What Does Quality Really Mean in Hospice Care?

More recently, the new inspection regime introduced by the Care Quality Commission (CQC) - the regulator for health and adult social care in England - is helping provide a better understanding of quality in hospice care.

Hospices have long been renowned for providing a high standard of care, especially by the people and families who use their services, but in an era where care is under more scrutiny than ever before what does quality really mean?

The very nature of hospice care, dealing with the uncertainties of dying and death, and its holistic model - providing clinical care and also spiritual and emotional support - means that it can be much an art as a science, so measuring quality in the sector can prove challenging.

Research such as the National Survey of Bereaved People VOICES has helped highlight some of the key characteristics of hospice care and also how it compares with other care providers. The most recent VOICES survey, which was published last year, rated the quality of care provided by hospices as significantly higher than that provided in hospitals and other care settings - 77 per cent of respondents rated hospice care as excellent.

Being shown dignity and respect by staff in the last three months of life was rated highest in hospices of all settings - 89 per cent for hospice doctors and 86 per cent for hospice nurses.

More recently, the new inspection regime introduced by the Care Quality Commission (CQC) - the regulator for health and adult social care in England - is helping provide a better understanding of quality in hospice care.

The CQC rates services as Outstanding, Good, Requires Improvement or Inadequate so that the public has clear information to help them make informed choices about their care.

While it is still early days of course we are pleased to see that the early CQC ratings for hospices have found that they are either "outstanding" or "good".

The outstanding hospices have ranked particularly highly for providing compassionate care. Inspectors noted how they placed the needs of terminally ill children or adults at the heart of service provision and how they were highly responsive to their needs, treating them as individuals.

Julia's House in Broadstone, Dorset, which provides support and respite services for children and young people, was one of the first hospices to receive the top rating under CQC's new approach to the inspection of care services. Inspectors observed how children and young people received care from staff who were compassionate and delivered individualised care with dignity and respect.

For St Cuthbert's Hospice in Durham, which was also ranked outstanding, it was noted how staff spoke with patients and families, taking time to get to know them better and to listen to their needs.

The recent developments by CQC to highlight standards of care and increase transparency through the regulatory system are to be welcomed. However, Hospice UK also recognises that more work is needed on how we define quality in hospice care, through developing hospice sector-specific indicators.

We need to understand more about the individual components of hospice care and its impact. This is important, not only to support and shape the future development of hospice care services - particularly in the face of increasing demand for care driven by the UK's ageing population - but also to continue to positively influence end of life care provided by other services such as hospitals.

We published a report towards the end of last year - 'Defining Quality in Hospice Care' which marked the first steps to begin to address this.

As part of this we held a national workshop with hospice clinical leaders from across the UK and sought to gain their views on what constitutes quality in hospice care. This, in addition to the findings of a literature review, led to the development of a proposed set of quality domains which we will be developing further in the future.

Hospice care often touches people's lives in intangible but impactful ways that cannot easily be measured. However, we are making significant inroads towards defining and evaluating quality in the sector and discovering more about its unique contribution in successfully supporting terminally ill people and their families.


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