Lewis-Manning Hospice Care

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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

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has remained good.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 83 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Patients’ needs were assessed effectively so they received care and treatment that met their individual needs. Referrals were consistently responded to in a timely way within clear timescales. A structured assessment framework was used to determine patients’ needs and suitability for the service. This ensured that patients were directed to the most appropriate care pathway and could be prioritised according to their needs.

Patients were actively involved in their assessments which supported effective care and treatment. Staff encouraged individuals to identify their main concerns, including symptoms, emotional wellbeing and practical challenges. These discussions informed care planning and ensured that support was meaningful and tailored to the individual. For example, staff understood the psychological and social impact of breathlessness and signposted patients to complementary therapies and counselling to address the emotional effects of their symptoms. We also spoke with a patient who had been recommended equipment following assessment to support them in dressing independently which had a positive impact on their wellbeing and quality of life. Another patient’s assessment resulted in them receiving support from other agencies which had provided them with information and equipment to fulfil their wish of continuing to live at home. Patients’ involvement in the assessment process meant their needs were understood and treatment was effective in helping them achieve their goals and live well.

The service was responsive to changes in patients’ conditions to ensure care remained effective and met their needs. For example, where one patient’s condition changed unexpectedly, staff arranged a prompt assessment at the end of a clinic. This enabled timely intervention so their hospital based cancer treatment was not affected. This demonstrated how care was adapted quickly to meet patients’ changing needs and achieve positive outcomes.

Staff were supported to develop and maintain the knowledge and skills required to deliver excellent, evidence based care. For example, within the lymphoedema service, staff had completed nationally recognised specialist training in lymphoedema management. This included ongoing recertification requirements ensuring staff maintained up to date clinical knowledge and competence. As a result, patients benefited from care delivered using current techniques and recognised best practice approaches.

In the breathlessness service, staff used established, evidence based clinical frameworks to guide care. For example, the Breathing, Thinking, Functioning model was used to support a structured, patient-centred approach to managing breathlessness. The clinical lead had also completed accredited training in health coaching, enabling them to apply evidence based communication techniques that supported behaviour change, self-management and improved patient outcomes. This ensured that care delivery was both clinically informed and tailored to individuals’ needs.

The hospice supported staff’s engagement with developments in clinical practice at both a regional and national level. Staff attended conferences, training events and professional forums, enabling them to stay up to date with research and share learning with peers across the sector. For example, staff within the lymphoedema service were active members of the British Lymphology Society and attended regional network meetings and conferences. These opportunities enabled discussion of clinical cases and best practice ensuring that learning could be embedded into service delivery.

Evidence and learning from external engagement were used to inform service development and improve patient care. For example, staff described how learning about the importance of early intervention in lymphoedema had influenced a preventative approach within the service. This included identifying opportunities to provide patients with education before surgery, ensuring they understood the risk of lymphoedema and could take early action to minimise complications. This demonstrated how evidence based learning was translated into proactive, preventative care to improve outcomes.

Feedback received from health care professionals demonstrated confidence in the hospice and its ability to provide effective treatment. Comments included: “The better breathing service enhances the care for our complex respiratory patients. Patient feedback is always high and they feel they are better equipped to manage their symptoms after clinic sessions.” This was echoed in feedback from patients who commented on the improvement in their symptoms since attending the hospice describing how treatment had improved their pain and mobility and enabled them to live well with symptoms of long term health conditions. One patient stated, “They’ve changed my life. I consider I’m very lucky to have Lewis-Manning. I feel more in control now, can handle it better”.

The registered manager told us it was estimated that for the year 1 April 2025 – 31 March 2026, the hospice had saved 403 GP contacts and 28 unnecessary hospital admissions. This meant the hospice was contributing to cost savings across the wider health care system by ensuring patients received effective care closer to home.

The hospice demonstrated effective collaboration between staff and external services to deliver coordinated, person-centred care. Regular multidisciplinary meetings supported clear and consistent communication across teams, including nursing, physiotherapy, occupational therapy, counselling and complementary therapy services. We observed staff from different disciplines coming together in a daily meeting to share information and identify opportunities to support each other. Staff spoke positively about this approach, with one stating, “I’m impressed with the model here and how services interface – we work closely together.” This reflected a culture of teamwork and shared responsibility for patient care.

Staff provided clear examples of collaborative working to meet patients’ complex needs. For instance, a physiotherapist and nurse had carried out a joint visit to a patient with a rare condition affecting their mobility and breathing. This enabled holistic assessment and coordinated care planning, ensuring the patient received effective support. Records also showed how the multidisciplinary team worked together to monitor and respond to patients’ needs over time. In one case, staff identified gaps in follow up care, arranged a hospital referral, ensured access to appropriate equipment and supported the patient’s emotional wellbeing through counselling and community based social support. Information was shared with the patient’s GP enabling medicines review and ensuring all professionals involved in their care were updated about the patient’s needs.

