King's Mill Hospital

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

The trust had a set of values which staff were aware of. Staff spoke well of their managers and told us they received good support and we observed good working relationships.  

There were clear governance and risk management strategies and leaders and staff strived for continuous learning including participating in research projects 

Leaders and staff had a formal written shared vision or strategy. The team understood and discussed a vision based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. Staff understood their roles and responsibilities. At our last inspection we rated this key question as good. At this inspection, the rating remained good. 

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 of care. The service had a vision, and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They understood the challenges and the needs of people and their communities. 

The service had a vision for end of life care focused on ensuring patients experienced a peaceful death, with dignity, choice and care that reflected their wishes and preferences. Leaders and staff shared a commitment to delivering high-quality, person-centred care and continuously improving services through learning, feedback and quality improvement initiatives. For example, we saw an aim as part of the end of life care vision for all nurses to hold a valid competency for syringe driver pumps. The end of life care team champions were working towards achieving this aim.  

Staff spoke passionately about end of life care and demonstrated a strong commitment to improving outcomes and experiences for patients and those important to them. Leaders used learning from deaths, governance processes and regular feedback to drive improvement and support ward teams to deliver high-quality care. 

The service promoted an open, inclusive and compassionate culture. Staff told us they felt respected, valued and supported in their roles and described leaders as visible, approachable and committed to providing high-quality care. Staff across all disciplines remained focused on meeting the needs of patients and families and spoke positively about the support they received from colleagues and leaders. 

There was a strong culture of teamwork across the service. Staff consistently spoke highly of their colleagues and described positive working relationships across professional groups. During our inspection, we observed respectful interactions between staff and a shared focus on delivering the best possible care for patients and families. 

Staff understood the service’s vision and demonstrated it in their day-to-day practice. We observed staff working collaboratively, treating one another with respect and maintaining a clear focus on providing compassionate end of life care. 

The service encouraged feedback from staff, patients and families. Staff felt able to raise concerns, suggest improvements and speak up about safety and wellbeing without fear. Leaders used staff survey results and other feedback mechanisms to identify opportunities for improvement and develop actions in response. 

Patients and relatives also described a positive culture and told us staff listened to them and responded to their concerns. Throughout our inspection, we saw a workforce that was motivated, engaged and proud of the care it provided. Staff consistently demonstrated compassion, professionalism and a shared commitment to ensuring patients and families received high-quality end of life care. 

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 end of life care service had leaders that were suitably skilled, experienced, and committed to delivering high-quality, compassionate end of life care 

There were systems to support leadership development and succession planning. Staff were encouraged to develop their skills and take on additional responsibilities, and leaders supported progression through training, mentoring, and development opportunities. 

Leaders demonstrated a good understanding of the challenges facing the service, including workforce pressures, and increasing demand. They were able to describe how they prioritised issues, managed risk and responded to emerging concerns. Leaders were keen to hear and respond to staff needs to improve their working lives and patient care. Wider staff groups could contribute to end of life care surveys to provide ideas for improvement. Staff forums had been introduced as a safe space for staff to talk about experiences in end of life care whether personal or professional. 

Leadership teams were visible and approachable. Staff told us they saw senior leaders regularly and felt able to speak with them. Leaders engaged with staff through walk rounds, meetings, and informal conversations, and actively listened to their views and concerns. 

The trust had a recruitment processes and ongoing checks to ensure end of life care leaders were competent in their roles. 

The service fostered a positive culture where most people felt they could speak up and their voice would be heard.  

Managers and most staff understood the importance of staff being able to raise concerns without fear of retribution. The trust had policies on speaking up, raising concerns and whistleblowing.  

The trust had had 1 freedom to speak up guardian (FTSUG) and 9 FTSU champions across all the hospital sites. Staff were aware of the FTSU guardian role and details of what FTSU was, and who to contact. 

Staff who we spoke to told us the culture within the service supported them to speak up and report any issues or concerns to their managers. Staff told us they felt confident to escalate matters if they felt their concerns were not being responded to. 

The end of life care champions had created a survey in 2025 for wider staff to feedback how helpful the champions were in enabling staff to deliver high-quality end of life care. The survey was made anonymous after feedback that some staff did not feel able to share negative feedback. However, the survey still had a very small response rate indicating that not all staff had shared their views.  

Staff had access to the freedom to speak up policy which provided information on how to speak up and what to expect to happen during the process. 

When concerns were raised, staff told us they felt assured that managers investigated sensitively and confidentially, and lessons were always shared with them and acted on.  

