Marie Curie Hospice and Community Services Midlands Region

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked for evidence that safety was a priority for everyone, and leaders embedded a culture of openness and collaboration. There was a culture of learning and people were cared for in an environment that was appropriately clean and well maintained. We checked that people were safe and protected from bullying, harassment, avoidable harm, neglect, abuse and discrimination.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

We assessed 8 quality statements within safe. All staff knew what incidents to report and how to report them. Staff worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. Staff knew how to identify adults and children at risk of, or suffering, significant harm. This included working in partnership with other agencies. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Staff made sure equipment, facilities and technology supported the delivery of safe care. The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. The service assessed and managed the risk of infection. Staff made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

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 had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

All staff knew what incidents to report and how to report them. Staff gave examples of incidents they had reported, confirming this. Staff raised concerns and reported incidents and near misses in line with the service's policy. From April 2024 to April 2025 684 incidents were reported. Fifty-six per cent of the incidents reported were clinical incidents and the rest were non-clinical incidents. Of the incidents reported, 45.3% were classified as no harm, 46.3% low harm and 8.3% as moderate harm. Staff reported pressure damage acquired while patients were receiving care at Marie Curie hospice as incidents and classified them either as low or moderate harm depending on the severity. Managers shared a flowchart which required staff to complete a rapid review within 48 hours and carry out a statutory duty of candour upon detection of a pressure damage.

Managers investigated incidents thoroughly. Staff followed the Patient Safety Incident Response Framework (PSIRF) process. Team leaders were notified of incidents and had a central tracker for incidents. They met weekly, to discuss patterns including flow chart and time scale. Staff had rapid and comprehensive reviews and discussed immediate learning. Incidents were discussed at quality assurance groups, nationally and cascaded back to teams including safety learning panel. There was a PSIRF action plan which detailed improvement actions taken.

Staff understood their responsibilities to meet the duty of candour and to be open and honest with patients when notifiable incidents occurred. Staff gave patients and families a full explanation and apology when things went wrong.

Staff received feedback from investigation of incidents, both internal and external to the service. The Midlands newsletter shared key news and updates from the region with the aim of keeping staff informed and connected with all teams across the hospice and wider teams. We reviewed the newsletters from January to May 2025 and these included information such as key highlights of the month and the Midlands quality notice board which contained incidents and complaints.

Staff met to discuss the feedback and look at improvements to patient care. The information we received following our inspection showed minutes which showed incidents and improvements were discussed on a regular basis.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The service’s referral and admission processes ensured that all essential information about the patient was received to determine if the patient’s needs could safely be met. Staff assessed referrals into the service to ensure the care and support available was suitable for the patient. They ensured they were always visible and available for the patients. Staff had excellent relationships and communicated well with colleagues both internally and externally to the service to enhance the quality of care, treatment, and support the service provided, and ensured continuity in the patients care journey.

Anyone with a life limiting condition could be admitted to the service regardless of their diagnosis. Patients were admitted to the inpatient unit for symptom control, and this was medically led and risk assessed depending on the complexity of the patient.

Patients were asked how their pain levels were, following administration of analgesia and this was recorded. Staff told us each patient was treated as an individual, pain levels were closely assessed, monitored and recorded. Staff were clear that each patient was an individual and that pain management was aided by the building of relationships with patients. Staff also demonstrated an understanding of the emotional and psychosocial impact upon pain.

Staff involved all the necessary healthcare and social care services to ensure patients had continuity of safe care, both within the service and post-discharge. Staff at the service and external partners worked as one, enhancing the experience of care for people using the service, whilst maintaining continuity.

Staff followed a separate sepsis pathway for the hospice and the community. They kept intravenous antibiotics in the hospice and followed the acute hospital guidance.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Staff were trained in safeguarding, knew how to make a safeguarding referral, and did that when appropriate. The completion rate for safeguarding adults’ level 2 was 98.4% for healthcare assistants and 98% for non-clinical staff. Safeguarding leads, nursing and medical staff completed level 3 safeguarding training, and the completion rate was 96.3%. Data showed 99.1% of staff were trained in safeguarding children. Staff had access to a safeguarding level 4 point of contact.

