Lewis-Manning Hospice Care

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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.

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 86 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The hospice had a clear strategy for the future incorporating a mission statement, vision and strategic goals for each area of the organisation’s provision.

Leaders supported staff to understand the vision of the hospice and services provided. The organisation had a clear vision which was based upon values of being patient-centred, kind, listening to what matters and accountability. Staff told us this included being able to spend one day each year volunteering in another area of the hospice. This provided opportunities for them to understand the organisation’s work more fully and connect with colleagues outside their immediate team. One member of staff described how this had formed part of their induction programme on joining the hospice enabling them to understand how teams could work together to achieve the organisation’s vision and get to know colleagues in other sectors. Opportunities to understand colleagues’ work and promote a shared direction was also observed in daily team meetings which staff told us they found valuable in understanding colleagues’ roles and responsibilities and building support.

Leaders and staff understood that working with other organisations to deliver patient care was key to their strategy. Staff described how they worked to fulfil this by collaborating with other organisations and raising awareness of hospice services. This helped fulfil the hospice’s vision of working collaboratively across Dorset to provide support for patients experiencing a life-limiting illness and their loved ones from the point of diagnosis. Staff showed commitment to this work and demonstrated pride in some of the connections they had been able to build with opportunities to bring hospice care closer to home for many patients. Staff understood the values of the organisation and described how listening to what matters to patients, and upholding their preferences and choices, influenced their work on a daily basis.

The hospice offered opportunities for team away days and conferences. For example, clinical leads had been able to meet away from the hospice to discuss current projects and how they could work collaboratively to achieve their aims. A volunteers’ conference had been scheduled providing an opportunity for the hospice’s large team of volunteers to learn about its plans for the future and meet the trustees for a question and answer session.

Minutes of the hospice’s People Committee, attended by the executive team and trustees, considered how the organisation could celebrate its staff and foster a culture of aspiration. We saw an example of how a volunteer had been nominated to represent the organisation at a Royal Garden Party at Buckingham Palace to recognise their outstanding contribution to the service for over 32 years. Meeting minutes demonstrated commitment from the executive team and trustees to continue to strengthen the organisation’s culture by ensuring elements of culture were embedded from the beginning of staff’s employment to affirm the organisation’s values and promote a shared direction from the outset.

A shared direction and culture was reflected in the last staff survey undertaken in May -June 2024 where 91% of staff agreed that they believed in the aims of the charity and felt proud to work for the organisation. The staff survey showed high levels of engagement from staff with a 87% response rate.

Leaders demonstrated they were capable, compassionate and inclusive, with a strong understanding of the hospice’s history, current position and future direction. They had a clear vision which considered developments within the wider healthcare system and national policy. This ensured the organisation was well positioned to respond proactively to change, challenges and opportunities.

Skills gaps were reviewed and trustees recruited based on their expertise, experience and ability to provide effective scrutiny and challenge. Recruitment checks followed a policy in line with national guidance to ensure suitability. Board members had a wide range of professional backgrounds including finance, marketing, health care, voluntary services, education, law and human resources. This promoted diversity of thought strengthening governance and oversight. Consideration was also given to innovative approaches, such as the potential for joint trusteeships with partner organisations, to further enhance collaboration and inclusivity.

Staff consistently described leaders as approachable and supportive. They told us they had regular contact with managers and felt confident in accessing support and advice when they needed it. Leaders demonstrated compassionparticularly when staff experienced personal challenges. Staff shared examples of leaders checking in on their wellbeing and facilitating compassionate leave where needed reflecting a caring approach to leadership.

Communication from leaders supported an inclusive and connected culture. The Chief Executive Officer maintained regular contact with staff through weekly communications providing updates, recognising contributions and sharing feedback. Staff had occasional opportunities to engage with trustees which reinforced that leaders took a genuine interest in their work and experience.

Evidence from committee meeting minutes demonstrated that leaders fostered a learning culture. When things went wrong, the focus was on learning and improvement rather than blame.

Leaders demonstrated a proactive approachanticipating the impact of new legislation and sector changes. They showed commitment to developing future leadership capabilitywithin the workforce with plans to identify gaps in skills and experience and provide additional training for line managers where required. This demonstrated an inclusive leadership style which would not only enable all staff to develop within their roles but also enable the organisation to adapt effectively to change.

The organisation promoted a freedom to speak up culture, supported by a clear policy that set out its commitment to an open and transparent environment. The policy emphasised the importance of staff being supported to raise concerns, with a focus on improving safety and learning.

Clear processes supported staff in raising concerns. The policy outlined the roles and responsibilities of both the executive team and staff including how concerns would be escalated and managed. Information about speaking up was visible across the hospice, with posters providing information and signposting staff to both internal contacts and external organisations for independent advice and support.

