Tynedale Hospice at Home

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• 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

This means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

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 the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

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.

We scored the service as 3. 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.

Staff told us they felt respected, supported and valued. Staff spoke highly of their colleagues and described strong teamwork across disciplines, with a shared focus on delivering high quality, person-centred care. Observations showed staff interacted positively with each other and with patients, and there was a visible sense of compassion, professionalism and mutual respect.

We heard how leaders promoted an open and supportive environment where staff felt able to raise concerns and share ideas without fear of blame. Staff told us they felt listened to and supported by their managers.

At the time of inspection, the board had recently approved a refreshed strategy for the service. Work was ongoing to develop implementation and monitoring plans.

We heard that staff at all levels had been involved in shaping the strategy. This was supported by evidence of all hospice meetings, monthly strategy development sessions, and discussions at team level.

Staff were aware of the service’s direction and described how their work contributed to achieving this. Leaders worked collaboratively with system partners and involved staff, patients and stakeholders where possible in shaping service development.

We scored the service as 3. The evidence showed a good standard. The service had 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 did so with integrity, openness and honesty.

The service was led by a team with the appropriate skills, experience and integrity to deliver high quality, person-centred care. Leaders demonstrated a good understanding of end of life care and the challenges faced by staff working in the community. They were able to describe how they managed priorities, responded to pressures and made decisions to maintain safe and effective care.

Staff were encouraged to develop their skills and take on additional responsibilities, with access to training, mentorship and career progression opportunities.

Leaders were visible and approachable, with staff reporting that they felt supported and able to raise concerns or share ideas. Staff described a positive leadership culture that was inclusive and respectful, where their contributions were valued.

The leadership team demonstrated a compassionate and supportive approach, recognising the emotional demands of end-of-life care. They promoted staff wellbeing and took steps to understand and address the challenges faced by those in patient-facing roles.

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 promoted a culture of openness, honesty and transparency, where staff felt able to speak up and raise concerns without fear of blame or detriment. Staff across all roles described feeling confident to report concerns, incidents or behaviours that did not align with the organisation’s values. There was evidence of a just culture, with an emphasis on learning and improvement rather than individual blame when things went wrong.

Staff were encouraged to share ideas and feedback through a range of formal and informal mechanisms, including team meetings and direct access to managers. They told us their views were listened to and acted upon, which contributed to a positive and inclusive working environment. Leaders were approachable and demonstrated a supportive response to concerns.

The service had systems to ensure learning from concerns, incidents and complaints was shared with staff and used to improve practice. Feedback from patients and families was encouraged, and there was evidence that concerns were responded to openly, with apologies provided where appropriate and actions taken to prevent recurrence.

Whilst the service had a Speaking Up policy there had been no incidents of staff raising concerns in this way. Leaders told us this was because they encouraged all staff and volunteers to raise any concerns and ideas for improvement with their line manager or with the senior team directly. They said this approach meant themes identified in the staff survey were already known to them and were being addressed through established feedback processes.

Leaders maintained oversight of concerns raised, including those escalated to senior leadership or trustees, and there was evidence that engagement with staff through visits and discussions informed service development. Such as a recent meeting between a member of the senior leadership team and a volunteer staff member that discussed safeguarding processes.

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

The service demonstrated a commitment to promoting equality, diversity and inclusion within its workforce. Staff described a culture that was respectful and inclusive, where individuals from different backgrounds felt valued and treated fairly. Leaders promoted equality in day-to-day practice and took steps to ensure staff with protected characteristics were supported and able to contribute fully to the service.

The service sought feedback through an annual staff and volunteer survey, which included questions on diversity and inclusion. Most respondents reported that the organisation valued diversity and provided an inclusive environment.

There was awareness among leaders of the need to identify and address potential bias in recruitment, progression and staff experience. Processes were in place to support fair recruitment and development opportunities, and staff described access to training and career progression regardless of background. Leaders recognised the importance of representing the diversity of the community served and were working towards improving representation at different levels of the organisation.

Staff told us they felt able to raise concerns about inequality, bullying or discrimination, and were confident these would be taken seriously. There were policies and processes in place to manage concerns appropriately, with a focus on creating a safe and supportive working environment. Leaders demonstrated an understanding of the importance of addressing discrimination and promoting equity across the workforce.

Reasonable adjustments were made for staff where required, including those with disabilities or specific needs, to ensure they could carry out their roles effectively.

