Southampton General Hospital

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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

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

We have not awarded this service a score for Well-led.

Find out about when we will not publish a key question score and what we look at when we assess Well-led.

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.

There was a transparent and open culture where staff could escalate concerns and report incidents. Staff reported that the palliative team was supportive and reported good team working.

The trust values were understood by staff and was based on patients first, working together and always improving. Staff demonstrated their understanding of the trust’s vision and values as they went about their work.

The palliative care team spoke passionately about the service they provided and were proud of the care they could offer to patients. They described the culture as positive with good working relationships with different wards and departments.

The trust had an end of life care strategy which set out how the trust would ensure the provision of high quality end of life care between 2025 and 2030. To increase awareness of the EOL strategy, the team planned to use their established link nurse programme to promote the strategy across clinical areas, supported by communications team, clinical leaders group, grand round and ward level engagement. So far, the team had delivered several teaching sessions and provided ward-based opportunities for learning. They also intended to assess familiarity with the strategy after six months by gathering feedback from staff, patients and families.

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 trust demonstrated compassionate and supportive leadership that promoted person-centred care, staff wellbeing and recognition of good practice. Staff delivering high-quality end-of-life and bereavement care were recognised through formal staff recognition schemes, and positive feedback from patients and families was routinely shared with teams to celebrate success, support morale and promote learning. Feedback consistently described staff as compassionate, responsive and supportive during difficult and emotionally distressing situations.

Leaders promoted a culture that prioritised personalised care and inclusivity. There was evidence of senior staff supporting teams to deliver highly individualised care, respond to cultural needs, facilitate family involvement and ensure patients’ wishes were respected. Examples included supporting patients to achieve important personal wishes at the end of life, enabling patients to spend time with loved ones in their preferred place of care and ensuring reasonable adjustments were made for those with complex communication or cognitive needs.

The trust had established arrangements to support leadership development and succession planning within end-of-life care services. Staff were provided with opportunities to develop leadership skills, confidence and expertise through champion networks, multidisciplinary forums, mentoring, bedside teaching and education programmes. These initiatives encouraged collaboration, supported professional development and helped build leadership capacity across clinical areas.

Leaders also demonstrated a commitment to service improvement and innovation. Clinical and operational leaders supported quality improvement initiatives aimed at strengthening communication, symptom management, care planning and patient experience. Staff were encouraged to identify opportunities for improvement and contribute to changes that enhanced the quality of end-of-life care.

There was evidence of visible leadership through engagement with frontline teams, ward visits, education sessions and involvement in the implementation of strategic priorities. Governance and improvement programmes were supported by senior clinical and nursing leaders, helping to maintain focus on service development, workforce support and continuous improvement.

The end of life care service and palliative care service was led by an interim chief nursing officer and a chief medical officer. Leaders within the service demonstrated effective leadership and worked across the trust to improve the care of patients at end of life.

All staff we spoke with reported the palliative care team to be visible, approachable and felt confident they could approach them about anything. Medical and nursing staff of all levels told us they had found the palliative care team to be responsive and accessible.

The end of life champions quarterly forum provided opportunities for registered nurses and healthcare support workers to develop their skills and leadership within end of life care. The forums were a mix of in person and online meetings aimed at all aspects of end of life care and there was a wide breadth of topics covered for example bereavement support, organ donation, research at end of life, management of symptoms. The palliative care team also supported a large number of medical and nursing undergraduate and post graduate learners to develop their knowledge and skills in palliative and end of life care. They held events as part of dying matters week which provided opportunities for staff to demonstrate and develop their leadership skills in interacting with staff members and the public.

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.

Staff had access to a freedom to speak up guardian who was available should staff wanted to raise any concerns. Staff were aware of who this was and told us they felt they could raise concerns without fear of reprisal. At the time of the inspection the trust reported they had not received any concerns from staff relating to end of life care for this financial year, the last concern being received in 2021.

Staff could also raise concerns through other routes, such as line managers and reported receiving good support from them.

Staff had access to the trust’s raising concerns whistleblowing policy and a freedom to speak up leaflet which contained information on how to speak up and what they could expect to happen after speaking up. Within the leaflet there was signposting to other external bodies if staff felt their concerns were not adequately addressed by the trust.

