The Prince of Wales Hospice

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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.

We looked for evidence that there was an inclusive and positive culture of continuous learning and improvement that was based on meeting the needs of people who used services and wider communities. We checked that leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred and sustainable, and to reduce inequalities.

At our last assessment we rated this key question requires improvement. 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.

This service scored 79 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The hospice had a clear, positive and compassionate culture that supported both patients and staff. Staff told us they felt respected, valued and supported in their roles. They described leaders as approachable, visible and committed to providing high‑quality, person‑centred care. Staff across all roles remained focused on meeting the needs of patients and those close to them.

There was an open and inclusive culture where staff, patients and families felt able to raise concerns or share feedback without fear. Patients and relatives spoke positively about staff attitudes and felt listened to when they raised questions or concerns. Staff said they felt confident to speak up about safety or wellbeing and knew how concerns would be handled.

Relationships between staff of all grades and disciplines were positive. We observed strong teamwork, mutual respect and collaboration across clinical and non‑clinical roles. Staff appeared cheerful, supportive of one another and engaged warmly with patients.

The organisation had a clear set of values and expected behaviours, which staff understood and demonstrated in practice.

Leaders told us that its current strategy covered the period 2023–2026. In preparation for the end of this period, work was underway to develop a new strategy for 2026 and beyond.

At the time of our visit, the hospice was finalising a more detailed strategy booklet and a supporting business plan. These documents were in development and scheduled to be presented to the board for approval in June 2026.

Leaders described a structured and inclusive approach to strategy development. This included a joint strategy event involving a local hospice, Integrated Care Board representatives, Place representatives and the Specialist Palliative Care Team from the local NHS Teaching Trust. This was followed by a programme of focus groups with hospice employees and volunteers, and a dedicated board strategy day.

Leaders told us that the developing strategy had been subject to ongoing scrutiny and assurance through board sub-committees and the full board. The overall strategic framework has been agreed and signed off by the board.

The hospice was well led by leaders who were highly skilled, experienced and deeply committed to delivering compassionate, high-quality care. Leadership was values driven and consistently focused on putting people first, creating a positive culture across the organisation.

The hospice operated an innovative and effective collaborative leadership model rather than a single Chief Executive Officer. Five directors worked together as a shared Chief Executive Office, with clear collective responsibility and authority. Leaders were able to clearly explain how accountability was maintained and how decisions were made jointly and transparently.

Leaders told us this model enabled them to work across a wider range of partnerships and system forums, describing how it allowed them to “get round more tables” and strengthen the hospice’s influence and impact. They explained that the approach improved leadership coverage and resilience, made best use of each director’s specialist expertise, and provided flexibility while maintaining clear lines of responsibility.

We spoke with members of the Board of Trustees, who expressed high levels of confidence in the leadership arrangements. Trustees told us they had no concerns about the model and said it was providing strong, effective leadership and strategic direction. They described open, constructive relationships with senior leaders and felt well sighted on performance, risk and future priorities.

There were robust systems in place to support leadership development and succession planning. Staff at all levels were encouraged to develop their skills and take on additional responsibilities. Leaders actively supported progression through structured training, mentoring and development opportunities, which helped build confidence, capability and future leadership capacity within the service.

Leaders demonstrated a strong understanding of the challenges facing the hospice, including workforce pressures, financial sustainability and increasing demand for services. They were able to clearly describe how risks were identified and managed, how priorities were set, and how the hospice responded proactively to emerging issues to maintain safe, effective care.

Leadership teams were highly visible, approachable and compassionate. Staff consistently told us they saw senior leaders regularly and felt confident approaching them to raise concerns or share ideas. Leaders engaged with staff through walk rounds, meetings and informal conversations, and staff felt listened to, valued and supported.

The hospice promoted an open, transparent and supportive culture where staff at all levels felt able to speak up. Staff told us they felt confident to be honest when things went wrong and were encouraged to raise concerns, share ideas and reflect on practice. This applied across all staff groups, including clinical, support and non‑clinical staff.

Staff described a just culture where concerns were treated fairly, with a focus on learning and improvement rather than blame. Leaders reinforced this culture through their actions and behaviours and made clear that speaking up was welcomed and valued.

There were clear mechanisms for staff to raise concerns, including line management, senior leaders and Freedom to Speak Up arrangements. Staff told us they knew how to raise concerns and felt assured they would be listened to and treated seriously.

Senior leaders and trustees-maintained visibility within the hospice. Regular visits and engagement with staff provided opportunities for people to raise concerns directly. These visits were recorded and informed improvement actions where needed.

When things went wrong, staff described a culture of openness and accountability. Apologies were offered and people were informed about actions taken to prevent reoccurrence. This applied to both concerns raised by staff and complaints raised by patients and families.

Staff had a clear understanding of the complaints process, appropriate to their role. Managers shared learning from complaints through meetings, updates and supervision, and this was used to improve practice.

The provider was part of the Disability Confident Employer scheme. This aimed to improve inclusive recruitment practices and ensure work environments were accessible. Leaders gave examples of how interview processes were adapted to support individual needs, including offering alternative interview panels or techniques for people who may be neurodiverse.

