Dorothy House Hospice Care

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

At our last assessment we rated this key question outstanding. At this assessment the rating has remained the same. This meant service leadership was exceptional and distinctive. Leaders and the service culture they created drove and improved high-quality, person-centred care.

This service scored 96 (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.

There was a transparent and open culture where staff could escalate concerns and report incidents. Staff reported that the team was supportive and reported good team working.

Staff spoke passionately about the service they provided and were proud of the facilities they worked in and the care they could offer to patients. Staff described the culture as positive with good working relationships with different departments within the hospice.

The hospice’s vision was to promote ‘A society where death is part of life’ and their purpose was to empower, collaborate and deliver so that no-one faced death alone.’Leaders promoted a shared direction centred on equitable access to care, including an ambition for people to receive the right support in their last 1,000 days, aligning with the principle of providing the best possible start in life during the first 1,000 days.

The Care Services Strategy 2025-2028 was in line with national recommendations and was developed with engagement from staff and the local community and reflected their ongoing needs. The strategy was focused on three core commitments, this included integration, innovation and impact. The hospice’s core values were at the centre of the care services strategy, and these were “we care, we create and we connect”.

Leaders had a clear strategic priority to address health inequalities, including a focused approach on improving access and outcomes for people with learning disabilities. They described a shared vision to reach more people and reduce inequities in care delivery.

The strategy also recognised future financial challenges, with plans in place to maintain a strong focus on delivering safe, high-quality care despite funding pressures.

The evidence showed an exceptional standard. 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.

Leaders demonstrated a strong commitment to being capable, compassionate and inclusive through a clear, co-produced leadership framework and shared behavioural expectations which prioritised kindness, accountability, psychological safety and inclusion. These values were embedded across key workforce processes, including recruitment, induction, development, promotion and succession planning, ensuring a consistent and values-driven leadership approach.

The workforce strategy, ‘One Workforce, Thriving Together’, reinforced this by integrating leadership development with staff wellbeing, equality, diversity and inclusion, and long-term workforce sustainability. Inclusive leadership was evident at executive and trustee level through formal commitments to equality, diversity and inclusion, supported by structured induction, mentoring and ongoing development.

Leaders were visible and approachable, maintaining regular engagement with staff through open forums and drop-in sessions. They actively listened to feedback and responded to concerns, supporting a culture of trust, openness and engagement where staff felt valued and able to contribute. The hospice also prioritised staff wellbeing through initiatives such as the ‘Year of Self Care’, which provided a range of forums, activities and support to promote wellbeing.

All people managers received leadership development, including participation in programmes such as Shiftworks in collaboration with The King’s Fund, and were supported through regular action learning sets.

Leaders demonstrated a flexible and compassionate approach to managing staff, supported by a flexible working policy. This policy set out clear arrangements for requesting and agreeing flexible working, including adjustments to working patterns, hours and locations, to meet individual needs.

Leaders worked collaboratively with staff to implement these arrangements, ensuring service delivery remained safe and effective while promoting staff wellbeing, inclusion and a positive working culture.

All staff we spoke with said they felt confident they could approach their managers about anything. Staff received regular supervision and could request a debriefing post a difficult event.

The hospice had a major incident business continuity plan and procedure which offered guidance, direction and information to staff to manage business continuity during an internal significant incident or major incident. The hospice had also held a major incident planning desk top exercise in September 2025 and had identified lessons learned and areas which required actions.

The evidence showed an exceptional standard. The service was exceptional at fostering a positive culture where people knew they could speak up and their voice would be heard.

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

The hospice had implemented a formal freedom to speak up guardian (FTSUG) model, reflecting a strong organisational commitment to openness and learning beyond regulatory requirements.

Multiple trained, named guardians were in place across a range of roles and services, ensuring high visibility, accessibility and independence. These arrangements provided staff with trusted and confidential routes to raise concerns, including anonymously where appropriate, particularly where traditional management pathways may not feel suitable.

Staff were aware of who these were and told us that they felt they could raise concerns without fear of reprisal. At the time of the inspection the hospice reported behavioral, culture and values as current themes arising through this channel. Leaders told us themes were being monitored for organisational learning and for ensuring appropriate actions were taken by managers and leaders.

Staff could also access support through other routes, such as line managers, the wellbeing services, human resources, safeguarding leads and volunteer-coordinators depending on the information of concern. We spoke with staff who told us they felt well supported by their managers.

The speaking up policy provided staff with the legal frameworks including the public interest and disclosure act, employment rights act and data protection act, as well as the freedom to speak up summary review, the poster, and how to raise a concern.

The hospice promoted an open culture around feedback from staff through staff discussion sessions and staff survey, where themes were identified, addressed, and actions were put in place.

