Boston West 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

The service leaders and governance processes assured high-quality, person-centred care. Leaders supported learning and innovation and collaborated with partners to deliver care that was safe, person-centred and sustainable.

We saw that leaders promoted a positive culture which enabled staff to develop and provide the best care for patients. Managers were capable and worked to ensure the long-term sustainability of the organisation. They valued and empowered all staff and encouraged colleagues to speak up if they had concerns. Leaders worked closely with other services and local communities to build relationships and improve people’s care. Leaders encouraged innovation within the service to enhance staff and patients’ experience.

At our last assessment we rated this key question good. At this assessment the rating has remained 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.

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.

Leaders promoted the ‘Ramsay Group Way’ vision, which was to be a leading healthcare provider of the future with a philosophy of ‘people caring for people’. Leaders at Boston West hospital had helped shape the overall group strategy and adapted this to best fit the services provided at the location.

Staff knew and understood the provider’s vision and values and how they were applied in the work of their team. Staff felt that the leadership were open and honest and that the culture of the Ramsay group meant that the individual needs and preferences of staff and patients were respected. The service had policies and standard operating procedures (SOPs) which ensured the service aligned with the overall strategy of the group.

Leaders told us they adapted the visions, values and strategy of the group to best fit the service. They adjusted specific clinical strategies to be most effective for the treatment offered at the service.

The 2024 staff survey showed that 86% of staff believed in the Ramsay Way, while 89% said they would recommend the service as a good place to work. Furthermore, 91% of staff agreed that patient safety and care were a priority for everyone across the organisation.

The survey had also indicated that some people in the service felt their work was not always recognised and there was concern from staff about the level of stress in their jobs. As part of an action plan to address these concerns, senior leaders developed a framework of recognition for individuals and made a renewed effort to promote an open culture and seek feedback from staff about areas for improvement.

Staff received the right training for their roles and were able to develop their skills to take on more responsibility Some staff described pathways they had followed to progress in their careers, while other staff said they were encouraged to focus on specialist areas of their role.

Staff were positive about the developments taking place at the service, including the development of the second operating theatre and introduction of new procedures. Staff were confident they could make suggestions and give critical feedback to colleagues and leaders.

We saw staff work effectively as a team to ensure patients had a seamless pathway in their treatment. Staff told us they worked well with colleagues in the neighbouring Ramsay Group hospital. Some staff worked across both sites and there was a positive culture of shared learning and opportunities for career development. One staff member said they felt "cherished here".

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 organization. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Leaders at the location were visible, approachable and supportive, and there were occasional site visits by the group senior leadership team. The head of clinical services and two deputies made sure there was always a manager available during surgery hours. These managers led daily meetings with all departments to share information updates and learning. They also shared staff highlights to acknowledge and encourage teamwork.

Leaders considered the future of the team and were involved in talent mapping sessions to source future leaders and create pathways for staff to move into management. They were also committed to working with the local Integrated Care Board (ICB) to make best use of the second theatre. This would enable more people to have their operations promptly and reduce waiting times.

Staff told us their line managers were open and supportive. They said they were encouraged to take responsibility for their career development by managers and that leaders recognized long service by awarding certificates and gifts to staff.

The service fostered a positive culture where people felt they could speak up and their voice would be heard.

Most staff said they were confident they could raise concerns with their line manager or another senior person if required. Administration colleagues told us they were confident to share information and queries with clinical staff.

There was a group wide Speak Up program, which provided guidance for staff to highlight any concerns about patient care. Staff were aware of the principles of freedom to speak up (FTSU) and most knew who their local Freedom to Speak up Guardian was and how to contact them if they preferred to use this method.

The service valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who work for them.

The service had policies for the promotion of equality and diversity, along with other guidelines to ensure staff were treated fairly. Data showed that all staff had completed the Equality, Diversity and Human Rights (EDHR) training, while leaders had completed EDHR training relevant to their managerial roles.

Leaders told us the service had people resource groups, including those for racial equality, and disability. These helped raise awareness for all staff and established networks across the group of hospitals. The service also had national cultural forums, and a recent Armed Forces Day had been organised by a group of staff members who were forces’ veterans.

Team managers made adaptations, such as altering communication methods, to enable staff to access information. Some staff had been able to alter their working hours to fit in with their family commitments.

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 acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate.

There were clear processes and systems of accountability to support the delivery of the surgical service. The service had a meeting structure which gave senior leaders and managers regular opportunities to discuss operational issues. These meetings included weekly senior leadership team meetings, monthly health and safety meetings and monthly clinical governance meetings.

Multi-team ‘management huddles’ were held every day with staff in both Boston West and a sister hospital. The agendas of these meetings included the planned procedures for the day, staff availability, any patient safety concerns and maintenance news. They also requested updates from each department to ensure leaders had full oversight of the two locations.

There were processes to ensure patient records were kept securely, in line with current General Data Protection regulations. Most records were kept electronically and staff told us any paper-based information about patients was scanned into their electronic records at the end of their treatment and the paper records disposed of appropriately.

