Pilgrims Hospice Ashford

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

We assessed 7 quality statements on shared direction and culture, capable, compassionate and inclusive leaders, freedom to speak up, workforce equality, diversity and inclusion, governance, management and sustainability, partnerships, communities, and learning, improvement and innovation.

At our last inspection we rated this key question good. At this inspection, the rating is outstanding.

The vision and strategy reflected the needs of people who used the service and wider communities and the challenges for the service. Staff, people and partners were well-informed, supportive and collaborative in achieving the vision, values, and strategic objectives.

Staff and leaders demonstrated a positive, compassionate, listening culture that promoted trust and understanding between them and people who used the service. The culture was focused on learning and improvement and there was mutual trust and respect between leadership and staff.

All staff and people felt psychologically safe and empowered to speak up and raise concerns to help learn and improve. Staff were highly motivated and consistently felt well-supported by leaders.

The service promoted equality, diversity and inclusivity. Equality and diversity and human rights approaches were embedded in everything Pilgrims Hospice did and was understood by all staff.

Governance and management systems enabled leaders to identify information about risks, performance and outcomes.

Staff and leaders worked in partnership with key organisations to support care provision, service development and joined-up care.

An inclusive, positive learning and improvement culture was well-established and was driving improvements in outcomes for people who used services and wider communities. Learning was shared with and sought from partners.

This service scored 89 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

At Pilgrims Hospices, they had a simple vision: “Of a community where people with a life limiting illness and their family and friends were supported and empowered to live well in mind and body until the very last moment of their life”.

The hospice had developed a strategic plan for 2024-2027 “For Every Patient, Every Family, Every Time” Strategy with 4 objectives around financial sustainability, driving excellence and innovation through a dynamic workforce, extending their services and putting patients and families at the heart of all they do.

They have sought to build on the strong foundations of their current strategy, whilst being ambitious in their aspirations to further develop their clinical services and widening access to those that needed their care.

Staff spoke passionately about the service they provided and were proud of the facilities they worked in and the care they could offer to patients. Staff described the culture as positive with good working relationships with different departments within the hospice.

The hospice had a clear shared vision, strategy and culture. The vision, strategy and culture were co-produced with staff, partners and people who used services. The strategy and supporting objectives were stretching and challenging, but realistic and achievable.

The service strategy was aligned to local plans in the wider health and social care economy and planned to meet the needs of the local population, improve care and patient wellbeing, tackle health inequalities and obtain best value for money. Managers and staff worked closely with local hospitals, commissioners and other healthcare partners to support people. Leaders had ensured the reason for the change in strategy was understood by staff and their role in helping them to achieve it.

The strategy was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and an exceptional understanding of the challenges and the needs of people and their communities. In a challenging economy leaders had identified a strategy which promoted excellence in the provision of complex end of life and palliative care which maximised efficiency and minimised duplication with other services.

Equality and diversity and human rights approaches were embedded in everything the organisation did. Staff at all levels had a well-developed understanding of equality, diversity and human rights, and they prioritised safe, high-quality, compassionate care. Staff and managers actively promoted equality and diversity, and identified the causes of any workforce inequality and they took action to address these.

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 service had exceptionally 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 integrity, skills and abilities to run the service. They understood and managed the priorities and issues the service faced. Staff and leaders demonstrated a positive, compassionate, listening culture that promoted trust and understanding between them and focused on learning and improvement.

The hospice’s “Board Walks” and “Coffee and Cake” initiatives with the Chair and Chief Executive Officer, gave trustees and senior leaders an opportunity to meet a wide range of staff and volunteers, to discuss matters raised at Board Sub-Committees and the Board of Trustees’ meeting and see the reality of the day-to-day operations on all their sites. They spoke with staff and volunteers throughout the year, providing accessibility and visibility of the senior leadership team to the wider workforce.

Staff we spoke with told us leaders were approachable and visible and supported staff to develop their skills and take on more senior roles. Staff said they felt supported respected and valued. Staff said they were proud to work for the service and of the high-quality care they provided.

