St Richard'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

We rated well-led as outstanding. We assessed all 7 quality statements for well led: 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.

The service vision and strategy reflected the needs of patients who used the service, wider communities, and challenges the service faced. Staff, patients and partners were well-informed, supported 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 patients 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 patients 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 St Richard's 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 patients who used services and wider communities. Learning was shared with and sought from partners.

At our last inspection we rated this key question good. At this inspection, the rating improved and was outstanding.

This service scored 93 (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 shared vision, strategy and culture. The vision, strategy and culture were co-produced with staff, partners and patients who used services. The strategy and supporting objectives were stretching and challenging, but realistic and achievable.

The hospice 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 patients 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. Staff and managers actively promoted equality and diversity, and identified the causes of any workforce inequality and they took action to address these.

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 patients. Leaders had ensured the reason for the change in strategy was understood by staff and their role in helping them to achieve it.

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 skills, knowledge, experience and credibility to lead effectively. They always did so with integrity, openness and honesty. Staff and leaders demonstrated a positive, compassionate, listening culture that promoted trust and understanding between them and focused on learning and improvement.

The volunteer coordinator facilitated the Volunteer forum, which consisted of a group of managers who had volunteers in their departments. The purpose of this group was peer support, share best practise and identify and share new ideas.

Staff said they felt supported respected and valued. Staff said they were proud to work for the service and the high-quality care they provided. Several staff said it was a privilege to work for the service and provide support to patients and their loved ones.

There was strong collaboration, team-working and support and a common focus on improving the quality and sustainability of care and patients’ experiences. The culture of the service centred on the needs and experience of the patients who used services. Staff were passionate about delivering high quality care and treatment for patients requiring it as well as their loved ones.

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 patients who did raise concerns (including external whistleblowers) without fear of detriment. When patients 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.

To support staff to ‘speak up’ St Richard's Hospice had 2 freedom to speak up guardians who worked to ensure the organisation was an open, transparent and inclusive workplace. Processes were in place which guaranteed confidentiality for anyone wishing to contact the freedom to speak up guardians. All staff we spoke with were confident they would be listened to. Staff gave us examples of how leaders listened to their suggestions about changes to the service. The 2024 staff survey identified 96% of staff were aware of the Freedom to Speak up Guardians and were aware of the Whistle blowing policy.

The service promoted equality, diversity and inclusivity. All faiths were welcomed and celebrated. There was a recognition that staff’s cultural backgrounds and values differed and were respected to provide a diverse and inclusive workforce.

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 in place to ensure the appointment and employment of staff was inclusive and fair. These included directions to ensure all staff were treated equally regardless of age, gender, ethnicity, sexuality and religious beliefs.

Staff and managers actively promoted equality and diversity, and identified the causes of any workforce inequality and they took action to address these. Managers provided support for neurodivergent staff. Meetings were held with individual staff to identify their needs and required adjustments were implemented. Five staff members had received support in 2025.

Staff told us they were supported personally and professionally. They raised no concerns about equality and diversity being supported and described a culture where discrimination would be challenged.

There were clear and effective structures, processes and systems of accountability to support the delivery of the service. The service had a meeting structure in place which gave senior leaders and managers regular opportunities to discuss operational issues and performance.

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.

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. The risk register for the hospice set out key risks as well as actions, mitigations, and environments, workforce and financial strategies. 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 hospice care against increasing costs, minimal NHS funding and being reliant 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 patients who had complex end of life care needs and to secure its long term future.

In addition, St Richard's Hospice had ‘green’ initiatives which provided additional support to its sustainability. Green initiatives included: updating the building for better energy efficiency, the installation of solar panels to deliver their electricity 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 patients based on good practice and their informed preferences. The hospice had a focus on delivering care in a way that supported patients’ care pathways.

All feedback we received from external stakeholders positively identified the commitment St Richard’s Hospice had to ensure timely access to provide high quality and timely end of life and palliative care. Stakeholders told us there was usually a timely transfer of patients depending on bed availability which included the direct transfer of patients from the Accident and Emergency to avoid an unwanted/unnecessary acute hospital admission.

Stakeholders identified the transparency of St Richard’s hospice around changes to ensure its ongoing sustainability.

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.

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

St Richard’s Hospice proactively provided information for carers which included the Carers Network. Information within the hospice publicised events and resources. sessions as patients. Fatigue, relaxation sleep, breathlessness and pain including an introduction to exercise and advance care planning.

The service planned and provided innovative approaches to care, providing integrated person-centred pathways of care that involved other service providers, particularly for patients with multiple and complex needs. Managers planned and organised services, so they met the changing needs of the local population. The organisation provided holistic care, and its services reflected the needs of the population it served. They had achieved this through community engagement; patient experience feedback and individualised care planning. Induction and mandatory training taught staff how to engage patients in conversations about characteristics and to consult closely with other key professional teams e.g. social services and community health care to ensure patients accessed the right help and support at the right time. St Richard’s Hospice staff attended clinical and nonclinical groups in Worcestershire and regionally to review end of life and palliative care. St Richard’s staff took an active part in the Annual Hospice UK conference sharing areas of innovation and work they had received awards for.

Staff and leaders engaged with patients, communities and partners to share learning with each other that resulted in continuous improvements to the service.

They used these networks to identify new or innovative ideas that led to better outcomes for patients.

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, equity of access, experience and quality of life for patients.

Staff learnt from incidents. Clinical staff attended regular clinical meetings 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 serious incidents. Information from these meetings was cascaded to all staff.

During a period of facilities work, the service had a virtual ward whereby patients could receive the same care and treatment in other settings such as at home. Information collected from this pilot was used to develop and redesign community nursing services.

St Richard's 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 patients’ wishes, support for autistic people and bereavement and use of acute services in the last 3 months of life.

Leaders and staff proactively fostered a wide range of external networks, including participating in research and embedding evidenced based care. 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 St Richard's Hospice and other staff working in other organisations. These relationships had improved palliative and end of life care not only within the service but also locally and nationally. Notifiable initiatives included: St Richard's Hospice piloting and then being one of the first hospices to implement the new “My Wishes Advance Statement;” evaluation of an audit “use of acute services in the last three months of life.” Several initiatives had been shared regionally, nationally and internationally. Methods of sharing had included published research articles, presentations at conferences, attendance at meetings and organised visits to the hospice. This had led to awards for the hospice and its staff.

The hospice worked with local schools painting animals which were then displayed as part of a trail walk throughout the city for the community to take part in. There were various fundraising events including initiatives to raise awareness of hospice care in the community.