Marie Curie Hospice and Community Services Midlands Region

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 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 as outstanding. At this assessment the rating has remained outstanding. This meant service leadership was exceptional and distinctive.

We assessed 6 quality statements within well led. The service had a very clear shared vision, strategy and culture. Leaders had the skills, knowledge, experience and credibility to lead effectively. They always did so with integrity, openness and honesty. Leaders fostered a positive culture where people knew they could speak up and their voice would be heard. Leaders, managers and staff strove for excellence through collaboration and shared practice. Leaders and the service culture they created drove and improved high-quality, person-centred care. The service had a strong focus on continuous learning, innovation and improvement across the organisation and local system.

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.

The service had a very 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.

There was a shared direction for the service. The service had strategies which had been developed in line with the Marie Curie strategy.The service’s vision statement was ‘Everyone will be affected by dying, death and bereavement and deserves the best possible end of life experience, reflecting what is most important to them. Marie Curie will lead in end-of-life experience to make this happen’.

To achieve their vision, they developed the following 3 strategic goals for 2025/26:

Goal 1: Grow their influence, scale and impact.

Goal 2: Deliver more vital care and support.

Goal 3: Build operational and financial resilience.

The vision and values of the service was clear,person-centred and included honesty, involvement, compassion, dignity, independence, respect, equality and safety. Managers and leaders led by example and monitored practice against the values.

The service’s vision, mission and strategic goals informed their priorities and objectives, which in turn informed their annual business plan and fed into directorate,team and individual objectives. This meant they could collectively see how individuals, teams and organisational actions contributed to their overall aspiration.

The service’s mission for the next 5 years was to close the gap in vital end-of-life care.Between now and 2028 the service intended to design and deliver services providing the best possible care and support to people living with any terminal illness, and those close to them. The mission was to play a leading role in shaping the end-of-life system across the UK; driving research, influencing public policy, campaigning for change, and fighting for better services to ensure everyone had access to the end-of-life care and support they needed.

The quality of care was dependent on three key priorities which included patient safety, experience of care and support, and clinical effectiveness. Between 2024 and 2025, they identified specific goals related to them, including strengthening the development and support of their nursing and volunteer workforce; integrating a safe staffing policy and enhanced career development framework; improving compassionate engagement and involvement of patients, families and staff.They were on track to achieve these goals by 2028.

Staff knew and understood the service’s vision and values and how they were applied in the work of their team.Leaders ensured staff in all areas understood the vision and strategy and supported the vision, values and strategic goals and how their role helped in achieving them.Staff we spoke with were aware of the vision and strategy.

Staff felt respected, supported, and valued. They were focused on the needs of patients receiving care and worked well together to ensure they achieved good outcomes for patients. All staff we spoke with said they were positive and proud to work in the organisation.

There were comprehensive and successful leadership strategies in place to ensure and sustain service delivery, and to develop the desired culture. There were processes in place to ensure the vision, direction, and culture of the organisation were embedded, through a comprehensive organisational induction, mandatory training, and ongoing individual and team support.

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.There were clear and effective structures, processes and systems of accountability to support the delivery of the service.

Leaders had the skills, knowledge and experience to perform their roles.Staff felt supported and guided by their leadership team.The service had a senior leadership structure which included ahead of operations, quality and clinical practice, hospice leads and a medical director who led the service.The service had 3 clinical leads which entailed a community, hospice and a family support clinical lead.The leaders were available when they were needed and led by example.

Staff told us their managers led with openness, and honesty.They ensured the organisational vision was delivered and risks were professionally managed.Leaders were knowledgeable about issues and priorities for the quality of services and could access appropriate support and development in their role. They were aware of their own limitations and could access support and independent scrutiny when required.

Staff and patients we spoke with told us that the leadership team were visible and approachable within the service, and they felt comfortable to raise any concerns. Staff within the community teams working as lone workers and at night told us there was always a member of the senior leadership team available through the on-call system.

The service had a nominated corporate Caldicott guardian. The head of operations,quality and clinical practice was the onsite Caldicott guardian. A Caldicott guardian is a senior person responsible for protecting the confidentiality of people's health and care information and making sure it was used properly.

Comprehensive and successful leadership strategies were in place to ensure and sustain delivery and to develop the desired culture.Sharing information and values helped them all to understand the vision of the organisation. They gave direction and encouragement to their staff and were inclusive and supportive, staff were listened to. Leaders supported and encouraged them to deliver excellence every day.

Managers and leaders understood the requirements made by CQC. They kept up to date with all relevant statutory notifications and changes and communicated these effectively to their team.Managers ensured staff consistently submitted data and notifications to the CQC and external organisations as required.

We scored the service as 3. 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.

Managers and staff had access to the feedback from patients, carers and staff and used it to make improvements. The staff survey results of November 2024 showed managers provided staff with the support they needed to complete their work. This was evident in the score of 8.9,which was better than the Marie Curie national benchmark of 8.4.

Through stakeholder engagement, including all groups who faced additional barriers to speaking up, there were plans to develop a Marie Curie Freedom To Speak Up (FTSU) strategy and implementation plan which was reflective of a four nations approach. To enable this strategy and further progress their work, they appointed a dedicated FTSU guardian. This meant staff were able to raise concerns without fear of detriment.