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. 

Leaders supported flexible working arrangements for the wider staff group where possible and considered individual circumstances when agreeing working patterns. Staff told us managers were approachable and made reasonable adjustments to support health needs, caring responsibilities and personal circumstances. This helped staff balance their work and personal commitments. 

The trust had policies and processes in place to promote equality, diversity and inclusion. Recruitment processes focused on candidates’ ability to undertake the role and included measures to support fair and equitable recruitment practices. Recruitment packs included equal opportunities monitoring information to help the trust understand and monitor the diversity of applicants. 

The trust monitored workforce diversity through workforce equality data and reviewed information from the Workforce Race Equality Standard and Workforce Disability Equality Standard to identify opportunities for improvement. Leaders used this information to understand workforce experiences and support the development of a fair and inclusive workplace. 

The trust also provided staff networks, including disability, ethnic minority and LGBTQ+ networks. Staff told us these groups provided opportunities for support, engagement and shared learning and helped promote an inclusive culture across the organisation. 

The hospital provided facilities that supported the diverse needs of staff, patients and visitors, including a multi-faith room that was available to people of all faiths and none. 

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 clear governance arrangements that supported the delivery of safe and effective end of life care. Staff understood their roles and responsibilities and knew how information, risks and concerns were escalated through the governance structure to senior leaders and the trust board. 

Leaders operated effective governance processes across the service and worked collaboratively with other teams and partner organisations. The EOLC team provided strategic direction and visible professional leadership within the organisation with regards to end of life care services. Staff within the team understood their accountability and had access to the information they needed to support patient care and decision-making. 

The trust had systems and processes to identify, assess, monitor and mitigate risks relating to the health, safety and welfare of patients and others. Leaders monitored risks through established governance forums and used information from incidents, complaints, audits and performance data to support continuous improvement. 

The end of life care team formed part of the ‘Clinical Support, Therapies and Outpatients Division’ within the department for end of life, spiritual and support services. The end of life care team collaborated with the division to hold monthly governance meetings.  Meetings were open to all team members, supporting transparency and staff engagement.  

Wider trust governance staff reviewed incidents, complaints, training compliance, safety issues, governance reports and progress against agreed actions.  

End of life care champions met every three months and discussed complaints, concerns and emerging themes. The champions also undertook audits across a range of settings, such as ReSPECT plan audits, to ensure consistency of quality in different areas in the hospital. Champions shared learning with ward teams to support service improvement and ensure learning was embedded into practice. 

Staff told us they felt able to attend governance meetings and contribute to discussions. Leaders and staff were clear about governance arrangements and understood who they were accountable to within the organisation. 

Ward teams held daily safety huddles following nursing handovers to discuss risks, patient needs and operational issues. These meetings helped ensure staff remained informed about current concerns and supported effective communication between teams. 

Risk management processes were effective. We reviewed the risk register and found the identified risks reflected the challenges and priorities of the end of life care service. Risks were monitored and reviewed through governance processes. Although the service did not maintain a separate risk register for the hospital site, the shared end of life care risk register covered both hospital locations and reflected relevant service risks. 

Leaders held regular governance meetings to review performance, risks, incidents, complaints and quality measures. They used this information to monitor service performance and identify opportunities for improvement. 

The service maintained appropriate arrangements for the management, security and confidentiality of information. Staff stored patient records securely, and leaders used data and information systems effectively to monitor quality, support decision-making and improve patient care. 

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 understood their duty to collaborate and work in partnership, so that services worked well for patients.  

Internally within the trust, the end of life care team worked with other departments to work towards improving patients’ experiences. For example, the end of life care team had undertaken consultation with consultants working within the Emergency Department to make sure patients at the end of their life had their initial priorities completed in line with national best practice and the trust vision for end of life care. The chaplain was part of the multi-disciplinary team who worked in end of life care and supported patients, families and staff as required. We saw collaborative working at the multidisciplinary meetings we attended between the local authority’s social care teams and the service. 

Externally, the service was part of the ‘End-of-Life Care Together Alliance’ which included Sherwood Forest NHS Foundation Trust, a local mental health trust which delivered community health services, several local hospices, primary care services such as GPs and bereavement counselling services. The alliance was working towards an end of life care together hub project with an aim to fast track patients between services to enable improved end of life care.  

More generally, the service shared information and learning with partners and collaborated for improvement. Service leaders engaged regularly with the Integrated Care Board, local authorities, neighbouring NHS trusts, and adult social care providers. These relationships supported services for patients at the end of their life, both within and outside of the hospital.  