To strengthen independence and confidence in the process, a trustee had been appointed as the organisation’s Freedom to Speak Up Guardian. This provided staff with an alternative route to raise concerns outside of line management structures, supporting those who may feel uncomfortable escalating issues through usual channels. The independence of this role helped ensure concerns could be handled fairly.

Staff were aware how to raise concerns. They reported feeling able to approach their line manager or, if needed, members of the executive team. They felt line managers would listen and be responsive to concerns. This reflected a culture where staff could raise issues that mattered to them and receive support.

Governance structures provided oversight of speaking up. Freedom to Speak Up was a standing agenda item at People Committee meetings,ensuring concerns could be reviewed at executive level and result in appropriate learning. This demonstrated the leadership team’s commitment to maintaining an open culture focusing on improvement.

Leaders had embedded a positive and open culture where equality, diversity and inclusion (EDI) were promoted and valued. There were systems to ensure that people were not disadvantaged due to protected characteristics. For example, recruitment processes were designed to be fair and inclusive, reducing the risk of unintentional exclusion. The organisation monitored the diversity of applicants through governance arrangements, including oversight by the People Committee, to identify any potential gaps or inequalities and take action where needed. Equality impact assessments were routinely completed when policies were developed and reviewed, ensuring that organisational practices did not disadvantage any group.

The organisation actively promoted EDI both internally and externally. Social media was used to raise awareness of national campaigns, including those relating to LGBT+ and mental health, helping to foster an inclusive culture and demonstrate the organisation’s commitment to equality.

Staff received mandatory EDI training, which was supported by additional learning opportunities throughout the year. These included sessions on sign language and menopause awareness designed to support staff’s understanding of diverse needs and inclusive care delivery. At the time of our visit, the leadership team was planning additional training in neurodiversity and disability awareness by a user led youth group. This demonstrated a commitment to co-production and to amplifying the voices of people with lived experience. There were plans for this training to be delivered initially to staff, with potential future expansion to patients. This reflected the organisation’s commitment to develop not only their own workforce but to benefit the local community too.

Governance frameworks supported continuous improvement in EDI. The board and executive team regularly reviewed emerging legislation and guidance to ensure the organisation remained responsive and proactive. Meeting minutes from February 2026 evidenced senior leadership commitment to strengthening the EDI strategy. For example, leaders were considering how to respond to emerging government guidance on menopause despite it not being a legal requirement for organisations of their size. They recognised the guidance as good practice which aligned with their values. This proactive approach demonstrated that leaders prioritised staff wellbeing, inclusion and equality beyond compliance and were motivated to create a culture where staff felt valued and supported.

The hospice had established governance systems to ensure effective oversight of practice, decision making and organisational performance. There were clear meeting structures for the executive team to review performance and escalate relevant issues to the board for further scrutiny and assurance. Meeting agendas were systematically structured to minimise the risk of omission and supported discussion across key areas including organisational risk, financial performance and policy review. This supported leaders to maintain oversight and drive informed decision making.

There were processes to promote transparency and integrity at all levels of governance. Declarations of leaders’ interests and any conflicts were formally recorded at the beginning of each committee and board meeting, promoting openness and accountability in decision making.

While trustee oversight had been planned through annual provider visits, these had not taken place since February 2024. Regular trustee visits during ordinary working days would enhance existing governance arrangements by creating opportunities for them to directly engage with patients and staff, gaining insight into their experiences of care and day to day operations.

The organisation maintained a comprehensive risk register which effectively identified risks relating to safety, quality and sustainability. Risks were clearly identified, rated and supported by defined actions to mitigate impact. For example, we saw that following an incident, the organisation had notified the relevant regulatory body and accurately reflected the event within the risk register. This ensured that risks could be monitored and reviewed effectively.

There was evidence of effective financial governance and forward planning. Financial sustainability was regularly reviewed at board level, including consideration of the organisation’s current financial position and three year financial plan. This supported oversight of income generation, expenditure and opportunities for external funding. The board was provided with comprehensive information in meeting packs, enabling robust scrutiny and informed decision making about effective service delivery.

The hospice demonstrated a proactive approach to developing and sustaining partnerships that benefited people using the service and the wider community. Leaders had established numerous collaborative relationships with a range of partners, including commissioners, local NHS and independent healthcare providers, residential care services, primary care networks, higher education providers, bereavement networks and other hospices. These partnerships enabled shared learning, joint working and the development of new initiatives to better meet the needs of the local population. Discussions with leaders showed a strong commitment to working collaboratively, reflected in both planned and ongoing projects designed to improve care and support within the community.