The service employed 4 FTSU guardians. They advised staff that if concerned, they should firstly speak to their line manager. If unable to do this, they could speak to one of the FTSU champions who would take the appropriate steps to support staff concern.

Leaders had an open culture, free from reproach and actively encouraged staff to raise any issues or concerns with the FTSU service. Staff we spoke with were aware of how to raise concerns and knew who the FTSU guardians were.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

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 act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

There were clear and effective structures, processes and systems of accountability to support the delivery of the service. The service had a meeting structure in place which gave senior leaders and managers regular opportunities to discuss operational issues and performance.Governance meeting minutes of April, May and June 2025 showed staff monitored the total number of patients falls, pressure damage and medicines incidents.

The voice of people who used services was represented in governance and decision-making structures at appropriate levels.The governance system monitored the quality of care provided, patient feedback, staff performance and changes to best practice guidance. Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet,discuss and learn from the performance of the service. Staff undertook or participated in local clinical audits. The audits were sufficient to provide assurance and staff acted on the results when needed.

Leaders used effective governance processes to monitor risks and outcomes, and to drive improvement. Leaders took a proportionate approach to managing risk that allowed them to assess new and innovative ideas. The risk register for the hospice set out key risks as well as actions and mitigations.

Leaders shared updates and learning with staff through a range of communications. Policies and procedures reflected this and leaders benchmarked the hospice’s performance against other services to help measure outcomes of care and treatment.

The service had plans for emergencies. For example, a business continuity plan had been developed to ensure contingencies were in place in the event of a major incident which disrupted critical processes within caring services, including the partial or full evacuation of a hospice and the partial or full closure of community services.

Information held about patients was secure and protected. There were arrangements for the availability, integrity and confidentiality of data,records and data management systems.

The provider aimed to close the gap in palliative and end of life care through growth and transforming their direct care and support, delivering more practical information and support and lead in shaping the end-of-life care system.

The service had a risk register which had 3 risks and demonstrated appropriate identification and recording of risks associated with clinical areas.The risk register evidenced clear ownership of mitigating actions and dates that risk registers were reviewed.The risks included being unable to recruit a full-time physiotherapist,unpredictability of staff sickness and continued long term sickness in specific teams and financial sustainability across all Midlands services.

The service used the Patient Safety Incident Response Framework (PSIRF). The PSIRF policy supported the requirement of PSIRF and the Marie Curie approach to developing,maintaining, effective, compassionate systems and processes. One of the principles of the PSIRF is to do fewer “investigations” but to do them better. Better means taking the time to conduct systems-based investigations by people that have been trained to do them.

Marie Curie Midlands had a 5-year plan with priorities from 2025-2026.They aimed to establish a robust quality assurance framework across the organisation,improve systems and processes to ensure all feedback from those who used their services, their loved ones, the public and their staff made a difference to how they shaped their services.

The service clearly understood and carried out their duty to collaborate and work in partnership, and services worked seamlessly for people. Staff always shared information and learning with partners and collaborate for improvement.

Patients and staff could meet with members of the provider’s senior leadership team and commissioners to give feedback.The hospice had a focus on delivering care in a way that supported patients’ care pathways.

Leaders, managers and staff strove for excellence through collaboration and shared practice.Leaders invested in developing diverse networks at local and national level.

Staff and leaders worked in partnership with neighbouring organisations to support care provision, service development and joined-up care.Partnerships supported leaders to identify innovative ways of working and priorities. Effective and creative changes were made in response to better meet the needs of local patients.

The service had strong external relationships that supported improvement and innovation.

Marie Curie hospice had a clear focus on quality of life for patients. We saw examples where collaborations with NHS and other providers worked to improve patient outcomes. This included work to support breathlessness and fatigue.In collaboration with the local NHS trust, the hospital companion service model was established to improve the experience of caring for people at end of life in hospitals.

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 contributed to safe, effective practice and research.

There were processes to ensure that learning happened when things went wrong, and from examples of good practice.Leaders encourage reflection and collective problem-solving.Staff learnt from incidents. Clinical staff attended regular clinical meetings where they had in depth discussions about what went wrong and what could have been done differently. They held round table meetings to discuss and learn from serious incidents. Information from these meetings was cascaded to all staff.

The service monitored themes and trends that were relevant to them, the patients they supported, and the service they provided. Action plans were formulated to address any issues or concerns, this drove improvement, promoted innovation, and enhanced knowledge and learning. The service completed audits and clinical audits, which were evidence based and measurable.

Leaders encouraged staff to speak up with ideas for improvement and innovation and actively invested time to listen and engage. There was a keen sense of trust between leadership and staff.For example,Marie Curie hospice offered ‘Schwartz rounds’which provided a structured,confidential forum where all clinical and non-clinical staff met regularly to discuss emotional and social aspects of working in healthcare. The purpose of Schwartz rounds was to understand challenges and rewards that were integral parts of providing care rather than to solve problems or focus on the clinical aspects of patient care.

The service’s support and well-being hub provided patients a range of specialised support groups and wellbeing activities that supported a range of diagnoses including Motor Neurone disease to groups specialising in Fatigue anxiety and breathlessness.

Marie Curie had created a career development and progression framework which consisted of a self-assessment tool and a personal development plan.The aim was to monitor progress and aid implementation. Clinical facilitators were tasked with evaluating learning processes and making rapid adaptations where possible to improve user experience of the framework.