Staff told us the communication systems and team working within the service were robust and effective. A staff member told us “Everyone works well together, it’s one of the few places where you can ask any question to anyone from housekeeping to executives”.

The service had a freedom to speak up guardian who was available should staff want to raise any concerns. Staff were aware of who this was and told us that they felt they could raise concerns without fear of reprisal. The guardian was provided with protected time to support with this role.

Staff had access to the freedom to speak up policy which provided information on how to speak up and what to expect to happen after speaking up.

The hospice provided staff with professional support with independent and appropriately trained counsellors through an advice helpline. This was an entirely confidential service and any discussions through this route was strictly confidential unless staff chose otherwise.

Whistleblowing policies and procedures were in place to enable people to raise concerns or complaints confidently, knowing they would be supported throughout and informed of outcomes and any actions taken.

Openness and honesty were encouraged at all levels within the organisation, leaders and staff understood the importance of being able to raise concerns without fear of retribution. There was a culture of speaking up, leaders supported staff to raise and concerns. Leaders and managers supported people who did raise concerns (including external whistleblowers) without fear of detriment. When people did raise concerns, leaders investigated sensitively and confidentially and took appropriate action on any findings. When something went wrong, people received a sincere and timely apology, and leaders and managers told them about any actions being taken to prevent the same happening again. The service told us that to date, they had not had anyone approach their speak up guardian.

The hospice valued diversity in their workforce and had an inclusive and fair culture where staff felt heard and supported.

The service promoted equality, diversity and inclusivity. All faiths were welcomed and celebrated. There was a recognition that people’s cultural backgrounds and values differ from one person to the next and that different cultures and values needed to be respected to provide a home from home service for people from all backgrounds and walks of life.

Training in equality and diversity was provided to all staff members and volunteers as part of the mandatory training syllabus. There were policies and processes to ensure the service was inclusive and fair. These included directions to ensure all staff and patients were treated equally regardless of age, gender, ethnicity, sexuality and religious beliefs.

Dignity at work procedures and equal opportunities protocol were in place to uphold the principles of equality and to assist in the avoidance of unlawful discrimination in activities such as recruitment and selection, promotion, transfer, training opportunities, pay and benefits, discipline, redundancy and dismissal.

The hospice made reasonable adjustments to accommodate and support staff in their work where possible. Staff could contact the occupational health via their line manager for added support.

We looked at minutes of an absence review meeting and a welfare meeting and saw that staff had been offered additional support and reasonable adjustments to help them.

There were mostly clear and effective structures, processes and systems of accountability to support the delivery of the service. However, improvements were required in the oversight and governance arrangements for safe and effective medicine management. The service had a meeting structure in place which gave senior leaders and managers regular opportunities to discuss operational issues and performance.

The hospice held quarterly clinical governance meetings to drive continuous improvement for the benefit of people who use the service and staff.

The Clinical Quality and Governance Committee received and received a data dashboard which included data and audit findings for all services provided by Pilgrims Hospice Ashford. This meant there was oversight of performance and risk across all services. In addition, data and audits were reviewed at the Nursing and Care leadership meeting. We noted that hospice at home staff did not support medicines administration in the community.

However, we found that not all governance processes were effective. For example, we identified a few areas in medicines management where processes were not being followed correctly but the provider responded immediately ensuring they were actioned; staff were informed and polices were revised.

Leaders used effective governance processes to monitor risks and outcomes, and to drive improvement. Leaders took a proportionate approach to managing risk that allowed them to assess new and innovative ideas. We looked at the risk register for the hospice which reflected risks in all services provided by the hospice. We saw that the risk register set out key risks as well as actions, mitigations, and environments, workforce and financial strategies. We saw that it was up to date and reviewed on a monthly basis at the Nursing and Care Strategic meetings and reported to Quality and Governance on a quarterly basis.

One of the highest risks was the inability to provide Specialist Palliative Care assessment and advice at Consultant level to patients in the community and inpatient units. We saw that 1 of the steps taken to mitigate the risk was expansion of senior clinical workforce to a multidisciplinary leadership team, in line with clinical hospice strategy (partially achieved 2024/2025).

