Nuffield Health Newcastle-upon-Tyne 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.

This was the first rated assessment for this service since 2016. This key question has been rated good.

This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

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 3. The service had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of patients and their communities.

The service had a vision for what it wanted to achieve and a strategy to turn it into action. This vision reflected the overarching provider aims and objectives, ambitions and values. These included providing the best care and support, delivering the best possible experience and be the best place to work in health and wellbeing. Staff we spoke with had full awareness of how their work contributed to achieving these targets.

Staff were focused on the needs of patients receiving care. The service promoted equality and diversity in daily work and provided opportunities for career development. The service had an open culture where patients, their families and carers, as well as staff could raise concerns without fear.

Staff felt respected, supported and valued. Staff reported that the leadership culture was inclusive and how they felt valued and respected. Relationships between staff of all grades were positive, with strong teamwork and collaboration.

Staff felt motivated about the future and planned changes for the service.

Team and Individual staff achievement, and success was recognised and celebrated. Staff were thanked for their work.

We scored the service as 3. The service had leaders who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders usually had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty and understood the impact their behaviours and leadership had on patient outcomes and experience.

The service was led by a management team consisting of a hospital director, a director of clinical services, a director of operations and an integrated care services manager. Heads of departments reported to the directors of clinical services and operations.

Leaders had a range of experience, skills and abilities to run the service, and they understood and managed the priorities and issues the service faced. Leaders were visible and approachable in the service for patients and staff All staff told us leaders throughout the service were accessible with an ‘open door’ policy. Staff felt the leaders supported them to develop their skills and take on more senior roles.

Leaders had taken incidents seriously and knew how to deal with concerns when raised which promoted a positive culture in the service. Leaders attend the wards and departments to assess for themselves how the service was running.

Staff and patient survey results were acted upon, for example the service had developed responses to comments about the working environment in theatre. The theatre renovation project addressed issues raised through partial refurbishment, additional funding to refurbish additional areas, and new instrument trolleys.

We scored the service as 3. The service fostered a generally positive culture where patients felt they could speak up and their voice would be heard.

Staff and leaders acted with openness, honesty and transparency. Staff were encouraged to raise concerns and offer ideas; the culture allowed staff to be confident their voices were heard. The freedom to speak up policy confirmed the service welcomed ‘… speaking up and we will listen. By speaking up at work you will be playing a vital role in helping us to keep improving our services for all beneficiaries and the working environment for our staff.’

Staff told us they had confidence that when they raised valid concerns they would be supported, without fear of detriment. We saw when concerns were raised, leaders investigated sensitively and confidentially. Leaders within the service and the provider were made aware when whistleblowers had raised serious concerns.

The service had a safety culture network designed to ‘…apply effective organisational triangulation of concerns raised via Freedom to Speak Up and other routes within Nuffield Health (NH) with the aims of ensuring: high standards of quality & safety, a responsible and appropriate approach to addressing concerns, giving thanks and feedback, learning and improving.’

We scored the service as 3. The service valued diversity in their workforce. Staff work towards an inclusive and fair culture by improving equality and equity for everyone.

Leaders acted to improve where there are any disparities in the experience of staff with protected equality characteristics and the service applied the principles in the equality, diversity and inclusion policy.

The service acted to prevent and address bullying and harassment at all levels and for all staff, with a clear focus on those with protected characteristics under the Equality Act and those from excluded and marginalised groups. Staff felt everyone was treated fairly and that they would be able to report behaviour or attitudes which were negative in style. Staff with disabilities were offered reasonable adjustments to support them to carry out their roles well.

Leaders took steps to remove bias to ensure equality of opportunity and experience for staff within their place of work, and throughout their employment. An example of this was the service pay gap report identifying actions to address gender and ethnicity differentials.

All staff told us they had opportunities to apply for project work, new roles and to undertake external studies through an open application process.

We scored the service as 3. The service had clear responsibilities, roles, systems of accountability and good governance. Staff used these to manage and deliver good quality, sustainable care, treatment and support. Staff act on information about risk, performance and outcomes, and shared this with others when appropriate.

