St Michael's Hospice (North Hampshire)

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• 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

This means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last assessment we rated this key question as good. At this assessment the rating has changed to outstanding. This meant service leadership was exceptional and distinctive. Leaders and the service culture they created drove and improved high-quality, person-centred care.

The service maintained a positive culture where leaders and staff focused on the needs of the community. Managers brought the team together with a clear goal of putting patient comfort first. This responsive and kind leadership empowered staff to honour patients’ personal wishes, while innovative safety measures ensured care was consistently good. This resulted in a stable environment where patients felt well-supported, and staff felt they had the guidance needed to do their jobs safely and effectively.

This service scored 87 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service established a clear and ambitious vision to extend its reach and improve the quality of end-of-life care. Leaders developed a strategy to expand ‘Hospice at Home’ into a 24/7 service and grew the ‘Living Well’ programme through new community outreach posts. By extending their scope to cover the entire last year of life and creating new child support services for bereaved families, the hospice ensured that care was proactive rather than reactive. This strategic growth meant more patients avoided unwanted hospital admissions and received expert support in their preferred environment.

Leaders prioritised financial stability and teamwork with other organisations to make sure the hospice stayed open for the long term. The team worked to fix the budget gap by growing their Major Donors Programme and launching a legacy marketing campaign. At the same time, the hospice built formal partnerships with other local care providers to share staff and resources. They also worked with health boards to secure fairer contracts that covered the real cost of providing care. These actions created a solid financial base, which meant the hospice could continue to support the local community without the risk of cutting services.

The hospice invested in its staff and new technology to keep care standards high and daily work efficient. To support the workforce, leaders re-launched pay scales that matched national levels and created a Nurse Competencies Framework to help staff develop their clinical skills. The strategy also focused on the future by offering more apprenticeships and using AI to handle time-consuming office tasks. These investments helped build a culture of togetherness and ensured the team stayed skilled and happy. As a result, patients received safer and more efficient care from a motivated team.

Leaders set a clear path for the future by matching the hospice’s values with goals for growth. They used the Thrive values, Trust, Honesty, Respect, Impact, Value, and Evolve as a foundation for future planning. These values helped every team member understand how their work contributes to the hospice.

The hospice created a space where patients and professionals felt like a group of friends supporting each other. Patients told us that coming to the hospice felt like being with friends who truly understood what they were going through. By breaking down walls between ‘patient’ and ‘professional’, the hospice had built a community in which everyone could draw strength from each other.

Leaders demonstrated a strong commitment to equality by establishing clear policies that protected staff from discrimination. Senior management fully supported an equality policy that covered all protected characteristics, including age, disability, and sexual orientation. This policy provided staff with clear examples of direct and indirect discrimination, ensuring everyone understood their rights and responsibilities. By setting these standards, leaders created a workplace where fairness was a priority. This culture of transparency was further reinforced by the Chief Executive Officer (CEO), who led a monthly forum for both clinical and non-clinical staff. This forum served as a platform for sharing key messages and clinical updates from the management team. Furthermore, the CEO ensured this information was uploaded to a shared digital space, allowing those unable to attend to stay informed.

The leadership team implemented fair and transparent recruitment processes to build a diverse and skilled workforce. They followed a system where at least 2 people shortlisted applicants using a pre-agreed marking scheme based only on the skills needed for the job. These steps helped to reduce the risk of unintentional bias, resulting in a team chosen purely on merit and expertise. Beyond recruitment, the hospice invested in professional growth. The Senior Leadership Team and the Clinical Management Team received regular leadership coaching to refine their management styles. In 2024 to 2025, a ‘Rising Stars’ leadership and management programme was offered to junior managers through an external coach. This initiative included ‘train the trainer’ sessions for the Human Resources (HR) manager, ensuring the hospice could continue to deliver this leadership development internally. Furthermore, a programme for Deputy Ward Leads was launched in 2024 to support Registered Nurses at the Band 6 level who were new to their roles.

Leaders launched a detailed people strategy to foster a culture of belonging and support clinical excellence. The HR Strategy 2025 to 2028 focused on making staff feel valued and empowered so they could deliver exceptional end-of-life care. Leaders took shared responsibility for this strategy, introducing new standards for work-life satisfaction and professional development. As the hospice invested in its staff as its “greatest asset”, staff felt more motivated and engaged, which led to a happier workforce and better care for patients and their families. This supportive structure extended to the service’s volunteer workforce, which was overseen by a volunteer manager. This manager ensured that volunteers were fully integrated, supported, and provided with a detailed induction and training program, while also maintaining a patient information booklet to assist them in their roles.

