Newark 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

Patients, care givers and loved ones had good outcomes. During our inspection we observed that people’s care, support and treatment reflected these needs and protected equality characteristics, ensuring people were at the centre of their care.

As part of our inspection, we reviewed evidence that showed people were encouraged to live healthier lives leaders and that consent to care processes were undertaken appropriately. Staff worked to ensure that current outcomes and exploring best practice was part of their everyday work.

At our last inspection we rated this key question good. At this assessment the rating has remained the same. This meant people’s needs were met through good organisation and delivery.

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.

Staff used appropriate assessments to identify patient need and levels of deterioration of physical, emotional and psychosocial needs of patients.

Patient needs were escalated appropriately, within the context of the service.

Staff provided care and treatment based on national guidance and evidence-based practice.

Staff worked together as a multidisciplinary team with the district nurses, GP’s and other partners in their care, to benefit patients and provide the best outcomes for them.

The service provided care and treatment based on national guidance and evidence of its effectiveness. The assessment and review of patients was based on the five priorities of care. These were particularly for end of life situations, and were: recognising when someone is dying, communicating with them and their loved ones, involving them in decisions, providing support, and creating and delivering an individual care plan.

Staff followed relevant guidance from The National Institute for Health and Care Excellence (NICE), Medical Royal Colleges and local guidelines.

Each patient had an individualised care plan. If the patient was at end of life, their care plan included a communication record for the person in the last days or hours of life.

The service used the Recommended Summary Plan for Emergency Care and Treatment process (ReSPECT) for every patient seen during the inspection. ReSPECT is a process that creates personalised recommendations for a patient’s clinical care in a future emergency in which they are unable to make or express choices. It provides health and care professionals responding to that emergency with a summary of recommendations to help them to make immediate decisions about that person’s care and treatment. ReSPECT can be complementary to a wider process of advanced/anticipatory care planning. The plan is created through conversations between a person and their health professionals. The plan is recorded on a form and included in their personal priorities for care and agreed clinical recommendations about care and treatment that could help to achieve the outcome they would want, that would not help, or that they would not want. If a patient has a do not resuscitate order, this is also included as part of ReSPECT.

However, staff did not always make sure patients consented to treatment based on all the information available, as not all DNACPR orders were completed correctly.

We reviewed twelve ReSPECT forms on Sconce ward and found 6 of them (50%) were not completed correctly for a number of reasons, including pages relating to Do Not Attempt Cardiopulmonary Resuscitation (DNACPR).

For example, one DNACPR stated the patient did not have mental capacity, however it was further stated by the doctor they had “Discussed the DNACPR with the patient”, but there was no mental capacity assessment undertaken stating the patient lacked capacity. If the patient did not have mental capacity, it was unclear why the doctor would enter into conversation with them to make a decision.

One DNACPR stated the patient did not have mental capacity, however, the completed mental capacity assessment was for another issue, not the DNACPR order. Additionally, the DNACPR also stated that no discussions had been had with the next of kin.

One more DNACPR stated the patient “lacks capacity”, however there was no mental capacity assessment.

We escalated these issues to the nurse in charge during the inspection. When the 6 ReSPECT forms were further reviewed by the inspection team, they had all been completed correctly.

Data supplied from the trust after our inspection showed that for the period August 2025 to December 2025 data showed 100% compliance for DNACPR completion on Sconce ward.

Following our inspection, we requested more information due to the risk to people’s individualised choices. The trust submitted audits and an action plan which included evidence of actions already completed and those being undertaken. In view of this, the trust is now meeting this area of the regulation.

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 ahead to live as well as possible right to the end.

We saw the malnutrition universal screening tool (MUST) being used in addition to the national screening tool. This is a universal five-step tool to identify adults who are malnourished, at risk of malnutrition or obese. It also included management guidelines, which can be used to develop a care plan. It is for use in hospitals, community and other care settings and can be used by all care workers.

We observed the morning nursing handover which is held at the beginning of each shift. Discussion between the nurses included medication, immediate safety risks, infection control issues and deteriorating patient conditions

This was followed by individual handovers from nurse to nurse highlighting areas such as patient behaviour, discharge, admissions, and observations.

There was an afternoon board round at 2pm, this was attended by a multi-disciplinary team of doctors, nurses, occupational therapists, physiotherapists and the ward manager. This meeting discussed all of the outstanding actions from morning handover.

As well as these structured meetings staff told us they had frequent informal meetings so they could ‘flex’ to the changing needs of patients. A member of the inpatient team said, “There are debriefs that go on spontaneously, we will go into a huddle and share information because we need to adapt as things are changing”.

Policies and procedures were readily available for all staff on the service electronic computer system. Policies appropriately referenced current good practice and national guidelines.

Staff shared key information to keep patients safe when handing over their care to others, during daily morning huddle meetings.

The service did not provide a consultant led daily ward round seven days per week or undertake pain or symptom control audits for end of life care patients.

