Campden Home Nursing CIO

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

We reviewed 5 areas of the well led key question. We found areas of good practice and areas for improvement. The scores for these areas have been combined with scores based on the rating from the last inspection, which was rated as outstanding for well led. We found managers had the skills to support most staff, review how well the service was being provided and engage with people who were involved in commissioning the service. Managers used information about the service to plan future services. However, there was not always detailed scrutiny by senior leaders of performance. There was a potential that opportunities for improvement could be missed. There were processes to provide support for staff and keep them informed of developments within the service. However, staff expressed variable experiences of these processes.

This service scored 82 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Leaders of the service had reviewed and agreed a realistic strategy and vision for the service. Managers understood the challenges and needs of people in the community. Most staff felt supported and were proud to work for the hospice. Behaviours were challenged regardless of role and seniority although the challenge was not always well received or acted on effectively. Staff safety was a priority and staff felt able to act appropriately to maintain their own safety.

Leaders used processes to review the service for the future. The strategic plan was discussed using nurse management and senior leaders input. Staff views were gathered and represented by nurse managers although there was no record of consultation with staff. Strategy aims were clearly articulated in documents available to patients and staff. Policies provided clear direction and staff knew how to access them. Staff followed policies to assess risks to safety when providing services in patients’ homes.

Staff felt they were part of a supportive team and the hospice at home service performed well for its patients. However, staff experience of support had been variable. Some staff had been well supported by managers and senior leaders and found them to be approachable and responsive. However, other staff felt they could not approach senior leaders, and their opinion was not valued. Some staff had made improvement suggestions, which they believed were based on clinical skills and knowledge and received negative feedback. Opportunities for staff advancement were not always shared with all staff.

Managers used processes to review and provide communication to staff and people who used the service. Policies were regularly reviewed and updated to reflect changes in practice or national guidelines. Recruitment processes helped to keep staff and patients safe. Skills of trustees were used to support the service. Succession planning was mainly around finances for sustainability. Providing a hospice at home service was an identified priority of the management and senior leadership teams. Additional services outside of this were reviewed by leaders and reorganised to meet financial constraints. There were close and organised links with external partners such as the local Integrated Care Board, NHS services and a range of partner hospices.

Senior leaders had an open door policy which some staff found effective. Most staff described they were happy to access and raise concerns with managers and senior leaders. However, some staff felt inhibited about expressing their views. People were allocated roles as freedom to speak up ambassadors and had attended training on awareness of the role. However, they had not attended additional training specific to undertaking the role of a freedom to speak up ambassador or guardian. Some staff felt their concerns would not be kept confidential if they used the freedom to speak up route. Leaders understood the importance of raising concerns and encouraging staff to speak up. However, their ability to ensure staff felt treated without bias was not always effective.

Policies demonstrated a clear process for staff to raise concerns and contribute ideas. The process and avenues for speaking up had recently been strengthened and communicated to staff. Freedom to speak up awareness training was mandatory for all staff to attend to ensure staff were aware of the process. There was no regular annual staff survey which would provide another avenue to gather staff views. Senior leaders felt they knew how staff felt by speaking with them on a regular basis. However, Hospice at Home staff were not always in the central house as their main work was in people’s homes. Staff comment was collected at exit interviews when they left the service and reviewed by senior managers.

Senior leaders felt staff were consulted about strategic planning. However, there were no records to demonstrate staff consultation. Staff felt their views were represented by their line manager and escalated to the leadership team. However, some staff felt their views had not been listened to by senior leaders. Most staff felt supported in maintaining their health and well-being and gave examples of how adjustments had been made to support them. Hospice at Home staff felt they worked well as a supportive team. Staff experiences of support from senior leaders was not always reliable or consistent. Some staff expressed there had been recent disagreements between managers, senior leaders and trustees and this had created a division between some staff and leaders. Not all the issues had been resolved and some managers and leaders had chosen to leave the organisation.

The service considered equality, diversity and inclusion and this was reflected in the policies developed for the service. The main hub of the service was at Jecca’s house and all staff had access to the house when they needed. The CEO attended staff meetings when they were able and cascaded information using a variety of methods. However, Hospice at Home staff were not always able to attend staff meetings due to work and/or personal commitments. Adjustments were made to maintain contact with Hospice at Home staff using daily telephone calls before and after visits and opportunities for debrief after difficult shifts.

Staff were aware of the management structure and were clear about their own and others’ responsibilities. Managers reviewed risks and took action to reduce these risks. Annual audit programmes were planned but the senior leadership team were not always aware if they had taken place in a timely way. Verbal reports were provided at leadership meetings. Audit outcomes which fell below required standards were raised as an incident and discussed at leadership team meetings. However, the documentation we saw of discussions regarding improvement actions was an overview rather than of detailed discussion or scrutiny. Staff and leaders looked beyond their own service for potential improvement actions by linking with other services or specialist roles. A recent vacancy had arisen for a nurse manager and recruitment processes were in progress.

Managers used processes which gave a general overview of the service and how effective it was for people who used the service. There was regular and planned engagement with other health partners and commissioners in the local area which helped leaders to understand needs in the community and plan services. Discussions with the local commissioners had prompted improved access to the service. Information about patient care was shared between the hospice and NHS services. Managers submitted notifications to external bodies as required. Matters affecting finance of the service was reviewed by senior management and we saw meeting notes of actions taken to maintain sustainability. Staff worked on flexible contracts or on a bank basis according to their choice. Managers monitored staff availability and allocated shifts to meet patients’ needs and in line with commissioned services. Organisational risks were identified and reviewed. There was provision to store patient records confidentially and this was increased as the need arose. An annual audit plan was used to monitor effectiveness of the service. Incidents were reported to senior leaders, reviewed at governance meetings and learning was shared with staff using team meetings and shift handover meetings.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Learning, improvement and innovation during this assessment. The score for this quality statement is based on the previous rating for Well-led.