The hospice had established an employee-led and self-governed staff network (“Our Voice”) to support a positive speaking-up culture. This provided a safe and accessible forum for staff to share concerns, offer feedback, and contribute to organisational learning.

The network enabled two-way communication between staff and leadership, supporting openness and transparency, while also promoting the sharing of learning and celebrating good practice. Staff were encouraged to take on the role of voice representatives, who actively engaged with teams to gather feedback and present this at regular six-weekly meetings, strengthening staff voice and influencing service improvement.

The evidence showed an exceptional standard. The service strongly valued diversity in their workforce. They had an inclusive and fair culture which had improved equality and equity for people who work for them.

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

The hospice had an equality, diversity and inclusivity strategy for 2025-2028 which supported the hospices ‘its personal’ organisational strategy by creating the conditions for dignity, fairness and belonging across the workforce and for the people they served. This included embedding inclusive practices, mandatory training for all staff, recruitment training for hiring managers, equality diversity impact assessments and improving workforce insight.

We reviewed the hospice’s equality and diversity in employment and volunteering policy which aligned with the Equality Act 2010, relevant EHRC Codes of Practice, and recognised good practice in equality, diversity and human rights. The policy provided a clear and proportionate framework to promote fairness, dignity and inclusion for both staff and volunteers and aimed to ensure that everyone who engages with the hospice was treated equally and with dignity, fairness and respect and to provide a work environment which is free of any type of discrimination, victimisation, bullying or harassment.

Additionally, the hospice also had an equality, diversity and inclusion charter which set out the hospices approach to ensuring respect, inclusion and success for everyone and actively encouraging the participation of underrepresented groups across all areas of the organisation.

The hospice made reasonable adjustments to accommodate and support staff in their work where possible. Staff were able to access additional support through occupational health services and the employee assistance programme. The hospice had also been recognised for its inclusive support of armed forces veterans, achieving a silver award.

Recruitment processes followed national standards and best practice guidance. Staff involved in recruitment were provided with training on fair recruitment practices, including recognising and reducing bias. The recruitment team had also received national recognition, winning awards for ‘Best Candidate Experience’ and ‘Recruitment Leader of the Year’ at the 2025 In-House Recruitment Awards.

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

Effective governance was a core component which drove the hospice’s operations and this was overseen by the head of governance. Specifically, clinical governance was managed by the clinical quality lead, overseen by the clinical governance sub-committee and accountable to the care services committee.

There was a clearly defined structure to the organisation, with a board of trustees providing strategic vision and direction for the hospice. The board of trustees met quarterly, supported by fivetrustee-led committees and one sub-committee who met prior to each board meeting.

We reviewed the minutes of the board of trustee meetings for the months of June, September and December 2025. Topics of discussion included the key points from the executive report, organisational objectives and business investment opportunities.

Staff at all levels were clear about their roles and understood what they were accountable for, and to whom. There were clear responsibilities among staff which interconnected and ensured governance was fundamentally strong.

There were effective governance processes that emphasised a transparent learning culture and the voices of patients and families which was proactively sought out through a number of feedback mechanisms.

The hospice had implemented the use of an electronic risk and incident management system for a comprehensive management of all risks. This enabled dynamic oversight of risks, including clear recording of controls, mitigations, and both current and target risk scores.

A review of the risk register identified the top organisational risks as financial sustainability, infrastructure (including cybersecurity), and clinical capacity (medical consultant provision). Each of these risks had defined controls and mitigating actions in place, demonstrating effective oversight and management.

Additionally, the hospice had a centralised alert management system in place, which used a RAG-rated approach to assess and prioritise alerts. Actions were clearly tracked and managed, supporting effective oversight and timely response.

The hospice had an effective audit programme to drive improvement across the hospice and had a high number of research projects in progress which evidenced excellent areas of innovation.

There were clear arrangements in place to manage and monitor business contracts, including agreed quality indicators and service level agreements with partners and third-party providers.

The hospice demonstrated strong and sustainable governance through a well-established, assurance-led framework. Governance was embedded across the organisation as a key enabler, supported by a Board-approved governance handbook aligned to the Charity Governance Code, with clear trustee responsibilities and effective sub-committee oversight.

Quality and risk were managed through an integrated, board-approved risk management framework, supported by risk reporting using a RAG-rated system. Independent assurance was provided through a risk-based internal audit programme that reported directly to trustees.

The service used a quality impact assessment tool to assess the potential impact of service changes on safety, patient experience and outcomes. This supported effective governance and informed decision-making.

