Ellenor Gravesend

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.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s needs were prioritised by a service whose leaders supported staff and collaborated with partners to provide the best possible 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 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.

Ellenor Gravesend had vision around ‘enabling every person we support to have a seamless and personal experience which meets their needs and wishes’ and values focused on inclusion, care, and high-quality services. They had a strategy for 2024–2027 developed through an understanding of local needs and challenges. They understood the context of service needs, particularly in relation to increased demand on services, improving access to underrepresented groups, supporting early engagement through wellbeing services and increasing awareness of services across the local community.

Strategic pillars included community, people, services, quality and the environment. There was a clear focus on diversity and inclusion with goals to increase access to underrepresented groups by 10% and to increase the diversity of the workforce to 15% to reflect the local community.

Implementation of the strategy was monitored by the board of trustees, and we saw that action had been taken in line with planned objectives. For example, in relation to increasing awareness of hospice services and engagement with underrepresented groups.

The service had inclusive leaders 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.

Staff told us hospice directors were visible, engaged, and supportive. However, some staff fed back that they did not feel that senior leaders were always visible. Leaders had recognised this in the results from the staff survey and had acted, including the development of leadership drop-in days and cross department working to improve engagement and collaboration.

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

Most staff we spoke with felt their views were heard. Staff were encouraged to share their views. An annual feedback survey was undertaken, and we saw actions to address staff concerns were in place and monitored to ensure they were effective.

A staff representative forum had recently been changed to a staff engagement forum with unrestricted access to all staff, where they could discuss ideas, issues, and concerns. A member of the board of trustees was a freedom to speak up lead and there were 2 staff representatives. Staff could raise concerns through a dedicated speak-up email. Senior staff had completed speak-up training. We were told a development day was planned from January 2025 for executive and senior leads to review how to further promote speak up initiatives.

The service valued diversity in their workforce. Leaders work towards an inclusive and fair culture by improving equality and equity for people who work for them.

In 2021 Ellenor Gravesend won a bid to look at the local and staff demographic, focusing on observing local cohorts of people who use services in the area. The service had a strategic objective to increase recruitment and retention of staff who were representative of the diversity of the local community to 15%. The service monitored staffing using a dashboard and we saw there had been an overall increase in staff from an ethnic minority, from 12% in 2023 to 14% in September 2024.

The hospice had an equality diversity and inclusion (EDI) team who worked to understand the demographic of the local community and raise awareness of the benefits and importance of increasing the diversity of the workforce. In October 2024, the EDI team carried out a 21-day diversity challenge. This involved openly discussing themes such as cultural awareness, using interactive approaches, and involving a cross range of staff.

The hospice was a disability confident employer. Staffing data showed an increase from 5% in June 2023 to 8% in September 2024 of staff who identified as having a disability. We saw that reasonable adjustments were made to support staff and volunteers with disabilities.

The service had clear responsibilities, roles, systems of accountability and good governance. Staff used these to manage and deliver good quality, sustainable care, treatment and support. Staff act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

There were effective governance structures, processes and systems of accountability and a clear governance framework to support the delivery of the hospice strategy. The hospice senior leadership team were accountable to the board of trustees. Information was shared at board meetings where the chief executive officer and sub-committee reports were reviewed by trustees. Members of the board of trustees chaired specific sub-committees; care, finance, people and property.

We saw that issues around performance, quality and risk were discussed at relevant leadership meetings. This included a non-clinical governance group and a clinical quality improvement group. We viewed minutes of clinical quality meetings and saw these included an external meeting with the local integrated care board where commissioned services were reviewed. The internal quality group reviewed areas of clinical risk, feedback, audit and quality improvement, complaints, incidents, policies and procedures, and statutory and mandatory training achievement.

Policies were regularly reviewed, kept up to date and ratified by the board or sub committees as appropriate. Risks were managed through a corporate risk register where mitigating actions were identified and managed. Quality assurance was sought through clinical audits. For example, in relation to the management of medicines, infection control and the quality of clinical record keeping and care planning.

The hospice had a sustainability strategy and policy. They had developed a travel plan focused on increasing the use of more active modes of transport and more sustainable travel to and from the hospice. They were raising awareness among staff, visitors and contractors of issues such as single occupancy car use. Initiatives in place included care charging bays, recycling, solar panels and paper light working. Plans were in place for a bike store and food waste recycling.

Staff were clear about their roles and accountabilities and who to report to. Staff were committed to improving the quality of service and maintaining high standards of care. They were involved in discussions about performance and were encouraged to work collaboratively to develop the service.

The service clearly understood and carried out their duty to collaborate and work in partnership, and services worked seamlessly for people. Staff always share information and learning with partners and collaborate for improvement.

Directors and service leads worked in partnership with relevant services and communities to improve services and care for patients. The hospice was part of a Quality and service improvement network group (QSING), involving southeast hospice representatives that was focused on quality and sharing of learning and improvements. They were part of the Kent and Medway education collaborative, a collaborative between local Kent hospices and the NHS community foundation trust, where local training in relation to palliative and end of life care was delivered in partnership. In addition, service leads had participated in a quality and service improvement network group meeting to prioritise health and social care themes and risks across the local Integrated Care System (ICS) where there was a focus on improving outcomes for the Kent communities.

Staff told us of examples where collaboration with partners led to improvements. This included where care home patients affected by frailty were supported by the hospice to improve their outcomes with measurable improvements achieved.

The service focused on continuous learning, innovation and improvement across the organisation and local system. Staff encouraged creative ways of delivering equality of experience, outcome and quality of life for people. Staff actively contribute to safe, effective practice and research.

There was a strong learning culture and staff were committed to learning and improvement. Specific examples of shared learning across the organisation and local system included reviewing a serious patient fall with other services to look at prevention and improvement. In addition, the hospice had shared their development work around physiotherapy and occupational therapy roles within hospice care. This involved sharing how they worked in partnership with the local NHS to create rotational roles to combat the difficulty in recruiting to stand alone hospice therapy roles. Methods of sharing included presentations at conferences, attendance at meetings and organised visits to the hospice.

In 2022 Ellenor Gravesend was shortlisted alongside the local NHS for the Health Service Journal (HSJ) partnership awards for ‘best not for profit working in partnership with the NHS’ award, in recognition of outstanding contribution to healthcare. This was due to their covid capacity support scheme designed to rapidly increase bed capacity on the inpatient ward to support step down care for the local community.

Ellenor Gravesend 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 support breathlessness, heart failure and frailty.

A Strategic priority for Ellenor Gravesend was to increase their equality and inclusion criteria. They had been awarded a grant to recruit an Equality, Diversity, and Inclusion (EDI) project lead with an aim to promote equality and inclusion in hospice care. This work was recognised as an example of innovation by Hospice UK and there has been success in increasing the diversity of the workforce, volunteer workforce and patients accessing the services in the last 2 years.