King's Mill Hospital

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

People were involved in assessments of their needs. Staff reviewed assessments taking account of people’s communication, personal and health needs. Care was based on latest evidence and good practice. Staff made sure people understood their care and treatment to enable them to give informed consent.  

There were systems in place to manage the safe administration and prescribing of medicine and staff attended mandatory and required training courses  

At our last inspection we rated this key question as good. At this inspection, the rating remained good. This meant patients’ outcomes were consistently good, and patients’ 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 evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing, and communication needs with them. 

Staff assessed and reviewed patients’ health, wellbeing, care and communication needs to ensure they received effective and personalised care and treatment. Staff completed comprehensive assessments for patients receiving palliative and end-of-life care, which considered their physical, psychological and social needs and informed individualised care planning. Staff reviewed and updated these assessments as patients’ conditions changed. The trust used additional tools, including the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) and the Electronic Palliative Care Co-ordination System (EPaCCS), to record patients’ preferences and support coordinated care. 

As patients approached the last days of life, staff completed holistic reassessments to identify when a patient was dying and to ensure care reflected their wishes and priorities. Wherever possible, staff involved patients in these discussions. When patients could not participate, staff involved family members and those important to them in decision-making and care planning. 

We reviewed nine records for patients receiving palliative and end-of-life care. Staff completed personalised care plans promptly following admission and kept them up to date to reflect patients’ changing needs. Records showed staff involved families and loved ones in discussions and decisions about care and treatment. 

Patients told us staff met their care and treatment needs and spoke highly of the care they received. Patients understood their care plans, saw the appropriate medical teams each day and felt involved in discussions about their current and future care needs. 

We observed multidisciplinary team meetings where staff reviewed clinical information, discussed treatment options and agreed plans of care before speaking with patients and their families. Staff worked collaboratively to ensure patients received coordinated care and support. 

Staff assessed and managed pain effectively. Care plans included pain management strategies and guidance on regular and anticipatory analgesia where required. Staff reviewed patients’ pain and comfort needs regularly. During our inspection, we observed staff discussing a patient's pain management with the specialist palliative care team and taking prompt action to improve symptom control. 

Staff assessed patients’ communication needs and provided additional support where required. They had access to interpreters, accessible information and communication aids to help patients understand information and participate in decisions about their care. 

Staff screened patients for mental health needs and made referrals when concerns were identified. Where patients lacked capacity to make specific decisions, staff followed the principles of the Mental Capacity Act and checked for any relevant legal authority, such as a Lasting Power of Attorney (LPA) for health and welfare. 

Staff understood how to assess and manage risks. They completed and reviewed nutrition, hydration and falls risk assessments in line with guidance and monitored patients for risks associated with pressure ulcers. Staff used body maps to document and monitor skin integrity and recorded repositioning where required. Staff told us they had good access to medical support and participated in daily ward rounds and clinical handovers to ensure continuity of care. 

Staff supported patients to meet their nutritional and hydration needs. They adapted meals to meet patients’ religious, cultural and personal preferences and ensured patients, including those with specialist nutritional or hydration requirements, received appropriate support. 

The evidence showed a good standard. 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 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. 

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. 

In accordance with the Gold Standards Framework, multidisciplinary team (MDT) meetings took place weekly to ensure any changes to patients needs could be addressed promptly.  

The Gold Standards Framework (GSF) is a framework used by many GP practices, care homes, hospices, and hospitals to enable earlier recognition of patients with life-limiting conditions, helping them to plan to live as well as possible right to the end. 

The trust used The AMBER care bundle. This was a hospital communication and care planning tool used for adult inpatients whose recovery is uncertain and who may be facing the end of life. It stands for assessment, management, best practice, engagement, and recovery uncertain. It supports medical teams, patients, and families to talk openly about treatment. 

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. 

The end of life care team had an audit programme in place that covered 8 areas of end of life care, and supported implementation of NICE guidance. However, we saw several audits did not have dates agreed at the time of our inspection. For example, the AMBER Care Bundle Audit had not yet started as the AMBER Care Bundle was still being rolled out across the trust.  

