South Warwickshire University NHS Foundation Trust

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 utilised the integrated care board (ICB) system wide end of life care strategy which was developed and co-designed in collaboration with the trust and University Hospitals Coventry and We looke

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 inspection we rated this key question as requires improvement. At this inspection the rating has changed to good. This meant there was clear, compassionate leadership and a culture of high-quality care and improvement.

Work was underway within the service to review and develop a trust wide end of life care strategy to ensure the trust’s role in local development and delivery of end-of-life care services that meets the needs of the local population. Staff felt supported and there was a positive approach to workforce equality, diversity and inclusion. Staff and leaders understood their roles and responsibilities. There was a culture of continuous improvement and innovation. There was evidence of improvement in relation to medical staffing, leadership of the service and referral processes.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

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 Coventry and Warwickshire integrated care system (ICS) strategy that had been developed between services across the region. Strategic priorities included early identification of palliative and end of life, timely access for all diverse communities, support for people with life limiting conditions, improved quality of care, and delivery of a sustainable system of palliative and end of life care.

Executive leaders for the service told us that work was in progress to develop and implement a new trust wide end of life strategy. This included developing a clear criteria for when the SPCT should be involved in patient care, capacity, demand, service specification, education, training and governance. Action plans were being developed as well as a review of a 7-day service model. Leaders were working closely with the Integrated Care Board (ICB), other local trusts, community services and hospices to ensure continuity of care, vision, strategy and consistency across the area.

Staff had the opportunity to contribute to discussions about the strategy for their service, especially where the service was changing. For example, the SPCT leads had written a business case for the development of the team within the service, and this was being reviewed as part of a broader review. Leaders told us there was a focus on clarifying the role of the SPCT and a clear criteria for referrals to the service where specialist palliative skills were required.

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.

Leaders had the skills, knowledge and experience to perform their roles. The chief nursing officer and chief medical officer were the executive leads for the service. The specialist palliative care team came under the management of the out of hospital division and reported to a general manager and lead nurse. The chief nursing officer chaired the end-of-life care committee meetings. Staff told us they were supported by their managers and that management were accessible and available to them. Staff told us they regularly had contact with the divisional lead nurse. Leaders were visible in the service and approachable for patients and staff.

Leadership development opportunities were available, including opportunities for staff. There was a focus on succession planning and this included offering opportunities to nurses from different backgrounds to develop their specialist palliative care skills. There was a trust workforce strategy that included leadership development.

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

There were Freedom to Speak Up champions across the trust. A Freedom to Speak Up Guardian is a named person in every hospital who can provide independent support and advice to staff that want to speak up.Staff told us they were aware of the champions and would access them if required. Staff we spoke with felt supported, respected and valued. There was a culture of openness and honesty. Staff felt able to raise concerns and told us they felt listened to and were able to contribute to developments and improvements.

Staff had opportunities to give feedback on the service they were able to provide. We reviewed survey data from the specialist palliative care team and saw some evidence of improved satisfaction in recent years. For example, there had been an increase in staff stating they would recommend their organisation as a place of work, from 50% in 2023 to 77% in 2024. There had also been an increase in staff stating they would be happy for friends or family to receive care from the service, from 60% in 2023 to 76% in 2024.

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.

The trust consulted with staff, service users and local community groups on its Equality Impact Assessments, which covers all areas of equality legislation including race, gender, disability, age, sexual orientation and religion and belief.

The trust had network support groups for staff including Black, Asian and Minority Ethnic (BAME), LGBT, Veterans, disability and neurodiversity.

There was an Anti-Discrimination helpdesk that was managed by the trust’s Equality, Diversity and Inclusion Lead and Freedom to Speak Up Guardian. All concerns were treated confidentially. There was an Equality and Diversity steering group which reported to the trust board. There was an equality and diversity policy. Equality and diversity and human rights training was part of staff’s mandatory training programme and 100% of the SPCT had completed this.

