The Shakespeare 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 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.

The vision, strategy and culture were co-produced with staff, partners and people who used services. It closely reflected the challenges and met the needs of people who used the service and wider communities. All staff and people felt psychologically safe to speak up and raise concerns to help learn and improve. Staff were highly motivated and felt well-supported by leaders. All staff felt treated equally. Staff and leaders monitored and anticipated current and future risks to delivering the strategy, including relevant local factors.

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 service had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding the challenges and needs of people and the community in order to meet these.

Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff and volunteers described the culture they worked in as warm, open, and like being part of a family.

The culture of the service was person-centred. It was inclusive and empowering. Leaders, managers and staff had a well-developed understanding of equality, diversity and human rights, and they prioritised safe, high-quality, compassionate care. The service had a clear person-centred vision for the care they wanted to offer and a strategy to achieve it. The vision was for everyone in the community affected by a life limiting illness or bereavement to be able to access compassionate care and the support they needed. There were shared values that underpinned the vision. These were ‘compassionate’, ‘accessible’, ‘respectful’, and ‘effective care’. The strategy to achieve the vision was focused on providing high standards of care and extending the reach of the hospice in the community, to ensure isolated groups such as carers and cancer survivors were provided with the care and support they needed.

Leaders said they used a ground up approach to ensure all staff were involved in developing the vision for the service and the strategy for achieving it. Staff told us they helped develop the vision and strategy and felt truly invested in it. Staff were proud of the service and wanted to deliver the best possible care for people living with life limiting and terminal conditions and their relatives and carers.

Staff told us they were currently in year 3 of a 5-year strategy. The strategy included building strength and resilience within the workforce and enhancing the current core service provision. The end plan was focussed on extending the reach of the hospice into the community to ensure everybody that needed hospice at home care could receive it.

The provider collected feedback from staff about their views on the services offered to improve their experience of working at the service. Senior leaders made changes to the service when staff fed back about things they were unhappy with. For example, when staff said they did not know who the board of trustees were, leaders invited trustees to attend all staff video calls. This meant staff had the chance to see trustees and ask them questions about the future of the service.

We saw posters displaying the vision for the service displayed in staff and patient areas.

The service had inclusive leaders who understood the context in which care, treatment and support was being delivered and they embodied the culture and values of their workforce and organisation.

Leaders had the skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff. They supported staff to develop their skills and take on more senior roles.

Staff told us leaders were visible and available. They led by example, modelling inclusive behaviours, and open and cooperative relationships. Staff told us leaders stepped in to cover sickness if required.

To improve their leadership skills managers had access to an NHS leadership development programme.

There was a registered manager with the required recruitment checks in place. They understood their responsibilities and were supported by the trustees and other managers to deliver good, effective, high-quality care.

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

Staff felt the culture within the service supported them to speak up and report any issues or concerns to their managers. Staff were encouraged to raise concerns and promoted the value of doing so. Staff told us they would feel confident to escalate matters if they felt their concerns were not being responded to.

Staff and leaders actively promoted staff empowerment to drive improvement.

The service had a freedom to speak up guardian. However, staff unanimously told us they did not have any fear of retribution for speaking up and they could talk about whatever was on their mind to any member of staff, the senior leadership team, or chief executive.

In the 12 months before the inspection 2 members of staff had raised concerns with the Freedom to Speak Up Guardian. Both issues had a positive resolution.

Leaders and staff valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for all staff.

The service promoted equality, diversity and inclusivity. All faiths were welcomed and celebrated. There was a recognition that people’s cultural backgrounds and values differed from one person to the next, and that different cultures and values needed to be respected to provide support tailored to individual and families to incorporate their values, traditions and beliefs.

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. They also contained information on how to promote inclusivity within the service. For example, asking patients their preferred name and using this throughout their appointment ensured transgender people, and others, had their human rights respected and their personal choices accepted.

Staff displayed information about death, dying, and spirituality in their offices so they could quickly reference specific rituals, beliefs, and preferences for patients from various religious and spiritual backgrounds. Staff understood that knowledge about different spiritual and religious practices was essential for ensuring a death that aligned with the patient's and their family’s cultural and spiritual values. A member of the team attended a local faith forum to network with faith leaders and help equip staff with a deeper understanding of religious spiritual preferences.

There was a large airy room called the ‘sanctuary’ that could be used by people wanting a quite space or somewhere they could pray or reflect. There was a display unit that held religious items from many faiths that people could choose to use.

The service had clear lines of responsibilities, roles, systems of accountability and good governance. These were used to manage and deliver good quality, sustainable care, treatment and support. Leaders and staff acted on the best information about risk, performance and outcomes, they shared this information securely with others when appropriate.

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

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 and teams used systems to manage performance effectively. They identified and escalated relevant risks and issues and identified actions to reduce their impact. Staff contributed to decision-making to help avoid financial pressures compromising the quality of care.

That was a structured process for policy management. Each month a different policy was chosen to be the ‘policy of the month’. The policy of the month was reviewed at team meetings to improve compliance and understanding. There was a process for policies to be regularly reviewed and to be revised when national guidance changed. Policies were easy for staff to locate on the providers intranet.

The provider used safer staffing processes to recruit staff. We saw evidence that all staff, including volunteers, had an up-to-date Disclosure and Barring Service (DBS) checks, evidence of qualifications where relevant, references to support their last three years of employment (good character references for volunteers), and a full employment history.

