Little Harbour

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 and innovation; and promoted an open, fair culture.

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 82 (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 understood the provider’s vision and values and described how these guided their work. At the time of inspection, the service was developing a new organisational strategy. This work involved staff at all levels, children and families, and trustees, to ensure a wide range of views were considered. Leaders recognised the importance of reviewing services in line with changes in children’s hospice care while maintaining the organisation’s values and legacy, with children and families remaining central to decision‑making.

Staff described a positive and inclusive culture. Teams worked closely together across the service to support children, families and each other. Senior leaders, including the Chief Executive and directors, attended team meetings to discuss the vision and values of the service and embed them into practice.

Staff told us they felt valued, respected and listened to. They said they could raise concerns openly without fear of reprisal and felt supported by managers. Staff consistently told us they enjoyed working at the service.

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.

Leaders had the skills, knowledge and experience needed for their roles. They understood the services well and explained clearly how teams worked to deliver high‑quality care. Leaders were proud of the teams and described them as being passionate and committed to making every visit for children and families count.

Leaders were visible and approachable for patients and staff. Staff told us managers were easy to contact and offered consistent support. One staff member told us “it doesn’t feel like there is a hierarchy, it feels like we are one big team.”

There were opportunities for leadership development. Staff were supported to take part in training, gain new skills and pursue areas of interest. This included support for further study, extended skills and shadowing opportunities. Professional development was actively promoted.

Leaders created a culture where feedback was welcomed and acted upon. Team meetings incorporated time specifically for staff questions, and an anonymous online submission process was available for anyone who preferred not to raise concerns in person. Senior care leaders also maintained an open‑door approach, which staff reported made it easy to share concerns, offer suggestions and contribute to service improvements. Improvement initiatives were often led by members of the care team, helping to foster an encouraging, collaborative and forward‑thinking culture.

We scored the service as 4. 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.

Patients and their families had opportunities to give feedback in ways that met their individual needs. Staff received this feedback and used it to make improvements.

Staff knew who the Freedom to Speak Up Guardians were but told us they felt comfortable raising concerns directly with managers and leaders. Negative feedback was viewed positively by leaders as an opportunity for reflection and an indication that staff felt able to use established feedback mechanisms and were confident that their views would be heard. This demonstrated a level of psychological safety within the workforce and supported an open culture.

Leaders emphasised that it was important for staff to have opportunities to express their views freely, including when concerns or areas for improvement were identified. Constructive feedback was considered valuable, as it provided insight into potential issues, supported learning and allowed the service to strengthen communication and the working environment.

The service remained committed to responding to all feedback in a constructive and collaborative manner. Leaders used this information to inform ongoing quality improvement and to support continuous development of the service for staff, children, young people and their families.

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.

Managers put reasonable adjustments in place to help staff carry out their roles. Shift patterns were adapted to meet individual needs. Staff told us they felt supported and able to speak with their line managers and the senior leadership team.

All staff were required to complete equality and diversity training. Leaders took action to review and improve the organisation’s culture, with a focus on equality, diversity and inclusion.

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 effective governance and management systems to support safe, high‑quality and sustainable care. There was a clear framework outlining the information to be discussed at ward, team and directorate meetings, which ensured learning from incidents, complaints and deaths was shared consistently. Staff had implemented recommendations from reviews and demonstrated learning in practice.

Staff participated in local clinical audits, supported by external audits where appropriate. These provided assurance, and actions were taken when audits identified areas for improvement. Staff understood how to work with internal and external teams to meet children’s needs, supported by formal partnership agreements and service‑level agreements that clearly defined responsibilities and governance arrangements.

There was strong oversight through quarterly quality and governance meetings. These reviewed incidents, audit findings, policy assurance, risk registers, staffing levels, sickness rates and updates from working groups. Learning from incidents was reviewed through the electronic incident reporting system, which staff were trained to use, and shared across the three houses. Key information was escalated through board and trustee meetings to ensure scrutiny and oversight.

Leaders maintained clear oversight of risks, including safeguarding, staffing, medical provision, funding and information governance. Risk registers were in place, although leaders recognised the risks associated with multiple systems and were working to maintain accuracy.

Contingency plans were established for business continuity, including managing adverse weather, increased demand, staffing pressures and system disruptions. The service had robust emergency plans, including backup power, supplies, and arrangements to maintain care during severe weather or other disruptions. The service had recently faced a red weather warning storm followed by a boiler failure. They followed business continuity plans to ensure staff, patients and their families were kept safe. They were able to provide care to patients who were most in need and postponed the remaining families stay until the weather warning was lifted.

Information governance systems ensured confidentiality, with clear policies for the secure storage and appropriate retention or destruction of records. Information was accessible, accurate and timely, and was used to identify risks and drive continuous improvement through dashboards and regular reporting to senior leaders and the board.

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 closely with partners and the wider community to improve care and experiences for children, young people and families. Patients and staff had regular opportunities to meet with members of the provider’s senior leadership team and commissioners to share feedback and contribute to service improvement.

The provider had developed effective partnership roles with local services to strengthen joined‑up care. A liaison nurse working in partnership with the local hospital was in place. This role was designed to strengthen palliative care delivery across the acute, community, and hospice sectors within the local area. Partnership arrangements were clearly defined through job descriptions and governance structures.

Families were included in bereavement working groups to help shape and develop the bereavement offer.

Staff presented at regional network meetings and the medical team sat on national and regional groups relating to symptom‑management planning for perinatal and neonatal care and paediatric palliative care education. The Registered Manager co‑chaired the national Heads of Care/Leads network, and a Senior Team Leader played a significant role in the Neonatal Palliative Care Network, supporting education delivery and benchmarking.

We scored the service as 4. 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.

The service supported learning, improvement and new ways of working. Leaders were passionate about change being the right thing to do. Staff were given time and support to suggest ideas and make improvements, which led to positive changes in how care was provided. Staff also had opportunities to take part in research and innovation.

The service supported shared learning by delivering regular professional development days and multi‑agency palliative care study sessions for staff working across the local area. These events provided information about the hospice’s roles, services and referral processes, and included teaching on symptom management and advance care planning. This approach helped build local workforce capability and strengthened the wider system’s skills and knowledge in palliative and end‑of‑life care.

The provider developed new roles to support learning and improvement. a liaison role with the local hospital to strengthen palliative care delivery across the local area and a business case for a research role one day a week had been recently completed.

Families were also involved in learning and improvement. The service held bereavement events, remembrance services and sibling days, which helped shape care and ensured services remained compassionate and responsive. Families and children sat on staff interview panels and their feedback was used in recruitment decisions.

The service had developed a pilot project for a toddler group within a children’s hospice after determining a gap in the support for parents of children with complex care needs under 5 years old. Parent feedback had been used to develop the programme and staff were working to share this more widely across the UK to help meet this need.

There was an in house education team who offered support for staff and arranged site specific training. Staff were able to request specific training to meet their needs to feel confident in performing their competencies. The service had an annual 3 day closure for staff to focus on education and learning.