All staff we spoke with consistently demonstrated genuine warmth and compassion. We observed that staff never appeared rushed, and they had the ability to dedicate quality time talking with patients and listening to their concerns. Employees described their leaders as both supportive and approachable, and every team member we met was eager to share their work and their achievements. One staff member expressed immense pride in making a meaningful difference during patients’ final moments, noting that the ability to effectively minimise pain and discomfort gave them a profound sense of purpose.

The leadership team appointed a Freedom to Speak Up Guardian (FTSUG) who operated outside of direct line management and maintained visibility through posters in the staff room. The Guardian met with the Chief Executive Officer every 3 months to discuss any emerging risks. This structure helped to ensure staff had a route to escalate sensitive information and voice their concerns. The organisation supported a transparent environment by treating feedback as an essential tool for learning. Leaders held monthly forums and when the FTSUG identified a theme of poor staff communication, managers tracked and monitored the issue, until improvements had been made. This commitment to staff wellbeing was supported by the Employee Assistance Programme, which allowed staff to access independent, confidential support from trained counsellors.

The hospice created a safe way for everyone to speak up about risks or mistakes. Leaders implemented a formal whistleblowing policy aligned with the Public Interest Disclosure Act (1998), which protects staff from detrimental treatment when raising legitimate concerns. The policy designated a specific non-executive director to handle whistleblowing cases. Beyond this role, every member of the Board of Trustees was expected to act as an independent ‘Whistleblowing Champion’, with a duty to receive concerns and ensure they are investigated, recorded, and reported appropriately.

To make the leadership team easier to talk to, managers moved into offices with glass doors and started weekly walkarounds to check in with staff. They launched ‘air and share’ meetings and a weekly newsletter to keep everyone informed about any changes. To continue improvements, new starters were asked for their ideas on how to improve things after their first 3 months, and those leaving the hospice had exit interviews so leaders could learn from their experiences. By offering coaching to senior leaders and introducing the ‘Thrive’ award to recognise hard work, the hospice built an open culture where staff told us they felt informed, valued, and safe to speak up.

Hospice leaders made the workplace more welcoming by including people with different needs in their workforce. This commitment was formalised within the service’s People Strategy, where Equality, Diversity, and Inclusion were specifically named as a core priority. All staff we spoke with told us they felt valued and supported regardless of their background or individual needs. This environment of mutual respect allowed staff to feel comfortable being their authentic selves at work, which in turn created a more representative and supportive team for the patients they serve. The hospice used expert training to help everyone understand and respect their colleagues’ differences. The service had a Code of Conduct policy which asked everyone to be patient and kind to one another, regardless of background, identity or beliefs. As a result, staff told us the team worked well together, making the hospice a friendlier place to work.

The Board of Trustees and the Clinical Management Team (CMT) maintained oversight of the service by checking data against national standards. The trustees met in August 2025, to approve the appointment of a new Chair and review the 2024/25 Financial Statement. The CMT conducted monthly reviews of their clinical dashboard, while the Clinical Governance Committee reviewed performance quarterly to ensure data accuracy before submission to the Integrated Care Board (ICB). This committee also monitored significant events and incidents, such as medicine errors, patient falls, pressure-related skin damage, safeguarding reports, and Deprivation of Liberty Safeguards applications. This approach to monitoring improved transparency and ensured both clinical leads and trustees had a clear, data-driven oversight of hospice performance.

Senior managers successfully handled service transformations by being open with staff and hiring new team members. When the Hospice at Home service moved to a 24-hour schedule, some staff reported feeling worried about working nights. To mitigate the risk of losing key people, managers created additional night only posts within the Hospice at Home team. This targeted recruitment helped stabilise the workforce and allowed the hospice to meet its ICB contract requirements for reducing hospital admissions. These interventions ensured the service remained reliable during a period of change.

