Monitoring questions for hospices

• Are infection risks to people using the service being thoroughly assessed and managed?
• Have you changed the layout/environment of clinical and non-clinical areas to continue to provide services safely in this period? For example clean sites, vehicle layout, separate entrances and waiting areas for known/suspected COVID patients, additional signage, spaces between stations, isolation facilities, ensuring compliance with best practice guidance when visiting people in their own homes etc.
• Do you have the resources to obtain, and reliable access to, all the supplies, personal protective equipment and COVID-19 testing it needs, for both staff and, where appropriate, people who use the service?
• Are working arrangements and procedures clear and accessible to staff, people who use the service, their supporters and, where appropriate, visitors to the service?
• Are people using the service being protected from abuse, neglect, discrimination and loss of their human rights?
• Where applicable, have you identified when they may be depriving a person of their liberty, and followed the correct and lawful procedures, for example DoLS application, Court of Protection?
• Are your safeguarding and other policies and practice, together with local systems, properly managing any concerns about abuse and protecting people’s human rights?

S1: Additional prompts

All hospices

• How do you support your staff to manage Infection, Prevention and Control (IPC) issues in patients’ homes? (for example, prevention of cross-contamination between homes; sanitisation of removed equipment)
• How have you managed training and support, particularly on revised arrangements to staff and volunteers throughout the COVID-19 pandemic?

• Are risks to the health and wellbeing of people using the service being properly assessed, monitored and managed?
• Are there enough suitable staff to provide safe care and treatment in a dignified and respectful way? Are escalation plans in place in response to surges in demand, for example second wave, seasonal pressures?
• How are you identifying and managing risks for patients including any restrictive practices or issues affecting their legal or human rights?

S2: Additional prompts

All hospices

• How are you assuring appropriate medical cover during the COVID-19 pandemic?
• What contingency measures do you have in place to maintain safe levels of nursing staff, including nursing staff with paediatric competencies where applicable?
• How are you identifying and addressing any safety implications as a result of reduced volunteer support during the COVID-19 pandemic?
• How are you ensuring the safe return of staff and volunteers after a period of absence?

• Do you have access to and follow guidelines around Treatment Escalation Plans (TEPs), anticipatory care planning, Do Not Attempt CPR (DNACPR) orders and individualised care plans? Are plans in place for rapid transfer to preferred places of care - relationships and planning with PMS, district nursing etc.
• Can you effectively manage referrals and, where relevant, discharges and ensure safe transfers of care? Where relevant, what testing arrangements are in place, and how do you handle transfers of known/suspected COVID patients safely? How are you working with other partners?

S3: Additional prompts

All hospices

• What steps have you taken to review care records and ensure that people do not have inappropriate DNACPR forms which were issued during the COVID-19 pandemic?
• How do you ensure that people (for example older OR disabled people) are not prevented from accessing active care and treatment through the inappropriate use of DNACPRs?
• How do you ensure staff (including temporary staff and volunteers) and access to records and that these are up to date?
• What arrangements have been put in place for the service to share patient information/records with other agencies/organisations during the COVID-19 pandemic?
• How do you ensure staff including temporary staff and volunteers have connectivity to appropriate record systems regardless of location?

• Are medicines being managed safely and effectively? Has Covid-19 impacted the service’s ability to manage medicines?

S4: Additional prompts

All hospices

• How do you support patients and their families/carers to manage their own medications?
• How have you ensured you have maintained adequate stocks of medication throughout the COVID-19 pandemic?

• Are there any significant trends in non-COVID-19 activity - Never Events, Significant Incidents, themes in incidents, Mortality, Unexpected deaths? What are you doing to assess and learn, including mortality reviews of non-COVID patients?
• Are there any significant trends where groups of patients are faring worse in terms of safety concerns?

S5: Additional prompts

All hospices

• How do you ensure that learning from incidents are shared widely with other organisations and partners?

• How are you identifying, cascading and keeping up-to-date with changes in clinical guidance?
• Where people are subject to the Mental Health Act (MHA) how are you ensuring compliance with the MHA?

E1: Additional prompts

All hospices

• How have you changed your Advanced Care Planning arrangements throughout the COVID-19 pandemic?
• How are you managing and enabling personalised care planning during the COVID-19 pandemic?

Children and young people

• How has care planning and transitioning to adult services changed throughout the COVID-19 pandemic?

• How are you collecting information about people's care treatment and outcomes? Where relevant, are they continuing to submit to relevant national clinical audits?
• How are outcomes being monitored for groups of people that may be at higher risk, such as different ethnic groups and older people?

E2: Additional prompts

All hospices

• Do you monitor preferred place of death outcomes? If so, what are the outcomes?

• How do you ensure that all staff, including those being flexibly re-deployed, have the skills and training to carry out their roles effectively?

