Helen and Douglas House

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 as good. At this assessment the rating has changed to outstanding. We found a service where leaders actively nurtured a culture of support, teamwork and inclusivity. Staff consistently reported feeling listened to, valued and empowered in their roles. The service had a clear vision, underpinned by detailed and credible strategies to achieve its aims. Leaders were visibly passionate and committed, ensuring well-developed governance systems and structured oversight that supported safe, high-quality care. There was a strong culture of continuous learning and improvement. Staff demonstrated innovation in developing the service, consistently seeking new and effective ways to strengthen governance, enhance practice and respond to the evolving needs of children and families.

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 clearly articulated vision, strategy and culture, which was understood and embraced by staff at all levels. The managerial team demonstrated strong leadership and fully supported the service’s vision and strategic objectives, ensuring that day-to-day practice aligned with long-term goals. Staff described feeling motivated and inspired by this shared purpose, contributing to a cohesive, values-driven culture.

All staff we spoke with were passionate about their roles, they enjoyed coming to work and they saw their roles as a vocation rather than a job, with one member of staff saying “this is such a special place, I wouldn’t want to work anywhere else.”

Staff who had worked at the service for longer described that there had previously been a developing “blame culture.” However, all staff attributed the significant cultural improvement to the new senior leadership team. One staff member told us, “There’s been a dramatic change in the culture for the better.”

Staff consistently described a supportive and collaborative team environment, which they said had increased their confidence and significantly improved job satisfaction. One staff member commented, “The culture is excellent and everyone has really supported me. It’s a unique place and has given me great opportunities. It’s opened my eyes and enabled me to explore my development”.

The senior leadership team recently launched a five-year strategy. Historically, strategies had covered a three-year period; however, the senior leadership team extended this timeframe to widen the scope for improvement and enable the service to achieve its long-term strategic goals. The strategy included a strong clinical focus on research and development, actions to prevent organisational complacency and plans to develop the community and outreach team to deliver a hospice-at-home service.

The service had also developed a bereavement strategy aligned with the wider organisational strategy. This included reviewing how bereavement care could be diversified, both in how support was delivered and by increasing the number of community-based locations.

As the therapy service continued to expand, managers were developing a dedicated therapy strategy to set clear objectives and overarching goals for the team.

Staff were actively encouraged to pursue areas of interest, supporting both their personal development and wider service improvement. One staff member, originally a midwife, was supported to expand their role into perinatal nursing, while another was encouraged to apply for a senior post they had not previously considered. Staff consistently attributed these opportunities to a significantly improved and supportive organisational culture.

There were also examples of staff who had left the organisation and later returned, reflecting positively on the overall working environment and the strength of staff experience within the service.

We scored the service as 4. The evidence showed an exceptional standard. All leaders embodied the culture and values of their workforce and organisation.

The senior leadership team (SLT) included; the Chief Executive Officer, Director of Nursing and Care and the Head of Care, who were all new to their roles, as well as the Head of Community and Family Support, Head of Professional Development and Research and Head of Governance and Quality. The SLT demonstrated a clear understanding of areas requiring change and implemented improvements in a measured and considerate way, with particular attention to communication and the pace of change.

Staff consistently told us that the new SLT was leading the service in the right direction and expressed confidence in their leadership. Staff described leaders as approachable, with an open-door policy and reflected that previous management had fostered a “them and us” culture. Staff also told us that managers continued to work clinically alongside teams when required, which helped maintain credibility and trust. In recognition of this leadership approach, staff had presented the director of nursing and care with a trophy.

The new leadership team had introduced several significant improvements, including a stronger focus on incident reporting, learning from incidents and actively addressing the previously identified blame culture. The director of nursing and care had introduced two new ‘head of care’ roles, one overseeing inpatient services and the other overseeing community and outreach care. As the senior leadership team expanded, the service implemented a 24-hour, seven-day-a-week senior on-call system, which had not previously been in place.

