Diana Princess of Wales Hospital

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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.

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 inadequate. At this assessment the rating has changed to good.

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

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

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

The service carried out assessments to identify and meet people’s needs. Patients received an assessment which identified key risks such as frailty, delirium, falls, tissue viability and continence needs. These assessments considered physical, psychological and social requirements and informed care planning. They were reviewed and updated as people’s conditions changed. The trust had processes which were used to document individualised needs and preferences such as the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) and the Electronic Palliative Care Co-ordination System (EPaCCS).

The “care in the last days of life” document was used to record patient’s preferences such as spiritual and religious wishes and patient’s needs such as psychological and emotional needs. Since the last inspection, audits of this document showed that there were improvements for those the percentage of patients on the end-of-life pathway who died at their preferred place of death. Data showed that 62% of patients died in their preferred place of death which was higher than the trust target of 60%

There were clear pathways for recognising and escalating reversible deterioration. Staff knew when and how to escalate concerns, and senior clinical review was available when needed. As patients approached the last days of life, a further holistic reassessment was undertaken, with a focus on recognising dying and aligning care with the patient’s priorities. Wherever possible, patients were involved in these discussions; when this was not possible, families and those important to the patient were included. 

Nutrition and hydration were assessed and monitored. Care plans included pain management plans, and staff considered the need for regular or anticipatory analgesia. Pain and comfort were reviewed regularly, and patients appeared comfortable. We observed staff in conversation with the end-of-life team discussing frequency of pain observations for a patient who had pain that needed improved control and saw the team take action to address this.

Communication needs were assessed. Staff had access to interpreters, accessible information and communication aids where needed to support understanding and involvement in care.

Patients were screened for mental health needs, and referrals were made when concerns were identified. Where there were concerns about capacity to consent, staff followed Mental Capacity Act guidance. Legal authority, such as lasting power of attorney, was checked where relevant.

Carers and family members were involved in assessments and reviews where appropriate and with the patient’s consent. The needs of unpaid carers and dependants were considered and signposted to additional support where required.

The Bluebell Comfort Observation Tool was introduced to increase documented interactions between staff and patients receiving end-of-life care. Bluebell Care Observations (BCOs) were evidence-based and focused on managing, monitoring and escalating common end-of-life symptoms.

The tool supported a holistic, person and family centred approach, encouraging discussion of preferred place of death, spiritual needs and care priorities. This also included supporting patient choice regarding the care environment, for example, whether they preferred to remain in a bay or move to a side room, recognising that some patients felt more comfortable in a shared setting based on past experiences.

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.

At the last inspection, the service was told that they must ensure clinical care and treatment were delivered in accordance with national guidance and best practice. At this inspection, we found that the service delivered care and treatment in line with current evidence, national guidance and best practice. Staff had access to up‑to‑date policies and clinical guidelines, which included review dates and references to relevant national standards. There were governance arrangements to ensure policies were regularly reviewed and updated in response to changes in legislation and guidance, and staff were informed of updates. The service was supported by links with clinical networks and specialist teams, which helped staff remain up to date with best practice.

Clinicians followed National Institute for Health and Care Excellence (NICE) guidance relevant to the service, including guidance on acutely ill adults in hospital: recognising and responding to deterioration and care of dying adults.

Patients identified as approaching the end of their life had timely discussions about their care preferences. Advance care planning was encouraged and recorded, and ReSPECT plans were in place to guide decision making in the event of deterioration.

There was a clinical audit programme in place that covered key areas of care and supported implementation of NICE guidance. Audit findings were reviewed through governance meetings, and action plans were developed where improvements were needed.

There were arrangements for managing acute, potentially reversible conditions alongside palliative care, with senior clinical oversight. Staff understood escalation processes and how to access specialist support when needed.

The service had a nutrition and hydration policy and used recognised screening tools to identify patients at risk of malnutrition. We saw a red tray system was in place, where patients at risk of under nutrition were identified and supported. Fluid and nutrition charts were completed where required and used to inform care planning.

