Butterwick Hospice Stockton

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 service was well-led and has been rated good. Leaders acknowledged it had been difficult articulating a clear future direction of the hospice, given the conditions we applied following the last inspection. However, they had developed positive working relationships with the local NHS trust and the Hospices North East and North Cumbria collaborative, to ensure shared direction and culture going forward. The new leadership team had implemented action plans, strategies and processes which had worked well and improved the overall governance of the service. Managers were open, honest and encouraged both patients and staff to provide feedback on the service. Staff survey results demonstrated staff had confidence and good relationships with the leadership team and felt supported by them. Staff were supported well with access to well-being resources, enabling staff to perform their roles to the best of their ability which enhanced the care and support given to patients. Appropriate governance processes were now in place to ensure managers had oversight of the service. Where required, lessons had been learned and communicated from incidents, which were used to drive improvement.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Leaders we spoke with explained the current strategy was under review and worked with the trustees to develop this. Leaders described difficulties in articulating a clear future direction of the hospice given the conditions we had imposed. However, they told us how they worked with the Hospices North East and North Cumbria collaborative to ensure shared direction and culture. They worked closely in partnership with the local NHS trust to ensure the needs of the local population were met. Staff and leaders demonstrated a positive, compassionate, listening culture. There was now improved insight regarding the culture of the service.

The service’s vision and values were summarised as themes of care, compassion, dignity, support and community. The core values were concerned with honesty, integrity, shared generosity of spirit, teamwork, to show respect and to be caring and responsive to need. These were displayed on the services website and detailed in their current strategy.

There was now a newly appointed leadership team. Leaders had the skills, knowledge, experience and credibility to lead effectively. This was confirmed by the staff we spoke with. Staff told us leaders were visible and we saw examples where leaders had recognised and improved the culture. For example, wellbeing initiatives such as the better health at work award, for which the service was to be assessed. Leaders saw staff wellbeing as a priority for example, promoting hydration, weekly walks, yoga groups and staff barbeques. They had introduced an on call rota to ensure staff were supported at all times. Leaders explained they operated an open door policy and management offices were based near the clinical area. Eleven staff had completed Mental Health First Aider training. We saw evidence that leaders took a proactive approach to collaborative working and leadership within the local hospice network. For example, we saw positive and supportive feedback from stakeholders. We also saw evidence of to demonstrate their understanding of the context in which care was delivered, including treatment and support, embodying the culture and values of the organisation.

Managers were clear regarding their roles and accountabilities. This was reflected in the recent staff survey which showed 87% of staff reported a good working relationship with their manager. 82% reported having regular meetings with their manager. 70% reported having confidence in the effectiveness of the senior leadership team with 69% confidence in the trustees. 76% reported being able to make team and departmental improvement suggestions.

A Freedom to Speak Up Guardian had been appointed. Freedom to Speak Up Guardians support workers to speak up when they feel that they are unable to do so by other routes and can do so without fear of retribution. Staff we spoke with told us they felt supported by leaders and encouraged to raise concerns, so that these could be appropriately and confidentially investigated and acted upon. We saw posters displayed, detailing information and contact details for the appointed Freedom to Speak Up Guardian, including a dedicated email address.

Policies and procedures we saw for Freedom to Speak Up and Whistleblowing were ratified and referenced to current best practice guidance. The service submitted data to the National Guardian’s office every 3 months, which indicated the process was embedded and utilised by staff.

Leaders we spoke with explained how they took action to promote a positive workforce culture and prevent bullying and harassment at all levels. Leaders ensured there were effective and proactive ways to engage with and involve staff. Staff we spoke with said they felt empowered and were confident that their concerns and ideas resulted in positive change, this concurred with the staff survey results.

We saw ratified policies for Recruitment and Selection and Equality and Diversity, referenced to current best practice guidance.

Leaders and staff had responded positively regarding improvements that were required, following our last inspection. We saw significant improvements to management of governance and risk and staff were fully engaged in the change process. There was substantial engagement and networking with other hospices in the area, with the ICB and the local NHS Trust.

Governance systems identified and monitored the quality of care provided and there was improved oversight from senior leaders. Leaders and teams now used systems to manage performance effectively. They now identified and escalated relevant risks and issues and identified actions to reduce their impact. The registered manager provided examples of management oversight in order to provide assurance that all necessary actions had been identified and addressed. The systems to manage current and future risk and performance to service quality took a proportionate management approach to allow new and innovative ideas to be tested within the service. Safe recruitment procedures and employment checks were now in place. All staff had full employment records. All staff had completed mandatory training. This included training for the Escalation of a Deteriorating Patient and Incident Reporting. A policies audit had been undertaken in January 2024. All policies checked during the assessment had been reviewed ratified and version controlled. New environmental and cleaning audits were in place. Records showed 100% compliance. The registered manager had applied for a home office license and there had been a robust oversight of the processes from external pharmacists from the community.

The hospice engaged in outreach work with local schools, other local hospices, look good feel better sessions, weekly Macmillan craft and chat groups, rehabilitation projects and a proposed project involving fitness for minority groups.

Staff we spoke with reflected different grades and a variety of roles. They spoke positively about the team working and patient focused culture. All staff told us they felt they were able to speak openly and honestly about the services they provided and found managers approachable and supportive. Staff appreciated the positive relationships they had with colleagues in the NHS trust who provided supervision and training.

The hospice worked in collaboration with external partners to shape services in and around the local area. The hospice also participated in forums to share best practice and national guidance. We saw positive relationships were forged with local hospice providers within the network which involved regular updates of communication streams across the hospice network.

The service worked proactively with the local NHS trust to ensure patients received appropriate end of life care and support, with a service level agreement in place.

Staff and leaders demonstrated good understanding of effecting positive change through teamwork. They explained how they sought views and ideas from patients and their carers to improve their experience. Staff were supported to share their ideas for improvement and innovation and staff engaged in initiatives introduced by the new management team. For example, staff wellbeing programmes. There was a strong sense of trust between leadership and staff.

Processes were now strengthened to ensure improved learning from events and from examples of good practice. Leaders encouraged reflection and collective problem-solving. The hospice had strong external relationships that supported improvement.