The governance system monitored the quality of care provided, patient feedback, staff performance and changes to best practice guidance. Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service. Leaders undertook a range of reviews and audits to monitor performance. Leaders and managers discussed the results of audits at governance meetings, which they also shared with the board and appropriate staff for learning.

Key reports kept leaders informed of challenges faced with short, medium and long-term plans identified.

Leaders shared updates and learning with staff through a range of communications. Policies and procedures reflected this and leaders benchmarked the hospice’s performance against other services to measure outcomes of care and treatment.

Managers and staff consistently submitted data and notifications to external organisations as required.

The strategy included providing a quality service whilst ensuring sustainability of the hospice against increasing costs, minimal NHS funding and being reliance on charitable donations and fundraising. As part of the strategy leaders had reviewed services the hospice provided, and services provided by other services. The new strategy aimed to support high quality end of life care whilst avoiding duplication. The new strategy focused on care for people who had complex end of life care needs and to secure its long-term future.

The management team consistently operated systems to ensure they shared information with external organisations effectively, in a timely way, for example, accidents and incidents were reported to the relevant authorities, including the CQC.

Managers were able to carry out quality improvement projects, and audits to improve communications and avoid hospital admissions.

The hospice published their annual quality account on their website, and this set out the priorities for the service which were focused on patient safety, patient experience and clinical effectiveness.

There were procedures to safely manage sensitive data which allowed them to maintain people’s privacy, dignity and confidentiality. Governance meeting minutes reviewed showed staff from different areas of the service attended and were involved in discussion about the service and how improvements could be made.

In addition, Pilgrims Hospice had ‘green’ initiatives which provided additional support to its sustainability. Green initiatives included: updating the building for better energy efficiency, and the use of recycling bins throughout the hospice as well as the hospice shops which sold used clothing in its shops.

Staff and leaders were open and transparent, and they collaborated with all relevant external stakeholders. The hospice worked in partnership with others to build seamless experiences for people based on good practice and their informed preferences. The hospice had a focus on delivering care in a way that supported people’s care pathways.

The hospice collaborated and worked in partnership with external partners to support people’s health and wellbeing. They shared information and learning with partners to improve the service.

The hospice worked with local care providers, GPs, district nurses, Macmillan nurses, specialist nurses and other health and social care professionals to coordinate and provide the best possible care.

Through the Living Well Centre, the hospice engaged and supported people in the community who were living with a life-limiting and progressive illness. The centre hosted and organised classes and activities and encouraged patients and their families’ members to take part in fundraising events within the local area.

The Stepping Stones Bereavement Service had expanded with the development of 3 walking groups, 1 in each locality. The demand for this service continued to grow and a co-ordinator post was recruited to support the recruitment and management of additional expert volunteers. Further expansion of this service was planned to support more bereaved people across east Kent. In addition, a new initiative of retail volunteers manning bereavement help points in Pilgrims shops was planned for 2024-25.

This year 2025, had marked a milestone for the Pilgrims Hospices Cycle Challenge, as they were incredibly proud to celebrate their 15th Anniversary year. Since 2010 £1,419,809 had been raised to fund the skilled and compassionate care that Pilgrims Hospices provided to thousands of patients and their loved ones each year.

Leaders, managers and staff strove for excellence through collaboration and shared practice. The hospice had a track-record of being an excellent role model for others. For example, the Business Intelligence Lead, was awarded Digital Champion of the Year at the Hospice UK Awards 2024, recognising his innovative contributions to data and digital transformation. They had been asked to present at Hospice UK event and Kent and Medway End of Life and Palliative care meeting.

The Medical Director, set up the East Kent “The need to do something” group with leaders from across Health and Social Care and produced a local End of Life Charter.

Pilgrims Hospice regularly contributed to the Hospice UK National Conference, with staff presenting posters and participating in plenary sessions. Posters were displayed across hospice sites post-conference to share learning internally and celebrate achievements.

