Alexander Devine Children's Hospice Service

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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

At our last assessment we rated this key question as good. At this assessment the rating has remained the same. We found a supportive and inclusive service where staff felt valued, listened to and empowered, and reported improvements in the organisational culture. Leaders had recently introduced a strategy and vision and strengthened speaking-up arrangements through an independent Freedom to Speak Up service. They recognised the need to further develop the role and capability of Board of Trustees and had plans in place to achieve this. Operational leaders were passionate and visible, with effective governance and oversight systems supporting safe, high-quality care. There was a strong culture of learning, improvement and innovation, with staff actively developing new approaches to meet the changing needs of children and families.

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.

Clinical, therapy and care staff demonstrated a strong sense of purpose and pride in their work. There was a shared commitment to delivering compassionate care. They described being “Proud of the difference we do make for the families we support.” This supported compassionate care delivery even when under pressure.

Staff relationships were positive, with teams working collaboratively and supporting one another. The staff said they communicated and worked together well across inpatient, day care and community services. This supportive culture enabled effective and consistent service delivery. A family said, “It is a family wrap around service”.

The culture of the service was reported to have improved following a period of organisational change. Staff described that the atmosphere had much improved and this had contributed to a more supportive and cohesive working culture.

Staff reported that leaders were accessible and visible, contributing to a culture of openness. Staff also said engagement was improving, as leaders were “leaning into the teams’ expertise. It feels a change.” However, some staff told us that they felt separate and not integrated. There were also examples where staff experienced uncertainty in how feedback was received, which impacted confidence. While many staff felt supported, this was not consistently experienced across all roles.

The service had recently published the new 2-year Hummingbird strategy. This outlined the vision and aims, strategic priorities, goals for delivering the strategy, and the expected outcome and impact. The strategy was supported by an operational plan which ensured safe and effective care as the service was expanded, a Communications Operations Plan 2025/26 to support the implementation of strategic aims and a Quality Improvement Plan. The service had commissioned mentoring and board development to strengthen leadership, roles and processes.

Leaders were described as knowing the children and families well and maintaining visibility within the service. Staff described leaders as caring and invested in the purpose of the hospice. Compassion was seen in care delivery and how leaders spoke about families, bereavement and the emotional impact of the delivering the service. Leaders consistently showed a strong commitment to providing compassionate, high‑quality care to children and families. Their focus on the lived experience of families was understood and shared across the workforce.

Emotional demands of the providing the service were acknowledged across the service, and leaders encouraged reflective practice and openness. Staff described leaders as approachable, supportive and as having an “open door” approach rather than operating at a distance. Leaders promoted regular supervision, wellbeing conversations, counselling and emotional support, helping staff feel valued and able to continue caring roles.

Leaders also promoted inclusivity by providing reasonable adjustments for staff to enable them to succeed in training. Leaders also encouraged open communication and supporting staff to speak up. Staff described a culture where “People come in to talk easily.”

Leaders demonstrated strong commitment and dedication; however, staff recognised there was recognition of capacity pressures within the senior leadership team. A period of change and transition had placed additional pressure on leadership roles. Staff acknowledged leaders were working exceptionally hard during challenging periods. Staff said Leaders had been very stretched.

There was evidence that leadership had contributed to improvements in organisational culture. Staff noted positive changes, describing that “Since last month the atmosphere is much improved.” This indicated that leadership actions were beginning to have a beneficial impact on staff experience and team cohesion.

Some staff expressed concerns about consistency of leadership approach across teams, with some staff experiencing less engagement and support than others. These variations meant that leadership was not experienced equally across the service. Despite these challenges, leaders demonstrated a clear commitment to improvement by being visible and accessible, combined with a willingness to listen and support positive change.

Staff raised concerns informally and described a supportive environment. They said, “Someone will escalate to the team leader if they have a concern.” Staff discussed incidents, near misses and risks openly during meetings and handovers. Learning from concerns and incidents was shared across teams. Staff felt supported to raise concerns about safety, quality and wellbeing, including concerns related to their own emotional capacity. Leaders supported Duty of Candour principles and described being open and honest with families when things went wrong.

Staff said they generally felt psychologically safe and supported to speak up. Regular supervision, one‑to‑one meetings and team meetings provided opportunities for reflection and discussion, and wellbeing was routinely considered, particularly following distressing events. However, during a period of organisational change, some staff felt uncertain about how feedback would be received.

While most staff felt confident to raise concerns, the service had recognised it should have a formal Freedom to Speak up service in place. They had recently commissioned a local NHS Trust to provide the Freedom to Speak up service which was being implemented and had yet to embed across the hospice.

There was a shared understanding that inclusive practice supported both workforce wellbeing and improved experiences for children and families. Staff said, “People are treated as individuals here and with respect.” The service demonstrated awareness of the importance of diversity and inclusion within both workforce development and service delivery. The service made adjustments in the simulation training to enable neurodivergent staff to succeed. This demonstrated a proactive approach to recognising individual needs and reducing barriers to participation and access.

Training and awareness around learning disability, autism and inclusive practice were being strengthened across the organisation. This supported staff to understand diverse needs within both the workforce and the population served. Leaders had begun rolling out relevant awareness sessions, reflecting a commitment to reducing inequalities and improving inclusive practice. Staff described training as helpful in understanding differences and supporting respectful interactions.

Leaders 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.

Most staff reported feeling respected and valued regardless of role, background or personal characteristics. Reasonable adjustments were made to support staff health and wellbeing where needed, and managers described making accommodations to help staff thrive in their roles. Leaders were described as addressing disrespectful behaviour promptly when identified. Staff felt confident raising concerns related to fairness or inclusion.