Where audits were completed, leaders reviewed findings through governance meetings and developed action plans when improvements were needed. We saw the outcome of an audit for end of life care patients – adult inpatients from March to May 2026. This audit looked at areas such as whether the patient had an end of life individualised care plan in place, whether staff had placed a butterfly symbol in the patients’ notes and if the patients’ wishes had been documented. The audit identified several areas of care were being delivered in line with national guidance such as anticipatory medicines, communication between staff and patients and loved ones and all patients received daily medical reviews. The audit also identified some areas for improvement such as patients dying in their preferred place, and documenting when spiritual care was declined. We saw evidence the end of life care team were working to address these findings with the local health care system, particularly with supporting patients to die in their preferred place.  

Staff used a range of nationally recognised assessment and screening tools to support safe and effective clinical decision-making, including the National Early Warning Score (NEWS2), venous thromboembolism (VTE) risk assessments, falls risk assessments, and recognised pain assessment tools. 

Managers ensured that staff had access to regular team meetings so updates and learning could be shared. Staff confirmed this during the inspection. 

The evidence showed a good standard. 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. 

Staff worked effectively with community services and external partners to plan and manage transitions of care. They developed discharge plans that reflected patients’ individual needs, circumstances and ongoing support requirements. When required, staff coordinated discharges with community health and social care services, care homes and other providers to promote continuity of care and support safe transfers between services. 

Staff had access to a wide range of multidisciplinary professionals to meet patients’ needs. This included doctors, nurses, occupational therapists, physiotherapists, speech and language therapists, dietitians and pharmacists. Housekeeping, portering and discharge teams also supported the delivery of care. 

We observed effective communication and coordination between staff of all roles and grades. Staff shared patient information promptly and effectively, which supported continuity of care and timely decision-making. Attendance at handovers, nurse safety huddles and ward rounds reflected the needs of each specialty and ensured the appropriate staff participated in discussions about patient care. 

Staff met regularly through multidisciplinary team meetings, board rounds, safety huddles and handovers. These forums brought together consultants, resident doctors, advanced clinical practitioners, registered nurses, therapists, pharmacists, healthcare assistants and students. Staff communicated openly and worked collaboratively to review patient needs, share learning, manage risks and coordinate care. This proactive approach supported timely escalation of concerns and effective planning for patients throughout their hospital journey.

The evidence showed a good standard. 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 end of life care team supported patients to maintain their health, wellbeing, and quality of life in ways that were meaningful to them as they approached the end of their life. 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 mental physical and spiritual health. 

All staff focused on ensuring patients had the best experience they could at the end of their life. This meant staff supported patients to engage with what patients wanted, rather than what was the healthiest. For example, patients could choose food and drinks they wanted to eat, rather than focusing on healthy eating.  

Where patients chose this, a healthy diet was available for palliative and end of life care patients. There were various menus, for example Kosher, vegan, and gluten free. 

The service incorporated “Taste for Pleasure" for patients who could no longer swallow. This is an end-of-life and palliative care approach that replace standard nil by mouth restrictions with comfort focused mouth care using a patient's favourite flavours. Instead of withholding all liquids when a person can no longer safely swallow in their final days or hours, healthcare staff or family members use a soft swab or toothbrush to dab favourite drinks onto the patient's lips and tongue. 

Where patients were unable to eat due to their ill health, we saw care plans were in place for staff to monitor their food and nutrition. We saw the malnutrition universal screening tool (MUST) being used in addition to the national screening tool, to help staff support patients’ nutritional needs. 

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 pastoral, psychological or spiritual care services. 

There were several patient information leaflets available on subjects such as living positively with cancer, managing breathlessness and the side effects of treatment. 

We saw posters and information about domestic violence for both men and women, and details of where to go for support. 

The evidence showed a good standard. 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. 

Staff and leaders monitored outcomes for patients to make sure patients at the end of their life were receiving the best possible service.  

The trust took part in the National Audit of Care at the End of Life (NACEL) survey which is an audit that assesses the quality of care for dying patients in hospitals. For the period January to March 2026 data showed 100% of bereaved people said they felt staff communicated sensitively to those important to the dying person. 100% of bereaved people stating the dying person received ‘excellent’ or ‘good’ quality of care during their final admission to hospital. However, only 50% of bereaved people believed there was an advanced care plan in place before the person passed away. The associated action plan looked at how to improve this. 