Staff could give examples of how to protect patients from harassment and discrimination, including those with protected characteristics under the Equality Act.

Staff knew how to identify adults and children at risk of, or suffering, significant harm. This included working in partnership with other agencies. Staff said they felt confident to recognise and raise issues with their managers and knew when they should make referrals to the local authority. The hospice had a safeguarding lead and staff were able to name the lead and knew how to contact them.

Staff followed safe procedures for children visiting the service. The service had a corporate policy in place for adult and children safeguarding concerns.

All staff including clinical, non-clinical and volunteers had disclosure and barring service checks in place. This information was stored securely at corporate level and could be accessed locally for assurance and oversight.

The service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe,supportive and enabled people to do the things that mattered to them.

Staff communicated with patients so that they understood their care and treatment, including finding effective ways to communicate with patients with communication difficulties.Patients and their families were involved in managing risks, risk assessments were person-centred, proportionate and reviewed regularly. Patients felt safe, listened to, and supported on the ward, and in the community. Their concerns were dealt with;individual risks were well managed.

Staff enabled patients to make advance decisions.There were robust processes to ensure patients risks were assessed,monitored, and managed on a daily basis. Individual patient risks were discussed in patient safety meetings, and multi-disciplinary team reviews. These included signs of deteriorating health, medical emergencies or behaviours that may challenge.

The therapy team offered a fatigue,anxiety and breathlessness programme for patients with a palliative diagnosis who struggled with symptoms of fatigue, anxiety, and breathlessness.The programme was multidisciplinary team led,comprising of an occupational therapist, physiotherapist, and doctor, and delivered in several ways according to need.It aimed to provide people with a “toolbox” of techniques to help them maximise their sense of control and quality of life.

Staff used the NHS Surface, Skin inspection, keep moving, Incontinence/moisture and Nutrition/hydration bundle and care round for adults'guidance.This helped staff access risk, implement interventions and document care to reduce pressure damage.

We saw a patient at high risk of falls had been put on a higher level of observation and check chart.The therapy team offered advice on falls prevention to patients who started to feel unsteady on their feet either due to their health, activity levels or their home environment.They offered simple things people may be able to alter in their environment or lifestyle to reduce their risk of falling.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The hospice environment was designed to meet the needs of patients and those close to them attending for stays within the in-patient service. Access to the building was through an open and spacious reception area.

The service had suitable facilities to meet the needs of patients and those close to them. The in-patient area provided communal spaces and large bedrooms with options for family members to stay overnight. The in-patient unit was commissioned to use 12 in-patient beds all with ensuite bathroom facilities at the time of our assessment.

A purpose-built play area for children had been incorporated in the inpatient unit. This provided a designated play area for younger and older children.

Staff carried out daily safety checks of specialist equipment. Syringe pumps for the continuous administration of end-of-life medicines were kept on site, maintained and used in accordance with professional recommendations. We saw portable equipment had been safety tested and were within date.

Staff attended a syringe driver training either online or face-to-face. A syringe driver competency book was available for staff to sign and uploaded to the e-system under competencies.

Staff carried out safe management of the care environment audits,and the results showed 100%compliance.

The service made sure there were enough qualified,skilled and experienced staff, who received effective support,supervision and development. They worked together well to provide safe care that met people’s individual needs.

The service had enough nursing, medical and allied healthcare professional and support staff to keep patients safe.The registered manager told us they followed the Marie Curie national safe staffing policy which outlined staffing ratios per palliative care bed.On the day of our assessment, the inpatient unit and community support services was fully staffed with a dedicated clinical nurse in charge. Each shift was covered with the correct ratio of registered nurses and healthcare assistants according to planned versus actual staffing records. We saw evidence to support that actual staffing met the planned numbers.The service’s whole time equivalent (WTE) requirement was 26.6 and they had fully recruited workforce of 26.66 healthcare assistants and nurses. The service did use bank or agency staff in the 12 months prior to our assessment for additional 1/1 patient support to ensure safe staffing was maintained at all times.

