Lewis-Manning Hospice Care

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• 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

This means we looked for evidence that the service met people’s needs.

At our last assessment we rated this key question good. At this assessment the rating has changed to outstanding.

This meant services were tailored to meet the needs of individuals and delivered to ensure flexibility, choice and continuity of care.

This service scored 89 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The hospice delivered care that was personalised and responsive to the individual needs and circumstances of patients and their families. Care planning and delivery showed a holistic approach addressing physical, emotional, psychological and social needs to ensure patients received meaningful support.

Patients and their carers were able to access a wide range of services, including counselling and complementary therapies, alongside clinical care. For example, one patient described how support from the breathlessness clinic was enhanced by access to counselling and complementary therapies. They were able to attend a shared complementary therapy appointment with their partner which enabled them to enjoy valuable time together while supporting their wellbeing. Records showed that relatives were supported through services such as hospice at home and counselling, helping them manage the demands of their caring role. This demonstrated how care extended beyond the individual patient to include those who supported them at home.

The service demonstrated flexibility in how care was delivered to meet individual preferences and lifestyles. Patients were offered choices about how and where they received support, including group sessions, one to one appointments, home visits, community clinics or online options. We observed staff making arrangements with patients taking into account practical factors such as transport and personal commitments. For example, clinic locations were selected to suit those who relied on public transport and appointment times were adapted to accommodate work or caring responsibilities. There was some flexibility to offer appointments outside standard hours which staff told us ensured that patients who worked found valuable as it enabled them to attend at the start or end of their day. This ensured care was accessible and tailored to each person’s circumstances.

Staff worked collaboratively with patients to identify what was most important to them using this to guide care planning and delivery. Patients were encouraged to set personal goals, which were incorporated into their care plans. This approach ensured that care was meaningful and aligned with individuals’ priorities, rather than being solely clinically driven. For example, one patient had identified that maintaining their mobility at home was a key priority. Staff worked with them to identify strategies and provide equipment that would support this goal, enabling the patient to remain as independent as possible. This demonstrated how care was shaped around what mattered most to the individual.

Feedback from healthcare professionals reinforced the person-centred approach taken by the service. Professionals described the team as flexible and accommodating to patients’ needs, taking the time to work out what their needs are and what support might benefit them.

The hospice demonstrated a strong, system wide approach to care provision, ensuring services were integrated, responsive and accessible to the population they served. The service showed a clear understanding of local needs and delivered care across multiple community locations, including Swanage, Wimborne, Bournemouth and Poole. Clinics, activities and support programmes addressed both physical and mental health needs and were designed to complement local NHS and voluntary sector provision to promote continuity of care.

Integration was embedded within service delivery with close working relationships being established with GPs, community nurses, specialist palliative care teams and other healthcare professionals. The hospice’s anticipatory care approach supported patients to remain at home and reduce avoidable hospital admissions, reflecting a preventative and coordinated approach to care. Staff demonstrated how they worked proactively with other agencies when risks or changing needs were identified. For example, social care services were contacted in response to concerns about patients’ home environments and communication took place with GPs and community nursing teams in relation to health issues. Joint visits with other organisations enabled patients to receive coordinated support without needing to repeat their histories reducing duplication and improving the overall patient experience.

The service promoted continuity of care during transitions between services. For example, when a patient planned to relocate to another county, staff were proactively identifying similar services in the new area to ensure the patient could continue accessing support. This demonstrated a commitment to maintaining continuity and supporting patients through change.

The hospice played a key role in bridging gaps between services and supporting integrated care pathways. Feedback from a health care professional indicated that they valued the breathlessness service for accepting referrals from primary, secondary and integrated care teams which meant patients could receive support before specialist palliative care input was required. The service was also recognised for addressing both physical and psychological needs, helping patients to understand and manage their condition in a holistic way. This bridged the gap between physical health and mental health services and contributed to a more seamless care experience for patients across organisational boundaries.

Leaders demonstrated a proactive approach to developing integrated services in line with national priorities, including the Department of Health and Social Care’s Fit for the future: 10 Year Health Plan for England and the National Cancer Plan for England. The hospice was taking action to engage with partners in strengthening pathways, including improving transitions between children’s and adult hospice services and enhancing co-ordination of lymphoedema care with NHS providers. Plans to collaborate with local organisations to co-design community based cancer and palliative care services showed a strong commitment to reducing fragmentation, clarifying responsibilities and ensuring patients received the right care at the right time.

