Grantham and District Hospital

On this page

• 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

The specialist palliative care team worked with the local health care partners, hospices and local commissioning groups to plan and deliver services to meet the needs of local people into the future.

Patients received person centred care. Systems were in place to ensure that people's physical, social, psychological needs and wishes were comprehensibly assessed.

Detailed and current information about people's needs and wishes was available to staff to ensure people received the support they required. The service ensured people experienced a comfortable, dignified and pain-free death, according to their wishes and preferences.

People knew how to raise a concern or complaint. Senior management were open and transparent with people when things went wrong. Complaints were investigated and analysed for trends and themes.

We have not awarded this service a score for Responsive.

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

Throughout our inspection we observed that patients, care givers, loved ones and families were at the heart of everything staff did. Staff responded compassionately when patients or their relatives and loved ones needed help. Support was always given by caring staff, to meet the needs of the patients and their families. Feedback from people who used the service was continually positive about the way staff treated them. Staff identified patients who needed extra support and discussed changes to patients’ care and treatment with patients, their families and their care givers.

The service provided support to families and care givers to maintain their own health and wellbeing.

We spoke with patients and relatives in the hospital and the hospice and observed their care and treatment. There was a strong, patient-centred culture from all staff. Staff were motivated and inspired to offer care for patients with kindness, compassion, dignity and respect through supportive relationships with patients and their families, care givers and loved ones.

We observed all staff members speaking to patients and their relatives and care givers with compassion and we observed sensitivity being shown during those conversations.

Patients and those close to them were partners in decisions about their care and treatment.

Relatives unanimously spoke highly of the care their loved one had received and reported they had felt fully involved in all aspects of care and also had their opinions considered.

On Harrowby ward they had developed ‘What Matters to Me’ signs, these were signs which went above the patient’s bed to provide staff with a way of engaging with patients who are confused or not able to make decisions for themselves. The signs were there to advise the staff who were supporting the patients to know what food and drink the patient may like, what time they usually got up in the morning, what pets and hobbies were important to them. This meant the ward could provide as far as possible the care that was individual to the patient’s needs, priorities and values supported them to do this. Staff told us the service monitored and evaluated feedback received through the Friends and family test which were consistently positive for both Harrowby ward and the chemotherapy suite. The hospice did not take part.

The service used the SWAN model of care. The SWAN model of Care was an NHS initiative used in hospitals to represent and deliver high quality end of life and bereavement care. When displayed, the SWAN logo acted as a prompt for staff to provide compassionate, personalised care and alerts them to offer specialised support to patients and their families.

The SWAN system supported staff to feel more confident in delivering care during the last stages of life, by focusing on dignity and comfort. Staff showed us the SWAN memory boxes for families after a loved one had died, which included teddy bears, knitted hearts and packets of forget me not flower seeds to be planted at some time in the future. On Harrowby ward, there were 2 SWAN battery operated candles that were used when there was an end of life care patient. One candle would be in the side room with the patient and the other candle at the nurse’s station, thereby signifying to all staff the end of life care status of the patient. During our inspection, we saw the SWAN sign on the door of the side room on one of the wards we inspected for an end of life care patient and an LED candle on the nurse’s desk. These let staff know there was a patient at the end of their life in the side room.

Patients and their loved ones described care that was responsive to their personal needs because staff had time to listen to them and understand their needs and preferences. One person said, “The staff always have time to talk to me, they are simply brilliant and all so kind”.

During our inspection, we found that call bells were always in reach of patients and observed they were answered quickly by the staff.

Data showed 100% compliance for patient safety, privacy and dignity for the chemotherapy suite, Harrowby ward and the hospice. This meant that patients received person centred care and that their safety, privacy and dignity was always upheld.

End of life care services understood the diverse health and care needs of their patients. This meant care was joined-up, person centred, flexible and supported the choice and continuity of patients and their loved ones.

Staff worked closely with patients to ensure their diverse needs were recognised, respected and met during their interactions with the service.

Staff in all areas of end of life care, worked closely with other teams and external referrers to ensure patients experienced a smooth pathway and joined up care. For example, they liaised directly with local GPs, who were one of the the main referral routes for patients. Staff updated records and shared information with relevant health care providers to ensure patients’ current needs were accurately documented.

The electronic palliative care coordination system meant that patients records could be accessed by other healthcare professionals in the community to ensure as far as possible, the patient had an individualised care plan on discharge from the hospital or hospice.

We saw evidence in patient care records that relatives were involved in decisions about patients’ care, 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 several leaflets available, for example Macmillan cancer support, carers passport and managing breathlessness.

Interpretation services were available for people whose first language was not English, including British Sign Language. Staff knew how to access this service.

There was an extensive number of information leaflets available for people to explain the different aspects of end of life care, the treatment available and any side effects.

Staff provided up to date information to people whilst delivering treatment and care. Patients and loved ones were provided with appropriate, accurate and up to date information at all stages of their care and treatment. We observed relevant information being shared between staff during a multidisciplinary meeting and the nursing handovers we attended.

The service used a third party provider to provide support services to D/deaf patients, and accessible information services for those patients living with dementia or other disabilities.

