New Hall 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 assessed 2 quality statements from this key question. Leaders had a shared vision for the service, managing their resources well to deliver improvements needed and plan for future challenges. Governance systems and processes held leaders accountable to their staff, patients and external stakeholders. People were valued and listened to, encouraging innovation.

This service scored 79 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

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

We did not look at Capable, compassionate and inclusive leaders during this assessment. The score for this quality statement is based on the previous rating for Well-led.

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.

Staff working for this service felt their personal values aligned with the organisation. Staff told us they knew who senior leaders were and felt they were visible and approachable. They spoke positively of their departmental leaders, who respected their views on clinical decision making and focus on patient safety. Leaders understood their responsibilities to their teams with supportive structures in place to ensure a bottom-up approach worked effectively. They took ownership of risks relevant to the areas they managed and escalated these to the senior leadership and relevant committees. Networking between committees and the sharing of this information with staff meant there was awareness of specific significant risks across the hospital, where department leaders understood which areas were in most need of development and which areas held the least risk.

The service had a governance structure which enabled committees addressing specific areas of oversight to feed into and inform the leadership team. The leadership team had a clear understanding of current and future operational challenges, involving staff in conversations to improve risk management, performance, and outcomes. A review of meeting records from committees and department meetings evidenced systems that encouraged accountability and ownership embedded into the culture of the service. Workforce planning and retention records displayed a strong focus on development of internal candidates. The service used third party review of retention and contingent workforce usage to inform their processes. The service had effective systems partnerships in place with local integrated care boards. The service had also received recognition of its contributions by NHS leaders, NHSE and GIRFT, for assisting with the reduction of the spinal surgery 78 week wait times for a specific integrated care board.

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.

Staff of different levels spoke of how managers had given them proactive encouragement at personal development reviews, citing ease of access to further training and development opportunities. Leaders were motivated to keep staff updated and share learning in various formats. They listened to staff and reviewed learning from incidents to formulate action plans that supported their staff and department. Outcomes and data were a key focus to drive understanding on which areas required improvement. Senior leaders were keenly aware of what challenges the service faced and how they would navigate these.

The service had a proactive approach to identifying areas for improvement, utilising a framework called ‘Outcomes with Learning’. We reviewed several of these and found they followed a consistent approach where leaders supported reflection and highlighted areas of good and bad practice. When they did not get things right, leaders invited people using the service and their families to share their lived experiences and expectations of care with staff, to inform and better address these areas. There was a gap analysis and action plan in place addressing areas identified as falling below expected standard. This was a continuous improvement tool that aided discussions at Patient Experience Committee meetings to improve on equity of experience, with a current focus on patients with hearing and vision impairment. The service had established a prehabilitation programme that engaged elective joint replacement patients in health education to empower them to make lifestyle choices that could impact on their recovery from surgery and manage expectations along their perioperative journey. This was championed by the pre-assessment and physiotherapy teams. The programme included an education booklet around topics like physiotherapy, the difference between nutritional balance pre- and post-surgery, further support options, education on joint replacement surgery and pain management. To support this, the service had implemented an evening physiotherapy service to promptly mobilise postoperative hip, knees and spines to improve their rehabilitation. Patients could also access resources online which demonstrated how to perform physiotherapy exercises both in preparation for their operation and during recovery.