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.

At the time of the inspection, the trust was undertaking a trust wide work to strengthen arrangements for managing violence, aggression and abuse, supported by governance structures and executive oversight. These initiatives were designed to promote staff safety, wellbeing and psychological security across the organisation.

The trust promoted an inclusive and compassionate culture through staff recognition programmes and mechanisms that enabled patients and families to recognise exceptional care. Positive feedback was shared with teams to support staff morale, celebrate achievements and reinforce compassionate, person-centred care.

There was also evidence of inclusive approaches to caring for people with diverse communication, cultural, cognitive and emotional needs. Staff worked collaboratively to advocate for vulnerable groups, promote accessible communication and support equitable care, demonstrating a culture that valued diversity, inclusion and person-centred practice.

The trust had an inclusion and belonging strategy 2023-26 which was launched in 2023. Within the strategy there were five themes and each of these had a programme of work with measurable outcomes, enabling action to be taken to address inequality faced by protected groups.

The trust gave us some examples of outputs from their inclusion and belonging strategy. One of these was the Allyship programme which provided staff with an understanding on what allyship is in creating an inclusive culture, tools and examples of where allyship can be used in practice, and tools/resources to help people to speak up and stand up for each other.

The end of life care team was part of equality, diversity and inclusion steering group which held monthly meetings to support care group representatives in leading on change/improvements in their areas to increase conscious awareness of the topic of equality, diversity & inclusion.

The trust’s workforce race equality standard (WRES) results for 2025 showed performance against the majority of indicators had either improved or stayed the same. Staff who were from black, Asian or other diverse ethnicities represented 31.3% of the UHS workforce, this had increased year on year and was significantly higher than the NHS target of 19%.

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.

We found some inconsistencies in the completion of end-of-life care plans and DNACPR documentation, with some sections incomplete or lacking detailed rationale for decisions made. The trust had already recognised these areas as opportunities for improvement and had proactively identified the need to strengthen documentation practices.

At the time of inspection, the trust had implemented a range of measures to support and sustain improvements in end-of-life care. This included the continued rollout of individualised care plans, the development of electronic documentation systems, workforce development initiatives, and proactive palliative care review models. The trust was actively monitoring the effectiveness of these improvements through ongoing audit, evaluation, and multidisciplinary collaboration. Quality improvement activity was embedded within routine operational and governance processes, providing oversight and supporting the delivery of continuous improvements in the quality, consistency, and sustainability of end-of-life care.

Care pathways were not always joined up or responsive to people’s preferred place of care and death. Staff described delays in discharging patients to hospice care due to limited bed availability, which in some cases resulted in patients remaining in hospital and dying there despite plans for transfer. Trust data showed that, of 37 patients referred by the palliative care team for hospice admission, seven died while awaiting a hospice bed. While hospice capacity, fast-track funding and community equipment provision were outside the trust’s direct control, the trust was working collaboratively with system partners and the ICB to mitigate these delays and improve access to appropriate end-of-life care settings. This demonstrated awareness of the risks and a commitment to addressing system-wide barriers through joint working and oversight arrangements.

The trust had an established governance and assurance framework through its clinical accreditation scheme, which incorporated unannounced ward reviews, multidisciplinary assurance activities, patient feedback, documentation audits and matrons’ walkabouts to identify quality and safety themes. Findings were reviewed through formal governance structures, with themes, risks, actions and quality improvement activity monitored and reported to the quality governance steering group, providing oversight of performance and supporting continuous improvement across clinical services.

The cancer care group had a risk register which was reviewed at governance meetings. Currently, there were two risks which were specific to the provision of end-of-life care. One of the risks belonged to the supportive and palliative care services relating to current vacancies and how they posed a risk to the team’s ability to provide a 7 day service in line with national standards. Actions for these were in progress while the risk assessment was underway, with agreement to recruit an additional nurse.

The cancer care group had a business continuity plan which included end of life. The plan was last reviewed in February 2023 and was in the process of undergoing a complete review, led by the lead matron.