There was an Accessible Information Standard (AIS) policy which staff were knowledgeable about. The AIS sets out how NHS and publicly funded adult social care services should ensure disabled people and people with impairments or sensory loss can access and understand information about NHS and adult social care services and receive the communication support they need to use those services. Staff told us they had access to an array of tools to improve communication. We observed a range of different medical and nursing pictorial information cards. For example, picture cards that showed a doctor wanting to give a patient an injection, a nurse asking if the patient was ready to go for an x-ray and a request to check the patients’ blood pressure. All of the pictorial cards also showed the applicable sign language as well.

Data showed a 100% compliance with patient records and documentation requirements for the hospice and the chemotherapy suite and 95% compliance for Harrowby ward.

The service made it easy for people to share feedback or raise complaints about their care and treatment. Staff involved patients and their loved ones in decisions about their care and what the outcome could be.

Families and care givers we spoke to were aware of how to make a complaint and how to provide feedback. They told us they felt they could raise any concerns with staff and felt they would be listened to.

Staff told us they tried to deal with any concerns and issues immediately, however, if a complaint was made formally; it was appropriately investigated through the complaints process. Complaints were registered in line with the trust’s complaint policy and reviewed by the leadership team. For the period April 2025 to March 2026 a total of 1 complaint was received for end of life care at Grantham and District Hospital, and this was for Harrowby ward.

Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service promoted equality and diversity in daily work. The service was inclusive and took account of patients’ individual needs and preferences and conversations with staff evidenced their understanding of person centred care.

The service was accessible to patients with disabilities. The service had access to bariatric beds for patients weighing up to 150 kilograms. All areas in the hospital were wheelchair accessible, and the wards were dementia friendly. For example. On Harrowby ward and the chemotherapy suit there was clear pattern free flooring, which was all one colour, and not highly polished. Appropriate flooring supports stability, encourages safe walking and reduces falls. Poor flooring can cause injury, anxiety, loss of independence and increased reliance on staff.

The SPCT were made aware of palliative and end of life care patients through the referral process. The trust also had an SPCT huddle each morning, where each site team joined to discuss operational issues, obtain updates, and discuss any complex patients with other members of the team.

The SPCT had an e-referral inbox for each site, which was managed and monitored daily by the team. At times when staff were not on each site, the inbox was monitored remotely, and referrals were actioned through remote support.

 Any member of the clinical team could refer a patient either directly by telephone or a link to the referral form which was provided on the Trust Intranet. In addition, urgent specialist palliative care medical advice was available twenty-four hours a day, 7 days a week, by the hospice In-patient Unit.

Staff understood the barriers to care and support and how to escalate these. For example, one staff member told us that in Lincolnshire due to its geographical layout and lack of street lighting, patients going home or another place of their choice in winter could be on the transport for a long time on rural roads that were small and not well kept. This meant transport to and from the hospital for some patients could take a long time and be anxiety provoking.

During our inspection we found there was no bereavement office at Grantham and District Hospital, as all bereavement services were centralised at Lincoln County Hospital. The bereavement office provided a fundamental role in supporting families after the death of a patient. This meant that families and loved ones of the deceased had to travel to Lincoln County Hospital which is approximately 1 hours travel time to speak with a bereavement staff in person, however, phone advice was available.

The trust considered patients’ individual needs, this included culture, age, disabilities and extra requirements, this enabled the service to put in any additional support required. For example, the family and loved ones of end of life care patients could stay in the side rooms with end of life care patients for as long as they and the patient wanted them to.

Staff received training in equality, diversity and inclusion. Service training records demonstrated all staff were up to date with this training.

The service had processes and policies which ensured patients were treated in line with legislative requirements and The Human Rights Act.

Patients were helped to make informed choices about their care and treatment. Staff referred them to specialist services when they needed ongoing care or follow‑up. Important information about patients care and treatment was shared with their GP on discharge.

The service had systems in place to support patients approaching the end of their life, working closely with other health care professionals to provide appropriate support. The service used advance care planning to support people on deciding their future care needs while they still had capacity to do so.

Staff spoke openly with patients and their loved ones to try and plan the last days and hours of life in a way that met with the patient's wishes.

Patients were actively supported to make decisions with regards to cardiopulmonary resuscitation. These decisions were clearly, documented as part of the ReSPECT paperwork and updated on a regular basis as appropriate.

Patients we spoke with told us that if their treatment was changed or withdrawn, they were part of the discussion and that staff spoke with them in a way they could understand. For example, one patient told us that the staff did not use medical language and acronyms when speaking with them about their treatment but instead used language they could understand.

There were suitable systems in place to ensure safe transfer and accessibility of patient records if a patient wanted to be transferred to home for their end of life care, or another service for treatment.

Patients and loved ones we spoke to, told us they had received information, both verbal and written, to enable them to make an informed decision about their care and treatment that had been provided and was planned for the future. They told us there had been sufficient time at their appointment for them to discuss any concerns.

There were systems in place to manage current and future performance and risks to the quality of the service. For example, during our inspection, a Dying Matters forum was being organised to promote open conversations about death, dying, and bereavement, encouraging reflection and learning across the multidisciplinary teams. The forum was designed to help to increase awareness, normalise discussions around end of life care, and reinforce the trust’s commitment to person-centred, dignified care.