Little Bridge House

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 the ‘shared direction and culture’, ‘capable, compassionate and inclusive leaders’, ‘governance management and sustainability’, ‘learning improvement and innovation’ quality statements for the well-led key question. This was rated as good overall which was the same rating as at the previous inspection. Staff felt supported and there were clear definitions of roles and accountability. However, there had recently been a turnover of staff in management positions and the Chief Executive had also announced his retirement. The service had recruited to the management positions and it was planned that the Chief Executive would retire in a year’ time in order that his replacement could be found and there was stability to the service during this period.

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 service had a strategy which informed the direction of the hospice. We were told by leaders that there would be a relaunch of the strategy in the near future. Some staff told us that there had been limited opportunity for staff to input into the strategy. Staff were concerned about some of the changes that had been made to the strategy in terms of the age of patients the service was able to accommodate and some staff wanted the service to be able to reoffer end of life care to patients. We were told by the leadership team that end of life care could be offered so long as there was adequate staffing cover and that it was safe. This involved staff from other hospices within the orgnaisation supporting the team at Littlebridge House. Despite this staff we spoke with were able to describe the current strategic direction of the hospice and were working to implement the strategy. The strategy reflected the challenges the service faced.

The service had processes which fed into creating the strategy and vision however these could be improved to ensure that this was co-produced with the input of service users and staffing groups. We spoke with some of the leadership team who were aware of this issue and working at improving processes.

There had been significant turnover in the leadership team during the past 3 years with the service having had 3 Heads of Care during this period. The CEO had also announced his resignation after co-founding the charity in 1991. We were told by some staff that this had created anxiety due to the uncertainty and challenges that change can bring. At the time of the assessment, the Head of Care post was vacant, although someone had been appointed and was due to start in June 2024. In order to bridge the management gap at the service, the Deputy Director of Care for all 3 hospices run by the provider had based themselves at the Littlebridge location and we were told by staff that this had improved staff morale and offered support to the team leaders.

Leaders had effective support and opportunities to develop and maintain their competence and skills to lead the service with credibility. The roles of staff and leaders were clear, and they understood their responsibilities and accountabilities. Succession planning was taking place to appoint the new CEO. There was a years grace for this process to take place.

We did not look at Freedom to speak up during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The service’s systems to manage governance and risk were not always fully effective. We reviewed information which indicated the service had identified that a member of the management team should have the overall responsibility for the oversight of the service’s governance processes and were currently reviewing how best to implement this. The service was also working towards recording staff appraisals using a central system so it could ensure that staff were receiving these developmental opportunities. The majority of meetings were minuted however we only received agendas for the locations monthly meeting which included all team leaders, senior team leaders, head of care and the medical director and deputy medical director. This meant we could not be assured that anyone unable to attend this meeting would be able to review what was discussed. We have received information following the site visit that indicates that meeting minutes and summaries are now being captured and shared with staff.

The service had processes to support governance, management and sustainability and had identified areas where this could be improved. There were regular leadership meetings. The senior management team for the provider met fortnightly and the senior care leadership team for the provider met on a monthly basis. As stated above there were some governance measures that could be improved such as the process for recording staff appraisals. The location held a monthly meeting which included the senior and team leaders as well as the Head of Care, medical Director and Deputy Medical Director. Meetings minutes showed areas of concern were identified and actions were taken to mitigate any risks.

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.

The service was looking to learn and improve its service offering. The service was working towards providing a 24/7 service and ensuring the service offering at each of its hospices was similar and would support and meet the needs of their patients. For example, a pilot that was run at Charlton Farm Hospice (part of the group of hospices) where the charity provided end of life care at a patient’s home was being reviewed to see if this was suitable to be rolled out across the group.

The service has mechanisms to learn and improve from child deaths reviews. A member of staff attends the child death overview panel on a monthly basis and shares any learning from this meeting with the staff.