Staff demonstrated a clear understanding of the wider system of care and the range of professionals involved in each patient’s journey. Patient records reflected co-ordinated involvement from multiple services and patients reported positive experiences of joined up care. For example, one patient described how support from the hospice had enabled access to community nursing and dietetic services and feedback from a relative described how the hospice had helped them navigate the care system when supporting their family member to fulfil their wish to die at home.

The service ensured patients were provided with information to support their understanding of their care and treatment. During our visit we observed staff sharing information both verbally and in writing in a way that was easy for patients to understand. For example, staff clearly explained the structure of health and wellbeing sessions, outlining what patients could expect each week. They talked through programme plans and encouraged patients to ask questions, helping them understand how the sessions could support their individual goals.

Written information was available for patients including leaflets and resources provided both at the hospice and through its website. Patients were also given a booklet, ‘My Personal Plan and Wishes’ on commencing the health and wellbeing programme, which enabled them to record what was important to them, their preferences for future care and their priorities. This helped patients understand their options and actively engage in planning their care.

Staff demonstrated awareness of local services and resources and used this knowledge to signpost patients to appropriate sources of support. This ensured that people had access to wider resources beyond the hospice, enabling them to access additional help when needed.

The hospice was able to take steps to make information accessible to patients with different needs. Although leaflets in different formats or languages were not readily available, staff felt confident in providing information in different formats such as larger print or different languages as required. For example, staff in the breathlessness service showed us how they could adapt leaflets into different languages, adjust text size and use text to speech tools to meet patients’ different communication needs. We also observed staff offering to reinforce verbal information with written materials to support patients’ understanding. For example, a patient with short term memory loss was offered a leaflet which would help them recall information from a wellbeing session so he could share information with his wife. The hospice acknowledged that further communication with GP networks was needed to ensure interpreters could be accessed in a timely way if they received a referral for a patient who required an interpreter. Action was in progress to address this.

The service demonstrated a strong commitment to listening to people and involving them in shaping and improving services. Procedures for patients to provide feedback included a structured complaints, concerns and compliments process. Information about how to raise concerns was available through the hospice website, on leaflets in the reception area and on posters.

The hospice responded appropriately and transparently to concerns and complaints. Two complaints had been received in the last year and records showed these were managed in line with policy. Responses included clear communication with complainants about actions taken and improvements made. For example, in response to a complaint about communication of changes taking place within the service, the registered manager had escalated this to a senior management meeting to support wider organisational learning. This led to a review of how change was communicated and an improved process. The outcome was shared with the complainant demonstrating openness and ensuring they felt heard and valued.

Staff were proactive in listening and responding to patients’ concerns. For example, when a patient had expressed frustration about equipment not arriving in time for their appointment, staff apologised and took immediate action to resolve the issue including rearranging the appointment. This demonstrated a responsive approach, where concerns were addressed promptly to minimise disruption to care.

The service sought to improve how it captured and responded to feedback. During our visit, a meeting with volunteers was held to explore how they could support gathering feedback through patient conversations. This approach, using an established framework, aimed to provide more immediate and meaningful insights into patient experience which would enable the service to respond quickly to emerging themes.

Patients and carers were actively involved in shaping how services were delivered. Feedback from patients attending the first health and wellbeing programme had been used to review the delivery of subsequent sessions. The service also created opportunities for staff to reflect on patient feedback through initiatives such as ‘You Said, We Did’ workshops, demonstrating how patient input translated into tangible improvements.

Co-production was evident in the development of services. For example, patients and carers contributed to reviewing the format of a breathlessness support group. Their feedback highlighted the value of unstructured time for sharing personal experiences which was incorporated into the group design. Participants were also involved in establishing the group’s purpose and a group agreement, helping to create a safe and supportive environment. This demonstrated how the service worked in partnership with people to design support that met their needs and preferences.

The hospice had a proactive approach to promoting equitable access ensuring that people could receive care regardless of their circumstances. Service use was monitored to identify underrepresented groups within the local population. This enabled the organisation to take action to improve access for those who may otherwise face barriers.

The service took practical steps to improve accessibility including expanding anticipatory hospice at home provision and developing virtual services. Community based hubs across Bournemouth, Poole and East Dorset improved local access with positive feedback from healthcare professionals highlighting their value. For example, one professional commented that “having the clinic in Wimborne is invaluable for our patients as many would be unable to attend otherwise.” Where a hub had closed, the hospice introduced a virtual programme alongside home visits ensuring continuity of access for patients in that area.

Staff were aligned to specific geographical areas, strengthening relationships with primary care networks and hospital teams. They were working to improve awareness of hospice services and encourage appropriate referrals. Staff demonstrated a clear understanding of patterns of service uptake, recognising where engagement was strong and where further work was needed. They described taking targeted action to address disparities including outreach, relationship building with local professionals and leaflet drops in areas with lower referral rates.

