Cleveland Clinic London 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

Leaders and staff had a shared vision and culture based on listening, learning and trust. Leaders were visible, knowledgeable and supportive, helping staff develop in their roles. Staff felt supported to give feedback and were treated equally, free from bullying or harassment. People with protected characteristics felt supported. Staff understood their roles and responsibilities. There was a culture of continuous improvement with staff given time and resources to try new ideas.

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.

Leaders ensured there was a shared vision and strategy. This had been achieved by leaders developing the vision, values and strategy through a structured planning process in collaboration with people who used the service, staff and external partners. The president told us the core values were critical to how the organisation operated and were included in the patient welcome pack.

There was a culture of safety and learning that ran throughout the organisation including through their values. People were positively encouraged to raise issues and concerns however minor. This approach of raising concerns or issues was reflected in daily safety huddles, governance processes and high levels of incident reporting.

We spoke with a staff member who had recently joined the service. They told us the culture was welcoming with a ‘can do’ attitude. They were encouraged to speak up and present ideas to improve the service. This environment encouraged development, and made staff feel supported by senior staff.

Leaders have the experience, capacity, capability and integrity to ensure that the organisation’s vision could be delivered, and risks were well managed. Staff said that leaders were open, transparent, visible and approachable. Staff said they were listened to in the daily huddles and concerns escalated were taken seriously.

Staff worked well together; advance care practitioners could liaise with clinical fellows to make a decision to admit deteriorating patients.

The medical advisory committee was chaired by the medical director and met monthly. We reviewed the minutes from four meetings and found it was attended by department chairs and leaders in governance. The agenda included a safety story at the beginning of each meeting, training compliance updates and research and education updates. The committee reviewed appraisals for medical staff carried out by the medic’s responsible officer and proposed future medical employees were signed off at the medical executive committee.

The provider introduced a system for self-rostering. This gave staff with caring responsibilities the ability to be flexible around their needs which staff found supportive.

Leaders promoted staff empowerment to drive improvement. Staff were encouraged to speak up and escalate concerns. All staff we spoke with told us managers encouraged this.

The provider had three trained Freedom to Speak Up Guardians (FTSUGs). The FTSUGs had a dedicated email address for staff to contact them directly. There was also an anonymous speak up function within the online incident reporting system. Staff we spoke with knew how to raise concerns in different ways.

The FTSUGs reported each quarter to the quality and safety board. Senior leaders told us this was a good way of sharing information if staff felt unable to raise concerns themselves. They were able to give an example of a whistleblower raising concerns via the FTSUGs and what action had been taken. The Care Quality Commission were notified by a whistleblower of these concerns, and the provider was able to provide assurance that action had been taken, and the concerns had been taken seriously.

The president was notified of all concerns raised by the FTSUGs which provided assurance to staff that all concerns were reviewed at the highest level.

All policies and procedures included an equality impact assessment (EIA). The assessment was embedded within each policy and reviewed and updated as necessary when the policy was reviewed. Staff were required to complete an action plan and escalate any potential discriminatory impact of the policy as part of the assessment. If new guidance or information emerged that could impact on equality, diversity and inclusion, the provider took immediate action to review and update all policies affected immediately. This assisted in addressing any disparities and ensured the needs of staff from protected or marginalised groups were consistently considered.

The provider promoted an inclusive and fair culture through initiatives and processes. Staff surveys were a key tool in monitoring how different groups, particularly those with protected characteristics under the Equality Act, felt about the workplace environment. If any group expressed concerns, action plans were developed to address those issues, and the impact of these actions was monitored through subsequent surveys.

The provider took several measures to prevent and address bullying and harassment. Freedom to speak up guardians were introduced to help encourage staff to raise concerns.

Staff and leaders engaged with people and partners to share learning and collaborate for continuous improvement. The provider was working with NHS trusts and universities to provide access to resources and training to help increase the number of people entering healthcare professions.

The service worked with other providers to transfer patients safely into their care when the referring provider was unable to provide the level of care and treatment the patient required.

The critical care unit participated in a number of independent audits, for example ICNARC, to benchmark themselves against other similar critical care units and identify new and innovative ways to achieve better outcomes for patients. Staff attended conferences to gain further knowledge which they presented and shared with staff on their return.

The provider was a member of PHIN and worked with partners to make sure patients could access independent information about care providers and doctors to inform their choice of care provider.

The provider had introduced a new framework to review incidents. This focussed on thematic reviews allowing senior leaders to identify themes where improvement was needed.

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Staff told us they felt empowered to suggest ideas for improvement and were listened to. Staff were encouraged to participate in pilots and further education to review and embed new strategies. Practice educators were available to provide staff with additional training and embed learning. The critical care nursing fellowship programme commenced in 2024 giving registered nurses the opportunity to work and train in the service and undertake a university qualification to become a critical care nurse.

Staff told us they valued the preceptorship support form senior colleagues and the internal training in critical care that the service had developed to upskill staff.

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Following our assessment the provider submitted evidence of a range of treatments, procedures and techniques that were stated to be more efficient and resulted in better outcomes for patients. As this information was provided following our assessment we have not evaluated the effectiveness of these procedures.