George Eliot NHS 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 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. Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

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.

Staff were aware of a vision and strategy was in place for the clinical support services directorate which the intensive therapy unit (ITU) was part of. In line with the trust’s values, the ITU’s vision was to support all patients and relatives who visited the department. The aim was to provide safe, high quality and compassionate care, strive to deliver evidence based best practice within a safe environment and to empower, develop and provide opportunities for professional development. The vision statement for the ITU was to excel in providing comprehensive and compassionate critical care that ensured patient safety, fostered clinical excellence, and promoted dignity and respect for all. The service’s strategy vision was to work in synergy with each directorate and the local population to deliver modern, safe and effective healthcare solutions. All staff on the ITU were passionate about their work and responsive to patients. The culture of the unit was focused on patient safety and care. It was clear from our conversations and observations that staff had confidence in the leadership at all levels. Staff reported feeling very supported by their teams and managers. There were high levels of staff satisfaction. Senior leaders knew staff as individuals and operated an open-door policy and safe space to discuss any concerns. Leaders recognised the importance of supporting individuals’ wellbeing. Most staff reported they were listened to by managers.

There were processes in place which identified the vision and strategy for the service and this was supported by strategic objectives for how they intended to achieve their ambition. The vision was in line with he trust’s vision and objectives to ‘Excel’ in patient care. The service shared their staff survey results after the onsite assessment activity as part of the data request. The results appeared to show there was distinct variation in the views of staff on the culture of the department. The results showed only 33% of staff looed forward to going to work and only 7% of staff believed there were enough staff to enable them to do their job properly. Half of the staff from the service who participated in the survey believed there was a good work and home life balance. However, all staff who participated agreed they were trusted to do their job and 97% of staff believed their role made a difference to the patients lives. The information from the survey did not provide any comparison for previous surveys to identify if the issues had declined or improved.

Leaders had introduced a new training course for new starters in ITU to help retention and recruitment of staff. It was a 7-month long course with a training day a month to look at teaching on systems, equipment, simulation and wellbeing. One of the key benefits of this initiative was to guarantee staff members dedicated time for learning, thereby facilitating the completion of their competency books. Another aim was to promote a supportive environment for new starters, providing them with a safe space for peer interaction and reflection. Staff told us that support was always available if they had been involved in an emotional situation or it was the first time they had been involved in a bereavement. The intranet was available to all staff and contained links to current guidelines, policies and procedures. All staff we spoke with knew how to access the intranet and the information contained within. All staff had access to their work email and we were shown that they received organisational information on a regular basis, including clinical updates and changes to policies and procedures.

The service was part of the clinical support services directorate. There was a leadership structure in place for the service which was published for staff to review. There was a process in place for leaders to meet and discuss issues and cascade information back down to the staff in the service. The minutes from the governance meetings showed leaders were knowledgeable about their issues and priorities in their services. However, the staff survey identified only 48% of staff received feedback from leaders about important issues There were processes in place to manage poor culture or behaviours which may impact the quality of care patients receive.

Staff told us the service had a freedom to speak up guardian. Staff had the opportunity to talk to the freedom to speak up guardian who fed back to the department anonymously. 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. Staff told us there was a no blame culture when incidents happened and the team supported each other through debriefs and reflective practice. All staff we spoke with told us that they felt confident in raising concerns with senior managers. An annual staff survey took place each year to gauge staff perception on a range of matters. The NHS staff survey 2023 result showed, 100% of staff were trusted to do their job; 83.3% of staff were able to make suggestions to improve the work of their team; 96.6% of staff felt their role made a difference to patients. However, only 36.7% staff would recommend the organisation as a place to work, compared to 61.12% of other trusts.

There was a trust wide process in place to provide staff with the ability to speak up and raise concerns across the trust. There was a Freedom to Speak Up policy in place to support this process. 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 staff survey results for the service identified only 53% of staff felt they would feel safe in speaking up.

We saw a diverse workforce to meet the needs of the local population across critical care services. Leaders supported staff by recognising excellent practices within the department. Staff were passionate and showed resilience to meet the needs of patients and their relatives. We spoke with an internationally recruited nurse who had worked with the trust for a while. They had supernumerary status for 2 to 4 weeks, were placed on the new starter programme and received intensive care competencies such as respiratory and cardiovascular competencies. They had received a lot of support from senior staff and had progressed to band 6 position. Staff were aware of the diverse needs of the patients they cared for and there were arrangements in place to support individuals with complex needs.

