Nuffield Health Brentwood Hospital

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• 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

This means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement.

This meant the service management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service was in breach of the regulation for good governance.

We have not awarded this service a score for Well-led.

Find out about when we will not publish a key question score and what we look at when we assess Well-led.

We scored the service as 2. The evidence showed some shortfalls. The service did not have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not always understand the challenges and the needs of people and their communities.

While the service had begun to develop a strategy and vision, these were not yet clearly understood or shared across the organisation. Leaders held listening events and other engagement activities, but these did not consistently translate into a shared culture or clear direction for the service. Staff views were mixed, and several told us they did not feel included in shaping improvements and felt their suggestions were overlooked.

Leaders spoke about the outpatient transformation programme and the planned expansion of the department, including six additional clinic rooms, a new treatment room, more workstations, and an enlarged waiting area. However, staff told us they did not feel leaders were listening to their concerns about the challenges created by the programme, particularly regarding the lack of space and the additional responsibilities they would be required to undertake. This meant there was a gap between leaders’ communication about change and staff confidence that their views were being acted upon.

Further details about how the hospital shared direction and culture can be found in the surgery report.

We scored the service as 2. The evidence showed some shortfalls. Not all leaders understood the context in which The service delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation.

Leaders did not always have the skills, knowledge, experience and credibility to lead effectively, or they did not always do so with integrity, openness and honesty.

At the time of inspection, both the outpatient manager and deputy manager were absent due to long-term sickness. Senior staff nurses had assumed managerial responsibilities, and staff told us senior leaders visited the department regularly to provide additional support in recognition of these extra duties.

Staff reported that senior leaders were visible within the service and that they felt well supported by their immediate line managers. One member of staff commented, “Managers are very experienced and leaders do as much as they can.” Physiotherapy staff highlighted the availability of a structured training programme to support those wishing to progress into leadership roles, and said they felt encouraged to develop their careers. However, this was not consistent across all staff groups. For example, housekeeping staff told us there was no equivalent training or development pathway if they wished to move into management. This meant that while some staff had clear opportunities for progression, others felt these opportunities were limited.

Further details on capable, compassionate and inclusive leaders can be found in the surgery report.

We scored the service as 3. The evidence showed a good standard. The service fostered a positive culture where people felt they could speak up and their voice would be heard.

The service promoted a culture where staff told us they felt able to speak up. There was two Freedom to Speak Up Guardians (FTSUG) in place, both of whom operated an open-door policy. Staff told us they knew who the guardians were and said they would feel confident raising concerns with them or directly with senior staff.

Further details on freedom to speak up can be found in the surgery report.

We scored the service as 2. The evidence showed some shortfalls. The service did not always value diversity in their workforce. They did not always work towards an inclusive and fair culture by improving equality and equity for people who work for them.

The service promoted equality, diversity and inclusion through clear policies and mandatory training, which helped set expectations for fair treatment and respect at work. Staff told us they felt comfortable being themselves and described a culture where colleagues treated each other fairly. That said, some felt that senior leaders didn’t always take the same approach when it came to support and development opportunities. For example, physiotherapists had access to a structured programme to help them move into management roles, and physio assistants were supported and encouraged in their development. However, other staff groups said they didn’t feel they received the same level of support from senior leaders when moving into management roles. Unlike the physiotherapy team, they felt there was less guidance available, and they were often left to navigate the transition on their own.

Further details on workforce equality, diversity and inclusion can be found in the surgery report.

We scored the service as 2. The evidence showed some shortfalls. The service did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

The service did not maintain risk registers at a departmental level. Instead, it prioritised an organisation-wide ‘top three’ risks. While this approach supported a clear focus on strategic priorities, it also increased the risk that some departmental or operational issues were not consistently identified, managed, or subject to oversight. At the time of the inspection, the risk register did not reflect any of the issues identified during this assessment.

There were areas for improvement in governance and oversight around the management of patient records in outpatient services. The service relied on handwritten notes, and staff told us that consultants occasionally took original records off site. This sometimes made it difficult to access key information.

During our review of 10 patient records from the previous day’s appointments, 7 were missing consultant entries. Staff explained that if notes could not be located, they would contact the consultant’s secretary or the consultant directly to clarify care instructions. There was a risk that staff would not have an awareness of the risks to people across their care journey if they did not have access to all the relevant information.

The service had carried out an outpatient record audit, which scored 97.3%, but this did not reflect the issues identified during our inspection. This indicated that the service’s audit was not robust enough to identify the concerns we identified during our inspection. Senior leaders acknowledged the concern and clarified that original records should not be removed from the premises. However, they could not provide clear evidence of actions taken to reduce the risk.

The service had a data protection policy, supported by standard operating procedures for the storage, tracking, and destruction of health records. However, this was scheduled for review in June 2025 and was out of date at the time of inspection.

Managers were supported by senior leaders to take forward new ideas. The outpatients and physiotherapy managers attended relevant governance meetings, including heads of department meetings, which provided them with oversight of risk at both a departmental and corporate level. Staff told us they received updates through daily communication briefings, and that specific monthly outpatient meetings were held where risks, required actions, and learning from incidents were shared in a timely manner. When asked to describe the current top three risks for the service, staff could not do so confidently. This indicated that staff lacked clear awareness of risk priorities and had limited access to information needed to support effective risk management.

Further details on governance, management and sustainability can be found in the surgery report.

We scored the service as 3. The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

The service worked in partnership with the wider local system, including NHS trusts and the integrated care board (ICB), which enabled leaders to better understand and respond to the needs of the local population. Staff and managers were also engaged in wider system initiatives, including participation in the patient safety “lunch and learn” pilots. These sessions, held throughout the year, covered topics such as engaging with patients and families, promoting psychological safety, and providing staff support.

Further details on partnership and communities can be found in the surgery report.

The evidence showed some shortfalls. The service did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research.

At the time of inspection, the service was undergoing a period of transformation. The outpatient department was expanding its role to take on additional responsibilities, which created opportunities for nursing staff to upskill. For example, outpatient nurses were being trained to take blood samples to support pre-assessment, allowing patients to have blood tests completed immediately after their consultation rather than attending a separate appointment.

The service did not provide information about changes made in response to patient feedback, despite patient surveys containing comments that could have supported improvement.

Further details on learning, improvement and innovation can be found in the surgery report.