Great Oaks 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 service leadership, management and governance assured high-quality, person-centred care; supported learning an innovation and promoted an open, fair culture.

At our last assessment we rated this key question as good. At this assessment the rating has improved to outstanding. 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 89 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We scored the service as 4. The evidence showed an exceptional standard. The service had a clear shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and an exceptional understanding of the challenges and the needs of people and their communities.

Staff spoke of an excellent working culture where teams were joined up and worked together to support patients and each other. Staff knew and understood the work the different areas of the hospice provided and were able to signpost patients to these different services as and when required. Staff could work across several teams if required. The chief executive officer (CEO) had improved the culture of the hospice since they started in 2023. One staff member stated the CEO had “united people and handled struggling or unsupported teams, now most people felt supported and that they can go to people for help, they can whistleblow if needed and put their hands up if something goes wrong.” Staff we spoke with said they had the opportunity to contribute to discussions regarding the future of the hospice.

Staff Surveys indicated staff understood the aims and vision of the hospice. In a staff survey undertaken in 2025 100% of staff either strongly agreed or agreed they understood what the hospice was striving to achieve. Staff surveys were carried out regularly on an annual basis.

The service had a clear vision and purpose along with goals which would help to fulfil the vision. The service had values of openness, accessibility, knowledgeable kindness, support along with showing care, taking pride and having courage. Staff we spoke with were able to talk about these values and the provider ensured any examples of this behaviour was documented and celebrated at staff meetings.

We scored the service as 4. 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.

The leadership team provided a clear, values-driven vision underpinned by role modelled accountability and governance which prioritised high-quality, person-centred care. Every member of staff we talked with showed they lived the organisational values and beliefs without exception. Leaders were credible, inclusive, and compassionate and held the needs of the patients, their families and staff at the heart of service provision. One of the hospice’s key aims was to give patients with life-limiting illnesses the chance to engage in meaningful activities that help them live fully and with purpose, even during the final stages of life.

Leaders had the skills and knowledge to ensure the hospice was able to offer services to the Forest of Dean population both now and into the future. The model the hospice operated meant that despite being reliant on charitable donations there was enough financial stability to ensure the future of the hospice for the next 5 years. The leadership team talked us through some of the measures they have taken to ensure the hospice generates income whilst cutting any unnecessary costs.

Leaders were visible, supportive, and adaptable. Staff gave us examples of managers being approachable and always available for support. Staff consistently told us they felt proud to be part of the organisation, highlighting a deep sense of purpose and alignment with the service’s values and direction. We spoke with a wide range of staff across the hospice, which included leaders, registered nurses, health care assistants, volunteers, complimentary therapy staff, team leaders and governors. All staff spoke of an open and respectful culture which ensured compassionate care was offered to patients and their loved ones.

Staff were offered training opportunities to support their development and competencies as well as to provide for future leaders. For example, staff we spoke with told us they had completed leadership courses run by the national hospice network, as well as course on advanced pain and symptom management. Staff were given regular appraisals and supervision.

We scored the service as 3. 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.

The service fostered a strong culture of openness, honesty and safety, where staff felt empowered to raise concerns without fear of reprisal. Management provided clear examples of occasions when staff spoke up, were listened to, and saw meaningful changes implemented as a result. Staff consistently reported feeling able to discuss challenges openly, confident their views were respected and valued. They described an environment where well-being was actively prioritised and embedded into everyday practice.

Patients and carers had opportunities to give feedback on the service they received in a manner that reflected their individual needs. All service users were invited to complete a feedback form via paper or email. During January to November 2025, 88 feedback forms were submitted, the majority of which were positive feedback. The senior management attended various groups arranged for patients and carers, for example the chief executive officer often attended the men’s group meetings. Patients knew who the chief executive officer was and felt they were approachable.

We scored the service as 3. The evidence showed a good standard. The service valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who work for them.

The service actively promoted emotional wellbeing and combated isolation through creative, community-based initiatives that engaged both service users and staff. The leadership team demonstrated a deep understanding of the diverse needs within its population and the unique challenges faced by rural communities. Recognising many patients live in areas with limited public transport, the provider had taken proactive steps to bring services closer to those most affected by deprivation. This approach ensured equitable access to care and reduced the need for individuals to travel long distances to the hospice

Managers put reasonable adjustments in place for staff members to help them carry out their roles. Staff said they felt supported and able to talk to their immediate line managers and senior leadership team.