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.

The service worked with external partners and system services to plan and manage transitions of care. Plans were in place to support safe transfer to community services, care homes or other settings when required.

Discharge planning took account of individual needs, circumstances and ongoing support requirements. Where appropriate, discharges were planned with community health and social care services to ensure continuity and safety.

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, reduced their future needs for care and support.

The service supported patients to maintain their health, wellbeing and quality of life in ways that were meaningful to them. Staff took a holistic approach to care, recognising that living as well as possible, including planning for a good death, was an important part of supporting health.

Patients were supported to understand and manage their health in line with their abilities, wishes and stage of illness. Staff encouraged movement and activity in line with patients’ abilities and wishes. Patients were supported to remain as active as possible, including getting dressed, mobilising safely and participating in activities.

The service recognised the importance of mental health and emotional wellbeing. Staff provided emotional support from admission through to the end of life, and patients could access additional support, including counselling or spiritual care services.

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.

We saw improvements in how staff monitored outcomes from the last inspection. The service was told that they must ensure that robust systems were in place to monitor the effectiveness of care and treatment delivered to achieve good outcomes for patients The service now used a range of resources to help monitor and measure patient outcomes.

A programme of clinical audits monitored patient outcomes against agreed standards, including end‑of‑life care. The service compared and analysed data from other organisations to inform improvements and help with planning. Audits included the deceased patient audit tool, the care in the last days of life tool, monitoring of the patients preferred place of death, use of anticipatory medicines and audits of patients dying in a side room. Data showed that compliance had improved since the previous CQC inspection with all targets being met apart from care of patients in a side room. This was at 79% compliant against a trust target of 80%

Pain management for end-of-life patients was audited using an assurance tool and audits undertaken bi-monthly by matrons. The service had identified that the trust wide pain management electronic tool for pain assessment could be improved. The end-of-life team had implemented the comfort observation tool as a result to help identify and manage common end of life symptoms in a timely way.

The service participated in the National Audit of Care at End of Life (NACEL). NACEL results from the 2025 report indicated that there was evidence that pain was being adequately managed once identified. The comfort observation tool that had been recently introduced showed early indications that pain management was improving. A full audit was planned once the comfort observation tool had been embedded further.

Staff focused on understanding what mattered most to patients and used this to define meaningful outcomes, including comfort, dignity, symptom control, emotional wellbeing and achieving preferred place of care. Patients’ expectations and experiences were explored through direct conversations, care reviews, feedback and complaints.

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

The service had arrangements to support informed consent and shared decision making. Staff who obtained consent were trained and competent to do so, and were able to explain the purpose, risks, benefits and alternatives to investigations and treatments in a way patients could understand.

Consent documentation was clear, legible and completed appropriately. Records showed that risks and benefits were documented.

Staff understood when and how to assess a person’s capacity to make decisions about their care and treatment. Staff knew how to recognise when a person might lack capacity and how to access advice from senior clinicians or safeguarding leads if required.

Where patients had reduced capacity, staff took appropriate steps to support them to make decisions for themselves wherever possible. This included using interpreters, communication aids, hearing support and involving family or carers with the patient’s consent.

When patients lacked capacity to make a specific decision, staff followed Mental Capacity Act principles. Best interest decisions were made with appropriate involvement from family members, carers or advocates and considered the patient’s wishes, beliefs, values, culture and traditions. Where a Lasting Power of Attorney was in place, staff checked and verified that documentation was valid and registered before accepting decisions.

Most staff were trained in the Mental Capacity Act though training compliance varied between 50% and 92% completed. Staff knew how to access policies and guidance and described confidence in applying this in practice. Leaders had assurance through audits, training records and supervision that consent and capacity processes were being followed.

At the last inspection, patient records were not always completed consistently and appropriately. We reviewed 10 patient records and found all forms were completed well with wishes clearly documented and discussions taking place with the patients or their representatives.