Derian House Children's Hospice

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

Well-led – 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 outstanding. At this assessment the rating has changed to good.

Good: This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

The service had governance structures in place that were used to improve the performance of the service and ensure the delivery of safe care and treatment. There was a good culture of learning. However, there were differences between staff and leaders that impacted the culture of the service.

This service scored 75 (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 3. The provider had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

The service had a vision to help children and young people, with life limiting conditions, to make happy memories in an environment of fun, respect and above all, high quality care. End of life care could be provided 24 hours a day seven days a week. The services ethos was to make sure that every child and young person that came to Derian was able to make the very most of the time they had there.

Six values were implemented, and a mnemonic was used derived from the name Derian; d: deliver outstanding care; e: engage with everyone; r: respond to change; i: innovative in our approach; a: aim for the highest standards and n: nurture and develop our people.

Staff could reference the vision and values, however they did not always feel engaged when changes were made to the service and how they related to the vision and values.

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.

The registered manager had been in post since 2023 and demonstrated the experience, capacity, capability, and integrity to ensure that the strategy could be delivered and risks to performance addressed. There had been changes to the strategic leadership team and new trustees appointed and the relationship was described as a forming team. Leaders described there were regular communications between the strategic leadership team, but needed more time to formalise agendas and relationships.

Staff and families told us that clinical leaders within the service were approachable and friendly and felt they could approach leaders with any issues. There was a clear leadership structure in place. Staff spoke highly of the clinical leadership team and felt supported by them through supervision and training. Following feedback that the leadership team were not always visible, work was underway at the time of assessment to transform office space in the main building for other senior leaders to work from. Leaders told us this would enable them to be more accessible and visible to staff.

Staff reported they did not always understand the strategic direction of the organisation and decisions were taken to appoint more senior leadership roles that were not always perceived to be needed. There was a bi-monthly ‘we are Derian' staff meeting with the senior leadership team chaired by the Chief Executive. The meeting was described as an opportunity for staff to attend and bring general issues to senior management, to raise any concerns, recommend improvements and to receive updates of plans and activities of the hospice.

We sought the views from stakeholders who worked closely with the service. Some stakeholders felt the strategic aims were not always understood by people working within the service.

3. The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

Staff knew how to raise concerns and the service had a freedom to speak up guardian and whistleblowing policy. There was a designated freedom to speak up guardian however, not all staff was aware of who this was. Staff told us they felt confident reporting issues to the clinical leadership team that would be acted upon.

There was a positive culture about speaking up about patient safety. Staff told us that they felt able to speak up about any concerns relating to patient safety and that these types of concerns would be welcomed. However, staff told us that they did not always feel able to speak up about concerns relating to how the service was run and did not feel that their voices would always be heard.

The service supported the wellbeing of staff with an external employee assistance programme for 24/7 confidential support, wellbeing events and mental health first aiders. All staff had completed training on equality and diversity and the service had equality and diversity embedded in recruitment processes for fair and equal opportunities

3. The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

The service valued diversity in their workforce. Staff worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

Leaders aimed to create an inclusive working environment for staff with disabilities. Staff were encouraged to speak to managers about any reasonable adjustments they needed to improve their working lives. Managers made reasonable adjustments to support disabled staff to carry out their roles well. A member of staff with a disability told us they felt well supported by the management and wider staff team. Reasonable adjustment had been made so they could perform their duties effectively. Staff with childcare or other caring responsibilities told us reasonable adjustments had been made to help them manage their work and home life balance well.

We scored the service as 3. The provider 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 acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate.

The Quality Safety and Improvement Committee held quarterly meetings. A report was prepared prior to the meeting so all the information was available to all attendees at the meeting. The meetings were used to look at the number and type of incidents reported, improvements from learning and ongoing operational risks. The reporting fed into the Board Assurance Framework and was also used provide incident data to external stakeholders.

The risk register was reviewed at quarterly governance meetings. The biggest risks facing the service was recruitment of registered staffing and limited community provision impacting the ability to provide planned respite, symptom management and end of life care.

Leaders had oversight of the outcome of audits so they could ensure any actions required to maintain or improve compliance was completed. Outcomes of audits were generally good with some areas for improvement identified. When areas on non-compliance were identified the actions taken and outcomes were reported on.

The service had processes to identify incidents that would be classed as a serious incident so these could be reported in accordance with legislation.

The service had information governance steering group which meet monthly to ensure they were compliance with information governance requirements.

We scored the service as 3. The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

The service leaders educated care professionals about the hospice's services to increase referrals and to provide support for families at the beginning of their journey at Derian House Children’s Hospice. Regular discussions took place with local hospitals to develop their services and offer more to children and families access to the service.

Staff were members of the Lancashire and South Cumbria Children and Young People Clinical Network and the North-West Palliative care network groups and attended these meetings to share learning and keep up to date with best practice

Following the pilot scheme of using a shared care record system the hospice engaged with other hospices to share working practices to assist other organisations to establish shared record system use for improvement of services.

The service has established relationships with other hospices across the wider region with the aim to provide seamless care for children and young people.

3. The provider 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 contributed to safe, effective practice and research.

The organisation invested in providing training and continuous learning and development opportunities for staff. Training and professional development sessions were delivered by 38 external professional organisations to compliment the internal training provided by the service. For example, Virtual Reality Tracheostomy Training, Symptom Management Train the Trainer, Neonatal Palliative Care, and Peritoneal Dialysis.

Senior clinical leaders were involved in research and development projects with external organisations in the sector to contribute to quality of care and better outcomes for children and young people in the wider communities.