We scored the service as 4. 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 acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate.

The hospice operated within a robust governance and risk oversight framework that ensured the quality of care was consistently monitored and improved. Regular audits were conducted to assess compliance and performance, with findings reviewed at quality meetings where appropriate actions were agreed and implemented. All identified risks were rated and recorded on a comprehensive risk register, providing clear visibility and accountability. The organisation was led by a chief executive officer who reported directly to a Board of Trustees, ensuring strong strategic leadership and governance.

Senior management played an active role in operational oversight. For example, the Medical Director, an experienced general practitioner and trustee, chaired the Quality Group, reinforcing clinical governance at the highest level. Management meetings were held monthly with a structured agenda to ensure key issues, including risk and quality, were consistently addressed. There were quarterly meetings with the integrated care board. Feedback from these meetings stated Great Oaks Hospice had ‘strong compliance across all areas of practice”.

The service had demonstrated significant progress in achieving environmental, workforce, and financial sustainability. Initiatives included the installation of solar panels to generate income and reduce environmental impact, and the introduction of a fleet of electric vehicles for staff use which reduced fuel costs. Financial resilience was supported by expert external advice on investment strategy, safeguarding the hospice’s future. Workforce sustainability was prioritised through competitive pay awards, aligned with or exceeding NHS benchmarks, helping to retain skilled staff and maintain service continuity.

Staff were well-informed about collaborative working arrangements, both internally and with external partners, to ensure seamless care for patients. Feedback from partner organisations was highly positive, reflecting strong relationships and effective joint working. A comprehensive suite of up-to-date policies underpinned safe and consistent practice across all areas of the hospice.

The service was aware that cyber security is an issue. This was discussed at board meetings and staff received training on cyber security.

We scored the service as 4. 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 shared information and learning with partners and collaborated for improvement.

Staff and leaders worked in partnership with key organisations to support care provision, service development and joined up care. The work with the integrated care board, district nurses and local acute hospitals ensured the people using the service received seamless care. For example, staff worked with local community hospitals to set up care and ensure patients at the end of life were quickly and safely discharged home to their preferred place of death as they were supported by hospice staff. Feedback from the local integrated care board stated they were, “always impressed by your commitment to achieving the best outcomes for the individuals that you support and your willingness to diversify”.

They also worked with other services which included GPs, district nurses, hospice and palliative care networks, and other care organisations. This helped people and families have the best experience at a very difficult time. For example, when a patient was transferred to a local hospice for end of life inpatient care, staff worked with the hospice to ensure the patient could keep having complementary therapy. This ensured comfort and continuity.

We observed integrated working with community services including district nursing and palliative teams. This meant patients experienced quicker and better quality referrals and reduced inappropriate referrals. Feedback from the ICB acknowledged the charity funded bridging support was used carefully to stabilise people at home, while statutory packages were arranged, and this supported the wider system objective of care in the usual place of residence.

We scored the service as 3. 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 and research.

Staff and leaders had a good understanding of how to make improvements happen. They measured outcomes and impact where possible. There was a continuous improvement culture through governance, training and shared learning. For example, staff told us they had completed additional training in medication management beyond their requirements of their role. This meant staff were continuously enhancing their knowledge and skills, fostering a culture of learning and innovation that drove ongoing improvements in care delivery. The integrated care board fed back they were struck by the service commitment to staff development and that it fostered a culture of learning and development.

Staff were supported and encouraged to speak up with ideas for improvement and innovation. One staff member had been supported to set up hydrotherapy sessions for the cancer support group. This helped people who were not confident to go to the pool. Staff were also encouraged to take training such as leadership courses. This meant staff felt confident to take initiative, use new skills and try new ideas that improved the service and met changing community needs

Medical students were welcomed for a shadowing day at Great Oaks. They were able to observe the compassionate care and holistic approach provided to people who used services. This reflected the service commitment to shaping future practitioners.