Leaders monitored workforce data, where available, to identify any disparities in experience or opportunity and to inform improvement actions. There was evidence of a commitment to listening to staff voices, including those from marginalised groups, and using feedback to improve inclusion and fairness.

As part of the strategy implementation, leaders planned further work to improve data and insight about the workforce. The aim was to identify opportunities to better reflect and meet the needs of the local community by ensuring the workforce was diverse and representative.

We scored the service as 3. The evidence showed a good standard. The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

The service had governance and management systems in place, with defined roles, responsibilities and lines of accountability across all levels. Staff were aware of their roles and described clear oversight from senior leaders. Governance structures enabled information to flow from frontline teams through to senior leadership and the board, with regular review of quality, safety and performance data to provide assurance and support decision making.

There were effective systems for monitoring patient safety, including oversight of incidents, feedback and infection prevention and control. Safety information was regularly reviewed through governance processes, with learning shared across the service and with system partners where appropriate. Leaders demonstrated awareness of national guidance and ensured that safety alerts and external recommendations were acted upon and embedded in practice.

Performance was monitored using a range of data sources, including clinical audit, incident reporting and workforce metrics. Leaders demonstrated that information was routinely reviewed and used to identify areas for improvement, with systems in place to track progress over time.

Staff reported that they were able to access relevant data to support their roles, and there was evidence that information was used to inform service development and drive improvements in the quality of care provided.

However, there was further opportunity to maximise the functionality of the electronic patient record system, which leaders recognised. In particular, improvements were needed in the consistent use of outcomes measures, including the Integrated Palliative Outcome Scale (IPOS), to strengthen the assessment of patient outcomes and support ongoing quality improvement.

Information governance arrangements supported the secure handling of patient information. Staff understood their responsibilities around confidentiality and data protection, and systems were in place to ensure records were accurate, accessible and secure. Leaders had oversight of information governance, including data security and compliance with regulatory requirements.

The service demonstrated preparedness for emergencies and resilience planning, with arrangements in place to respond to incidents such as staffing pressures or system disruption. Workforce planning supported sustainability, with leaders considering recruitment, retention and development to maintain a stable and skilled workforce.

We scored the service as 3. The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

The service worked collaboratively with a wide range of external partners to improve care and outcomes for patients. Staff and leaders described strong working relationships with GPs, community nursing teams, local authorities, acute trusts and specialist services. These partnerships supported coordinated care, timely referrals and shared decision making.

Stakeholders from a local primary care network and palliative care partnership told us the service had a strong presence within the partnership and was receptive to feedback and open to new ideas.

Feedback from partners indicated that the service was responsive to local need and demonstrated a commitment to ongoing service development and improvement.

The service engaged with local community groups and stakeholders to understand and respond to the needs of the population it served. This included working with patient and carer groups and, where possible, seeking feedback to shape service development. Staff described efforts to reach underserved or seldom heard groups, with some outreach and partnership working to improve awareness and access to hospice services.

The service contributed to relevant professional networks, including palliative care and end of life care forums, which supported learning, consistency of practice and service improvement. There was evidence of collaboration with external organisations such as charities and specialist providers to enhance patient support.

There were systems in place to share information appropriately with external partners, including where concerns arose about care or professional practice. Leaders understood the importance of transparency and worked within regulatory frameworks to ensure concerns were escalated where necessary.

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.

The service promoted a culture of learning and improvement, with staff demonstrating a clear commitment to developing practice and enhancing patient care. Staff described regular opportunities to reflect on care delivery through team meetings, supervision and informal discussions, and there was evidence that learning was embedded into day to day practice.

Leaders supported quality improvement activity and encouraged staff to contribute ideas for change. Staff understood improvement approaches and were able to describe examples where changes had been implemented to improve patient experience or safety.

Current and recent improvement work included reviewing workforce, demand, and capacity, which aimed to support delivery of identified strategic priorities, ensuring services remain responsive to local need, sustainable, and aligned with wider organisational objectives.

The dementia service, formally launched in February 2025, continued to develop. This included caseload management, delivery of dementia cafés and wellbeing programmes, and partnership working with acute and community stakeholders.

We heard of other projects and service improvement initiatives that had been developed and were waiting for funding approval.

Learning from incidents, complaints and external reviews was used effectively to drive improvement. There were systems in place to review events, identify themes and share learning across the service.

Learning from deaths was supported through routine reflective discussions held at monthly care service meetings and through wider multidisciplinary working. Staff also contribute to GP palliative care register MDT meetings and specialist palliative care MDT meetings.