Staff were also highly positive about the new CEO. We reviewed the service’s intranet, which included a monthly CEO update, supporting transparent and consistent communication. The SLT met bi-monthly and included a focus on staff wellbeing and effective communication. All changes introduced by the leadership team were informed by staff and, where appropriate, family feedback. For example, following the introduction of the new SLT on-call system, the director of nursing and care implemented a staff survey to assess its effectiveness. Responses were reviewed, an action plan was developed, changes were implemented and outcomes were subsequently re-evaluated.

The month following assessment, leaders were focusing on workflow by completing a roles and responsibility review. The purpose of the review was to ensure “everyone comfortable with the hats they are wearing, where can we add value and do we need a rethink. Hopefully it will help the team be more agile.”

We scored the service as 3. The evidence showed a good standard. Staff felt that they could speak up and that action would be taken.

All staff we spoke with reported that they felt safe to speak up. They were aware of who the Freedom to Speak Up Guardian was and how to access them. Staff told us they were confident that any concerns raised would be taken seriously and acted upon.

When changes were implemented because of concerns or feedback, staff were regularly kept informed and up to date with progress and outcomes.

We scored the service as 3. The evidence showed a good standard. The service valued diversity in their workforce and there was an inclusive and fair culture.

Staff at all levels told us they felt included and valued and that they were able to be themselves at work regardless of their background, ethnicity, or religion. Culturally important dates were recognised and celebrated, reflecting an inclusive workplace culture.

Staff were actively encouraged to pursue areas of interest, supporting both their personal development and wider service improvement. One staff member, originally a midwife, was supported to expand their role into perinatal nursing, while another was encouraged to apply for a senior post they had not previously considered. Staff consistently attributed these opportunities to a significantly improved and supportive organisational culture.

There were also examples of staff who had left the organisation and later returned, reflecting positively on the overall working environment and the strength of staff experience within the service.

The service had won a government ‘Disability Confident Employer’ award and National Centre for Diversity ‘Top 100 Most Inclusive UK Employers 2025’ award.

Managers acknowledged that the diversity of the staff team did not fully reflect the families they supported. In response, they were developing recruitment strategies to improve team diversity over time, while ensuring that appointments were made based on suitability for the role.

We scored the service as 3. The evidence showed a good standard. All areas of the service demonstrated clear responsibilities, defined roles and robust systems of accountability. Managers were focused on using data and feedback from staff, children and families to inform governance and drive performance.

Governance processes were proactive and forward-looking. A dedicated working group was reviewing the referral process, including performance against key indicators, to ensure systems remained responsive, effective, and centred on the needs of children and their families

The senior leadership team (SLT) held regular meetings to review service performance, staff and family feedback, incidents, complaints, and wellbeing. Department heads and clinical leads met routinely to coordinate care, admissions, risk management, and multidisciplinary working.

Clinical leads and medical staff met bi-monthly to review practice changes, quality improvements, and patient safety, with issues escalated to quarterly Clinical Governance Meetings attended by trustees and senior leaders. Reporting culture shifted from blame to learning, reducing harm despite increased incident reporting.

The SLT supported complementary therapy integration, maintained oversight of principal risks via a detailed risk register, and developed a quality improvement hub to strengthen governance. Overall, the SLT demonstrated cohesive, transparent, and data-driven leadership, which staff described as collaborative and effective.

We scored the service as 4. The evidence showed an exceptional standard. The service understood their duty to collaborate and work in partnership, so services work seamlessly. Staff shared information and learning with partners and collaborated for improvement.

Managers were actively exploring ways to make services more accessible and welcoming to teenage oncology patients. At the time of our assessment, most contact with this group occurred later in their care, often when treatment had been unsuccessful and end-of-life support was required. The service was developing strategies to engage these young people and their families earlier, raising awareness of counselling, support groups, networks and events. The aim was to promote the hospice as a place of support and connection, rather than solely a setting for end-of-life care. This approach was informed by parent feedback, many of whom wished they had accessed the hospice’s facilities sooner but had been intimidated by the term “hospice” when their child began treatment.