The hospice had changed its recruitment approach by advertising roles through a range of job boards rather than relying on its own adverts. Leaders felt this approach was wider‑reaching and supported greater inclusivity. They acknowledged that some communities may be discouraged from applying for roles due to fear or misunderstanding associated with the word ‘hospice’. Work was ongoing to break down these barriers through increased community engagement and outreach.

The hospice hosted a Community of Practice meeting, bringing together a range of organisations focused on supporting LGBTQ+ people within the workforce. This demonstrated a proactive approach to shared learning and supporting inclusive workplace cultures. We heard that the hospice was part of an initiative to demonstrate its commitment to inclusion and support for LGBT+ staff, patients and visitors.

We also heard from staff that Pride celebrations had taken place within the hospice, involving staff alongside patients and members of the wider community.

There was a governance structure from ward level through to senior leadership and the board. Quality and risk information was reported through these structures providing the board with assurance about service performance.

There were systems overseeing infection prevention and control, medicines management, equipment safety and incident reporting. Safety risks relating to estates, equipment, water quality, fire safety and medical devices were monitored through established governance processes.

Incidents were reviewed proportionately, learning was identified, and actions were taken to reduce recurrence. There was shared learning across teams, and staff told us they felt involved in and supported following safety reviews.

Leaders were aware of trends and areas requiring improvement. We saw evidence of incident themes being discussed at the clinical governance operations group. Safety alerts, external recommendations and changes to national guidance were reviewed and acted upon. Leaders could describe how learning was shared internally and with system partners where appropriate.

The hospice had performance governance arrangements. Data from audits, national datasets, patient feedback, workforce metrics and local performance indicators was reviewed regularly and used to inform service improvement.

Information systems were secure and supported good governance. Staff completed information governance training (100% staff training compliance) and understood their responsibilities around confidentiality.

The risk register reflected known risks across the service, including staffing, funding and clinical processes. Risks were reviewed regularly, with mitigations, ownership and trend analysis, although we were unable to see clear review dates.

The hospice worked in partnership with a wide range of external organisations to improve care, experience and outcomes for patients and those close to them. Leaders and staff understood that strong collaboration across the system was essential to delivering high‑quality, coordinated end‑of‑life care.

Service leaders engaged regularly with the Integrated Care Board, local authorities, neighbouring NHS trusts and adult social care providers. These relationships supported service planning, demand management and joint problem solving, particularly around access, discharge planning and community support.

Leaders from local community services described positive and effective partnership working with the hospice. They discussed how clear referral pathways could support timely access to specialist advice, including symptom management and psychosocial support. We were told multidisciplinary working between community teams, hospice clinicians and primary care enabled shared care planning, anticipatory decision‑making and continuity of care.

They said collaborative working supported early identification of deterioration and timely intervention, helping to reduce avoidable harm and unplanned hospital admissions. Hospice staff were described as open, friendly and receptive to working in partnership.

A nurse consultant from a local NHS trust provided highly positive feedback about the lymphoedema service at the hospice. They described the team as consistently professional and a pleasure to work with. The team were said to demonstrate a high level of clinical knowledge and expertise, which was reflected in the quality of care provided to the patients. Their approach was described as collaborative and clearly patient‑centred.

We heard how staff running the lymphoedema service at the hospice worked closely with the hospital‑based service and primary care colleagues to streamline pathways. We were told this integrated working supported patients to access the right care, at the right time, and in the most appropriate setting.

The hospice demonstrated efforts to engage with groups who may experience barriers to accessing hospice care. This included working with community organisations to raise awareness and improve access for people from disadvantaged or seldom‑heard groups. For example, we heard that the hospice worked closely with a local Alzheimer’s team, specialist dementia nurses, a local action group supporting people living with dementia and their carers, and people with lived experience of caring for someone with dementia. This partnership working informed service development and led to the creation of a group which aimed to discuss issues experienced by careers and explore possible solutions. This work had led to local and national award nominations.

The hospice promoted a culture of learning, reflection and continuous improvement. Leaders encouraged curiosity and openness, and staff described a shared commitment to continually improving the quality of care and experience for patients and families.

Staff had access to training and support to develop quality improvement (QI) skills and an understanding of improvement methods. Leaders could describe completed and ongoing QI projects that had led to improvements in care, safety and patient experience. Staff were encouraged to take part in improvement work and felt their contributions were valued.

Patients, families and carers were involved where appropriate in shaping and evaluating improvement initiatives. Feedback and patient stories were used to influence service development, helping to ensure improvements reflected what mattered most to people using the service.

Staff described regular learning at team meetings, reflective discussions and through supervision and appraisal. There were opportunities for continuing professional development, including specialist training, postgraduate study and leadership development.

The hospice demonstrated learning from when things went wrong. Incidents, complaints, deaths and external reviews were reviewed, and learning was identified and shared.

Staff could describe examples of excellence in everyday care, showing pride in noticing and responding to small details that made a difference to patients’ comfort and dignity.

Leaders took part in professional networks, audits and quality improvement programmes. For example, they led the End-of-Life Care Board Education and Training Group, which supported shared learning and improvements in practice across services.

The service shared learning with other hospices and partners to promote consistency and best practice across the system. Where appropriate, the hospice collaborated with academic or professional organisations to support evidence‑based practice and innovation.