Staff demonstrated a good understanding of equality, diversity and inclusion.

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.

There were clear and effective governance, management and accountability arrangements. Staff understood their role and responsibilities. The local governance structure included daily specialist palliative care (SPC) capacity meetings, weekly multidisciplinary (MDT) meetings and monthly governance meetings. MDT meetings were held with palliative care services across the wider community, this included other local trusts, hospices and community services. The meeting discussions included staffing, risks, training and Dying Matters week.

County wide and place based (North, South and Rugby) Quality and Performance meetings were held and reviewed staffing, patient referrals, training and appraisal compliance, complaints and incidents. We saw action logs were assigned to staff with dates for completion and escalation. Quality improvement group meetings were held where there was discussion of shared learning, audits, service improvement and research relating to palliative and end of life care.

Place based SPC team meetings were held monthly. Lead nurses used these meetings to share information, learning and discussion with their teams.

Policies were available on the shared drive and included trust wide and service specific policies and procedures. We saw there was a community SPC business continuity plan. In addition, there were protocols such as those relating to specific palliative and end-of-life care situations that staff may experience.

The service had a risk register with 2 risks recorded, one for staffing within the SPC community team and one for the lack of psychological support for end-of-life care patients within Rugby community. We saw there were specific action plans and review dates. Mitigating action had been taken to address the risks. This included raising concerns about psychology support with commissioners and increasing patient facing hours for managers to mitigate some staffing issues.

Staff undertook or participated in local audits. The audits were sufficient to provide assurance and staff acted on the results when needed. Audits included a review of death certification and the timeliness of completion, and anticipatory prescribing for patients at the end of life.

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 SPC team worked closely with other local trusts, acute SPC staff, GPs, hospices and local charities. The daily SPCT capacity meeting looked at patients’ needs, capacity and staffing levels. MDT meetings ensured that care was delivered collaboratively across relevant services. Patient information was shared to ensure continuity of care.

One consultant met regularly with the local ICB to review provision for care both in the trust and the community. In addition, the trust’s SPCT engaged with other services around specific development issues. For example, they participated in county wide meetings around palliative and end of life care for people experiencing homelessness.

The trust contributed to an external website that proved Care and Support Towards Life’s End (CASTLE) the website had evidence-based guidelines, documents and policies. The website could be used by staff, patients and relatives across the trust and community.

The team engaged with local charities that offered support to patients and families at the end of their lives, including a singing choir, hand holding services and listening and counselling services. In addition, the trust had contributed to the county wide palliative and end of life care strategy, alongside other services in the community.

Feedback from partners in the community was positive about the engagement of the trust’s palliative and end of life care services. They described trusting and collaborative relationships.

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.

Staff were given the time and support to develop opportunities for improvements and innovation and this led to changes in care delivery. They had opportunities to participate in research. We saw evidence of research papers relating to breaking down barriers to the use of the individualised plan of care in aiding patient centred assessment and the use of patient reported outcome measures. We also saw a paper that had been written on work to upskill heart failure specialist nurses in advance care planning and IPOS to support the identification of previously unidentified symptoms in patients with advanced heart failure.

The service was committed to learning and improvement. We were given examples of how improvements had been achieved through improvement methods such as audit. For example, in relation to mouthcare, anticipatory prescribing and sourcing ‘just in case’ medicines to help manage symptoms at the end of life in a timely way.

Since our last inspection the trust have employed additional consultants to work in the SPCT team. They work closely with other local trusts to ensure there is 24-hour access to consultant support. They are currently reviewing the 7-day service and developing business cases. We also saw improvements in how managers demonstrated the skills and abilities at all levels and there was a clear referral process to the specialist palliative care team.

Community inpatient wards participated in accreditation schemes relevant to the service and learned from them. Staff on Nicol ward at Stratford hospital were awarded the 2025 ‘going the extra mile’ (GEM) award for their end-of-life care.