The hospice worked collaboratively with partner organisations to promote equitable access across different care settings. For example, partnership working with a local private hospital meant that patients awaiting cancer surgery were able to access education and support from the hospice in relation to lymphoedema. Staff were working with the hospital to introduce information sessions so patients understood the risks and could access timely support after surgery. This approach promoted equity by ensuring patients were informed and supported from the outset of their healthcare journey regardless of where treatment was taking place.

The hospice took steps to remove practical barriers to accessing services. Transport was arranged for patients with mobility difficulties ensuring that those who might otherwise be excluded could access care. Hospice facilities were accessible to people with disabilities, including those using wheelchairs, supporting inclusive access to on-site services. They also offered home visits ensuring that patients who were housebound could access support and benefit from services.

Leaders demonstrated awareness of the additional barriers faced by underserved groups, including people experiencing homelessness, and were taking action to address these inequalities by linking up with organisations with specialist knowledge. The hospice was applying for funding which would enable them to expand their services so that more people could benefit from free palliative care services closer to home. It was anticipated that this would enable the hospice to achieve more equitable access to palliative care.

Feedback from healthcare professionals reinforced the hospice’s inclusive and equitable approach. One professional highlighted that the hospice prioritised symptom need over diagnosis ensuring that patients were not excluded based on rigid eligibility criteria. This reflected the organisation’s vision of working collaboratively to support every adult living with a life-limiting illness.

The hospice demonstrated a clear and proactive commitment to promoting equity in experience and outcomes by identifying and addressing variation in patient experience. An anticipatory hospice at home model was in place to support housebound patients helping to ensure they experienced the same quality of care and support as those able to attend hospice services. Plans to expand this model across Dorset alongside extended day services, increased opening hours, and enhanced telephone support aimed to reduce inequalities particularly for those requiring crisis support. This approach aimed to support all patients to live as well as possible and engage in advance care planning regardless of their circumstances.

The hospice recognised the needs of patients who may not meet specialist thresholds but still required support to manage symptoms of their health condition. Through clinical supervision and guidance from a specialist palliative care nurse, the wider team were enabled to deliver appropriate care ensuring no patient group was disadvantaged. Collaborative working between the breathlessness team and day hospice further ensured that patients with higher dependency needs received tailored support.

The hospice had developed a palliative care education programme for delivery in residential care and nursing home settings to promote equity of experience for people living there. Early implementation with a large provider had informed plans for wider rollout with a deliberate focus on engaging smaller care services in more deprived areas. This demonstrated a targeted approach to reducing inequality linked to socioeconomic factors and accommodation type.

Leaders showed awareness of geographical disparities which may impact on patient experience of palliative care. Planned partnerships with other organisations were in progress aiming to improve engagement and outcomes for people in marginalised groups including people living in rural and coastal communities, prison settings and those with low literacy and limited digital access. It was anticipated that, once embedded, this would further develop outcomes for underserved groups

The hospice demonstrated a strong commitment to supporting people with planning for the future. They did this by promoting the value of advance care planning and facilitating meaningful conversations about individuals’ wishes and preferences. Patients were routinely provided with information about advance care planning and given opportunities to discuss their future wishes with staff in a supportive and timely way. Data showed that from 1 April 2025 to 31 March 2026, 117 advance care plans had been completed and 348 were in progress indicating that patients were actively engaged and empowered to make choices about their future care.

Staff demonstrated confidence and skill in initiating and supporting sensitive conversations about future care including end of life decisions. Feedback from hospital based healthcare professionals highlighted the value of this, noting how hospice staff were able to begin difficult conversations as part of patients’ palliative care. Staff described how they had worked with a patient and their family to explore their wishes including decisions about allowing a natural death. Staff had received appropriate training to support advance care planning and ensure that patients were able to make decisions in line with their values and preferences.

The service ensured patients’ wishes about their future were clearly recorded and communicated. Staff were able to identify and address discrepancies between community and hospital records, working with patients and GPs to ensure information about patients’ preferences was accurate and up to date. This supported continuity of care and ensured their wishes could be respected across different services and settings.

The hospice supported patients to consider future care options and make informed choices. For example, through the health and wellbeing programme, patients were being offered opportunities to visit local residential care homes. Being able to experience this gave patients the opportunity to see what a care home looked like and consider whether this may be an option for them in the future. This proactive approach supported patients to feel informed, prepared and in control of decisions about their future care.