The EOLC team followed the Nottingham and Nottinghamshire Integrated care system end of life care clinical and community services strategy. This aims to integrate health and social care for holistic support, focusing on proactive, person-centred care closer to home, emphasising early recognition, sensitive communication, shared decision-making, and support for patients and families 

The evidence showed an outstanding standard. The service focused on continuous learning, innovation, and improvement across the organisation and local system. They 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 trust demonstrated a commitment to learning and improvement. Leaders encouraged staff to develop their knowledge, share learning and contribute to service development. Staff consistently described a positive learning culture and demonstrated a commitment to improving the quality of care and experience for patients and families. The end of life care team had all completed training in quality improvement, service improvement and redesign.  

The end of life team worked with external organisations to promote improvement and innovation. For example, the team were part of the Nottinghamshire end of life programme board which had reviewed and updated documentation in March 2026 for staff working within this area of care across the county; ‘The Nottingham and Nottinghamshire Adult Guidelines for Care in the Last Year of Life - A Guide for Professionals’.  

The end of life team were part of the North Nottinghamshire End of Life Care Together Alliance which had created an integrated end of life hub team whereby discharge staff within the hospital processed referrals to support more patients to die in their preferred place. This had started very recently at the time of our inspection and was supporting a quicker transition for patients to the most suitable location for them and their loved ones, including to areas outside of the local county.  

We saw that the end of life care team were nominated for awards due to their commitment to development and quality improvement. For example, the end of life care team were finalists in the 2025 trust Staff Excellence Awards in the ‘Most Improved Team Award’ category, they were finalists in the national Palliative and EOLC Awards in 2025.  

Staff actively engaged in learning opportunities and professional development. They were encouraged to attend multidisciplinary team meetings to enhance their understanding of end of life care, treatment options and best practice. Staff told us the service supported continuing professional development through specialist training, leadership development and further academic study where appropriate. 

The Learning from Deaths Committee met monthly and reported to both the Patient Safety Committee and to the trust board on a quarterly basis. Staff reviewed learning from deaths, monitored actions and shared findings across the organisation to improve care and patient outcomes. Learning and actions relating to end of life care were shared by the end of life care champions through newsletters, visits to wards and training events.  

Leaders encouraged staff to participate in quality improvement activities and valued their contributions. Staff felt able to suggest ideas for improvement and told us their views were listened to and acted upon.  

Staff demonstrated pride in the care they provided and could describe examples where attention to detail had improved patients’ comfort, dignity and experience. This reflected a culture that recognised the importance of both clinical excellence and compassionate care. 

Staff consistently demonstrated innovative and flexible approaches to care. They adapted services to help patients achieve personal goals, maintain important relationships and create meaningful memories with loved ones. Staff felt empowered to find creative solutions to individual needs and routinely worked beyond traditional care pathways to ensure care reflected what mattered most to patients and families. 

The service used audit activity to identify opportunities for improvement and monitor the quality of care. At the time of our inspection, the annual ReSPECT development group had completed a trust-wide audit of ReSPECT documentation, including the quality of care planning and completion of mental capacity assessments for patients being discharged from the trust. The audit reviewed 79 patient records across 15 wards and clinical areas and involved doctors, nurses and members of the end of life care team. 

We saw other examples of audits to identify ways to improve care for patients at the end of their life such as an audit into adult deaths within 48 hours of arrival to the emergency department at King's Mill Hospital. However, this audit was from data gathered from January to March 2025. This audit was due to be repeated however a repeat date had not been decided at the time of our inspection.  

Leaders used the findings from audits to identify areas for improvement and develop action plans. The audit demonstrated good compliance in some areas, including the accessibility of ReSPECT documentation within patient records. The trust had also identified areas requiring further improvement and had developed actions to strengthen documentation and support consistent practice across services. 

Staff in critical care developed an innovative follow-up support programme for bereaved families aimed at reducing psychological distress and the risk of post-traumatic stress disorder (PTSD) following the death of a loved one. The team used validated self-reported outcome measures before and after support interventions to evaluate their impact on family wellbeing. Staff reported positive outcomes from the programme and told us that other NHS trusts had expressed interest in the approach and sought advice on how to implement similar support within their own critical care services. 

The service demonstrated a commitment to staff wellbeing and learning from the emotional impact of care delivery. The trust provided information and guidance on moral injury, recognising the psychological impact that challenging situations, bereavement, end of life care decisions and unresolved trauma can have on staff. This supported staff to reflect on their experiences and access appropriate support when needed.