Nightingale 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 looked for evidence on how the service provided was well-led. During an inspection in June 2022, we rated this key question as requires improvement. At that inspection, the service was in breach of regulation 17 (good governance). At this inspection, the rating has changed to good. The service has made improvements and is no longer in breach of regulations. The service has taken action to improve its governance and oversight systems. The service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care. The leadership team was proactive, reflective and committed to delivering consistently high-quality care.

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.

The service had a shared vision, strategy and culture that was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding and meeting the needs of people.

Staff felt respected, supported and valued. They said the service promoted equality and diversity in daily work. They could raise any concerns without fear.

Staff spoke with pride about the service and felt empowered to deliver high quality care and support to patients and carers. Staff spoke about the importance of team working to provide the best outcomes for their patients.

Staff had the opportunity to contribute to discussions about the strategy for their service, including when the service was changing through staff surveys, reflective practice, team meetings and clinical improvement meetings, for example staff were fully informed about the current building works that were taking place and how any associated risks were being managed.

Staff told us ward managers were experienced, knowledgeable and supported them in their roles.

Staff knew and understood the provider’s vision and values and how they were applied in the work of their team. These were shared with staff on their induction to the service.

The service had inclusive leaders with the skills, knowledge, experience and credibility to lead effectively and did so with integrity, openness and honesty.

All staff we spoke with said that the hospital director and other senior leaders were visible, approachable and engaged well with staff, patients and carers. Senior leaders carried out of hours visits to support staff that were not available during regular working hours.

Leaders had the skills, knowledge and experience to perform their roles. Leaders had a good understanding of the services they managed. They could explain clearly how the ward teams were working to provide high quality care. Leaders we spoke with demonstrated that they had the experience, capability and understanding to deliver the service's vision, and manage risks. They were aware of the key challenges, priorities and risks and were open in sharing them.

The leadership team within the service promoted and prioritised safe, high quality, person-centred, compassionate care. Staff we spoke with said they felt supported to do their job and described staff morale as good.

The provider created a positive culture where people felt that they can speak up and that their voice would be heard.

There were procedures for staff to speak up if they had any concerns. Staff told us they were able to do this and understood the processes in place. Staff had regular meetings as a team and with managers. Staff were able to use these to contribute information about their experiences and listen to feedback from others.

Patients had opportunities to give feedback on the service they received. For example, through community meetings, one-to-ones with staff and the patient feedback app.

The service valued the diversity in its workforce. The service worked towards an inclusive and fair culture by improving equality and equity for people who worked there. The service had a human resources strategy and action plan, which had a focus on inclusion and equity.

The service employed a diverse team of staff from international backgrounds. Since our last inspection several nurses had been employed through the service’s international recruitment programme. Employment practices promoted equality of opportunity. Staff did not raise any concerns about discrimination and all the staff we spoke with said they were treated fairly.

Managers put reasonable adjustments in place for staff members to help them carry out their role. Staff were supported with their individual needs. Staff told us the managers supported flexible working arrangements and had regular discussions to understand their individual needs and how they could best support them.

The service addressed any discriminatory behavior. All incidents of racial abuse directed towards staff or patients were reported. Minutes of the Medical Advisory Committee meeting detailed that an incident of racism towards a doctor by a patient had been followed up on and support provided.

The service had clear responsibilities, roles, systems of accountability and good governance to manage and deliver good quality, sustainable care, treatment and support.

Our findings from the other key questions demonstrated that governance processes operated effectively at team level and that performance and risk were managed well. Governance arrangements were proactively reviewed and reflected best practice.

The service had made improvements in the governance and oversight of the service since our last inspection. All areas of governance, risk and performance monitoring had been strengthened. The service had improved this area of work since the last inspection and was no longer in breach of regulation.

Governance and performance monitoring arrangements were in place to support the delivery of the service, identified risk and monitored the quality and safety of service provision. There were systems and procedures to ensure that the ward was clean and safe. Environmental works were planned for each ward including anti-ligature bedrooms.

There were sufficient staff on duty to meet the assessed needs of patients safely and additional staff could be rostered if needed. Staff were trained, supervised and appraised appropriately. Staff ensured patient outcomes and clinical effectiveness.

The service maintained a risk register and staff could escalate concerns when required. Staff concerns matched those on the risk register. The service had an up-to-date business continuity plan which outlined actions in emergencies to ensure business processes could continue. The service submitted notifications to external organisations as required.

The hospital director and senior leadership team were aware of areas where improvements could be made and were committed to improving care and treatment for patients. The service had a comprehensive site improvement plan that was reviewed on a weekly basis. Regular quality walkabouts were being conducted by the senior leadership team on each ward.

There was a clear framework for communication, this enabled staff to be kept updated about the service, incidents, safeguarding, complaints and essential information through regular team, clinical governance, and daily hospital meetings. Leaders had established proper policies, procedures and activities to ensure safety and assured themselves that they were operating as intended. Regular audits were carried out and action plans with timescales developed where shortfalls had been identified. Monthly analysis of audits and actions were carried out to ensure that identified actions had been completed. Results from the analysis were shared at the clinical governance meeting to ensure that all identified gaps had been addressed. We saw that audit processes had led to improvements within the service, for example record keeping.

The staff worked in partnership with other professionals to ensure patients received holistic and joined up support which met their needs. They supported patients to access a range of services and had effective systems of communication with health and social care teams.

Patients and staff could meet with members of the provider’s senior leadership team to give feedback. Patient forum meetings were held every two months. Meetings were attended by the hospital’s management team and patients were able to share their views about the service.

All staff were committed to continually learning and improving the service. The service had a strong learning and improvement culture.

There were clear processes in place to ensure that learning happened when things went wrong, as well as from examples of good practice. Reflective practice sessions were held with staff, and debrief sessions were held when needed. Learning was shared with the staff team at regular handover, team meetings, clinical governance meetings, learning bulletins and multidisciplinary team meetings.

The service participated in accreditation schemes relevant to the service and learned from them. For example, British Association for Counselling and Psychotherapy (BACP).

The service had successful academic placement contracts with Bath University for Psychology students and Metropolitan University for Dietetic training.