Milton Keynes Hospital

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 rated well-led as good. We assessed 7 quality statements. Staff were focussed on continuous learning, innovation and improvement. Leaders worked towards an inclusive and fair culture by improving equality and equity for staff. Staff and leaders worked in partnership with key organisations to support care provision, service development and joined-up care. Staff were aware of freedom to speak up processes and leaders could describe actions that had been taken in response to concerns raised by staff. However, leaders did not always operate effective governance processes. The risk register did not reflect all the risks identified during our assessment. We requested minutes from governance meetings as part of our assessment and these were not provided. However, we were provided with governance reports and action logs from meetings.

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 described a positive and compassionate culture. Staff felt supported in their roles. Staff said raising concerns was encouraged and valued. We saw positive interactions between staff at all levels on inspection.

“The MK Way” was the trust's refreshed vision, values, strategy and objectives for Milton Keynes University Hospital and had been developed in collaboration with staff. The vision for Milton Keynes University Hospital NHS Foundation Trust was to be an outstanding acute hospital and part of a health and care system working well together. The trust had adopted a stepped approach for staff wellbeing aligned with NICE guidelines and mental wellbeing at work guidance.

Staff told us they were happy and well supported in their roles. Leaders were visible and approachable within the ED. Staff did not raise any concerns and felt they were engaged by leaders, had regular appraisals, and were kept up to date by senior staff. Leaders within the ED described they had a good relationship with the executive team. They met with the executive team quarterly and described they were approachable and supportive. Leaders described they had an ‘open door’ for all staff, and felt processes were fair, structured and equal.

The medicine division had a clear senior management and leadership structure with a divisional director, associate director of operations and divisional chief nurse. The emergency department also had their own leadership structure. The department also had a sepsis lead, a mental health lead, governance lead and an audit lead.

Staff and leaders recognised the importance of acting with openness, honesty and transparency. Staff were aware of the service’s freedom to speak up processes. Leaders told us they listened to staff feedback and gave examples of recent improvements following staff feedback. In the latest NHS staff survey, 64.9% of all ED staff said they would feel safe to speak up about concerns, and 59.5% of all ED staff said they felt confident that the organisation would address their concerns.

The trust had 6 freedom to speak up champions and 5 guardians. The trust had a Freedom to Speak up policy and form available on the trust intranet.

Staff spoken with during our inspection felt they were treated equitably. Leaders described a commitment to ensuring the service was inclusive. Leaders demonstrated an understanding of equality, diversity and human rights. Leaders told us a focused piece of work around racism was underway and listening events were regularly being held to gather staff feedback. In the 2023 staff survey, 82.8% of staff in the ED agreed with the statement “I think that my organisation respects individual differences”.

The trust had an Equality, Diversity and Inclusion Strategy running for 3 years from 2021. This was due to be updated shortly after our assessment. The trust had an Associate Non-Executive Director as the Equality, Diversity and Active Inclusion Transformational Lead. They had a focus on best practice and diversity and inclusion strategy development and governance. The Equality Delivery System (EDS) report of 2022/23 reported the trust scored a total of 16 points which meant they were ‘Developing’. To be rated as ‘Achieving Activity’ the score needs to be raised to 22-32. The trust had put an action place in place to report in 2024. The latest annual report on equality and diversity was from 2022-2023. It stated 40.2% of their employees were people from ethnic minority groups. The workforce was 78.6% female.

Leaders demonstrated a good awareness of governance processes and described a range of assurance systems were in place to monitor the service. Staff at all levels were clear about their roles and understood what they were accountable for, and to whom. Leaders said they had already identified some areas of concern that were raised during our assessment through their internal governance processes. These concerns had been added to the risk register and this meant there was ongoing monitoring of progress.

ED governance reports were completed monthly which covered the number of incidents, serious incident investigations, incident themes, learning from incidents, complaints and compliments. However, governance reports did not include data on all relevant topics. The governance reports did not include staffing data such as vacancy and sickness rates, or performance data. We requested minutes from governance meetings as part of our assessment, but these were not provided. That meant we could not gain assurance about the content of meetings. There had been an executive level decision to use action logs to record governance meetings, instead of meeting minutes. Emergency department staff had recognised the use of an action log to record governance meetings was ‘not adequate’ as ‘no discussion is recorded’. The risk register did not reflect all the risks identified during our assessment. For example, we identified concerns regarding medical staffing levels which was not present on the risk register. However, the management of risks that were on the risk register was effective. Initial scoring based on consequence and likelihood were given to described risks. Controls, assurances and ongoing monitoring of actions were recorded with clear review dates. The service had a systematic programme of clinical and internal audit, and systems to identify where action should be taken. The monthly ED newsletter contained learning headlines, policy updates, themes in incidents and the top 3 risks within the department.

This evidence category did not form part of our inspection.

Leaders described a close working relationship with a mental health trust and the mental health liaison team. They held quarterly interface meetings where Key Performance indicators (KPI’s) were discussed and monitored. Leaders described collaborative working with the Integrated Care Board and children’s social care for children who required specialist mental health support. Staff described positive partnership working with the local ambulance trust and told us monthly meetings were held between senior operational and clinical staff. Leaders described how the trust actively engaged with the Thames Valley Trauma Network (TVTN) and regularly attended TVTN meetings.

We received positive feedback from partners that highlighted collaborative working between organisations. Partners felt patients were well managed and there was trust between staff. Partners described staff embraced joint training, learning and sharing of updates between organisations. Partners described staff were kind and compassionate.

Processes were in place to collaborate and work in partnership with relevant external stakeholders and agencies. There was evidence that service level agreements with third parties were monitored and managed. Standard operating procedures and operational policies were in place with partner organisations.

Leaders told us learning, improvement and innovation were a priority. Leaders gave examples of a sepsis dashboard that had been developed, structural work to increase triage capacity and plans to implement E-triage within the patient pathway. Leaders told us the ED worked closely with a local university and has a research lead in post. Staff told us the ED was going through a transformation programme that was overseen by a transformation lead. Leaders described that outcomes and learning from national audits were presented at monthly clinical improvement group meetings, divisional meetings and audit half day sessions. Leaders said there was an ED specific Sepsis quality improvement group to ensure implementation of improvement plans.

There were processes to ensure learning happened when things went wrong, and from examples of good practice. Leaders encouraged reflection and collective problem-solving. Leaders encouraged staff to speak up with ideas for improvement and innovation and actively invest time to listen and engage. There were 3 quality improvement projects ongoing within the ED, focusing on analgesia in sickle cell crisis, nerve blocks in patients with fractured neck of femur and quick reference resuscitation guidelines. Key learning points were shared monthly within ED and were derived from clinical governance meetings, mortality and morbidity reviews, incidents and claims.