Warwick Myton 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 reviewed 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 and communities, and learning, improvement and innovation.

The focus for all staff and leaders was on the needs of patients receiving care.

Leaders had the skills and abilities to run the service. They were visible and approachable in the service for patients and staff.

The service had a Freedom to Speak Up Guardian. The culture supported staff to speak up and report any issues or concerns to their managers.

Staff received training inequality diversity and inclusion. There were policies and processes to ensure the service was inclusive and fair.

There were effective structures, processes, and systems of accountability to support the delivery of good quality, sustainable services.

The service worked with partnership organisation and the local community to improve the care they provided.

There were systems to support participation in local and national research.

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.

Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service had an open culture where patients, their families and staff could raise concerns without fear.

Staff and volunteers described the culture they worked in as warm, open, and like being part of a family.

Staff continually demonstrated a clear understanding of the provider’s vision and values and what they wanted to achieve. Staff were proud of the service and wanted to deliver the best possible care where people were supported to manage their life limiting conditions and spend their final days peacefully. One staff member told us, “I think the people here are phenomenal, everyone pulls together and are welcoming and really care for the patients. The hard work all the staff do to care for the patient and their families, we offer so much support”. Another member of staff told us, “It is a privilege to do my job,” A volunteer told us the provider’s vision and values had been covered in their induction and added, “Culture is the hardest thing to get right. They (the staff) respond in the quickest possible way and with a caring attitude. There is an intensity in caring for the individual and giving them the best experience at the end of their life; and those who care for them, giving them a treasured memory.”

The service had a clear vision for what it wanted to achieve and a mission statement to support it. There were shared values that formed the foundation of the culture. They included respect (and dignity for all), and value (every individual and ourselves).

Managers received training on using wellbeing tools to help support staff wellbeing.

The service supported staff wellbeing and mental health through various support sessions and activities. The provider collected feedback from staff about their views on the services offered. Of the staff that completed the feedback, 85% said they could talk openly to their manager about their well-being, 68% of respondents had accessed one or more well-being resource, 83% of respondents said their personal well-being was supported by the provider, and 88% of respondents said they were satisfied with the well-being guidance support and activities provided.

Staff spoke of visible and supportive management within the service. One staff member told us, “I see managers all the time. My boss is always around, and I see the other managers supporting their staff." A volunteer commented, “I have seen the CEO to talk to. We see them around here. I see the volunteering coordinator every time I am here which I think is incredibly professional and she asks, how are you doing and is there anything else we should be doing.”

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.

There was a process for succession planning. For example, a deputy to the clinical governance lead had been appointed to ensure knowledge of this role and the associated processes would not be lost if the lead left the service.

Staff felt the culture within the service supported them to speak up and report any issues or concerns to their managers. Staff told us they would feel confident to escalate matters if they felt their concerns were not being responded to. One staff member commented, “I think it is really important to speak up if you see something wrong. I would feel comfortable to speak up and report it so we can prevent it from happening again.”

Staff told us there was 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.

The service had a Freedom to Speak Up Guardian. Evidence collected from staff demonstrated they were aware of the guardian and how to raise their concerns with them.

In the 12 months before the inspection 2 members of staff had raised concerns with the Freedom to Speak Up Guardian. One was about staffing levels in the inpatient unit, the other was about how staff were supported following a traumatic event. We saw action had been taken to address both concerns. For example, to increase staff support following a traumatic event managers received specific training on supporting colleagues following the death of a patient, or a family member. The provider also had a plan to increase the clinical staffing model to increase protected time for clinical staff to access the additional support and wellbeing interventions that were in place for staff. This support included clinical supervision and reflective practice which could be facilitated within 48 hours of it being requested to help manage a clinical incident or complex case.

The service promoted equality, diversity and inclusivity. All faiths were welcomed and celebrated. There was a recognition that people’s cultural backgrounds and values differ from one person to the next and that different cultures and values needed to be respected to provide a home from home service for people from all backgrounds and walks of life.

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. Comments included: “There is an inclusive attitude towards faith and spiritual matters” and “I do feel Myton is a very diverse company, they are caring and do believe in teamwork. From what I have seen, I am quite confident everyone is treated fairly, and diversity is recognised and valued.” One staff member told us how they had been offered support on returning to work after a period of absence. This staff member explained, “They (managers) were very proactive in helping me back to work. It was like 'how can we make this work' and all the grey areas were ironed out.” Another staff member told us, “They asked me questions in my interview as to whether there was anything I needed support with. I would feel comfortable to approach them if I needed support or adaptations.”

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.

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 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.

Clinical practice forums and clinical governance meetings were held monthly. We looked at meeting minutes and saw trustees attended the governance meetings along with senior leaders and clinical staff. Reports from these meetings were shared at the management board meetings as necessary. All meetings were documented and key areas including performance, risks and incidents were discussed.