Leaders and staff used systems to manage performance effectively. Staff and managers were clear about their responsibilities, risks, and accountability. The service had policies that covered the management of risk.

Managers controlled risk by identifying and escalating issues and outlined actions to reduce their impact. Safety flashes were shared with all staff and there were quality assurance checks on the mitigation measures put in place.

There were location specific risk registers and benchmarking of the service's performance against national targets and accreditation schemes. There was also a specific register for surgery. The risk management policy stated that this should be reviewed at least every 3 months. We saw that all risks in surgery had mitigation in place and were due for review at the start of October. At the time of inspection, the surgical department did not have any risks which met the criteria for being on the main hospital risk register.

Staff conducted regular audits on infection prevention and control (IPC), surgical procedures and resuscitation and emergency responses. Staff reported incidents and escalated them appropriately. Managers tracked the tasks on these reports and worked with staff to put improvements in place. Central Alerting System (CAS) alerts were also reviewed and appropriate actions taken. The central alerting system (CAS) is a web-based government system for sharing patient safety alerts, important public health and other safety critical information and guidance to NHS and independent healthcare providers

The service regularly audited performance and shared this data across the Ramsay group, and in their annual quality account report displayed on their website. Leaders also provided information to the Private Healthcare Information Network (PHIN) and encouraged their consultants to share their biographies and fees. The service reported incidents and provided statutory data to the Home Office, Care Quality Commission and accreditation organisations.

We saw evidence of monthly medical advisory committees which reviewed incidents and shared learning. Medical staff also discussed updates to national guidance and how to implement these across the surgical service.

Staff had access to the right equipment and technology to provide the best care for patients. There was a secure information governance system which ensured patient records were kept confidential. Administrative staff told us they could only access relevant administrative information and were unable to see clinical data in patient records.

Staff told us they could access all policies and updates on the group intranet system and there were regular reminders about training updates, safety flashes and wider clinical developments.

The service had relevant, up-to-date business continuity plans, with guidance on managing the service after any unplanned disruptions. It also included details of key contacts and their responsibilities in an emergency.

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 operated as part of a network of Ramsay hospitals, and there was close collaboration with the neighbouring hospital in Peterborough.

The service had contracts with external providers of histology and microbiology services, and a contract with the local NHS Trust for the provision of various diagnostic imaging services, which could be provided at the local NHS hospital in Boston. Although there was no formal protocol with the local NHS hospital regarding urgent transfers, the surgical team had a good relationship with various departments in the hospital. This helped ensure swift and efficient information sharing and prompt care for patients if they were transferred.

Staff told us they worked closely with local GPs, opticians and physiotherapists, to help patients experience a seamless process before and after surgery.

Managers told us the service was involved with local community initiatives and charities. A staff member had recently put their clinical expertise to use to teach a Basic Life Support session with a local community group which had recently purchased a community automated external defibrillator (AED). The group said this gave them confidence in how to respond to an emergency of this kind, use an AED and perform cardiopulmonary resuscitation (CPR).

The service held all staff events involving both hospitals. Staff were also encouraged to take part in “Giving back” days to local communities and were recognised for their charitable work.

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 contributed to safe, effective practice and research.

Managers encouraged continuous learning and development for staff. Some staff told us they had been encouraged to learn skills to help them progress into more senior roles, while others undertook graduate training in specialisms within their area of practice.

Staff told us the service was looking to offer minor procedures to deal with dermatology issues, such as skin tags and the removal of moles identified as a potential cause for concern. They believed this may encourage local people to take up this treatment at the service to avoid longer NHS wait times.

In 2023, the service decommissioned the theatre sterile services unit. They carried out major renovations to improve the space. A second operating theatre was built, and new outpatient consulting rooms were added. The reception area was upgraded, and the waiting room was refurbished to improve comfort and increase capacity.

Staff continued to clean contaminated equipment on-site but sterilization was moved to a central Ramsay Group facility. The new layout made equipment handling more efficient, with clear pathways and timed movements to maintain infection control. These changes improved patient flow and enhanced patient experience and increased capacity across the site.

Staff were involved in the refurbishment from the planning stage, and their input ensured that improvements were also made to staff areas. A window was put into the staff room and larger staff changing rooms were created with new facilities. These changes enhanced the working environment and meant staff felt part of the improvements process which boosted morale.

The endoscopy team had recently received their annual Joint Advisory Group (JAG) accreditation and recognition for their commitment to patient safety through the National Joint Registry (NJR). Managers used the NJR scheme to assess their performance and improve. The registry includes NHS and private patients, and includes the implant, potential side effects and potential complications. The data also allowed patients to be contacted in case the implant was recalled for safety reasons. The service had achieved silver accreditation in aseptic non-touch technique (ANTT) from the Association for Safe Aseptic Practice.

The theatre manager was leading on plans to self-audit the service to benchmark against accreditation criteria with the Association for Perioperative Practice (AfPP).

The service promoted innovation and participation in research. The surgical team at the location was currently identifying possible pre-operative risks and actions to mitigate the impact of perioperative hypothermia in patients.