Capacity to admit 24 – 7 to our beds is pivotal – Paul Madden, Hospice in the Weald

Categories: Care and Leadership.

I want to shed light on a pivotal aspect of our organisation: our unwavering commitment and capability to admit patients into our 25 beds around the clock, seven days a week.

With a legacy spanning over four decades, Hospice in the Weald acknowledges that the journey towards the end of life transcends the confines of weekdays and regular office hours.

We have endeavoured to establish an operational framework that facilitates admissions whenever our patients require it, whether for end-of-life care or symptom control.

And to be admitted, no referral by a health professional or a Palliative Care Team in a hospital is needed. 

This progressive approach has assumed heightened significance, as underscored by a recent publication in the British Medical Journal (BMJ). The article unequivocally emphasises that individuals who pass away within UK hospitals, in the absence of expert palliative care intervention, frequently encounter “significant and poorly identified unmet needs.”

It is indeed alarming to note that an estimated one in ten patients admitted to UK hospitals will die during their in-patient stay.

The researchers further expound on the challenges associated with recognising the imminence of patient death, compounded by the pervasive stigma surrounding palliative care, which contributes to under-referrals. On a specific day, between April 25th and May 1st, 2022, palliative care specialists evaluated the holistic well-being of 284 adult patients nearing the end of life who had not been referred to palliative care services.

Equipped with two distinct admission sites, our In-Patient Ward in Pembury caters to the needs of complex patients, while the Cottage Hospice in Five Ashes offers admission for non-complex patients.

To ensure seamless admissions, we have meticulously devised staffing ratios tailored to each location, working closely with our medical practitioners to develop strategies for managing admissions during “out of hours” periods.

It became apparent that certain admissions necessitated telephone or video consultations with our on-call doctors and Advanced Nurse Practitioners (ANPs). In a limited number of cases, the on-call personnel were required to be physically present. Our comprehensive policy has been meticulously revised to reflect these adaptations, empowering our staff with a well-defined framework within which they can operate.

We established a valuable collaboration with a local ambulance service during the challenging COVID-19 pandemic, enabling them to admit patients into our care 24/7 directly. This collaborative effort eliminated the need to transport patients unmistakably approaching the end of life to hospitals, thus preserving their comfort and dignity within the hospice environment and under the care of our incredible staff.

One poignant example of an ‘out of hours’ admission involves a homeless individual who, had it not been for the ambulance contacting us, would have passed away in a public establishment. By admitting the patient, we provided them with a dignified death.

While we take pride in our current achievements, we recognise that there is more work to be done in promoting this approach and ensuring that all pertinent external partners within our notional catchment area of West Kent and East Sussex consider reaching out to us, even if they harbour doubts about the appropriateness of a referral.

It is always preferable to initiate a conversation with us and discuss the patient in question, thus enabling us to offer guidance and support.

If you have an urgent enquiry for our medical and nursing teams (which may be for help and advice) please phone 01892 820515. 

Our Mission:

Hospice in the Weald strives to provide care, advice, and support for everyone in our community living with terminal or life limiting illness, together with their loved ones. We empower people to celebrate life and make the most of the precious time they have for living.


Hospice in the Weald provides care completely free of charge to patients with a terminal illness, and those important to them, in West Kent and northern East Sussex. This means we are there 24 hours a day to help, support and care for patients with an illness where a cure is no longer possible, and for patients who will at some stage die from their illness, whenever that may be (you may hear this referred to as “palliative care”).

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