There were systems to manage current and future performance and risks to the quality of the service. Each committee had its own risk register which was regularly reviewed and updated. Each risk register fed into a central risk register which had oversight by the board of trustees. Staff we spoke with were aware of the main risks facing the service.

A sustainability review was underway at the time of our inspection to identify if the business and technology functions of the service were adequate. A service review was also underway as the cost of the service had increased and leaders needed to ensure patient safety was being maintained while additional funding was being negotiated.

The electronic patient record (EPR) could be used to audit the care staff provided to patients.

Leaders and staff understood their duty to collaborate and work in partnership, so the service worked seamlessly for people. They shared information and learning with partners and collaborated with them for improvement.

The service worked with the wider health system to relieve pressure on acute trusts. Referrals for patients being discharged home to die were picked up as soon as they were made, and every effort was made to ensure these patients were seen on their day of discharge from hospital. As the ‘single point of access’ (SPOA) the team would work with their end of life network to ensure home visits were made even if this was by other providers.

Nursing and therapy staff worked in partnership with other organisations to improve outcomes for people in the local area. For example, they worked collaboratively with other agencies to provide specialist support for people with motor neuron disease (MND). The other agencies included, for example, staff from another local hospice, a specialist MND nurse from a local NHS trust, speech and language specialists, podiatrists, and dieticians.

The service was embedded in the community it served and was considered a valued partner by others in the community. Fundraising staff organised community events to raise the profile of the hospice as well as to raise funds to keep the hospice open. Businesses and local people from the local community regularly took part in fundraising events or made donations to provide financial support to ensure the hospice could continue to provide care to local people and their relatives and carers.

An element of the 5-year strategy was to extend the reach of the service. Leaders were aware they received far fewer referrals from some GPs than others. They were working on a plan to engage with these GP’s and social prescribers. They aimed to offer targeted education to raise the profile of the service and thus increase their reach into the community.

The 5-year strategy also included building a dementia strategy so that people who were underserved in palliative and end of life care had improved access to the service. The service had identified that people with dementia and their carers did not have equitable access to end of life care. To ensure the service could improve access they had plans to develop their workforce by providing training and education, so staff had the knowledge and skills to safely care for people with dementia. The dementia strategy also involved leaders working with other health care providers to consider how they could work collaboratively to ensure a fair and equal distribution of access to services.

Staff and leaders engaged with partners to share learning with each other so they could make continuous improvements to the service. They also used their network with local and national organisations working in end of life care to identify new or innovative ideas that could lead to better outcomes for people.

The service had a focus on continuous learning, innovation and improvement across the organisation and the within the local system. Leaders encouraged staff to develop creative ways of delivering equality of experiences, outcomes and quality of life for people.

The service held a regular Motor Neurone Disease (MND) clinic. The clinic included professionals from different providers and different clinical areas who came together to deliver the clinic. The other providers included specialist nurses from local acute NHS trusts, internal therapy staff as well as therapy staff from another hospice, a respiratory consultant from an acute trust, and an MND representative. Plans for the clinic in 2026 included using the hospice as a ‘one stop shop’ for patients, instead of them traveling to lots of different places for their appointments. Furthermore, they planned for staff to visit a regional MND specialist centre to look at ways of enhancing the service offered to patients with MND and their relatives.

There were processes to ensure that learning happened when things went wrong and from examples of good practice. Staff told us they felt confident to own any mistakes knowing they would receive support, and that learning would be taken from it. Leaders encouraged reflection and collective problem-solving which extended to the wider end of life network.

All staff were committed to continually learning and improving services. Staff attended local and national events for professionals working in end-of-life care including conferences.

Staff attended a monthly colleague forum which could be used to raise suggestions for improvement in ways of working. These suggestions would be taken to the senior manager for quality improvement and on to the clinical governance committee for their approval. Complaints and incidents were also used to look at how learning from them could be used to improve the service. Plan-Do-Study-Act (PDSA) cycles were used to test the efficacy of any changes implemented, through planning what the change would look like, trying it out, studying the results, and acting on what was learned.

Managers and leaders genuinely welcomed feedback, even if it was critical, and could demonstrate what action had been taken in response. They did this by ensuring patients, their relatives and carers were given opportunities to feedback on care at regular intervals throughout their treatment journey. They also ensured staff had regular opportunities to provide feedback on what it was like to work for the service and become involved in developing and evaluating improvement and innovation initiatives.

All staff were committed to continually learning and improving services. Leaders encouraged innovation and participation in research. For example, staff contributed to research conducted by local universities and acute NHS Trusts. In the 12 months before our inspection, staff had participated in research about ‘family carers administration of injectable end-of-life symptom management medications’, and ‘Implementing national ambitions for end-of-life care in South Warwickshire: identifying enablers, barriers and opportunities for service improvement’.

Senior leaders conducted a service review in 2024 and 2025. They used the experience of staff and patients and their relatives to review what effective care looks like, efficiency of processes, and what patients want from the hospice. The review resulted in the creation of different pathways including for hospice at home care. booklet was developed for staff to easily review patient needs to ensure they were having the appropriate support at the right time and in the right place. The electronic patient record (EPR) system was also updated to ensure patient needs could be more easily documented and shared better with other relevant organisations using the shared EPR.