Feedback from community partners demonstrated how much they valued their partnership with Lewis-Manning Hospice Care with opportunities to share facilities in the community and work together in delivering information, care and support. We observed how these relationships enabled shared learning with staff being invited to deliver presentations at a local university and take part in health promotion activities such as a lung health day at a local GP practice.

The organisation maintained strong links with its community and partners through a variety of engagement methods. This included the use of social media platforms to collaborate with other providers, contribute to shared campaigns and promote awareness of hospice services. The hospice took deliberate steps to ensure it remained visible and accessible within the community it served helping people to understand the support available to them.

Partnership working supported sustainable income generation and community involvement. The hospice worked with local organisations to plan fundraising initiatives and ensure continued provision of free specialist palliative and end of life care across home, hub and virtual settings. Community activities, such as annual remembrance events where people can dedicate a candle as part of a display of lights, provided meaningful opportunities for people to reflect and celebrate their loved ones strengthening community connections. Additional initiatives, including sponsored events and social activities, further promoted community engagement, awareness and inclusion.

The hospice demonstrated innovation in partnership working through integration of services to support people’s wellbeing. For example, collaboration with a local choir for people living with and beyond cancer led to the development of the Lewis-Manning Rising Voices Choir. This expanded access to the choir for people living with life-limiting illness and their families where people could build connections and benefit from the emotional and physical wellbeing of group singing.

The hospice demonstrated a strong culture of learning, continuous improvement and innovation. Leaders actively sought to develop knowledge and evidence based practice through established partnerships including a longstanding collaboration with a local university. This included providing scholarships, in partnership with a nursing grant giving charity, to support learners undertaking healthcare programmes. These opportunities enabled learners to gain high quality palliative care experience, apply their knowledge in practice and pursue careers in palliative care and older people’s medicine. This contributed to workforce development and the wider sustainability of specialist care services.

The organisation demonstrated commitment to research and innovation. Leaders had worked collaboratively with the university’s research team to develop a research proposal exploring the impact of community hospice interventions, particularly within residential care settings. This reflected their ambition to generate new knowledge to inform service development and influence commissioning decisions. The proposed research aligned with wider health and social care priorities, including reducing inequalities, strengthening community based provision and supporting preventative approaches to care. Leaders described how the hospice was already responding to these priorities through initiatives such as expansion of a virtual care programme, delivering services closer to home and partnership working to reduce gaps between services.

The hospice promoted learning and dissemination of best practice through academic links. Staff delivered teaching at a university and the hospice’s visiting professor of palliative care medicine delivered annual lectures in collaboration with the university to share expertise. At the time of the inspection, the organisation planned to strengthen links with higher education institutions by identifying ways to formalise partnerships and expand opportunities for student and staff involvement, including volunteering.

Services provided by the hospice demonstrated innovation in practice. Breathlessness and lymphoedema clinics offered specialist interventions that healthcare professionals reported would otherwise be unavailable for patients. These services addressed both physical and psychological needs and promoted a holistic approach. Feedback from both professionals and patients consistently identified the significant positive impact of these services on quality of life.

Quality improvement activity was embedded across the organisation and was informed by patient experience and feedback. For example, recognising that patients experiencing breathlessness often felt isolated, the hospice facilitated the development of a user led support group enabling peer support. Patient insight also informed the design of a structured four week breathlessness management programme incorporating elements such as values based discussions and mindfulness. Feedback showed that patients were able to better manage distressing symptoms as a result of this intervention. Similarly, the lymphoedema service had responded positively to gaps in provision by working collaboratively with a local provider to ensure inclusive access to information and support.

The hospice demonstrated commitment to learning and improvement for staff. While results from the 2024 staff survey showed that most staff felt encouraged by their employer to improve their wellbeing, leaders recognised opportunities for development. They had taken action to increase awareness of wellbeing support while continuing to review provision. Leaders also responded to feedback from the staff forum by introducing opportunities for staff to spend time in different parts of the organisation. This supported shared learning, improved understanding of roles and greater collaboration between services. Feedback received from staff indicated how successful this had been, inspiring them to think beyond their own team and learn from others.

The organisation actively engaged in national learning initiatives and used these to drive improvement. Participation in Dying Matters Week in 2025 had provided an opportunity for the hospice to lead a piece of work exploring cultural perspectives on death and bereavement. Learning from this project contributed to a published article in a professional journal, demonstrating how the organisation shared knowledge to influence practice. The hospice had also developed an external education programme to support learning and development for health and social care staff. This was designed to promote awareness of palliative care for staff working in different settings who could then go on to identify and refer patients for timely intervention.