Hospice at Home West Cumbria

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 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.

Leaders and staff had a shared vision and culture based on listening, learning and trust. Leaders were visible, knowledgeable and supportive, helping staff develop in their roles. Staff felt supported to give feedback and were treated equally, free from bullying or harassment. People with protected characteristics felt supported. Staff understood their roles and responsibilities. Managers worked with the local community to deliver the best possible care and were receptive to new ideas. There was a culture of continuous improvement with staff given time and resources to try new ideas.

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 now consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

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.

The evidence showed a good standard. The service 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 provider had a clear statement of purpose, which described the service’s aims and objectives, and services provided.

The service had a clear 3-to-5-year strategy to turn plans into reality. Staff were very much involved in its development and contributed to discussions about the service, especially where it was changing.

In addition, volunteers, service users and other organisations were asked for feedback regarding what they valued in the services and their feedback helped to inform the strategy. The senior leadership team involved staff in development of the vision and values and staff we spoke with knew and understood how they were applied in the work of their team.

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 a clear leadership structure and staff we spoke with knew who to approach for support.

Leaders had the skills, knowledge and experience to perform their roles and had a good understanding of the services they managed. They explained clearly how the teams were working to provide high quality care.

Trustees were appointed from a variety of backgrounds and had received a comprehensive induction with periodic probationary reviews and scheduled performance appraisals. They were clear about their role and provided appropriate challenge in a constructive way. They also provided support with audit activities.

Leaders were visible in the service and approachable for service users, their families, carers and the staff. For example, some we spoke with attended the bereavement café to talk with patients and families and provided emotional support. They shared examples of patient experiences and presented patient stories (with prior permission), at leadership meetings, to maintain strong focus on service users and provision of quality care.

Leadership development opportunities were available, including opportunities for staff. For example, leaders we spoke with described how they engaged with staff for succession planning.

The evidence showed a good standard. The service fostered a positive culture where people felt they could speak up and their voice would be heard.

Patients and carers had opportunities to give feedback on the service they received in a manner that reflected their individual needs. For example, online, and by completing feedback forms.

Patients and staff could meet with members of the provider’s senior leadership team and trustees to give feedback.

The service had an annual staff survey. Feedback was mostly positive, however, leaders explained how they had acted in response to negative feedback. For example, human resources (HR) team now hosted staff forum meetings to encourage staff to engage and talk about improvements and new ideas.

In addition, the service had resourced an external freedom to speak up guardian, who had direct input at board level, participation in HR reviews and completed an annual report. The staff we spoke with told us they worked in a culture where speaking up was encouraged and valued. They knew about the freedom to speak up guardian and how to contact them if needed.

The evidence showed a good standard. The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

Leaders worked to create an inclusive working environment. Staff felt encouraged to speak to managers about any reasonable adjustments they needed to improve their working lives.

The organisation had an annual survey so staff could share their views about working for the organisation.

Leaders encouraged staff to provide positive feedback about each other and to celebrate excellence and kindness.

The evidence showed a good standard. The service 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.

Management of risk, issues and performance was now strengthened. An Assurance and Improvement Manager and Peoples’ Services Coordinator were appointed, ‘’compliance calendars’’ were introduced and embedded and there was a clear framework of what must be discussed at quarterly board, and quarterly governance meetings. This ensured that essential information, such as learning from incidents and complaints, was shared and discussed.

Staff participated in local clinical audits, which were scheduled for the year. The audits were sufficient to provide assurance, and staff acted on the results when needed.

Leaders maintained and had access to strategic and clinical risk registers, and all staff could escalate concerns when required. Staff concerns matched those on the risk registers.

The service had business continuity plans for emergencies – for example, IT failure natural disaster and flu pandemic.

Staff had access to the equipment and information technology needed to do their work. Information governance systems included confidentiality of patient records.

Team managers had access to information to support them with their management role. This included information on the performance of the service, staffing and patient care.

Managers ensured that staff had access to 3-monthly team meetings. Staff also received information via a newsletter, which was sent out 3 times a year. This included information about changes, new starters, and a spotlight focus on different teams.

The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

Leaders engaged proactively with external stakeholders. For example, the Chair of trustees met collaboratively with other regional hospice Chairs every 6 to 8 weeks and the associated Chief Executives met regularly to share information.

Leaders met regularly with the Integrated Care Board (ICB), local NHS services and networked with national hospice organisations through national conferences and webinars.

In addition, they linked with GP’s, district nurses, specialist palliative teams, end of life ward teams at the trust, palliative clinical nurse specialists, health centres, other hospice organisations across Cumbria and the Northeast, local adult social care providers, bereavement nurses, and third sector and voluntary organisations.

The service led the palliative and end of life care partnership group. This was a workstream for the ICB, to develop and deliver the North Cumbria palliative end of life strategy. The strategy was developed in conjunction with health and third sector providers to address the needs of the North Cumbria population. It aimed to deliver a comprehensive approach to care for individuals living with a life-limiting illness. Focused on providing the support needed to manage the diagnosis and development of a palliative illness, it included physical, emotional, spiritual, and psychosocial support for the individual their family and caregivers.

The group recently completed a service directory for North Cumbria, populated the NHS England Ambitions self-assessment framework for the ICB, and developed projects around rapid response and a 24/7 advice line.

The service held joint clinical supervision sessions with colleagues at another Hospice at Home service.

Clinical staff conducted joint visits to patients with community teams and practice nurses.

Patients and staff could meet with members of the provider’s senior leadership team and commissioners to give feedback.

The evidence showed a good standard. The service 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.

The service linked with local universities, and accommodated placements for medical students as part of their training.

Staff were actively encouraged to share ideas for service improvement and given the time and support to develop opportunities for improvements and innovation. For example, as the lymphoedema service was the only specialist service in west Cumbria, to better manage need, they aspired to develop the lymphoedema service as a wider education role, by promoting self-help. Staff kept up to date by completing specialist training and attended national conferences for hospice care and lymphoedema management.

We saw from patient and family feedback how a variety of complementary therapies were used effectively and enhanced patient care.

Innovations took place in the service. For example, the service hosted weekly bereavement cafes in the community for those coping with loss, to meet and find comfort in shared experiences. Associated information signposted people to further help if required.

The service was nominated for Pride of Cumbria Awards 2025 and was a finalist for Charity of the Year.