Sue Ryder palliative Care Hub- South Oxfordshire

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

At our last assessment we rated this key question outstanding. At this assessment the rating has changed to good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care, however the service did not have a clear shared vision, strategy and culture.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We scored the service as 2. The evidence showed some shortfalls. The service did not have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement.

The service did not have a clear shared vision, strategy and culture to guide staff and support consistent ways of working. The service had experienced significant organisational change. The direction and priorities for the service were not consistently understood or embedded across the workforce.

Leaders had a strategy focused on improving palliative and end of life care, including expanding bereavement support, using evidence and feedback to drive improvement, supporting local communities and sharing specialist expertise with wider health and care services. Services included hospice at home, virtual wards and wellbeing support. However, staff did not always share leaders’ understanding of, or confidence in, the service’s direction. Most staff told us changes to roles, responsibilities, shift patterns and working hours had created uncertainty and negatively affected morale. Staff reported feeling overwhelmed by workloads and told us the changes had not always been communicated effectively. A staff survey from June 2026 asked whether they felt the changes had been well led and scored 33%. Staff told us the service had taken on "way too much, too quickly" and that the senior leadership team "were not listening" to concerns. Some staff told us they felt there had been a decline in the service and described delays in responding to some referrals.

We saw evidence demand for the service had increased significantly, with the number of people supported rising from 120 in April 2025 to 474 in March 2026. Staff turnover was 27.8% during this period. Staff told us this created additional pressure on teams already adapting to new ways of working. Leaders acknowledged these challenges and told us staff wellbeing was included on the organisational risk register.

We also found some systems, processes and frameworks were still being developed and were not fully embedded. For example, a Hospice at Home induction process was in place and healthcare assistants completed the required competencies when starting. However, some supporting documentation remained in draft form because the scheduled review had been delayed. This meant the provider’s approach had not been fully formalised and embedded as intended.

Leaders acknowledged the impact the transformation had on staff and told us they were committed to improving morale and communication. For example, following feedback from staff, alternative arrangements had been introduced so nurses would no longer be required to work overnight shifts. Leaders told us they remained committed to embedding the new model of care and supporting staff through the transition.

We scored the service as 3. The evidence showed a good standard. The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Leaders had the skills, knowledge and experience to lead the service and drive organisational change. There was a clear leadership structure with defined responsibilities across clinical, operational, wellbeing, transformation and governance functions. Leaders demonstrated a good understanding of the services they managed and could clearly explain the organisation's strategic goals for delivering person-centred palliative and end of life care.

Leaders were aware of the challenges facing the service and had taken steps to address them. For example, leaders recognised the impact that significant organisational changes had on staff wellbeing, morale and workforce stability. We saw evidence leaders responded to concerns raised by staff and introduced changes to working arrangements following feedback. Leaders also recognised staffing pressures and were actively recruiting to vacant posts and reviewing workforce models.

However, staff experience of leadership was mixed. While some staff told us they felt supported by their managers and senior leaders, others told us leaders were not always visible within the service. Some staff felt communication could be improved during periods of change. In a regional staff survey, staff were asked about their confidence in the executive leadership team, who were leaders of the overall charity and located nationally. The score was 47%, indicating only moderate confidence in the organisation’s senior leadership. Leaders acknowledged these concerns and told us they were committed to improving engagement, visibility and communication as the new operating model continued to develop.

We scored the service as 3. The evidence showed a good standard. The service fostered a positive culture where people felt they could speak up and their voice

Staff and volunteers were encouraged to speak up and raise concerns. The service had a whistleblowing policy which encouraged staff to report concerns and set out how concerns would be investigated and managed. All staff had access to an online reporting system and we saw speaking-up information and posters displayed in staff offices.

The service used a range of methods to gather feedback and understand staff experiences. For example, annual staff and volunteer surveys provided opportunities to share views, raise concerns and suggest improvements. Survey questions covered areas such as organisational change, workplace culture, bullying and harassment, reasonable adjustments and staff wellbeing.

Many staff felt able to raise concerns and give feedback. Survey results showed 79% of staff felt comfortable giving feedback to their immediate line manager. In addition, 65% of staff felt concerns they raised would be acted upon and 66% felt the organisation treated staff involved in an error, near miss or incident fairly.