Nursing numbers was calculated based on the level of care required.This meant the ratio of patients to registered nurse was 4.5:1. The number of nurses and healthcare assistants matched this number on all shifts.

The service had 5 band 7 registered nurses in the community and 1 band 7 in the inpatient unit. A clinical nurse specialist managed hospice at home team.There were 2.6 WTE consultants who provided onsite cover for 5 days per week and 24/7 consultant cover.

The managers could adjust staffing levels daily according to the needs of patients. If minimal staffing levels could not be achieved, then consideration would be given to the ability to take admissions and bed numbers could be reduced to ensure safety of those using the service.The service did not report any period of minimal staffing levels at the time of our assessment.

The service operated an on-call system with a senior manager (band 7 senior manager) available from 5pm till 8am daily. Medical cover was available on site from 9am till 5pm and on call from 5pm. A consultant and 2 specialty doctors were available daily.

Medical staff led daily clinical rounds which were followed by daily huddles, including at weekends. A consultant was always available for advice 24/7 and for face-to-face reviews if clinically indicated. The medical staffing levels matched the planned number.

There was adequate 24-hour medical cover.There was a service level agreement (SLA) in place with the local trust for the supply of medical services out of hours. The service had a standard operating procedure for the palliative care consultant on call covering the Birmingham and Solihull area 7 days a week.

Specialist registrars from the acute trust delivered training packages to nursing staff.The service had an educational and clinical lead to support staff.

The service had low staff turnover rates of 1%in June 2025. The service had reducing vacancy rates and at the time of our assessment,there was 1 physiotherapy vacancy. Therapy technicians were available to work with various teams.

Staff received training appropriate and relevant to their role. Staff were required to complete mandatory training which was comprehensive and met the needs of the patients and staff. Data showed the overall mandatory training compliance was 96%. This exceeded the service’s target of 90%. Mandatory training for both medical and nursing staff included but was not limited to infection prevention and control, fire safety, inclusion and diversity, information governance and safeguarding.

A performance review framework was available for staff to use to support their overall performance and enhance personal growth.Line managers and team members were required to record performance review conversations and outcomes on a dedicated form under ‘performance activities’on the Marie Curie’s learn and develop site. 

Staff were experienced,qualified and had the right skills and knowledge to meet the needs of patients. The service ensured staff completed training appropriate to their role, clinical staff also had an internal clinical skills training programme which included syringe driver training, cardiopulmonary resuscitation and manual handling.

Managers gave all new staff full induction tailored to their role before they started work. All new staff were given an induction pack which explained the service vision and goals, useful information and a checklist for managers to complete. Volunteers to the service were also given full induction and a training pack.

Managers supported staff to develop through yearly, constructive appraisals of their work.All staff with the exception of volunteers were required to undertake performance reviews ensuring a consistent approach to evaluating and improving performance across the organisation. In July 2025, 59% had completed it, 33% were in progress and 8% had not completed it due to being away from work.However,all staff had received an appraisal within the last 12 months.

The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Patients did not raise any concerns around infection,prevention and control during this assessment.

There was a comprehensive system for assessing and managing infection control risks, incorporating policies, procedures, roles and responsibilities,training and monitoring. Managers oversaw infection prevention and control (IPC) audits which were done routinely. Managers took immediate action if infection prevention and control procedures fell below expected standards.

There was an effective approach to assessing and managing the risk of infection, which was in line with current relevant national guidance.The service had infection control policies and procedures to help control infection risk.Infection prevention and control training compliance for clinical staff was at 97% and 100%for non-clinical staff respectively.

The inpatient unit was visibly clean and had suitable furnishings which were clean and well-maintained. We observed that all areas were tidy and free from clutter. Cleaning records were up-to-date and demonstrated that all areas were cleaned regularly.

Regular hand hygiene audits were carried out both on the in-patient unit and within patient homes on community visits. Compliance with the most recent hand hygiene audit(April 2025)was 100%in the hospice and 99% in the hospice at home service.

