Questions every Hospice Trustee should ask

The Charity Commission has a very helpful document for boards, Charity governance, finance and resilience: 15 questions trustees should ask.

It’s a great starting point and I’d encourage every hospice board to familiarise themselves with the document and review it annually. The guide however is general in nature so to make it more helpful I’m providing a specific set of questions for hospice trustees to work through, in addition to the Charity Commission questions.

In no particular order here are my questions every hospice trustee should ask:

What are the major risks that could prevent you achieving your strategic goals and what are you doing to mitigate them? We recently went through this exercise at Hospice UK and it was instructive in triggering conversations about issues which had not surfaced in a long time.

Do you fully understand the financial position of your charity and key financial risks? This isn’t something that should be left to the treasurer to worry about. Trustees should make sure they understand the key assumptions underlying the budget, explanations and implications of any major variations to the budget. And they should understand the range of likely financial outturns for the hospice over a three to five year period, and the implications those have on service delivery.

What are your referral criteria? Can patients access your services 24/7? If not what are the barriers to achieving this, and what implications does it have for getting the best care to everyone if for example, you cannot take new referrals at the weekend?

What are the biggest priorities of your local health system with regard to end of life care? What is worrying your local acute sector or commissioners? How can you work together to help solve their problems and demonstrate the value of the hospice. What can you do together to tackle unmet need?

In what areas would it be more appropriate for your hospice to collaborate with others – including other hospices, other local charities or the NHS? What are the barriers to that cooperation – including any that you may have inadvertently put in place – and how can you think creatively to overcome them?

Do you understand the makeup and needs of your population – e.g. breakdown of ethnicity or religion, leading causes of death or age profile? How does this differ from the characteristics of the patients you currently support? What does any gap say about the extent to which the hospice is achieving its objectives and the future challenges the hospice might face?

What procedures do you have in place to ensure that your hospice is complying with all key regulations and that your service is safe? How are you learning from any patient safety incidents or near misses to ensure that repeats are avoided? How are you learning from the experience of other hospices who have received regulatory visits more recently than you – what can you gain from their experience?

We know that the digital revolution is changing the world around us and it is likely that the rate of that change is only going to increase. What is your hospice doing to make sure it is keeping up with that change, whether it is in terms of fundraising, using digital to engage with your community, using technology to drive better care or using data to better understand the needs of your patients?

What should your service look like in ten years? Given hospices have only limited resources, are you investing yours in the right areas? The chances are that the proportion of resources needed in your inpatient unit, day care, community services and bereavement care will not be the same in ten years as it was ten years ago. How are you planning to make sure you adjust your services in response to the changing needs of your community?

Do you understand the workforce model that will be needed to ensure your hospice can excel in the next decade? How will that differ from the current model? How are you going to recruit and retain those staff? How are you ensuring staff continue to feel supported and are not at risk of burnout?

If you find these questions useful I’d encourage you to explore them as a trustee group. And do have a look through the Hospice UK website, where we have lots of great resources to help with many of these questions for hospice trustees and those in other leadership positions.

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