The provider used safer staffing processes to recruit staff. We looked at 5 staff files and saw they all had an up-to-date Disclosure and Barring Service (DBS) check, evidence of qualifications, references to support their last three years of employment, and a full employment history. We also looked at 5 volunteer files and saw all volunteers were subject to a DBS check and could provide 2 references to demonstrate they were of good character before they could start volunteering with the provider.

Staff in the hospice at home team sent surveys to patients bereaved nominated next of kin. This could be a relative, friend, or carer. The survey was sent 6 to 8 weeks after the patient’s death. The feedback was used to understand their perception of care for their loved one. The survey included questions about if people thought patients had been in pain while being cared for, and if their dignity had been maintained. There were questions about the persons experience, for example, if they had been kept informed about their relative or friends’ condition, and if they had received enough emotional support from staff.

Staff told us they were encouraged to work in partnership with other organisations to improve outcomes for people in the local area. For example, collaborative work with another local hospice, a national charity, and specialist nurses who support people with motor neuron disease (MND). One staff member told us, “Well over a year ago we set up a joint MND clinic. We have really good links with the therapy team at the other hospice. They developed it and we joined them early on. We have got the regional specialist MND nurse to come into the clinics. We have also partnered with the main MND charity - they will come to our clinic and sit outside, and it will spill over. The senior manager was very happy for us to manage it. She laid down all the Standard Operating Procedures…and how we would work together outside of our clinical space."

The hospice at home team survey had been sent to 80 nominated next of kin following the death of their loved one. The results represent the combined responses from the Warwick and the Rugby Myton at Home teams. The response rate was 53% and demonstrated that most people thought the care provided by the team was exceptional. The survey looked at what could have been done to improve the service and gave people the opportunity to add comments rather than ticking boxes. Feedback reflected how highly relatives and friends thought about the care that had been given and showed that people felt able to make suggestions about how the service could develop and improve.

The provider recognised some groups of people from the local community were underrepresented in their patient data. This included people from Asian communities, people affected by poverty, and older people living in rural areas. To explore what barriers may have prevented people from these groups accessing the service they held some community focus groups, staff joined key community forums and committees, connected with key ambassadors, and they reviewed national research about underrepresentation of some groups in hospice care. They found barriers included a lack of awareness of the service, digital exclusion, societal stigma, language barriers, perceived cultural incomparability, and a mistrust of providers. To help overcome these barriers they reached out to 37 organisations that work with people from these unrepresented groups, joined 9 forums specifically to boost influence within these groups, and had some bespoke literature created to help raise knowledge and understanding of the services offered by the hospice.

The provider also undertook some online research about the terminology they used to talk about the service so that they could reach people earlier in their illness so they could support them for longer and make a bigger difference to people’s quality of life. They received 1500 responses and learnt the language or phrases used should always be tailored to the audience.

Staff told us they felt confident to own any mistakes knowing they would receive support, and that learning would be taken from it. Comments included: “Everyone makes mistakes, but it is important to report it and learn from it” and, “You don’t get judged, but they will talk it through with you" and, “It is not a blaming or accusatory culture, it is a supportive culture.” Two staff told us how they were supported and encouraged to review the way they worked and explore new ideas to improve in response to the needs of the people using the service and the wider local community. One of those staff told us, “Exercise and cancer - there is lots of emerging evidence in the palliative sector, particularly for people with bone disease. I went on a course 2 years ago paid for by Myton, so we have strengthened our circuit exercise group. Myton is supportive of that. We also need to increase the referral rate because this is a safe place to exercise.” Another staff member told us how they were working on establishing a neuro group with other healthcare professionals and added, “They do allow us to be creative here.”

Some nursing assistants told us they would like more opportunities to develop their skills and take on more responsibilities. They told us they had raised this with managers who had held some ‘listening meetings’ to understand their wishes and expectations.

All staff were committed to continually learning and improving services. Leaders encouraged innovation and participation in research. The service employed a research nurse, this was a part time post, and the nurse worked across the whole service. Between July 2021 and October 2024 patients, loved ones, and staff had participated in 18 external research studies. The research nurse led participation in the studies which had the potential to enhance the experience of end-of-life patients. For example, the service took part in research regarding hydration in dying people to establish if hydration improved cognition at the end of peoples’ lives.

To encourage and develop a research culture employees and volunteers had the opportunity to join a multidisciplinary book club to read and reflect on literature relevant to end of life care. They also had access to a journal club and received an annual research bulletin.

Staff attended local and national events for professionals working in end-of-life care including research activities and conferences. Staff were in the process of developing a research study to explore the impacts of a financial and benefits advisory service on the experience of those accessing community and inpatient palliative care.

Staff learnt from incidents. Clinical staff attended regular clinical forums 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.

Staff from all levels, including healthcare assistance, were encouraged to attend ward rounds and the multidisciplinary team meetings to develop their knowledge and understanding of end of life care.