The hospice worked in partnership with external healthcare providers to promote continuity of care. Positive relationships with local primary care networks enabled staff to access timely support for patients from community nurses, frailty teams and palliative care services. For example, when a patient attending the day hospice presented with health concerns, staff had contacted their GP, resulting in a same day medicines review and a visit from the frailty team. This demonstrated effective coordination and timely escalation of care needs. Staff also maintained close links with specialist services, including those for Motor Neurone Disease and hospital based respiratory and cancer services. These relationships supported joint working, and shared care planning where needed, ensuring patients benefited from specialist expertise and co-ordinated input from both the hospice and the NHS.

Feedback from external professionals reflected the positive impact of this collaborative approach. One professional described the breathlessness service as providing “a consistently high standard of incredibly valuable care”. Another highlighted the hospice’s role in bridging the gap between acute care and specialist palliative support with a beneficial holistic approach which included support with patients’ emotional wellbeing needs.

The hospice supported people to live healthier lives by promoting wellbeing, independence and self-management through a proactive and person-centred approach. They delivered a structured health and wellbeing programme offering a range of sessions covering topics such as palliative care, nutrition and hydration, sleep, physical activity, skin care, communication and exercise. These sessions were accessible to patients attending the hospice for treatment if they wished ensuring an inclusive approach to promoting health.

We observed a wellbeing session focused on learning about activity and risks of inactivity. Patients actively engaged in learning, shared experiences and participated in chair based exercises. The session provided a supportive, fun, environment where individuals were encouraged to take an active role in living well and using what they had learned at home. Feedback received about the programme was highly positive, with participants describing the sessions as enjoyable and beneficial in helping them manage their long term health conditions. Outcome data further demonstrated the effectiveness of the programme, with 100% of participants from the previous cohort reporting an improved understanding of palliative care and 97% reporting a positive impact on their wellbeing. Patients also had access to one to one support from nurses and therapists, enabling personalised advice and discussions about their health and wellbeing if they wished.

Staff worked closely with patients to support lifestyle changes and improve independence. We observed staff encouraging individuals to set personal goals and explore ways to achieve these safely. For example, one patient described how treatment for lymphoedema had improved their mobility and confidence enabling them to dress independently and engage with people socially. Another patient accessing the breathlessness clinic highlighted that being able to go for walks was important to them but was now more difficult. Staff acknowledged this with a plan to work with them in developing strategies to manage their symptoms. This included addressing both physical and psychological aspects of their condition and enabling access to counselling and complementary therapies as part of a holistic approach to health.

The hospice recognised the importance of social wellbeing and community engagement in helping people lead healthier lives. Staff demonstrated high levels of awareness of community resources and supported patients to access social and wellbeing activities. This included signposting patients to local resources or, where patients required additional support, facilitating access through community hospice support. This approach helped reduce isolation, promote social connection and enhance wellbeing.

The service was developing its approach to monitoring and improving outcomes for patients accessing lymphoedema and breathlessness clinics. Feedback gathered to date indicated that services were achieving positive outcomes and meeting patients’ expectations. The services provided had a positive impact on patients’ lives. However, the service acknowledged that further development of evaluation tools would enable meaningful measurement of patient outcomes.

In the lymphoedema service, staff currently monitored progress through measurement of limb circumference. Reductions in swelling provided an indication of treatment effectiveness. However, the service recognised that this approach alone did not capture quality of life outcomes, functional ability and patients’ confidence in self-managing a chronic condition. As a result, the service was progressing work to introduce outcome measures that better reflected the holistic impact of treatment.

Within the breathlessness clinic, assessment tools were also under review to include evaluating the effectiveness of specific interventions, such as the use of hand-held fans and breathing techniques as well as impact on quality of life. It was anticipated that this would provide valuable quantitative data at both an individual patient level and across the service enabling continuous learning and improvement.

Feedback gathered to date by the service indicated that the service was achieving positive outcomes and meeting patient expectations. It was anticipated that the ongoing development of outcome monitoring processes would further strengthen their ability to demonstrate their impact.

The hospice had clear systems and processes to ensure consent to care and treatment was obtained appropriately and in line with legislation and guidance. A consent policy provided staff with clear direction, and staff demonstrated a sound understanding of their responsibilities. Records showed that consent was routinely sought and documented at key stages, including at the point of referral, initial assessment and before interventions during home visits. This helped ensure that care and treatment were always delivered with the patient’s agreement.

Staff consistently involved patients in decisions about their care and respected their right to make informed choices, including where these involved a degree of risk. For example, staff supported a patient to consider safer alternatives within their home environment, such as living on the ground floor. However, where the patient had capacity and chose to continue using the stairs, staff respected their decision. The patient’s understanding of the associated risks was clearly assessed and documented, and relevant professionals were informed. Staff worked collaboratively with the patient to identify ways to minimise risk, demonstrating a balanced approach that promoted both safety and autonomy.

We observed that staff adapted their approach to meet individual needs and supported patients to make decisions at their own pace. For example, when working with a patient who found it difficult to engage with support at home, staff were sensitive to their circumstances and gave them time to consider their options. This demonstrated a person-centred approach where patients were empowered to make decisions without pressure.

Staff actively involved patients in discussions about treatment options and ensured they understood the choices available to them. This included offering different equipment options and seeking consent before making referrals to other services. Where care needed to be adjusted or paused, patients were given information including next steps. This ensured that patients were informed about their treatment.