Nuffield Health Warwickshire Hospital

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• 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 shared direction and culture, capable, compassionate and inclusive leaders, freedom to speak up, workforce equality, diversity and inclusion, governance, management and sustainability and learning, improvement and innovation as part of the well-led key question. We found well-led remained good. The service had suitable arrangements for identifying, recording and mitigating risks to the service. The senior management team had a good understanding of these risks which they regularly discussed. Staff at all levels were clear about their responsibilities, roles and accountability within the governance framework.

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 vision for what it wanted to achieve and a strategy to turn it into action. The vision and strategy were focused on sustainability of services and aligned to local plans within the wider health economy. Leaders and staff understood and knew how to apply them and monitor progress. Staff were helpful, welcoming and professional in their communication with each other, patients and their relatives. They described good teamwork and respect amongst their colleagues. Most staff we spoke with felt supported, respected and valued in their working environments. Departmental managers supported an open and honest culture and promoted the service’s values. However, some staff told us that they felt there was a blame culture at times within the senior management team and this had a negative impact on staff well-being.

There were processes in place which identified the vision and strategy for the service. This was supported by strategic objectives for how they intended to achieve their ambition. There was a 5-year cancer strategy issued in March 2022 which assisted in providing high quality, safe patient care within the resources available to ensure the achievement of local key performance indicators. The vision was to provide activities that contributed to public benefit and delivered high quality care. The service was committed to their vision of ‘building a healthier nation’. The mission statement was to create a patient centred, holistic healthcare approach which facilitates trust, compassion, empowerment and humour.

There was a clear management structure with clear lines of responsibility and accountability. However, there had been a lack of stability within the leadership team, and they had recently had new leaders. Staff told us leaders were well respected, visible, approachable, and supportive. A senior nurse led the oncology service.

There was a leadership structure in place for the service. The senior leadership team consisted of the health system director, director of clinical services, director of operations and finance and human resource business partners. Each head of department reported into 1 of the senior managers and there was a monthly heads of department meeting. The endoscopy service had a lead nurse who reported to the theatre manager. Departmental managers worked clinically and provided cover for sickness when required. The consultants we spoke with felt the hospital was well run and efficient, and the managers were responsive. The service had processes in place to ensure staff were recruited fairly and for roles they were competent in. Where new leaders were recruited, there were processes in place to ensure they were supported. There was a process in place for leaders to meet and discuss issues and cascade information back down to staff in the service. The minutes from the governance meetings showed leaders were knowledgeable about issues and priorities in their services.

The hospital had a freedom to speak up guardian and staff were aware of who it was. Managers told us the service was committed to continuously improving patient safety and staff experience by ensuring that all staff could speak openly about things that went wrong or the things that worried them. Most staff felt the senior leadership team and their managers were very approachable and felt they could raise any concerns. However, a few staff members reported blame culture within the senior leadership team which meant they could not always raise concerns. Following our assessment, the health system director arranged for the head of safety culture, head of inclusion and employee engagement to visit the hospital and undertake an independent review of the leadership, culture and team working.

There was a freedom to speak up policy and a whistleblowing policy and staff were aware of this. The service had contact details in place for staff to access if they needed to speak up about concerns which impacted the care delivery and environment which staff experienced. The service had a quarterly staff survey where comments were anonymous. This allowed staff to voice any concerns. Results of the April 2024 staff peakon engagement score showed 7.8 engagement core outcome. This employee engagement level was in line with the benchmark of 7.8. The service had various avenues to raise concerns such as during 1:1 meetings, daily safety huddles, freedom to speak up ambassadors and the peakon employee voice. The peakon employee voice was an engagement platform which empowered everyone to take ownership for change.

The service promoted equality and diversity in daily work and provided opportunities for career development. Staff received a monthly newsletter which kept them informed of issues relating to topics such as pay reviews, health and well-being matters, vacancies and new starters and local events. Staff understood the importance of supporting equality and diversity and ensuring care and treatment were provided in accordance with the Act. Staff gave examples which demonstrated their understanding and showed how they had considered the needs of patients with protected characteristics. Staff received clinical supervision to support them cope with a recent loss within the service. A psychologist was available to provide emotional support to staff as required.

There were clear policies and protocols in place to ensure that people did not experience discrimination on the grounds of disability, gender, age, pregnancy and maternity status, religious or cultural beliefs. For example, the equality, diversity and inclusion policy contained a policy statement which referenced that employing from different backgrounds including skills and varying sexualities would add value to the organization. Staff received training in equality and diversity and had a good understanding of cultural, social and religious needs of patients and demonstrated these values in their work.

The service maximised the effectiveness of people’s care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them. A robust governance system was available to monitor the quality of care. The service had a risk register which contained risks and control measures and was monitored by the senior leadership team. It was discussed within the monthly clinical quality and safety meetings. Staff were aware of the main risks within the service and managers communicated these to the staff. The governance processes were the same throughout the hospital. Consultants were employed on practising privileges which were signed off by the health system director. The endoscopy suite had a drying cabinet which was out of action at the time of our assessment. Staff ordered endoscopes which came vacuum packed with an expiry date from a neighbouring decontamination hub. This meant that the scopes had to be decontaminated more frequently so that they were fit to be used. Staff reprocessed and used endoscopes during the day using a 25-minute decontamination cycle. The endoscopy team held quarterly staff meetings, which were also attended by consultants. Staff were aware of how to use and store confidential information. During our assessment, we found computers were locked when not in use.

There were mostly governance structures, processes, and systems of accountability in place to support the delivery of good quality services. The hospital’s governance framework was supported by a medical advisory committee (MAC) meeting and a clinical quality and safety meeting. We reviewed the minutes of the last 3 MAC meetings and clinical governance committee minutes and saw they discussed incidents, risk registers, audits, new processes and practicing privileges. A local business continuity plan was in place to provide contingency and operate in the event of an unexpected disruption to the service. The service had an endoscopy user group (EUG) meetings every 3 months. We observed an EUG meeting during our assessment. Staff held discussions about, for example, availability of resources, utilisation of the endoscopy unit, quality improvement, cancer follow up and bowel preparation preferences. Staff held regular water safety committee meetings where they discussed next steps for water sampling. Water testing was escalated during the meeting which took place in February 2024 and in the next water safety committee meeting held in March 2024. Minutes of the meeting showed additional actions were raised and assigned during the meeting. We reviewed staff meeting minutes and could see they were planned, structured and followed a set agenda. They were thorough in their content with evidence of quality issues of safety, risk, clinical effectiveness and patient experience being discussed and actions taken if needed and the lessons learnt.

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 Milverton Suite was awarded the Macmillan Quality Environment Mark (MQEM) in July 2022. MQEM is a national evidence-based award which recognises the provision of high-quality cancer care facilities, which puts patients and their care first. The endoscopy unit had recently achieved Joint Advisory Group rating which demonstrated it had the competency to deliver against measures in the endoscopy global rating scale. Staff regularly took time out to work together to resolve problems and to review individual and team objectives, processes and performance which led to improvements and innovation. There were systems to support improvement and innovation work, including objectives and rewards for staff, data systems, and processes for evaluating and sharing the results of improvement work.

Leaders and staff aspired to continuous learning, improvement and innovation. This included participation in appropriate research projects and recognised accreditation schemes.