Grantham and District 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

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.

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 made sure 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.

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

Staff used appropriate assessments to undertake physical, emotional and psychosocial needs of patients. During our inspection we observed staff undertaking these and that they were completed correctly.

We saw as part of our inspection that staff used a person centred and holistic approach to assessing patient needs. This was to ensure patients received care and treatment that was specific to their individual needs and requirements, and took the whole person into account, their psychological health and wellbeing, practical and social needs, as well as their physical health.

Patient needs were escalated appropriately, within the context of end of life care services.

Staff had daily handover meetings at the start of each shift, so they knew what changes there had been in patients’ needs since they had last cared for them. As well as these structured meetings, staff told us they had frequent informal meetings so they could flex to the changing needs of patients. One nurse told us, “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”.

Staff on the hospice unit and Harrowby ward undertook intentional rounding for end of life care patients. This was a structured, pre-emptive nursing intervention where staff conducted regular, scheduled hourly checks on patients and checked pain, position, personal needs and placement of items.

Data for February 2026 showed for Harrowby ward, and the chemotherapy suite had a 100% compliance with intentional rounding. The hospice unit did not take part in the audit.

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 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.

The SPCT used a clinical guide for healthcare professionals to identify patients with advanced, life-shortening conditions for early palliative care.

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 provided care and treatment based on national guidance and evidence of its effectiveness. The service completed a range of audits, including audits of sepsis screening, ReSPECT forms and mental capacity assessments. ReSPECT forms are Recommended Summary Plans for Emergency Care and Treatment. These forms are personalised documents outlining a person's preferences for clinical care during an emergency when they cannot make decisions. It includes, but is not limited to, decisions about being resuscitated in the event of cardiac or respiratory arrest. It is used by health professionals in people’s homes, ambulances, and hospitals.

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.

The service had an acute pain service at Grantham and District Hospital that was provided by the Critical Care Outreach Team. This service operated seven days a week (8am – 8.30pm), outside of these hours the service was provided by the Hospital at Night team.

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

The service used the Recommended Summary Plan for Emergency Care and Treatment process (ReSPECT) for every end of life care patient seen during the inspection. ReSPECT was a process that created personalised recommendations for a patient’s clinical care in a future emergency in which they are unable to make or express choices. The plan included personal priorities for care and agreed clinical recommendations about care and treatment that could help to achieve the outcome they would want. If a patient had a do not resuscitate order, this is also included as part of ReSPECT.

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 used to enable earlier recognition of patients with life-limiting conditions, helping patients 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 tool to identify adults who are malnourished, at risk of malnutrition or obese.

Staff shared key information to keep patients safe when handing over their care to others, including the nutrition and hydration needs of the patient. For example, any mouth care needs, if the patient needs support with their intake of food and if there are any swallowing concerns.

Staff knew how to access policies and procedures on the trust wide webpage. Policies referenced current good practice and national guidelines.

Staff worked as a multidisciplinary team to enable a coordinated approach to the way in which care was delivered. Staff and volunteers worked closely and effectively together with a culture of respect for each other’s roles. 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, their circumstances changed or were discharged from the service.

We observed the morning nursing handover which is held at the beginning of each shift on the hospice and Harrowby ward. Discussion between the nurses included medications, infection control issues and deteriorating patient conditions.

All staff had appropriate access to patients’ records to ensure treatment was delivered in line with best practice. Staff shared relevant parts of patient records with other organisations, with consent from the patient, such as the patients’ GP.

During our inspection we observed staff worked well together for the benefit of patients, supported them to make decisions about their care, and had access to good information.

Patients and relatives, we spoke with told us they felt there was good information sharing from staff and involved in all decision making regarding on-going care and were kept up to date about any changes.

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 SPCT were made aware of patients through the referral processes. The SPCT undertook a huddle every morning to discuss operational issues, clinical updates, peer and senior support and to discuss any complex patients.

The SPCT had e-mail referral inbox, which was managed and monitored daily by the team members. When the SPCT were not on site, the inbox was reviewed remotely, and referrals actioned. If a face-to-face assessment was required, this was arranged, however in the period in-between, remote advice would be given.

The SPCT worked across all the hospital sites.

Additionally, the ward staff could escalate concerns or contact the Hospice in the Hospital for advice.

An out of hours urgent advice line for specialist palliative care was provided by a local hospice.

A healthy diet was promoted for palliative and end of life care patients. There were various 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.

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. We saw staff supported patients to eat and drink.

End of life care patients could order anything they wanted from the menu. For example, if they wanted ice cream for dinner, that was facilitated or if they wanted something to eat that

was not on the menu, the staff would facilitate this either by on site catering or nearby take away services.

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

Managers made sure staff completed a full set of vital signs when a patient was admitted and when they moved between wards. They checked that each patient had a daily review of their symptoms and condition. They also checked whether the patient had a subcutaneous line and confirmed that it was properly recorded in the patient record, including the exact site location.

Data showed for February 2026 that cannulas and other in-dwelling devises had 100% compliance for the hospice and 98% compliance on Harrowby ward.

The service audited the patients preferred place of care or death. The preferred place of care or death refers to a person’s preferred location to receive end-of-life care and to die. This normally discussed with the patient and documented in the advance care plan. While home was the most preferred location, choices could vary based on individual needs, family support, and the type of illness. Data from April 2025 to February 2026 showed that a 100% of patients died in their preferred places of care or death.

The service completed a patient experience audit between November 2025 and January 2026. Results showed consistently positive feedback, with 100% of patients on the hospice and Harrowby ward reporting they felt involved in discussions and decisions about their care and treatment. All patients also reported that staff were kind and that they had confidence in the doctors caring for them.

However, earlier results from October 2025 showed lower satisfaction within the hospice, where 83% of patients reported confidence in nurses and 83% said they were happy with the care and treatment they were receiving. Overall, the most recent audit results demonstrated a clear improvement to 100% positive responses across all areas measured.

However, following our inspection the trust advised us the hospice audits are conducted monthly by the Matron and involve a sample review of patient feedback. Whilst the sample size provides only a snapshot of patient experience at a given point in time, the regular and ongoing collection of data enables trend analysis over time. This supports the identification of areas requiring additional focus or support, helps monitor progress, and contributes to the Trust’s ward accreditation process.

For the period September 2025 to February 2026 data showed that pain and symptom control audits for end of life care patient displayed 100% compliance for the hospice, Harrowby ward and the chemotherapy suite.

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 8 ReSPECT forms and found 2 of them (25%) were not completed correctly. For example, one DNACPR stated the patient ‘Lacks capacity’, however there was no mental capacity assessment (MCA). The second case stated the patient ‘lacks capacity’ however there was an MCA from a previous date, for a different reason and therefore was not applicable or legally correct in relation to the DNACPR.

We escalated the DNACPR orders to the nurse in charge on Harrowby ward, when we returned, they were completed appropriately. The ward manager told us they had spoken to the safeguarding lead with a view to undertaking some training in this area.

Mental capacity assessments are both situation specific and time specific. For example, a situation specific mental capacity assessment must refer to the situation on which the decision is being made at the time the MCA is being completed and not another decision made previously. The MCA must also be at the time the decision is being made for it to be a legally binding document.

However, date showed 100% compliance for the completion of mental capacity assessments for the hospice, the chemotherapy suite and Harrowby suite. For ReSPECT paperwork, data showed 96% for Harrowby ward, 98% for Harrowby ward and 70% for the chemotherapy suite for completion.

Relatives and patients told us staff obtained consent before undertaking any care or treatment. We looked at 9 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.

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

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.