Grantham and District 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

Evidence shows a good standard of care.

Feedback from people and staff was positive about the quality of end of life care provided by the trust.

There was a clear vision and strategy to ensure the delivery of high quality care and treatment.

There was a shared direction and culture throughout the end of life care service. Leaders supported staff and collaborated with health care partners to deliver care that was safe, integrated, person-centred and sustainable, and to reduce inequalities. Patients and their loved one’s views were sought and valued.

Governance systems were in place, leaders operated effective governance processes throughout the service.

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.

There was a strategy in place for palliative end of life care across all of the hospitals in the trust .The Lincolnshire palliative and end of life care Strategy 2023 to 2028 set out a countywide, unified approach to delivering high quality, equitable, and person-centred palliative and end of life care for adults across all communities in Lincolnshire. It was based on national guidance, clinical evidence, and engagement with patients, families, carers, NHS staff, hospices, social care providers and voluntary organisations.

There was a clear sense of teamwork across all the areas we inspected, and everyone spoke very highly of their colleagues. Staff described the culture they worked in as like being part of a team and that it was a privilege to be part of the team. In the hospice, staff described as being part of a family and as soon as patients were admitted, they because part of that family along with their family and loved ones.

When talking with all staff it was clear that their priority was focussing on the needs of the patients they cared for. Staff told us that, in end-of-life care at the hospice within the hospital, the chemotherapy unit, and on Harrowby Ward, there was a very open culture. Everyone felt able to raise concerns without fear. Staff also described a genuine environment where having to raise concerns about others was a very rare occurrence.

Staff told us that they felt respected, supported and appreciated. We spoke with leaders who aimed to promote a team ethos of caring for patients with dignity and respect no matter what their role within the service. We observed positive interactions between all members of staff regardless of seniority.

Staff were proud of the service and wanted to deliver the best possible care where people were supported to manage their life limiting conditions and spend their final days peacefully. Staff continually demonstrated a clear understanding of the vision and values and what they wanted to achieve.

Leaders had the skills and abilities to run the service. They promoted a culture of safety and learning within the trust. They understood and managed the priorities and issues the service faced. They were visible and approachable in and around the patients and staff.

Leaders supported staff to develop their skills and take on more senior roles. Staff told us they were encouraged to speak up and discuss their concerns openly.

Leaders supported staff to develop their skills and take on more senior roles. Staff told us they were encouraged to speak up and discuss their concerns openly. When staff had raised concerns, they felt the management team could take appropriate action. Staff felt confident they could raise concerns or risks openly.Leaders engaged with staff and used staff survey results to explore issues and discuss solutions and improvements to the service.

The trust had effective recruitment processes and ongoing checks to ensure all leaders were competent in their roles.

Managers and 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 1 freedom to speak up guardian (FTSUG) and 35 Freedom to speak up champions across all the hospital sites within the trust, 2 of the champions were based at the Grantham site.

Staff were aware of the freedom to speak up guardian role and details of what freedom to speak up was, and who to contact. Staff could raise concerns with any of the freedom to speak up champions by phone, by e-mail or face to face. Staff 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.

All staff completed mandatory freedom to speak up training.

There was a very open culture where everyone could raise concerns without fear and a genuineness among staff that having to raise concerns about others was a very rare occurrence.

The service valued diversity in their workforce. Staff and leaders told us there was a diverse workforce with a positive sense of inclusion. Managers told us they made workplace adjustments where necessary. For example, if staff wanted to change their working arrangements either temporarily or on a permanent basis.

Grantham and District Hospital had a multi-faith room on site for everyone in the hospital to use, for those of all religions and none.

The trust had a policy on equality and diversity which meant recruitment decisions were based on the candidate’s ability to undertake the job and eliminated discrimination on any grounds. Recruitment packs included an equal opportunity monitoring form.

Training was available for all staff in equality, diversity and human rights and this was a mandatory requirement. We saw the compliance rate of 100 % for staff for the hospice unit and the chemotherapy suite and 93% for Harrowby ward against the trust target of 90%.

