectiveness and efficiencies in terms of the impact on hospital “bed/days” and improved patient outcomes.

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.

People were signposted to services that provided health promotion support for example, through participation in smoking cessation schemes or healthy eating advice. They provided relevant information leaflets as part of their care and support. The service had also set up a “Talk to Us” initiative, using QR codes, posted in public places. This enabled people with mobile technology to ask questions and receive guidance and signposting.

The service was focused on supporting patients in their preferred place of care. This included where patients chose to stay at home rather than be admitted to hospital. Staff worked closely with other services in the community to support people’s independence, choice and control. The local community trust told us that their work with LIVES to develop a single point of access pathway would enable more people to receive care at home or the most appropriate place for them.

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.

Staff used recognised tools to improve the detection and response to clinical deterioration in patients as a key element of patient safety and improving patient outcomes. They routinely audited patient record forms to ensure appropriate completion of these tools.

Staff used technology to support patients effectively for example, for prompt access to blood test results and ultrasound scans. Point of care testing enabled staff to assess patients with up-to-date clinical test results. This contributed to prompt treatment and care in an appropriate setting, for example, enabling some patients to be cared for at home rather than transported to hospital.

The service monitored the impact of the support provided on patient outcomes. For example, as an aim of the CEMS team was to provide an enhanced level of care in the community, there was a target of less than 25% of patients requiring transfer and admission to hospital. Achievement showed that 27% of patients required transfer to hospital between 1 April 2025 and 30 June 2025, with 73% of patients effectively managed in the community. This was an improvement of 3% from 2024. Leaders continuously reviewed data and trends with an aim to improve this achievement where possible. Action to improve patient outcomes had included the implementation of an electronic record system which enabled better use of data and information to help identify and understand opportunities for improvement. Within the falls team there was a target to reduce the number of patients requiring an NHS ambulance to less than 50%. Between 1 April 2025 and 30 June 2025 performance was on target at 39%. Within the community first responder (CFR) team, there were no defined contract targets as this is not a commissioned service. Leaders monitored activity and we saw that the CFRs were first on scene in 69.1% of cases attended between 1 April 2025 and 30 June 2025..

Additional work on measuring and monitoring patient outcomes was underway. The service had developed complexity scores which included frailty, national early warning scores, clinical complexity and injury severity. It enabled the service to measure the care provided against the improvement in the patients’ clinical outcome.

Audits of patient record forms were carried out monthly. These were used to identify issues with assessment and treatment recording with a view to improving. At our previous inspection we found that these were not always being completed regularly. At this assessment we found that the audits were routinely conducted every month and that areas for improvement were identified. For example, service leads worked closely with the company that designed their electronic patient record system to ensure feedback from the audits was used to make improvements to the system. Staff received regular feedback from these audits and were involved in learning and improvements. Audit performance was consistently positive with the CEMS team performing at 97%, the falls team at 84% and volunteer response team at 86%.

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

Staff took all practical steps to enable patients to make their own decisions. For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. They did this on a decision-specific basis regarding significant decisions. For example, where a patient wished to stay at home rather than go to hospital. We saw that staff informed people of their options, including risks and benefits and possible outcomes of decision making.

When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history. Staff had completed training in mental capacity and understood their responsibilities in relation to this.