The executive team focused on patient outcomes above bed occupancy targets. During the August 2025 Board meeting, the Chief Executive Officer successfully negotiated reducing a 100% occupancy target, highlighting the importance of having available beds to meet immediate community needs. The IPU lead also began using the Patient Safety Incident Response Framework (PSIRF) to foster a culture of learning from patient incidents through After Action Reviews. This shift in management philosophy improved the speed of admissions and facilitated a more responsive care model that better addressed the needs of the North Hampshire population.

The hospice achieved financial stability by securing long-term NHS contracts and raising money through local events. This, combined with successful events like the Summer Ball which raised £120,000 and won a Sustainable Business Award, meant they had enough money to cover their £14,000 daily costs. This financial safety allows the hospice to keep its doors open and plan for the future.

Leaders saved money by fixing old buildings and finding new ways to sell donated items. They used a government grant to replace a drafty conservatory that was wasting energy and heating money. They also grew their online sales by 40% to make up for fewer people donating high-quality items to their physical shops. These business moves helped lower the hospice’s bills and brought in more money, making sure the service stays reliable.
 

The hospice leadership team focused on building strong ties with NHS partners to make sure palliative care was consistent across the area. They did not work in isolation; instead, they participated in bi-monthly meetings in Basingstoke for all stakeholders involved in palliative deaths, and monthly calls with the Integrated Care Board (ICB) across Andover and Hampshire to escalate and review concerns. By working closely with the ICB, the hospice won funding to expand their Hospice at Home service. This teamwork helped to make the local health system more stable and helped to reduce unnecessary hospital admissions.

Staff ensured patients moved smoothly between different types of care by staying in contact with other medical teams. Every morning, the hospice held a call with a local hospital palliative care team and other external services to discuss new patients and bed space. They also met with local district nursing teams to coordinate care in people’s homes. For example, the hospice shared medical consultants with a local hospital to ensure the patient always saw a familiar face. This helped to ensure excellent communication and partnership working between different services.

The hospice offered education to the local community. They partnered with the Meerkat service to provide bereavement support for children and taught local nursing home staff how to use syringe drivers and medical equipment safely.Senior leaders, including the Chief Executive Officer, Medical Director and Clinical Director, collaborated with another hospice and local trust to develop a shared clinical dashboard and a 24/7 specialist advice line for patients and relatives.They also integrated external expertise, by hosting NHS Neurology Consultants for Motor Neurone Disease (MND) clinics, received in-person training from the Community Tissue Viability Team, and worked closely with the Blood Transfusion Team to offer complex treatments on their Inpatient Unit. These partnerships meant every patient received the same level of care whether they were at home, in the hospital, or at the hospice.

The service used external feedback to monitor the quality of its physical surroundings. The hospice conducted a ’15 Steps Challenge’ in November 2024, where a Hospice User Group (HUG - people who have used the service) identified the environment as clean, with well-lit wards and calming gardens. The HUG identified areas for improvement like tired external signage and open laundry room doors. The service used this feedback for making improvements, and it meant individuals who had experienced care within the hospice had direct input into these changes.

The hospice served as a centre for high-level medical training and national research. The team taught new doctors on 4-month rotations and successfully signed up 30 patients for a national study on hydration at the end of life. This involvement meant staff stayed up to date with the best ways to care for patients, while their research helped the wider medical community find better ways to manage confusion and agitation in dying patients.

Leaders took real steps to look after staff mental health and help prevent burnout. The service ran a survey to understand the specific stresses faced by specialty doctors and launched wellbeing huddles and private spaces for staff to talk about their feelings. This focus on support helped doctors feel more valued and less overwhelmed. This helped to create a stable and more compassionate environment for everyone.

The clinical team made patient care safer by fixing how they checked blood sugar levels. After an audit showed monitoring was inconsistent, staff put up easy to follow wall charts and added a blood sugar section to admission forms. These simple changes saw the number of patients getting the right checks improve from 29% to 71%, which showed an improvement in the trajectory in this area.

Staff used a live tracking system to solve delays in getting medical equipment for patients. They kept a daily spreadsheet for 2 years to track every equipment request and referral, helping them manage the typical 7 to 10 days wait for items like hospital beds. This organised approach allowed staff and families to plan more effectively and helped patients get the tools they needed to stay comfortable much faster.

The hospice used creative ways to raise the large amount of money needed to stay open. The team managed a network of shops and organised public events like the Moonlight Walk, and the Big Wheel Cycle Race. This business approach helped the hospice to remain financially steady, ensuring that end-of-life care was available for the local community.