• How do you ensure that the necessary staff, teams and services are involved in assessing, planning and delivering peoples care and treatment?

E4: Additional prompts

All hospices

• How is access to hospice services facilitated for a person with a learning disability/mental health condition?

• How do you ensure consent to care and treatment is always sought in line with legislation and guidance? Including, where appropriate:
  • ensuring that people are involved in decisions about not providing care and treatment, including advanced care plans and DNACPR decisions?
  • promoting supportive practice that avoids the need for physical restraint? Where physical restraint may be necessary, how do you ensure that it is used in a safe, proportionate, and monitored way as part of a wider person-centred support plan?
  • ensuring staff apply relevant legislation where people may lack capacity to consent to particular care and treatment, including the Mental Capacity Act 2005 (including DoLS) and the Children’s Acts 1989 and 2004?

• How have you adapted how you support and engage with patients and their families/loved ones?
• How do you ensure the care delivered is compassionate and upholds people's human rights?

C1: Additional prompts

All hospices

• How do you support patients to have contact with their wider group of family and friends during the pandemic?

• How do you support people to express their views and be actively involved in making decisions about their care, support and treatment as far as possible?
• Where appropriate, how are you managing the impacts of limited visiting on patient's wellbeing?
• Where appropriate, how are you promoting and ensuring patients know how to access advocacy support in the absence of ward visits?

C2: Additional prompts

All hospices

• How do you support people to express their preferred place of care/death?

Children and young people

• How have you ensured the views of children and young people have been sought throughout the COVID-19 pandemic?

• How do you ensure that they meet the needs of the population served and do you enable flexibility, choice and continuity of care?
• Where relevant, do individual patients have choices about how, when and where they are seen?

R1: Additional prompts

Children and young people

• How do you ensure continued delivery of respite care?

• How are services delivered, made accessible and coordinated to take account of the needs of different people, including those with protected characteristics under the Equality Act and those in vulnerable circumstances? This may include:
  • How do you ensure that each patient has their information and communication needs identified, recorded, flagged, shared and met?
  • How do you identify and make other reasonable adjustments for disabled people?
• Where new protocols for admission are being used, how are these being communicated to staff and how are they reviewed to ensure they are non-discriminatory?

R2: Additional prompts

All hospices

• How do you ensure access to care and treatment for people who are digitally excluded, for example due to disability, poverty or language needs?
• Do people at end of life and their families have access to differentiated and appropriate spiritual and pastoral and religious support? For example Muslim, Hindu, Buddhist, Humanist, Jewish, Sikh?

• How are you managing access to the service to ensure that high-risk patients/pathways are being identified and prioritised appropriately, including reinstating services and handling backlogs of activity?
• Is there a structured approach to patient flow that ensures all components of the system are appreciated and managed appropriately, and flow issues are escalated appropriately? How does the approach take account of the pandemic?

R3: Additional prompts

All hospices

• How do you ensure that there is sufficient capacity in the community to meet any increase in demand? Is there any capacity to build in flex in the system?
• How do you ensure that patient’s wishes about their preferred place of death are acted on quickly?

Children and young people

• What if any, gaps are there in the provision of services to children, young people and families in the community as a result of the pandemic? How is the impact of this being mitigated?

• Has there been any impact on leadership capacity as a result of the COVID-19 crisis? Are there plans and mitigations in place should it be affected?
• Do leaders understand the challenges to quality and sustainability during this period, and can they identify the actions needed to address them?

W1: Additional prompts

All hospices

• How have senior leaders looked beyond their own service and supported the local health and social care system during the pandemic?
• How are trustees playing a role in providing oversight and challenge during the pandemic?
• How are financial sustainability issues impacting on the quality of care?

• Are you monitoring and protecting the health, safety and wellbeing of staff?
• How are you taking action to protect the health, safety and wellbeing of staff, for example access to emotional support, supporting staff to raise concerns, adequately risk-assessing and placing staff in appropriate environments to protect their health and safety, including staff in different ethnic groups and other staff at high risk of COVID 19? (not for NHS Trust - covered at trust level)

W3: Additional prompts

All hospices

• How have you adapted your lone working arrangements to ensure the safety of staff working in the community throughout the COVID-19 pandemic?
• How are you developing innovative practices during the COVID-19 pandemic?

• Are you able to work effectively with system partners when care and treatment is being commissioned, shared or transferred?

W4: Additional prompts

All hospices

• How have the governance and oversight arrangements had to change to be more responsive to issues caused by the COVID-19 pandemic?

• Do you have effective systems and methods for monitoring the overall quality of the service and for responding to business risks and issues as they arise? How often are these reviewed?

W5: Additional prompts

All hospices

• Do you have plans in place to provide continuity of care in case of emergency? For example, if a hospice building cannot be used.
• How have you responded to the risk of financial sustainability?
• How are you adapting your future strategy and business model as a result of the pandemic?