Leaders demonstrated a strong commitment to improving equity of access and community engagement. They were actively reviewing opportunities to extend support groups beyond Oxford, recognising limitations in accessibility for families travelling by car. Managers were developing community hubs and proactively promoting the service to increase visibility and engagement, particularly for families living outside the city and those from minority communities.

Leaders showed a clear understanding of local population needs, including the significant economic inequalities within Oxford, where areas of high deprivation exist alongside affluence. In response, they were developing targeted plans to ensure underserved and disadvantaged families were better supported. This proactive and inclusive approach demonstrated a clear focus on reducing inequalities and improving access to support for all families.

Analysis of bereavement group attendance highlighted that families who had experienced a loss within the first year regularly attended, but participation dropped after the second year. In response, staff explored alternative formats for group support, recognising that traditional counselling sessions were not always preferred. This led to the introduction of activities such as kickboxing sessions with time for informal discussion, providing opportunities for peer support in a way that was engaging and accessible.

Families told us they valued opportunities to connect with others who shared similar experiences, particularly younger families and siblings. Staff described how these connections helped build confidence, friendships and peer networks.

In response to feedback from extended family members, the service introduced Grandparent Days, enabling grandparents who had lost grandchildren to meet and build supportive relationships. Managers had increased the frequency of these events in response to demand. Staff demonstrated a clear understanding of the impact of a child’s death on the wider family and ensured ongoing support, helping families develop strategies to remember their child while moving forward. Families were reassured that they could return to the service at any time for support.

We scored the service as 4. The evidence showed an exceptional standard. Managers and staff had fostered a culture of continuous learning and improvement, where research was actively used to enhance practice and outcomes for children and families. Leaders and clinicians did not only implement best practice, but they also played a significant role in shaping it at regional, national and international level.

Staff reported that managers were highly supportive of research and development opportunities, responding promptly to implement plans and manage logistics. For example, managers expediated the introduction of a perinatal care role in response to the national increase in palliative care for children aged 0–1 year. Staff commented that managers “really listen to ideas and respond; it isn’t tokenistic.”

Medical staff held prominent leadership positions within the Association for Paediatric Palliative Medicine (APPM). These roles included secretary, co-chair, digital lead, research lead and co-lead of the Patient and Public Involvement (PPI) group. The chair role involved representing the specialty nationally, engaging with national Royal Colleges, contributing to All-Party Parliamentary Groups and working collaboratively with partner organisations such as Together for Short Lives and The True Colours Trust. A member of the medical team was also conference session chair for the Royal College of Paediatrics and Child Health (RCPCH).

A member of the medical team acted as a link between APPM and international bodies including the European Association for Palliative Care and the International Children's Palliative Care Network, strengthening international collaboration and knowledge exchange. Another clinician contributed to the APPM formulary group, influencing medicines guidance for paediatric palliative care nationally.

Staff were closely involved in national education initiatives, including the APPM Opioid Education Programme, facilitation of trainee teaching and supporting the All-Ireland team to establish regional teaching programmes. The Director of Nursing and Care as well as nursing and medical team members contributed to the Cancer Collaborative in partnership with NHSE. The service funded the Thames Valley Improvement Collaborative and a member of the medical team acted as a spokesperson for the British Association of Perinatal Medicine framework, further demonstrating sector-wide leadership.

Staff at all levels were actively encouraged by managers and the research practitioner to contribute to the development and improvement of services for children and young people. We were provided with multiple examples of staff leading innovation in research and service development in all aspects of hospice care.

Staff collaborated with Together for Short Lives’ Collaborative Paediatric Palliative Care Research Network, to explore how hospices can become research-ready and to identify priority areas for future studies.

One member of staff led a quality improvement programme to broaden research coverage and reduce duplication by connecting local networks and improving the sharing of knowledge, research opportunities and skills across the service.

The service was mindful of staff workload and the risk of overburdening teams. A senior team member was reviewing best practice approaches to support upskilling, particularly for newer departments who wished to develop their research expertise.