Staff maintained equipment well and kept them clean. ‘I am clean’ stickers were visible and in date.Cleaning records were up to date and demonstrated that the ward area was cleaned regularly.The in-patient area had suitable furnishings which were well-maintained. We saw housekeeping staff actively maintaining the cleanliness of the environment throughout the assessment.

Staff adhered to infection control principles, including hand washing. They cleaned equipment after patient contact and labelled equipment to show when it was last cleaned. We saw evidence to support this during our assessment.

The provider had a national infection prevention and control lead and the hospice had a link nurse responsible for infection prevention and control.

The service had a food premises inspection in January 2025 which found the general condition of the kitchen of high standard. The service scored a 5 rating in the food hygiene rating from environmental health officers.

The service made sure that medicines and treatments were safe and met people’s needs,capacities and preferences. They involved people in planning, including when changes happened.

Patients and their families received information about their medicines, and if they did not understand the information, staff explained it to them.

Patients we spoke with told us they received pain relief soon after requesting it.

Staff followed good practice in medicines management (that is, transport, storage, dispensing, administration, medicines reconciliation, recording, disposal) and did it in line with national guidance.

Staff prescribed, administered, and recorded pain relief accurately. The service used differing specialist equipment to manage pain.Pain relief medications were prescribed following initial assessment and could be administered orally, via skin patches or transfusion pumps. Syringe drivers were used within the in-patient unit and community to administer some pain medication. A syringe driver (or syringe pump) is a small battery-powered pump. It delivers a steady stream of medication through a small plastic tube under the patient’s skin. Syringe drivers were used for medicines that helped with pain, sickness,fits,agitation and breathing problems.

The service employed an advanced specialist pharmacist. They provided support to medical staff, dealt with prescribing and managed patients who required anticipatory medicines.

The specialist pharmacist attended incident meetings weekly and fed into the Midlands and national group. They provided support to the controlled drugs(CD)accountable officer, clinical specialist and went through non-medical prescribing with clinical staff. The service had started a non-medical prescribing group, and a peer review process was in place. There was a regional group which comprised of consultants, pharmacists and staff met with local pharmacist to share learning.

Staff gave an example of actions taken when liquid medication discrepancy was noted. Senior staff carried out an investigation which revealed documentation errors. They discussed reporting of spillage and shared learning with staff.

The service had an antimicrobial stewardship week. Antimicrobial stewardship is a systematic approach to support and educate staff to follow evidence-based guidelines for prescribing and administering antimicrobials. Staff filled out a quiz around antimicrobial stewardship. Staff worked with the national infection prevention and control lead and had done a national audit.

The service had an official arrangement to manage emergency supply of medicines out of hours.A procedure had been agreed to procure emergency medicines and staff went through a procurement process to get medicines from a local pharmacy.

Staff stored and managed all medicines and prescribing documents safely. We saw prescription pads stored securely with appropriate recording systems in place.

We saw clear processes for disposal of medicines.Sharps bins were used and labelled appropriately. We saw CD checks were in place along with regular controlled drug CD audits.The registered manager was the CD accountable officer. A pharmacy technician supported the inpatient unit. Staff carried out monthly audits of the CD book, action plans were reviewed at the audit and governance group. Staff kept a log of minor medicine incidents and common themes were distractions and interruptions.

Staff kept a record of CDs for destruction from deceased patients and required 3 authorised witnesses. Medicines were left undestroyed if the death had been referred to the coroner and only destroyed if the medical report was ready.

A CD competency book was available for staff who had been in post for over 6 months. A single nurse CD administration process was in place after staff had received observed practise including an advanced practise assessment.

Registered nurses who had completed the relevant competency administered Schedule 2 CDs such as morphine using single nurse administration in line with local standard operating procedures. This included the disposal of any wasted or part used medication such as part ampoule, tablet, or transdermal patch.

Band 2 hospice at home staff did not administer any medicines to patients receiving end of life care in the community but had direct access to the patient's community nurse, Marie Curie's band 6 hospice at home lead or a member of the band 6 or 7 clinical nurse specialist work force.