Leaders invested in developing diverse networks at local, national and international level. Partnerships supported leaders to identify innovative ways of working and priorities. Effective and creative changes were made in response to better meet the needs of local people.

Pilgrims Hospice Clinical and Education Collaboratives had set up two formal collaboratives across Kent and Medway. The Kent and Medway (KM) Hospice Education Collaborative has representatives from all hospices across the regions to jointly review education, both internally and externally. They liaised with the Integrated Care Board (ICB) and Health Education England to bid for funding to provide End of Life care education to local Health and Social Care providers.

The Kent and Medway Nursing and Care Directors Collaborative had representatives from all hospices across the region. This forum allowed for peer support, sharing of good practice and joint working alongside a robust voice of hospice care across Kent and Medway. Pilgrims’ Director of Nursing and Care was the current chair.

“The Need To Do Something” group had been established by the clinical leads at the hospice to identify areas of collaboration to improve end of life care pathways across east Kent, in line with the “Nine Principles of Sustainability”, which underpinned many elements of Kent and Medway ICB Palliative and End of Life Strategy. Following an initial task and finish approach, this group will then focus on mutual education and shared experiences, potentially through quarterly sessions.

There was an established, significant and sustained culture of continuous and creative learning, innovation and improvement based on evidence and local need. This delivered improved outcomes, equality of access, experience and quality of life for people.

Staff learnt from incidents. Clinical staff attended regular clinical forums where they had in depth discussions about what went wrong and what could have been done differently. They held round table meetings to discuss and learn from patient safety events. Information from these meetings was cascaded to all staff. For example, we looked at the Clinical Quality Quarterly Report 2024/2025 and noted in particular the learning from a patient safety events involving a member of temporary workforce which prompted a review of patient safety events involving temporary staff and led to the following change. The recommendation had been to not allow temporary staff who were new to the hospice to single check high risk drugs. The hospice have also rewritten and are in the process of re-embedding the induction list, allowing temporary workforce to be signed off by a member of the nursing team once they are assured they are safe to do so.

Pilgrims Hospice, its leaders and staff had a clear focus on quality of life for patients. We saw examples where collaborations with NHS and other providers worked to improve patient outcomes. This included work to identify peoples wishes, support for people with autism and bereavement and use of acute services in the last 3 months of life.

For example, Pilgrims Hospice had a programme “THINK TALK ACT” that helped to identify people at risk of being in their last year of life. The service ran THINK sessions to help people proactively plan for the future and explained things like Lasting Power of Attorney, living wills and do not resuscitate orders. The service also assessed these patients to see if they had any needs that could be addressed without therapy centre programmes. The aim was to identify patients earlier, support them and avoid admission to hospital, where appropriate. Pilgrims hospice worked with GPs and the integrated neighbourhood teams with this project and told us that they had excellent feedback.

Leaders and staff proactively fostered a wide range of external networks, by participating in research and embedding evidenced based practice. They used these to identify and share improvements and innovations. As part of this collaboration leaders had shared expertise and provided education and training opportunities for staff working for Pilgrims Hospice and other staff working in other organisations. These relationships had improved palliative and end of life care not just within the service but also locally and nationally.

The hospice was part of the quality improvement programme which involved setting up a Clinically-Assisted Hydration in patients in the last Days of Life CHELsea II trial, a palliative care study, linking with those hospices of similar size and learning from each other what processes, systems, equipment and how they managed hydration in the last days of life.

The aim of the CHELsea II trial was to assess whether giving patients in the last days of life fluids via a drip (“clinically-assisted hydration”, CAH) was effective at preventing them from developing delirium (“terminal agitation”). In terms of timelines, they expect the results of the trial to be available in September 2025. The results would be published in open access journals.

The National Institute for Health Research (NIHR) 2021 NIHR and Charities Consortium Hospice and Community Research "Hospice UK Award" (highly commended) was awarded to the group of hospices which had made significant progress in becoming research active through contributing to NIHR Portfolio Studies.

There was an established, significant and sustained culture of continuous and creative learning, innovation and improvement based on evidence and local need. This delivered improved outcomes, equality of access, experience and quality of life for people.