Governance arrangements supported partnership working with external organisations, including NHS services and another children’s hospice. Shared governance arrangements enabled continuity of care and clarity of responsibility. Leaders maintained oversight of shared care arrangements to reduce duplication and manage risk across organisational boundaries.

Governance systems were in place to provide oversight of quality, safety and operational performance. Leaders demonstrated knowledge of key risks affecting the service and took steps to mitigate these. There was evidence of structured governance processes, including incident reporting. Learning was shared through team meetings and governance forums, supporting improvement in practice. Staff understood the importance of governance in supporting safe care. The service recognised that regular and systematic audit activity could be improved and had an action plan in place to address this.

Managers were closely involved in the operational delivery of services and had a detailed understanding of pressures affecting staffing, capacity and care provision. Senior staff were accessible and responsive, enabling timely decision‑making. This supported safe service delivery during periods of increased demand or complexity. However, leaders acknowledged that the senior management team was operating with limited capacity, which at times placed pressure on the consistency of oversight.

Risks were identified through incident reporting, audits and staff feedback. Mitigations were put in place, and learning was shared. There was evidence that risks were managed proactively rather than reactively. Environmental, staffing and clinical risks were recognised and escalated appropriately. Operational risks were well understood by leaders, and the service recognised that not all risks were consistently escalated or reviewed by the Board of Trustees. The service had a Board development plan in place to address this.

There was limited evidence of a fully embedded Board Reporting Framework that consistently captured all strategic risks. Some governance information remained operationally focused and was not always escalated to the Trustees. Although the service had recently published the Hummingbird Strategy, capacity constraints affected the leadership’s ability to undertake strategic leadership alongside day‑to‑day management. The service recognised this and the Chief Executive had decided to step down from the Board of Trustees, to focus on service leadership. The service also had Board development plan, Trustee and Chief Executive mentoring and an action plan in place to address the identified development needs.

Leaders demonstrated a clear understanding of financial pressures and the importance of sustainability. Decisions about service delivery, staffing and capacity were made with safety and quality as priorities. Directors had oversight of financial management and compliance with charity governance requirements. Finance staff were described as accessible and supportive to the wider organisation. Staff understood that financial constraints affected service capacity. One staff member told us, “Everyone knows funding is tight, but safety always comes first.”

Recruitment and retention challenges required adaptations to service delivery, including reduced availability of some respite and inpatient services. Leaders took steps to mitigate these risks through targeted recruitment, training and flexible rota management. The use of substantive staff and an internal bank supported continuity. Despite these efforts, staff described feeling stretched at times due to capacity pressures.

The leadership team recognised where they needed to make improvements and had action plans in place to develop their capabilities and practice to deliver.

The service actively developed and maintained strong partnerships with external organisations to support children, families and service sustainability. Partnership working was described by staff and leaders as a strength of the service. The service worked closely with NHS community paediatric teams, children’s community nursing services, GPs, hospitals and another children’s hospice. These partnerships enabled continuity of care and timely access to specialist support.

Partnership arrangements supported continuity and quality of care, particularly for children with complex needs or those approaching end of life. Shared care agreements and joint working ensured clarity about roles and responsibilities. For example, we found that the Transition Lead worked in partnership with a local adult hospice to facilitate seamless transition between services.

Regular communication with partner organisations supported safe decision‑making and reduced duplication. Families said that they experienced the positive impact of this joined‑up working directly especially during stressful times for their family.

The service was well supported by the local community. Volunteers played an important role across clinical support, family activities and fundraising. The Gardening Club looked after the hospice’s gardens.

Relationships with local faith leaders supported culturally sensitive end‑of‑life care, including rapid certification of death where required. The service had developed a service in partnership with the Director of the Out of Hours GP services to facilitate the timely burial of Muslim children in line with faith traditions.

The service engaged with external networks, including other children’s hospices and professional groups, to share learning and good practice. This supported service development and professional learning. Staff described benefiting from shared training opportunities and exposure to different models of care through partnership working.

Leaders recognised partnership and community engagement as essential to the long‑term sustainability of the hospice. Financial sustainability relied significantly on community fundraising, volunteering and corporate support. Leaders demonstrated awareness of this dependency and valued the role of community connections in maintaining services.

Leaders and staff described a culture where learning was encouraged, promoted and valued. Staff felt able to reflect on practice, share learning and identify opportunities for improvement. Learning from incidents, near misses and feedback was discussed openly in meetings and supervision. Staff described learning as part of everyday practice.

Learning and innovation improved practice for children with similar needs and team working. Staff described adapting care creatively to meet complex needs, including joint working between disciplines and flexible use of resources.

Feedback from families was also used to inform improvement. Leaders and staff gave examples of changes made in response to family views, such as adapting service offers or introducing new support opportunities. Examples included combining therapeutic approaches to enable children to actively participate, adapting service delivery in response to changing family needs, providing family orientated and therapeutic activities for supported children at the same time, the outdoor play area designed for children of all abilities and the development of the bereavement cafe. Families said they liked this flexibility for their children and family.

Leaders demonstrated commitment to learning and improvement, even during periods of staffing and operational pressure. Staff described leaders as open to ideas and supportive of reflective discussion. However, leaders acknowledged that workload and capacity pressures limited time available for structured improvement work and innovation.

The service engaged with external networks to share learning and improve practice. For example, the education lead and Transition Lead presented a poster at a national conference.