Leaders used staff feedback to identify areas for improvement and promote a culture where people could speak up without fear of blame. However, some staff told us they did not always feel listened to during the recent service transformation and expressed concerns about communication and decision-making.

We scored the service as 3. The evidence showed a good standard. The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

The service had policies in place to support inclusion, equality, dignity and autonomy. The service aimed to ensure individual needs, personal circumstances and cultural identities were recognised and respected. Staff completed mandatory equality, diversity and human rights training as part of their induction and refresher training.

The service monitored equality and inclusion through staff feedback, complaints and incidents. Staff survey results showed 81% of staff felt people from all cultures and backgrounds were respected and valued, and 79% felt the service was committed to equality, diversity and inclusion for employees.

The service actively promoted an inclusive culture. For example, staff were encouraged to participate in activities supporting LGBTQ+ communities and colleagues, including events and awareness initiatives.

We saw evidence the service supported flexible working arrangements to help staff balance work and personal responsibilities. For example, staff could request flexible working or special leave to support caring responsibilities or health needs.

We scored the service as 3. The evidence showed a good standard. The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

The service had governance systems in place to monitor performance, manage risks and support improvement. There was a clear framework for meetings at team, service and senior leadership level. Records showed discussions included incidents, complaints, patient feedback, risks, staffing, training, audits, medicines management and quality improvement activities. Action logs identified responsibilities and timescales, helping leaders monitor progress and accountability.

Structured meetings took place to review risks, capacity, staffing levels and patient needs. Staff concerns were reflected on the organisational risk register. For example, concerns about staff wellbeing, sickness absence and workload pressures had been identified by leaders and were being monitored with actions in place.

Systems were in place to monitor quality and drive improvement. The service participated in an audit programme aligned with national guidance and completed local clinical audits to monitor the quality and safety of care. Audit findings, root causes, actions, responsible leads and completion dates were clearly documented and reviewed by senior leaders. For example, learning from an incident investigation identified gaps in staff knowledge in a specific area of practice. Managers responded by introducing a quality improvement initiative to strengthen staff knowledge and improve practice. Evidence showed audit results, actions and learning were used to support continuous improvement across the service.

A central and accessible online portal to access policies was available to staff. Any policy updates and changes are emailed to staff and discussed at quality improvement meetings.

Leaders considered the long-term sustainability of the service. For example, workforce planning and business cases were used to review staffing structures and future service needs. Staff had access to equipment and technology to support their work, including an artificial intelligence note-taking system designed to reduce administrative burden.

We scored the service as 3. The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

The service worked effectively with partners and local communities to support patient care and improve access to services. Records showed the service worked closely with hospitals, GPs, district nursing services, specialist nurses and care homes to coordinate care and support positive outcomes for patients.

Strong partnership working supported the delivery of care across the region. For example, occupational therapists worked closely with hospital palliative care teams to support discharge planning and arrange equipment to help people receive care in their preferred place. Staff also told us they worked with specialist nurses, including Parkinson's, heart failure and diabetes teams, to ensure patients with complex conditions received appropriate support. Also, multidisciplinary team meetings brought together doctors, clinical nurse specialists, therapists, wellbeing staff and counsellors to plan and review care. Access to social workers was also available via the central team, when required.

The service was actively involved in supporting and engaging with local communities. For example, community engagement through the ‘Dying Well’ project, which is a collaborative initiative that aims to improve the wellbeing of people living with terminal illness. Care home staff have access to the services training academy, helping to develop knowledge and skills within the wider health and care system.

We scored the service as 3. The evidence showed a good standard. The service focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

The service had systems in place to support learning and improve patient care. Learning from incidents, audits and feedback was shared with staff and used to improve practice. For example, monthly ‘Learning for Safety’ memos highlighted key learning and actions from incidents, including pressure ulcer prevention and falls management. Staff received regular updates, helping to share learning across teams.

Documents we reviewed showed quality improvement activity was monitored through structured governance processes. For example, a clinical development and service plan included a ‘document dashboard’ which tracked progress, outstanding actions and completion dates.

The service was developing new ways of working to improve consistency and responsiveness. For example, the service introduced a new triage tool to assess referrals according to need and urgency which provided staff with a consistent framework for prioritising referrals and determining response times.

The service also recognised opportunities for further improvement. For example, leaders identified that more feedback was needed from people and their families. In response, the service introduced a process to ensure feedback from patients and families was collected and used consistently across the service.