There were policies and processes in place to ensure the service were inclusive and fair in they way they operated. Where concerns were raised or identified, leaders acted swiftly and appropriately to address the concerns. The processes in place demonstrated they were aware of the needs of the local population and acted to address any groups who were marginalised. All processes and policies in place had an equality impact assessment. Where individual risk assessment for staff had been completed, there were processes in place to make reasonable adjustments to enable them to complete their roles. The staff survey for the service recorded low numbers of staff who had experienced discrimination from patients (3%). However, the survey identified 10% of staff who had experienced discrimination from their managers or peers. No additional information around the actions the leaders were taking in relation to these serious concerns raised.

The management team and senior staff were aware of the issues on the risk register and agreed they were representative of the risks they identified in the service. The unit’s risk register was RAG rated and identified the following key risks: airway emergencies, intensive therapy unit essential maintenance, ITU consultant cover, lack of portable EEG service, lack of real time and electronic monitoring, pressure area care and staffing risks in ITU. The risk register showed that controls were in place to mitigate these risks. Staff told us A service level agreement was in place for acute heart attack and other acute conditions. However, transfers remained a historical concern. Clinicians raised concerns about time critical transfers to a neighbouring NHS trust with potential impact on patient outcome. For example, clinicians had to go through the switch board due to the lack of speed dial which often proved to be challenging. Doctors gave an example of challenges faced whilst attempting to transfer a urology patient who required an urgent nephrotomy. We raised this with leaders who said there was work in progress to improve communication. Staff told us the service held monthly clinical governance, mortality and morbidity meetings, we reviewed three sets of the meeting minutes from December 2023 to February 2024 and noted brief documentation of discussions around governance, quality, training and performance. Staff also told us safety huddles were completed within the department and the issues raised were recorded to ensure there was an auditable trail of the information shared amongst staff.

The clinical support services which the critical care service was part of had clear governance structure with various committees that met regularly. There were monthly governance meetings which had a set agenda. We reviewed 3 sets of minutes and found these were details and reviewed important aspects of the way services provided safe and effective care. Risks were regularly reviewed and new risks were discussed prior to being entered on to the risk register. Regular updates on audits was provided during each meeting and there was also an agenda item dedicated to learning from deaths. In addition to the clinical support services governance structure and meetings, the service also held local leadership meetings where key governance issues solely related to the service were discussed. The service also held mortality reviews in relation to the patients who had unfortunately died whilst admitted. The evidence provided after the assessment provided minimal evidence of how the learning from these meetings was used to shape the care and treatment being provided on the unit. The service had their own risk register in place which contained 7 risks most of which were graded moderate risk. There was 1 risk identified as extreme even after mitigation and this was in relation to essential maintenance which was required on the hoses which supplied medical gases. The mitigation in place at the time identified measures were due to be put in place which would remove the risk, however until this had happened, the risk was to remain on the register. The service had a dashboard in place which showed key performance indicators including (but not limited to) unit acquired infections, readmissions, number of transfers and the level acuity. Leaders monitored this data and used this to drive improvements across the service. Locally the teams had systems in place to ensure any key information was disseminated and shared amongst staff.

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 told us the triumvirate led on compliance with training and routinely monitored training compliance during the directorate business meeting. They worked in partnership with the heads of departments who needed to improve their compliance in both the critical care unit and outpatients’ department. Leaders had identified a lead for innovation who worked in partnership with a neighbouring school with the aim of developing and integrating cutting-edge technological solutions into critical care practices to enhance patient outcomes. They were in the process of developing smart mattresses to reduce pressure sore in ITU. A custom version of artificial intelligence had been created which combined instructions, extra knowledge, and any combination of skills that would prepare candidates for intensive care exams. This engaged staff partaking in the intensive care exam preparation with a professional style interaction. Encouraged by the trust, critical care had recently formed a shared governance/decision making council for front line staff to have the opportunity to meet once a month to undertake projects they decided on to improve things for either the patients, families and/or staff. The council model empowered staff to have a voice and take the responsibility and accountability for change and quality improvement in their area. Staff shared these projects through the leadership council chaired by the chief nurse.

The service had processes in place to continuously learn, drive improvement and look for innovation on how to improve the service which patients receive. As part of the Clinical Support Services Governance and Safety Report, all members who attended the meeting were requested to update on aspects within their department which was going well. Evidence reviewed identified the service were regularly proud to demonstrate the improvements and investments made in the workforce within the service. Staff had been invested in to progress training and develop into leadership posts. Additional evidence provided after the assessment identified the service had implemented a lead for innovation who was working with the local university. The project they were currently working on was in relation to the reduction of pressure sores within ITU by developing a smart mattress. Other additional innovative changes made included the use of artificial intelligence to support staff who were studying to improve their intensivist skills. This supported hem in their clinical skills and decision making. The service had also implemented a shared decision-making council which aimed for staff to take the lead on undertaking improvement projects locally. The information from the local council was fed up to the trusts leadership council chaired by the chief nurse.