St Andrew's Healthcare - Essex

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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 requires improvement. At this assessment the rating has changed to good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care. Leaders had the skills, knowledge and experience to perform their roles. Staff knew and understood the provider’s vision and values and how they applied to the work of their team. Staff felt respected, supported and valued. Governance processes operated effectively. Performance and risk were managed well. Teams had access to the information they needed to provide safe and effective care. Staff collected analysed data about outcomes and performance. They used this to identify improvements.

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 evidence showed a good standard. 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 people and their communities.

Staff felt respected, supported and valued. They said the service promoted equity and diversity in daily work and provided opportunities for development and career progression. They could raise any concerns without fear.

Staff knew and understood the service’s visions and values and how they were applied in the work of their team. Staff had the opportunity to contribute to discussion about the strategy for their service, especially where there were changes being made to the service. Patients and carers were involved in decision making about changes to the service. The senior leadership team had communicated the vision and values to staff and patients who used the service.

Leaders were aware of any risks to delivering their strategy and local action plans to address that they monitored and reviewed these for progress.

We scored the service as 3. The evidence showed a good standard. The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Staff and patients told us that leaders were visible on the ward, approachable and engaged well with them. Managers said they received good support from senior leaders. Leaders were visible within the service and had the experience, capacity, capability, and integrity to ensure that the organisational vision could be delivered, and risks were well managed.

Senior leaders were skilled, experienced and knowledgeable. Experienced leaders had a strong understanding of the service they managed. They were aware of the service performance and aware of challenges faced by the service. They collaborated with one another and other staff to develop solutions or mitigations and were supported by management at provider level.

Leadership development opportunities were available, including opportunities for staff.

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 had a freedom to speak up process if staff wished to raise concerns confidentially. Staff told us they felt they could raise concerns with their managers, staff said they felt confident in speaking up, staff told us they felt listened to and where there was learning this was shared amongst staff. The hospital had freedom to speak up guardians. The hospital had held a session open to all staff to discuss the importance of speaking up, staff spoke openly about any concerns they had. There was also regular listening sessions held on the ward, themes raised were staff allocation of duties.

Leaders collected staff feedback. We reviewed the hospital-wide staff your voice survey 2024, which had a response rate of 80%. The hospital scored high on areas such as career progression, equality, diversity and inclusion and staff felt valued by their line manager and colleagues. However, the hospital scored lower on senior managers acting on staff feedback and also communication between senior management and staff being effective. Senior leaders had put things in place to address this and when we spoke to staff they gave positive feedback.

Patients had the opportunity to provide feedback about the service. They knew how to raise concerns and received a response. Staff facilitated regular community meetings on the wards, which gave patients the opportunity to give feedback and receive updates about progress or changes following their feedback.

We scored the service as 3. The evidence showed a good standard. The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

The provider had a range of equality, diversity and inclusion networks that staff could access. These included Unity, Wish, Pride and Dawn, which were all open to staff to join. The hospital also had a Patient and Carer Race Equality Framework (PCREF) plan for 2025-2026, initiatives included cultural awareness e-learning, YourVoice annual survey for staff, and unity listening events.

The service employed a diverse team of staff from international backgrounds. Employment practices promoted equality of opportunity. Staff did not raise any concerns about discrimination.

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

Leaders attended regular governance meetings for safety, audit, quality and governance. The service discussed and addressed key areas of performance, risk, audit, culture and workforce. Minutes showed areas of concern were identified and actions taken to learn and improve. Ward team meetings included topics such as staff morale, ward acuity and boundaries. They also included actions, and progress was updated.

The service held a risk register which we reviewed. All identified risks had actions in place to mitigate them. The risks were allocated to an individual and reviewed regularly. Progress was monitored on a regular basis. The risks identified were rated by their severity. Issues raised by staff matched what was on the risk register.

Staff undertook or participated in local clinical audits. The audits were sufficient to provide assurance and staff acted on the results when needed. For example, clinical staff completed audits of mental capacity and high dose antipsychotic monitoring on a regular basis.

Managers had access to information to support them with their management role. This included information on the performance of their wards, staffing and patient care. The electronic system used by the service allowed managers to have access to information such as whether care plans, physical health checks and legal status were up to date. They also had access to information on staff training compliance. Service performance was discussed in clinical governance meetings.

Leaders explained how they communicated and interacted with staff to ensure they managed risk and sought staff views to make improvements. Leaders spoke about their responsibilities in relation to maintaining oversight of the services, by being present and ensuring they had managers on the wards.

Staff knew how to deal with complaints and reported incidents and safeguarding concerns. Leaders shared lessons learned from investigating complaints, incidents and safeguarding issues.

The service had plans for emergencies – for example, adverse weather or an outbreak of illness. The hospital had a business continuity plan in place for all wards. The plans identified the process to be followed in the event of several different emergency scenarios.

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.

Carers had access to a central forum where they could be supported and involved in care planning. A carer’s post-discharge survey was in place, helping gather feedback and improve care. This meant carers were recognised as key partners in patient’s recovery.

Patients were supported to access NHS screening programmes and had regular reviews for long-term conditions. This meant the service worked in partnership with wider health systems to promote physical wellbeing.

Post-discharge surveys were used to gather feedback from patients, helping the service understand patients’ engagement and improve transitions, people’s views were valued beyond their time in the service.

Service leaders engaged with external stakeholders, such as integrated care boards (IBC) and local authorities. Leaders and staff developed and maintained effective working relationships to support patient care and maintain their safety.

Patients and staff could meet with members of the provider’s senior leadership team and commissioners to give feedback. Patient feedback was included in clinical governance meetings which were attended by the senior leadership team, there was a section on the clinical governance for patient and carer experience. Patients could also attend the service user forum to give feedback to the leadership team.

The hospital had appropriate processes in place to support effective links with the community and with partners. Feedback we received from partners was positive, partners told us queries were responded to quickly, regular meetings were held involving the necessary people, and the staff were caring and knowledgeable about the patients. We were told that a patient on the ward had been able to demonstrate greater insight into their illness and had progressed well through the pathway and had reached some recovery milestones.

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

The service focussed on continuous learning, innovation and improvement across the organisation. Regular audits, ongoing monitoring and actions drove improvement across the service and the wider hospital. Tiptree had a ward action log, which detailed any issues, action required and progress on the actions.

Leaders had initiatives in place to improve the quality-of-care across the hospital. The hospital had introduced the care premiership program, aimed at enhancing the quality of patient care, professional development, and leadership skills amongst nursing staff. The care premiership was an internal based competition programme, working around 3 areas, team building, patient engagement and ward reporting. A premiership newsletter was sent out to staff monthly, this included an article about the monthly champions, score updates and the league table. The hospital held fun Friday games and care awards.

The hospital had a must read 2-minute weekly update, which was shared with staff, it detailed what staff needed to know for the week ahead, learning, actions and information on speaking up. There was also an open culture messages, overview page which listed all channels available to speak up, a list of improvement measures in place to make services better for patients.

The hospital had a physical health quality improvement project, with the aim to improve communication about the physical health of patients, this had involved an introduction of a weekly physical healthcare huddle and summary sheet/dashboard, which had evidenced improvements.