Updated 7 October 2022
We carried out an unannounced inspection of Surgery services provided by the trust because we had concerns about the safety and quality of services. We inspected the Surgery core services at Gloucestershire Royal Hospital and Cheltenham General Hospital.
We rated well-led (leadership) from our inspection of trust management, taking into account what we found about leadership in individual services. We rated other key questions by combining the service ratings and using our professional judgement. Use of Resources was not assessed during this inspection.
At our last comprehensive inspection of Gloucestershire Hospitals NHS Foundation Trust, published in 2019, we rated well-led and the trust as good overall.
Our ratings for both the core service inspections and the well led assessment deteriorated.
For Surgery at Gloucestershire Royal Hospital and Cheltenham General Hospital, we rated the services as inadequate for safe and well-led. We rated the key questions of effective and responsive as requires improvement and caring as good. The overall ratings for Surgery were inadequate.
Following the inspection, we issued a section 29a Warning Notice to the trust as we found significant improvement was required in areas of safety, leadership, risk management and governance for the surgery services.
We did not inspect a number of core services at the trust's locations. We continue monitoring the progress of improvements to services.
- We rated well-led as requires improvement following the well-led assessment.
- We rated safe and responsive as requires improvement, effective and caring as good.
- In rating the trust, we took into account the current ratings of the services not inspected this time. We rated 10 of the trust’s 16 services as good, two as outstanding, and two as inadequate.
Our rating of the trust went down. We rated them as requires improvement because:
- Leaders did not always use the organisations’ values to improve the culture and services for patients. Not all leaders were visible and approachable for patients and staff and not all staff felt respected, supported and valued.
- The trust did not have an open culture where staff could raise concerns without fear. Leaders did not always promote equality and diversity in daily work, and some staff groups did not get provided opportunities for career development.
- Not all levels of governance and management functioned effectively and interacted with each other. There was a disconnect between some senior level leader’s perception and the reality for the frontline staff. Staff did not always feel actively engaged in the planning and delivery of services and in shaping the culture.
- Learning following incidents was not always shared effectively to make improvements and change was not always sustained. Middle level managers and leaders did not all feel listened to or involved in improvement strategies.
However:
- Most leaders had the skills and abilities, experience and capacity to manage the trust. However, many were new to the organisation. Leaders were aware of the challenges the trust faced as a whole including the system and political context.
- The trust had a vision for what it wanted to achieve and a strategy to turn it into action, developed with relevant stakeholders. There were collaborative relationships with external partners to build a shared understanding of challenges within the system and the needs of the relevant population, and to deliver services to meet those needs.
- A review of the effectiveness of committee structure and governance was underway. Changes were being implemented to improve risk management and visibility from frontline services to the board. Senior leaders were clear about their roles and accountabilities.
- Leaders encouraged innovation and participation in research. Staff and leaders had a good understanding of quality improvement methods and the skills to use them.
How we carried out the inspection
We carried out an unannounced inspection of Surgery core services at the trust’s locations of Gloucestershire Royal Hospital and Cheltenham General Hospital. During the on site inspection, we spoke with approximately 98 staff, seven patients and saw feedback from patient surveys. We reviewed 14 patient records. We conducted four interviews following the inspection. Twelve members of staff contacted the Care Quality Commission directly to share their views as they were not able to speak with us during the inspection.
The team that inspected the Surgery service comprised a CQC lead inspector, a CQC inspector, the CQC national professional advisor for surgery and three specialist advisors. The inspection team was overseen by Catherine Campbell, Head of Hospital Inspection.
We also inspected the well-led key question for the trust overall. During the well-led assessment we undertook a number of interviews and staff focus groups including matrons, consultants, pharmacy staff, trust leadership team, governors and staff representative, executive and non-executive directors. Fifty members of staff contacted the CQC directly following the well-led inspection.
You can find further information about how we carry out our inspections on our website: www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.