The NHS Workforce Race Equality Standard (WRES) is an essential tool in supporting the NHS to be an inclusive and fair workplace. It helps evaluate progress and identify areas where further improvement is needed. WRES data for 2024-2025 for the trust showed that black and ethnic minority staff employed by the trust had increased from 24.6% to 27.5%, and that out of 10,372 members of staff on 31st March 2025, 27.5% (2848) of employed ULTH staff were from BME backgrounds, 71.2% white, 1.3% not stated. Data showed an increase in the 52.8 % of BME staff who believed the trust provided equal opportunities for career progression or promotion against the national average of 46.7%.

Leaders operated effective governance processes, throughout the service and with partner organisations. 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 acted on information concerning risk, performance and outcomes, and shared information securely with other professionals as appropriate.

There was a systematic programme of clinical and internal audits to monitor quality, operational and financial processes, and systems to identify where action should be taken.

Committees were in place for significant areas. For example, the specialist palliative care speciality governance meeting took place every 2 months and was responsible for ensuring continuous improvement for in patient care, service delivery, operational performance, sustainability and improvements within each specialty.

The committee reported upwards into cancer services clinical business unit and then into Alliance Care Group Clinical Cabinet for oversight, which drove improvements within the service.

Staff implemented recommendations from reviews of deaths, incidents and complaints. The service held mortality and morbidity meetings (M&M). These were recurring, peer-reviewed medical meetings where healthcare professionals analyse adverse patient outcomes, complications, or unexpected deaths. Its primary goal is to identify medical errors, modify clinical judgment, and drive quality and patient safety

The service had a risk register, which we reviewed as part of our inspection. There were 6 documented risks. All risks had a risk reduction plan, controls in place, a named handler a named manager and a named executive lead. All risks had been reviewed in 2026.

Patient information, such as medical records, were stored in line with data protection and Audit outcomes were displayed on notice boards and used by leaders to drive improvement in the service. Managers met with staff and provided feedback on local audits to recognise success and share feedback on areas for improvement.

During our inspection we observed that all professional clinical staff were registered with the appropriate professional body, and the service had systems in place to ensure that revalidation took place as required.

The service worked with local health care partners to ensure there was a good understanding of local needs and improve the care they provided.

For example, Harrowby ward collaborated with the community receiving care provider to provide, as far as possible a structured and timely discharge. This included making sure the patient had the necessary anticipatory (pre‑emptive) medications on discharge and a completed controlled drug form (CD1) issued by the medical team. The CD1 form authorised the community nurses to administer specific, anticipatory medications to terminally ill patients at home without needing a GP to sign off on every dose. This meant there was no delay in the administration of medication.

The SPCT provided strategic direction and visible professional leadership within the organisation with regards to end of life care services.

The team worked collaboratively with the divisional teams, hospital clinical teams, and all stakeholders within primary and community care services. Including mental health services, carers organisations and local ambulance services clinical commissioning groups and the voluntary sector. The aim was to promote joined up services that effectively provided coordinated discharge as well as an equitable and high-quality standard of 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. The chaplaincy service had connections with community services, including representatives from different cultures

The service worked in partnership with the University of Lincoln and regularly accepted students for clinical placements for both nursing and medical students.

All staff were committed to continually learning and improving services. Staff described a culture of learning and of opportunities to develop their knowledge and skills. Staff were encouraged to attend multidisciplinary team meetings to develop their knowledge and understanding about end of life care, including to gain an understanding of different treatment options.

The trust provided infrastructure, information and support for specialist palliative care consultants who worked across community settings, hospital environments, and the hospice itself. The consultants also participated in regional palliative care forums to support service development and clinical consistency across the wider health setting.

The end of life care champions attended forums and governance meetings to ensure they were up to date with changes in guidance, information and to offer support were needed. Following these meetings the champions devised posters for the ward areas across the Trust to provide the learning from these meetings. For example, we observed posters on communication, thinking outside of the box and symptom management.