Rivers 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 outstanding. 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.

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 could explain the values of the children’s and young peoples’ service. All staff we spoke with were committed to being the number one choice in the local area for children and young people’s services, delivering high quality care and working in desirable place of work. Staff were proud of their place of work and spoke highly of their peers. Staff were clear of their responsibilities and how their role within the service contributed to delivering high quality care.

The culture of the service was person-centred. It was open, inclusive and empowering. Leaders, managers and staff understood equality, diversity and human rights, and they prioritised safe, high-quality, compassionate care.

Although there were no formalised local children and young peoples services strategy, staff within the hospital were proactive in the oversight of paediatric pathways across the hospital and with other agencies. For example, there were regular safety drills conducted within the hospital regarding paediatric patient deterioration that was assessed by the paediatric team, with learning shared with the wider hospital staff.

We observed good working relationships between medical and clinical staff. Staff spoke positively about the senior leadership team and their visibility.

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

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.

Leaders had the skills, knowledge and experience to perform their roles. Leadership within the service was embedded and experienced in delivering high quality CYP care in a hospital setting.

Leaders had a good understanding of the services they managed. They could explain how emerging risk was mitigated within the service and how the teams were working to provide high quality care.

Leaders within the service showed a positive, compassionate, listening culture that promoted trust and understanding between them, staff and people using the service. Leaders focused on creating trust, learning and improvement between leaders and staff.

Leaders within the service led with integrity, openness, and honesty. They ensured that the patient centred care was delivered, and that organisational risks were professionally managed. Staff felt that managers were supportive and were professionally respected.

Leaders were visible and available. They lead by example, modelling inclusive behaviours, and nurtured open and cooperative relationships. Leaders took account of their staff’s specific needs. For example, managers supported staff to develop.

Leaders were visible in the service and approachable for patients and 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.

Patients and carers had opportunities to give feedback on the service they received in a manner that reflected their individual needs. Survey results from service users were almost always positive in satisfaction regarding patient care.

There were almost no complaints or negative feedback relating to patient care and treatment.

CYP staff were embedded within the hospitals governance structure to advocate for better care and treatment of children and young people. Staff at all levels were encouraged to speak up and provide challenge to ensure safe working practices.

Patients and staff could meet with members of the provider’s senior leadership team and governors to give 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.

Leaders took steps to remove bias from practices to ensure equality of opportunity and experience for the workforce within their place of work, and throughout their employment.

Although independent healthcare providers are not required to collect or report Workforce Race Equality Standard (WRES) data, the service voluntarily monitors workforce race equality information to support equality, diversity and inclusion. There were actions in place to target areas for improvement in eliminating discrimination in the workplace.

Leaders were committed to promoting equality, valuing diversity, and fostering an inclusive workplace. There are equality and diversity champions within the service. Staff also received mandatory training on equality and diversity.

We scored the service as 3. The evidence showed a good standard.

There was a clear governance framework that was led from information from the ward and fed into the oversight of the service. This ensured that key information from the ward such as incidents and patient feedback was everyone’s business. We saw leads within the service had a comprehensive audit process to ensure that staff were frequently assessed for hand hygiene technique and skin surveillance conducted for nursing staff.

There was a medical advisory committee led by a chair and supported by the service leadership, which included approval of practicing privileges and a review of clinical outcomes from individual doctors. This was to ensure the medical practitioners who received privileges to practice within the clinic were of an appropriate and satisfactory standard.

If there were any concerns with performance, there were processes to follow and if necessary, information would be shared with professional bodies as required including the GMC. The service’s practicing privileges policy and handbook stated that practicing privileges were reviewed annually, and a formal review carried out every 2 years. The review was based on a full review of the practitioner’s performance taking into account the most recent appraisal.

Staff undertook or participated in local clinical audits. The audits were sufficient to provide assurance and staff acted on the results when needed.

Please refer to the surgery, outpatient, and diagnostic and imaging report for more information

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.

Staff within the service had links to local safeguarding networks and worked collectively across the health network. Staff worked with other local hospitals to mitigate safeguarding risk and improve outcomes for vulnerable children and young people.

The service audited consent throughout the patient pathway and conducted the relevant identity checks of parents at pre-assessment to ensure correct parental responsibility was accounted for.

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, consultant surgeons wrote letters to the registered GPs of patients treated at the clinic to confirm the outcome of procedures undertaken and any further medical advice needed post-procedure. These letters were sent electronically to the registered GP addresses of the patient and which were securely stored in the NHS medical records for the patient.

We scored the service as 4. The evidence showed an exceptional standard. The service had a strong focus on continuous learning, innovation and improvement across the organisation and local system. They always encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

Staff and leaders were committed to continually learning and improving services across all hospital departments. There was a focus on excellence that centred on a positive patient experience.

Departments actively sought feedback from staff and patients to improve the quality of care provided.

There was an embedded governance programme that meant that the pediatric lead nurse was able to collate feedback from staff to refine how the service was delivered. The service learned from incidents from other locations and received support from the national leads. Learning from emergency scenarios included all services within the hospital. This led to improving the responsiveness of staff to pediatric deterioration and appropriate escalation. For example emergency grab bags were being updated and made more accessible to improve emergency response times.

Staff were creative in the ways that they could improve patient experience based on feedback. The service had developed bespoke communication aids to support patients with additional needs to support understanding of medical procedures and support consent. Staff were clear in their roles about the support that could be provided and this was demonstrated in the care plans that were developed by a multidisciplinary team working at the hospital.