Staff assessed, monitored and managed pain effectively. Records showed staff completed pain assessments and responded appropriately when patients experienced discomfort. During our inspection, patients appeared comfortable and staff regularly reviewed symptom control to ensure people remained as pain free as possible. 

NACEL data for January January to March 2026 showed that 100% of bereaved respondents felt the dying person had received enough pain relief. However, the trust was unable to separate this data by hospital site, and it included responses from more than one location. 

The trust's April 2026 ReSPECT audit reviewed 79 patient records across 15 wards and clinical areas at King’s Mill Hospital. The audit found good compliance in several areas, with 100% of ReSPECT forms located at the front of patient records, an improvement from 96% in the previous audit. A Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decision was recorded on 94% of ReSPECT plans reviewed. However, the date of completion was documented on 84% of plans, which represented a decline from 96% in the previous audit. The trust had identified areas for improvement and developed an action plan to strengthen documentation and improve consistency in the completion of ReSPECT records across the organisation. 

The trust audited patients preferred place of care or death for King's Mill Hospital. For the period 1 to 31 March 2026,100% of end of life care patients had their preferred place of care or death documented. At the time of our inspection 83% of patients passed away in their preferred place of care or death. 

Whilst there was not a national requirement to do so, from March 2026, the end of life care team monitored what percentage of patients at the end of their life were seen by the end of life care team within 24 hours.  

During our inspection we observed staff worked in line with best practice when working with patients at the end of their life, and their loved ones. This meant patients and loved ones were more likely to get better outcomes. This helped to identify the reasons why not all patients were seen within this time frame, and to identify if any elements of care could have been improved.  

Staff within critical care worked with families and loved ones after patients had passed away to improve psychological symptoms and reduce the risk of post-traumatic stress disorder (PTSD). Staff used self-reported (filled in by the family member or loved one) pre and post outcome measures to identify if this support was having a positive effect. Staff leading this project reported positive outcomes and stated that other NHS trusts had approached them about how this could be integrated into their critical care units.  

Some patients at the end of their life chose to donate organs, where their conditions permitted this. The trust had a specialist nurse in organ donation (SNOD) team along with organ donation champions working on wards and within clinical areas. The service monitored the number of patients and loved ones who had kindly chosen to donate organs after death following sudden or expected deaths. In 2025, 6 patients chose to donate organs which was above what was expected.  

The evidence showed a good standard. 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 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. 

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. 

In accordance with the Gold Standards Framework, multidisciplinary team (MDT) meetings took place weekly to ensure any changes to patients needs could be addressed promptly.  

The Gold Standards Framework (GSF) is a framework used by many GP practices, care homes, hospices, and hospitals to enable earlier recognition of patients with life-limiting conditions, helping them to plan to live as well as possible right to the end. 

The trust used The AMBER care bundle. This is a hospital communication and care planning tool used for adult inpatients whose recovery is uncertain and who may be facing the end of life. It stands for Assessment, Medical plan, Best practice, Escalation, and Review. It supports medical teams, patients, and families to talk openly about treatment. 

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. 

The end of life care team had an audit programme in place that covered 8 areas of end of life care, and supported implementation of NICE guidance. However, we saw several audits did not have dates agreed at the time of our inspection. For example, the AMBER Care Bundle Audit had not yet started as the AMBER Care Bundle was still being rolled out across the trust.  

Where audits were completed, leaders reviewed findings through governance meetings and developed action plans when improvements were needed. We saw the outcome of an audit for end of life care patients – adult inpatients from March to May 2026. This audit looked at areas such as whether the patient had an end of life individualised care plan in place, whether staff had placed a butterfly symbol in the patients’ notes and if the patients’ wishes had been documented. The audit identified several areas of care were being delivered in line with national guidance such as anticipatory medicines, communication between staff and patients and loved ones and all patients received daily medical reviews. The audit also identified some areas for improvement such as patients dying in their preferred place, and documenting when spiritual care was declined. We saw evidence the end of life care team were working to address these findings with the local health care system, particularly with supporting patients to die in their preferred place.  

Staff used a range of nationally recognised assessment and screening tools to support safe and effective clinical decision-making, including the National Early Warning Score (NEWS2), venous thromboembolism (VTE) risk assessments, falls risk assessments, and recognised pain assessment tools. 

Managers ensured that staff had access to regular team meetings so updates and learning could be shared. Staff confirmed this during the inspection.