The service operated governance processes through various committees and on-site activities. The quality strategy, business continuity processes, the management of adverse events, never events, incidents and learning responses, all supported effective and evidenced governance. Quality scorecards and a quality strategy oversight forum enabled the service to benchmark performance against other providers.

There was a range of information collected, monitored and communicated internally at relevant committee meetings and was reported to the provider. Performance data was analysed and compared and where improvements were needed at the local level, action plans were developed to make this happen.

There was a medical advisory committee led by a chair and supported by the service leadership. The committee reviewed performance, strategic objectives and plans, patient activity by speciality, as well as approval of practicing privileges and review of clinical outcomes. If there were concerns with performance, these were reviewed through the medical practitioners review process and shared with professional bodies as required.

Staff at all levels were clear about their roles and accountabilities. Staff had job descriptions, and these set out expectations and responsibilities. Where senior staff had designated tasks related to audit and monitoring quality of services, they understood what was required of them.

Staff could find the data they needed, in easily accessible formats, to understand performance, make decisions and improvements. The information systems were integrated and secure. Data and notifications were consistently submitted to external organisations as required. Risks were clearly identified and a formal log of these was used to keep oversight, manage mitigation and bring to resolution. Staff contributed to decision-making to help improve sustainability and improve quality of care.

Audit processes and their outcomes were used to ensure quality of services were maintained. Where improvements were required, leaders ensured action plans and the monitoring of these led to positive changes. Risk registers were consistently updated and management reports contained analysis of concerns over time and associated action plans.

We discussed an instance of improper access of patient records resulting in disciplinary action. This had been dealt with appropriately and system safeguards implemented to prevent a recurrence. We were assured patient identifiable information was handled correctly.

We reviewed several service level and provider policies and found these were up to date and readily available to staff. There was leadership oversight of the accuracy and validity of each policy.

We scored the service as 3. The service understood their duty to collaborate and work in partnership, so services work seamlessly for patient. Staff share information and learning with partners and collaborate for improvement.

Staff and leaders at the service collaborated with relevant external stakeholders and agencies to improve care and treatment for patients using the service. For example, the Getting it Right First Time (GIRFT) initiative, NHS healthcare professionals for the cancer activity programme, local NHS trusts and universities (patient initiated follow-up, integrated musculoskeletal service), the Integrated Care Board, general practitioners (orthopaedic symposium), and consultant medical secretaries external to the hospital.

The service worked with a local sports team to deliver a free fitness education programme to monitor clinical markers beneficial to participants. Another initiative involved a social media campaign in collaboration with the ‘She Thrives’ collective to improve health education and information for women in the North East. The service had introduced two specialist doctors who provided information and advice.

The service had recently presented a free Women’s Health Symposium with topics including ‘menopause cases: decisions and dilemmas’, ‘females and physical activities’ and ‘the functional pelvic floor’.

Senior leaders were part of regional networks to understand the needs of the community and actively and openly engaged with patients, staff, equality groups, the public and local organisations to plan and manage services.

We scored the service as 3. The service focused on continuous learning, innovation and improvement across the organisation and local system. Staff encouraged creative ways of delivering equality of experience, outcome and quality of life for patient. Staff actively contribute to safe, effective practice and research.

Staff were committed to continually learning and improving services. There were processes for learning when things went wrong or of good practice, either locally or nationally. Several staff we spoke with had a good understanding of quality improvement methods and had been trained in this area of work.

Staff were supported to have the time to develop their skills around improvement and innovation and to pursue areas of interest in the service. Leaders encouraged innovation and participation in research.

Staff and leaders were committed to excellence that centred on the patient experience. We saw examples of where they saw a need, they worked together to find a solution, for example the development of guides for patients. We saw examples focussing on a proactive approach to improving physical and mental health before surgery, aimed at enhancing recovery and reduce complications (prehabilitation).

The service had developed an extensive series of ‘lunch and learn’ sessions concentrating on different topics such as medicines optimisation pre-admission, improving safety through compassionate reflection, and kindness, civility and speaking up for patient safety.