Marie Curie Hospice and Community Services Midlands Region

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

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

We assessed 5 quality statements within effective. Staff always made sure people’s care and treatment was effective by thoroughly assessing and reviewing their health, care, wellbeing and communication needs with them. Care plans were personalised and holistic. Staff 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 worked well across teams and services to support people. Staff ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves. Staff understood the relevant consent and decision-making requirements of legislation and guidance and they knew who to contact for advice.

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 always made sure people’s care and treatment was effective by thoroughly assessing and reviewing their health, care,wellbeing and communication needs with them.

Staff treated patients as individuals, and involved them and their families in care, and treatment decisions. They were invited to attend care and treatment reviews. Patients were involved, listened to, and everyone involved worked well together.

Staff completed a comprehensive health assessment of the patient in a timely manner at, or soon after, admission. Staff developed care plans that met the needs identified during assessment. Staff used an Integrated Palliative Care Outcome Scale (IPOS) to measure patients' physical, psychological,emotional and spiritual, and information and support needs. Upon admission/first assessment each patient had a holistic assessment during which an IPOS was completed to give the “headlines” of the symptoms most pertinent to the patient.

Care plans were personalised and holistic.All the information needed to deliver patient care in a timely manner and to understand the care, medical and spiritual needs of patients was detailed in the patient care plan.Staff updated care plans when necessary.

We reviewed 6 care records during our assessment. They were up to date and showed comprehensive assessments undertaken leading to effective ongoing care.

Patients were involved in the assessment of their needs, and support was provided where needed to maximise their involvement. They were given information and advice about their health,care and support to enable them to be as well as possible, physically, mentally and emotionally.

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 to plan and deliver high quality care according to best practice and national guidance. Staff holistically assessed people’s physical, mental health and social needs, and delivered care and treatment in line with legislation,standards and evidence-based guidance.

The corporate brand had a national process in place for review of National Institute for Health and Care Excellence (NICE) guidance. All guidance was ratified. Review of Local NICE guidance was completed by the clinical leads group at local level.

The service provided evidence-based practices including cognitive behavioural therapy, art therapy, creative writing and children’s counselling services. The wellbeing hub planned and delivered appropriate groups such as gardening.

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.

Patients care was well coordinated, and everyone involved in their care worked well together.

All staff had a clear understanding of each other’s roles and how they worked together to provide holistic care. Staff told us that each profession and staff group was equally respected within the team.

Where appropriate, staff shared information with other service providers such as GP surgeries, care homes and mental health teams. Staff referred patients for mental health assessments when they showed signs of mental ill health and / or depression. Staff we spoke with knew how to access the local mental health team and other providers for support, such as substance misuse teams.

The teams had effective working relationships, including good handovers, with other relevant teams within the organisation (for example, care co-ordinators, discharge teams, and specialist teams).

A consultant led community multidisciplinary team meeting (MDT) took place every Wednesday morning and staff discussed all patients flagged up with concerns. This was followed by an inpatient unit MDT in the afternoon.A comprehensive review of all patients accessing the Marie Curie night service occurred on a weekly basis and was led by a community clinical lead or a senior nurse.

Senior staff held daily meetings at 9 am with the local acute trust and hospices. They reviewed the waiting list and made decisions on where patients needed to be placed. There was one waiting list for patients receiving palliative care across Birmingham and Solihull area.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

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

Patients we spoke with told us their health and wellbeing were checked regularly and monitored throughout the day, and night when necessary.

Staff adhered to legislation and good practice guidance. Treatment and assessments were evidence based and monitored for outcomes. Staff continually monitored and assessed the patient’s needs. Changes to treatment and support were discussed and made if needed to benefit and drive improvement for people using the service. Lessons were learned from both positive and negative occurrences, and were shared to help improve the service, what it offered, and the way it was delivered.

Staff participated in clinical audit, benchmarking and quality improvement initiatives. There was a national oversight of audit completion with national analysis of trends and themes for organisation wide sharing. We saw evidence of local implementation of action plans where actions were identified from audits. There was national oversight of the progress on action plans.

The service participated in a comprehensive range of Marie Curie national and local level audits. Scheduled audits included but was not limited to infection prevention and control, pain and preferred place of death audits.Results of confirming pain on first assessment was registered as 1.98 and reduced to 0.60 on the final assessment.The introduction of integrated palliative care outcome scale and standard operating procedure also provided individualised patient assessment and improved clinical outcome measures.

The service audited the patient’s preferred place of death and accommodated this as far as possible. The service collated this information, we saw data from April 2024 to March 2025 which evidenced that 100% of patients who had died in the inpatient unit had died in their preferred place of care.

The hospice delivered the priorities in a variety of ways such as through the provision of palliative study days, patient survey results, embedding of the Karnofsky performance status assessment tool scale and information provision for families and service design.

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. Patients were always asked for their consent to care and treatment. Where patients did not have capacity to make decisions, the appropriate assessments were completed.Staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings,culture and history.

All staff received and kept up to date with training in the Mental Capacity Act and Deprivation of Liberty Safeguards.

Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. Staff understood the importance of ensuring that people fully understood what they were consenting to and the importance of obtaining consent before they delivered care or treatment.

Staff understood the relevant consent and decision-making requirements of legislation and guidance, including the Mental Health Act,Mental Capacity Act 2005 and they knew who to contact for advice. Staff understood the relevant consent and decision-making frameworks and the changing implications during a person’s last days of life.

Staff protected the rights of patients subject to the Mental Health Act and followed the Code of Practice. People felt supported by staff, who took time to explain treatment and decisions. Staff were sensitive and knowledgeable when giving updates to families. The service had effective systems and practices to ensure people understood the care and treatment being offered or recommended.

Managers monitored the use of Deprivation of Liberty Safeguards (DoLS) and made sure staff knew how to complete them. The use of DoLS was monitored weekly. All DoLS were reported through the incident reporting system and individual risk assessments for individuals on DoLS were reviewed through regular meetings.

We reviewed a patient’s care record and saw evidence Do Not Attempt Cardiopulmonary Resuscitation decision had been made appropriately and in line with national guidance.