Transparency and continuous improvement were supported through the annual quality account, alongside strengthened trustee-led safeguarding assurance, demonstrating effective leadership, oversight and organisational resilience. There were procedures to safely manage sensitive data which allowed them to maintain people’s privacy, dignity and confidentiality.

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

The hospice provided care across BaNES and parts of Wiltshire and Somerset and worked closely with local care providers, GPs, district nurses, specialist nurses and other health and social care professionals to coordinate and provide the best possible care.

The hospices community groups who were also based across the BaNES and offered a wide range of groups which met during the week and weekends, virtually and in person. Some of these included the allotment group, grief chat café, the coffee connection and walking through grief.

The family support team held ongoing engagements and collaborated with various organisations which ranged from compassionate companions partnership, cancer alliance and with schools across the community to provide wrap around support for children and families most in need. The children and young people’s south network met regularly and held meetings throughout the year with partner hospices to share information and improve care.

The hospice engaged with people through social media to provide Dorothy House podcasts, which gave people the opportunity to have an informal chat. The Dorothy House podcasts enabled difficult conversations about death and dying. The provider’s website had videos which addressed topics such as death as a part of life, living life well, peaceful death and supported bereavement; these provided a useful source of information.

As part of contractual arrangements, the hospice met quarterly with their commissioner, HCRG, a local integrated community based care contract provider to provide assurance regarding the work of the hospice, financial, operational and quality metrics and performance and to share information and work in partnership to improve the quality of care to patients. We reviewed the minutes for the contract review meeting for December 2025, topics of discussion included key service risks, finance update, performance update and quality update. As the hospice was the lead hospice for end of life care across BaNES, Swindon and Wiltshire, it also sub-contracted another hospice within that area and held quarterly contract review meetings to gain assurance regarding activity, quality, finance, operational and safeguarding.

The hospice worked in collaboration with the local acute trust haematology team to provide a community-based outpatient blood transfusion service at the hospice.

One of the key priorities for improvement in 2025-2026 for the hospice was to develop a mouth care video for their workforce and people who access their service and other professionals. The hospice at home carers were currently working with mouth care matters, education department and communications team to deliver a video tutorial in order to improve palliative mouthcare and overall quality of life.These mouth-care videos were now being shared and used by other hospices across the southwest as best practice.

The hospice had also recently collaborated with other hospices and the founder of I want great care to develop an AI-driven clinical software platform for hospices called GRACE- giving respect, autonomy and control at End-of-Life. At the time of the inspection, the hospice was in the process of starting phase one of implementation with 12 clinical staff being given access to a dictation tool and web interface.

The evidence showed an exceptional standard. The service had a strong focus on continuous learning, innovation and improvement across the organisation and local system. They always encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

Leaders strived for continuous learning and improvement and innovation. Learning was shared amongst the wider team and could be seen to contribute to their quality agenda and learning culture.

To ensure research and innovation at the hospice was truly focused on the needs of patients, families and the community, the hospice had established a hospice user group to hear from people with connection to the hospice and invited them to complete surveys or join in a group discussion virtually or in person.

The hospice had a large research and education team who were affiliated to a number of universities and had current or previous substantive academic roles in research.

The team ran research and education programmes which contributed financially to the running costs of the hospice. The education team within the hospice delivered post-graduate and under-graduate training for healthcare professionals across the region and routinely supported undergraduate clinical placements. Additionally, the team also provided all in-house training for clinical, non-clinical staff, and volunteers within the hospice. The majority of this training was available for external participants to join.

All people referred to the hospice are invited to be part of the Hospice User Group (HUG) and to opt in to have their clinical data available for research purposes. The research and education team also had a high number of research projects underway which included innovative neurotechnology interventions and a grief mapping tool with universities to enhance patient care and improve end of life care. Some of the studies they were working on currently included understanding the quality of life and needs of people with Parkinson’s disease towards the end of life and Arthritis at end of life. Additionally the hospice took part in quality improvement projects which enabled them to benchmark themselves in quality improvement, organisational development and patient-centred care. One of the projects included Aqua, a quality improvement building blocks framework which was launched across Bath and North East Somerset, Swindon and Wiltshire to oversee the successful implementation of a safety culture across the system and the organisation.

There was a strong ethos of evidence-based practice with the vision to improve patient care. The hospice held palliative care conferences which brought together experts in the field to discuss the latest findings, innovations and best practice in providing palliative care in both residential and community settings. The conference included keynote talks by experts in the field, experts with lived experience and abstract posters.

The hospice had a detailed education and research strategy 2025-2028 which had been developed to align with and support the 2025-28 organisational care services and workforce strategies. The strategy included progress made since the last strategy and had identified six new priorities to maximise opportunities for research to improve people’s care. This included expanding research partnerships and promoting evaluation expertise.