The trust had strengthened governance and organisational learning through a trust-wide morbidity and mortality improvement programme. This included the introduction of standardised review frameworks, multidisciplinary review processes and clear governance arrangements to support consistent oversight of mortality and morbidity reviews. A single trust-wide recording platform was implemented to capture learning, themes, actions and escalation outcomes, improving the monitoring of improvement activity and supporting sustainable organisational learning across services.

Additionally, the trust had established a range of governance and oversight mechanisms to support patient safety and continuous improvement. These included mortality surveillance processes, the patient safety incident investigation oversight group (PSIIOG), the deteriorating adult group, learning from death reviews, and thematic reviews of patient deterioration and safety incidents. Learning, themes and improvement actions were reviewed through governance structures and shared across the organisation, supporting oversight of risks, organisational learning and the sustainability of quality improvement activity.

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.

Staff worked together across clinical and support teams to meet individual patient wishes and preferences at the end of life. Examples included facilitating urgent personal wishes, supporting culturally sensitive care planning, enabling memory-making opportunities for families and ensuring care was tailored to the needs of people with complex communication, cognitive or emotional needs.

The trust also demonstrated a coordinated approach to discharge planning and continuity of care. Structured communication, escalation processes and collaborative planning across different systems and services helped support timely and safe transitions of care, reduce delays and ensure patients received appropriate support as their needs changed.

The palliative team worked closely with the local authority, hospices, GPs and other health and social care professionals to coordinate and deliver compassionate, person-centred support for patients approaching the end of life ensuring their comfort, dignity and individual wishes were prioritised.

The trust bereavement and family support team worked in partnership with different charities and community groups to support end of life patients and their families. They also collaborated at community events and worked with local education providers in providing volunteering opportunities for trainee counsellors to communicate with families in the acute stages of grief.

The palliative care team members attended multi-disciplinary meetings for patients who were in hospital or in the community, to support recognition of terminal phase and care planning.

Following feedback, the trust had collaborated with local registrars to develop a ‘weddings and civil partnership’ policy. Since its implementation, the palliative care team reported patients’ feedback as overwhelmingly positive. As a result, end-of-life weddings were now carried out efficiently, with compassion.

The evidence showed a good standard. The service focused on continuous learning, innovation and improvement across the organisation and local system.

There was a strong commitment to continuous learning, workforce development and reflective practice within end-of-life care. Staff were supported through end-of-life champion forums, reflective learning opportunities, multidisciplinary education sessions and bedside teaching. Learning activities covered a range of topics, including bereavement support, symptom management, organ donation and complex end-of-life care, helping staff develop their confidence, knowledge and leadership skills.

A trust-wide community of practice supported the sharing of learning and good practice across clinical areas. This encouraged collaboration, supported workforce development and succession planning, and provided opportunities for staff to learn from one another and spread innovation across services.

The trust had also invested in communication and decision-making education through structured teaching programmes and simulation-based learning. Training was provided to a range of professional groups and focused on supporting high-quality conversations about deterioration, end-of-life care and treatment decisions. Clinical guidance and educational resources were available to support consistent, evidence-based practice.

Learning and improvement were embedded within governance and assurance processes. Through structured review and accreditation activities, the trust identified themes, reviewed patient feedback and monitored quality indicators. Findings were used to inform improvement projects, action plans and ongoing monitoring, ensuring learning translated into service development and practice change.

The trust demonstrated a proactive approach to innovation and quality improvement. Examples included proactive palliative care review models, digital systems to support the identification of patients approaching the end of life, improvements to clinical documentation, enhanced patient and family information resources, and collaborative improvement initiatives designed to strengthen the quality and consistency of care.

The trust had recently introduced a series of matrons walkabouts in July 2025 with end of life care as a theme. The aim of this was to evaluate ward level knowledge around quality improvement measures, any barriers to the provision of good end of life care, staff confidence levels, awareness of trust support services, confidence in communicating with patients and families, and to seek suggestions for improvements. Results from these were used to help inform their education and training focus.

In addition to this, the clinical leads for end of life care were working on a quality improvement project regarding end of life care communication and were already engaging with staff to define resources required to support their development.

End of life champions were in place for most adult wards and liaised with the clinical practice educator and palliative care team in identifying how to meet staff’s learning and development needs.