Members of the multidisciplinary team worked and interacted well with each other to enable a coordinated approach to the way in which care was delivered.

Staff also worked in partnership with external providers of end of life care in assessing, planning and delivering care and treatment. This included GP's, primary care nursing teams and allied health professionals.

All relevant teams, services and organisations were informed in writing, over the telephone or by email if patients died or were discharged from the service.

The service used Electronic Palliative Care Coordination System (EPaCCS). This is an electronic computerised system that shares a patient's end-of-life care preferences, wishes, and key medical details between healthcare providers (GPs, hospitals, hospices, social care) and could be accessed by all staff.

All end of life care patients were named on the trust electronic patient system, where referrals to the SPCT were made when requesting an inpatient review. The list was triaged 7 days per week at several times throughout the day from 09:00 to 17:00.

For urgent requests and advice referrals were made via the telephone advice line which was available 24/7.

The trust incorporated a Smart List on their electronic patient system for end of life care patients. Patients were automatically added to the Smart List when in the last days of life. Once added to the list, the patients individualised care plan was implemented, and comfort observations commenced.

The Smart List was managed by the EOLC team Monday-Friday, with the SPCT given shared access.

A copy of the SPCT entry into the medical/ last days of life care plan notes were uploaded onto a separate electronic GP and community health record. This meant that entries were visible to all health care professionals involved in the patient’s care.

End of life and palliative care patients were discussed at weekly and daily multidisciplinary meetings, nursing, medical handovers and daily huddles.

A healthy diet was promoted for palliative and end of life care patients. There were various different menus, for example Kosher, vegan and gluten free.

Where patients were unable to eat due to their ill health, we saw the 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.

A red tray and red jug system was in use for end of life care patients. The red tray and jug system is a visual tool used to identify patients at risk of malnutrition or dehydration, signalling staff to provide extra help with eating, drinking, and to monitor intake, or offer modified diets.

We observed meals were served for some patients on a red tray, and sometimes red cups and jugs with red lids that were used for fluids, ensuring palliative and end of life care patients received necessary nutritional support.

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

Staff used a recognised pain score tool to assess pain. Patient records we reviewed, evidenced appropriate pain relief medicines were given to patients to manage symptoms.

Patients and their relatives told us staff were good at monitoring them to ensure they received the right pain relief when they needed it.

We saw evidence in patient care records that relatives were involved in decisions about patients’ care and treatment and in developing their care plans. Relatives told us staff answered questions about care and treatment openly and in plain English they could understand.

There were no audits of the referrals to or the response times of the SPCT or EOLC team.

The trust told us the number of referrals seen within 24 hours is not currently audited and that patients are prioritised by clinical need rather than a chronological order of referral received.

This meant the trust were unable to identify any issues or their level of performance in these areas.

However, they did audit if patients should have been referred to the SPCT. At the time of our inspection, data showed that 75% of patient seen by the SPCT, had been referred to them appropriately for Sconce Ward at Newark hospital.

The trust took part in the National Audit of Care at the End of Life (NACEL) survey which is a UK-wide audit that assesses the quality of care for dying patients in hospitals, collecting feedback from bereaved families, carers, and hospital staff to identify areas for improvement in end-of-life care.

For the period January 2025 to September 2025 data showed 80% of bereaved people believed that staff communicated sensitively with the dying person and 84% of staff communicated sensitively with those important to the dying person. With 71% of bereaved people who rated that the overall care and support given to the person who died during their final admission to hospital as excellent.

However, the trust told us they were unable to separate which survey responses related to those patients who died at Newark hospital or at King’s Mill Hospital. The survey responses were therefore reported as a total number and percentages for both sites combined.

The trust audited patients preferred place of care or death for Newark hospital. At the time of our inspection 87% of patients had their preferred place of care or death documented, with 86% of patients in their preferred place of care or death.

The trust also undertook trust-wide audits for consent, record keeping and medicines management, however, these were not specific to end of life care or to Newark hospital.

Relatives and patients, we spoke with told us staff did not provide any care without first asking their permission. We looked at 10 set of patient care records and saw consent was appropriately obtained and, consent forms had been signed.

The service had up-to-date policies and procedures regarding consent and the Mental Capacity Act 2005. These included the Mental Capacity Act documentation, deprivation of liberty procedure, consent procedure and lack of capacity procedure.

Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent. They knew how to support patients who lacked the mental capacity to make their own decisions or were experiencing mental ill health.

Staff we spoke with understood the importance of consent when delivering care and treatment to patients. We observed staff seeking consent from patients prior to examination, observations and delivery of care.

Staff told us consent was gained before any sharing of patient information, both internally and with other primary care services.

Relatives and patients, we spoke with told us staff did not provide any care without first asking their permission. We looked at 7 sets of patient care records and saw consent was appropriately recorded on all of them as well discussions about their holistic and care needs, as well as preferences.