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

Leaders ran services well using reliable information systems and supported staff to develop their skills. 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 all staff were committed to improving services continually.

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.

Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service had an open culture where patients, their families and staff could raise concerns without fear. Staff were positive and proud to work in the organisation. The culture was centred on the needs and experience of people who used services. Managers told us the medicine vision was to ensure they were getting the fundamentals of care right and ensuring they were making a difference to every patient. They aimed to tackle health inequalities within the area and the respiratory and cardiology teams had set up new initiatives to assist with this. These included a tobacco dependency service and a cardiology bus to assist with health checks in more rural locations or for people who could not easily attend health centres. There was a positive culture within the service. Almost all staff we spoke to told us this. Staff all had a good relationship with each other and were not afraid to raise concerns.

The managers on the acute medical unit had a vision for improving the department. They wanted more high dependency beds, a designated frailty area and direct admissions from the community. They felt this would improve the flow and ensure patients accessed the right care promptly.

Leaders had the skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff. They supported staff to develop their skills and take on more senior roles. Staff told us how they had progressed through the service and were supported by their managers to do this. Leaders had the skills, knowledge, experience, and integrity to run the service. They attended appropriate leadership courses and were supported by the managers to do this. Leaders understood the challenges to quality and sustainability and could identify the actions needed to address them. Staff told us leaders were visible and approachable. There were clear priorities for ensuring sustainable, compassionate, inclusive, and effective leadership, and a leadership strategy and development programme, which included succession planning.

Staff and leaders acted with openness, honesty, and transparency. Staff were encouraged to raise concerns with their managers. There was a freedom to speak up guardian, although not all staff we spoke to were aware of them. Leaders promoted staff empowerment to drive improvement. They encouraged staff to raise concerns and promote the value of doing so. Staff we spoke to were confident their voices were being heard. Staff told us they had raised concerns and action had been taken promptly. For example, there were some issues with the estate on the acute medical unit and these issues were fixed within a few weeks. When concerns were raised, leaders investigated sensitively, and lessons were shared and acted upon. The recruitment and retention team completed wellbeing walkarounds to ensure staff had opportunities to speak up if they did not want to speak to their managers. Matrons completed night time visits to ensure they were visible to night staff. There was a ‘rumour mill’ on the website where staff could post anonymous questions and see the answers. There was a shared decision council staff group on some of the wards including Alexandra and Arbury Lodge that met to discuss topics to improve on the ward. They were given 6 hours a month to meet and make changes needed.

Leaders took action to continually review and improve the culture of the organisation in the context of equality, diversity and inclusion. The service promoted equality and diversity in daily work and provided opportunities for career development. Managers told us there was diversity within the workforce. This had increased since they had employed international nurses. They had been integrated into the teams and all international nurses we spoke to felt part of the team and welcomed. Equality and diversity training was part of staff’s mandatory training programme; 95.9% of staff had completed this. Managers told us they had accommodation and toilets specific for staff who were undergoing gender reassignment to ensure they felt supported.

There were policies and processes in place to ensure the service were inclusive and valued diversity in their workforce. All policies and processes in place had an equality impact assessment. Leaders took action to improve any disparities in the experience of staff with protected characteristics. We spoke to a number of staff with protected characteristics, and they felt supported and included by their team and managers. Leaders took action to prevent and address bullying and harassment. Managers told us there had been an improvement with bullying as there had been a big focus on this from the wellbeing and retention team. Leaders ensured there were effective ways to engage with and involve staff and staff felt empowered to raise their concerns. Where staff needed adjustments at work, managers completed risk assessments to ensure they were able to complete their role.

All levels of governance and management functioned effectively and interacted with each other. Staff at all levels were clear about their roles and understood what they were accountable for, and to whom. Staff told us there were governance, management, and accountability arrangements in place, and that they understood their role and responsibilities, what they were accountable for, and to whom. There was a monthly governance meeting where leaders reviewed incidents, complaints, audits, and risks. Ward managers attended from the wards and fed back key information to the staff via newsletters, meetings or encrypted social media applications. Staff completed a survey in 2024 about how they felt at work. Managers had reviewed this and completed an action plan to make improvements where possible. For example, only 51% of staff felt involved in deciding changes introduced that affected their work. The actions were to bring in shared decision-making councils including a well-being shared decision council with representatives from each staff group. Staff told us they received feedback from audits that were undertaken.

The medical service had a clear management structure. Leaders monitored quality and operational processes and had systems to identify where action should be taken. Audits and action reports demonstrated action was taken when required and improvements monitored. The service had a clear governance structure with various committees. There were monthly governance meetings as well as a specific governance meeting for the acute medical unit. We reviewed 3 sets of governance meeting minutes which showed there were effective processes in place to review risk and create improvements. Learning was shared with staff using several avenues. Managers told us that team meetings were difficult to achieve but they always ensured staff were communicated with. An action on the staff survey action plan was to improve the access to team meetings to ensure staff had a voice. We reviewed ward meeting minutes and newsletters which showed staff were kept informed. There were arrangements for identifying, recording, and managing risks, issues and mitigating actions. There were 23 risks on the medicine risk register. There was alignment between recorded risks and what staff said was ‘on their worry list’. Risks had been reduced. For example, 12 months ago, staffing was on the risk register. They had completed an international recruitment programme, retained staff, developed their own staff and driven the vacancy rate down. This meant most wards we visited during our assessment had no nurse vacancies and this risk had been removed from the risk register. The leaders were aware of future risks and planned to ensure they were reduced. Matrons and the head of nursing did a detailed ward assurance audit every 2 months. We looked at these and found them to be detailed and actions had been taken to drive improvement. A dashboard was in the process of being created to display these results in a red, amber, green system allowing wards to compare their results against others.

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.

All staff were committed to continually learning and improving services. They had a good understanding of quality improvement methods and the skills to use them. There was a learning panel every 3 months which agreed further training for staff within their job role. Trained staff were each allocated money every 3 years for further training. Leaders encouraged innovation. Wards had practice facilitators to assist with learning and support staff with progression. Doctors told us they had a good teaching programme that was supported by their managers. Leaders and staff aspired to continuous learning, improvement and innovation. This included participation in appropriate research projects and recognised accreditation schemes. Learning from internal and external reviews was mostly effective and included those related to mortality or death of a person using the service. The service had recently gained funding for a cardiology bus to help tackle health inequalities and provide a service to patients within the community who found it hard to attend appointments. The service had created a thoracic day unit and a gastroenterology day unit. Both were utilised for minor procedures. These were created as the staff asked for them and saw the benefit in providing these facilities for patients. The physiotherapy team in the Felix Holt Ward had created a new leaflet which was going through governance which explains each professional role, what happens on the ward, therapy activities available. It was developed in order for patients and relatives to understand how the unit worked. The hospital had commissioned an audit into the governance systems and looked at the strength of the services governance meetings and what improvements were needed. We saw these were discussed in April 2024 governance meeting and put together a proposal to make improvements.