Spire London East 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 and fair culture.

At our last assessment we rated this key question as good. At this assessment, the rating has changed to requires improvement. This meant service management did not always support the delivery of high-quality, person-centred care.

The rating changed because governance, senior management and culture were not consistently effective. Staff did not always feel listened to, supported or confident to speak up, and some described fear of blame or negative consequences when raising concerns. Governance systems were in place, but they did not always provide clear accountability, consistent follow-through or assurance that risks, actions and learning were fully embedded.

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 did not consistently demonstrate a shared vision, strategy and culture that was understood and experienced positively by all staff.

Staff feedback, interview evidence, the September 2025 staff survey and post-inspection whistleblowing information showed that the provider’s vision and values were not consistently experienced in practice. The balance of evidence was negative and identified concerns about senior management behaviours, limited feedback after concerns were raised, little visible follow-up action, low morale and limited confidence that feedback would lead to meaningful change. Whistleblowing information raised concerns about some senior management behaviours, including intimidation, discrimination, bullying, repeated criticism, excessive pressure, close monitoring, disrespectful and unfair treatment. These behaviours were not consistent with the provider’s stated values of openness, inclusion and respect.

Culture was not experienced uniformly across the department. Staff interview evidence showed that positive understanding of the provider’s vision and values was not consistent. While examples were identified where minority of staff understood how their work supported high-quality care, the wider evidence showed limited confidence that staff feedback led to meaningful change. There were examples where feedback led to practical improvements, such as the reintroduction of free breakfast items. However, the evidence did not show that these actions addressed the wider concerns raised about culture, staff confidence in senior management and follow-through.

The provider had a clearly defined vision and clinical strategy for surgical services, focused on personalised care, improving patient outcomes and developing the workforce. Departmental strategies outlined priorities including safety, quality improvement, training, workforce development, communication and MDT working. Senior managers had implemented structures to support communication and engagement, including staff surveys, meetings and team discussions. Staff also described systems such as governance meetings, daily huddles, audit programmes, and quality improvement initiatives, which supported safe and effective care delivery. The service provided staff engagement activities, including the “London East Easter Egg Hunt” and learning activities such as “court room drama.”

However, these arrangements did not consistently translate into a shared or positive culture in practice. Staff feedback showed that engagement activities, feedback routes and communication structures did not consistently address wider concerns about morale, recognition, psychological safety and confidence in senior management. Staff feedback identified limited confidence that concerns would be heard, acted on or used to inform improvement. This limited assurance that the provider’s vision and values were consistently understood, experienced and embedded across the department, or that leaders had effective oversight of the culture experienced by staff.

The evidence identified some shortfalls in how leadership was experienced across the service. While leaders had the skills and knowledge to perform their roles and described governance structures, risk management systems and clinical pathways clearly, staff experiences of senior leadership were not consistently positive.

Staff told us they did not always feel safe or confident approaching senior managers and reported that concerns were not consistently listened to, acted upon or followed up. Staff feedback, survey results and post-assessment whistleblowing information identified concerns about leadership behaviours, communication and visibility. Several staff described a fear of negative consequences when raising concerns, which indicated that a positive speaking-up culture was not consistently embedded across the service.

Staff experiences of senior management varied. Some staff described senior managers as visible, approachable and supportive, while others reported limited engagement, unclear communication and delays in resolving issues. Staff also described occasions where responsibilities were unclear and decisions were not communicated effectively. This reduced assurance that leadership was consistently accessible, responsive and accountable across all areas of the service.

Staff wellbeing and morale were affected by organisational change and workload pressures in some areas. The September 2025 staff survey contained negative feedback regarding staff welfare and senior management engagement, and whistleblowing information received following the assessment described behaviours including intimidation, repeated criticism and excessive pressure. Taken together, this evidence indicated that the provider's values of openness, inclusion and respect were not consistently experienced by staff and reduced assurance that a compassionate and inclusive culture was embedded across the service.

Senior management accountability and follow-through were also experienced inconsistently. Staff identified a need for greater leadership visibility, clearer accountability and more consistent management of difficult behaviours and performance concerns. This reduced assurance that operational concerns and staff wellbeing issues were identified, acted upon and communicated consistently.

However, leaders demonstrated a clear understanding of the service, and governance, risk management and incident reporting arrangements were established. Some staff confirmed that escalation routes were available to support safe care, and there were examples of effective local leadership and teamworking. Staff in some areas described positive relationships within their immediate teams and reported that local leaders were approachable and supportive. Structured handovers, team communication and collaborative working supported the delivery of safe care at team level.

The service had formal routes for staff to raise concerns, including incident reporting systems, line management routes, staff surveys and whistleblowing processes. However, these routes were not consistently trusted or experienced as effective by staff.

The service has established arrangements in place to support staff and patients to raise concerns or share feedback. Staff had access to a dedicated incident reporting system, line management routes, staff surveys, a FTSU guardian and FTSU ambassadors and whistleblowing processes. Patients also had routes to provide feedback, including complaints, surveys and patient forums. There was evidence that some concerns were escalated through governance and risk processes, and senior managers described systems for reviewing incidents, complaints and staff feedback.

However, staff feedback, interview evidence and post-inspection whistleblowing information showed that speaking-up arrangements were not consistently trusted or experienced as effective. The balance of staff feedback identified limited confidence that concerns would be handled fairly, acted on or lead to meaningful change. Staff also raised concerns about possible negative consequences when speaking up and limited visible action after concerns were raised.

Post-inspection whistleblowing information reinforced concerns about the service’s speaking-up culture and how concerns were received, responded to and followed through by senior managers. Staff feedback showed that some staff did not feel sufficiently safe or supported to raise issues internally. Concerns included limited confidence that issues would be handled fairly, acted on or fed back, and fear of negative consequences when speaking up. This limited assurance that speaking-up arrangements were consistently embedded, effective in practice and supported staff to raise concerns safely.

The service had arrangements to promote inclusion and reasonable adjustments, but evidence showed these were not consistently applied or experienced by staff across all areas.

The provider had an equality, diversity and inclusion (EDI) framework, governance policies and support processes to promote fairness, inclusion and reasonable adjustments. EDI was defined within organisational policy, with equality focused on fair access and opportunity, diversity on valuing difference, and inclusion on removing barriers and discrimination. These principles were reflected in organisational strategy and policy.

Policies and support structures were in place to promote inclusion. These included an Equality of Opportunity policy covering recruitment, employment and progression, and a Bullying and Harassment policy with a zero-tolerance approach to discrimination. Equality Impact Assessments were required for new or revised policies to identify and reduce potential inequalities, and policies were reviewed against legislation and best practice.

The service had established roles and networks to support inclusion and staff wellbeing. These included colleague networks for LGBTQ+ staff, race equality, menopause, and mental health and wellbeing, alongside designated champions, FTSU guardians and mental health first aiders. The service also promoted inclusion through cultural awareness events, listening groups and staff forums. These arrangements provided routes for support, discussion and staff voice.

The service monitored workforce composition and data showed a diverse workforce of approximately 200 staff, excluding bank workers. Of these, 78.7% identified as female and 21.3% as male. Ethnicity data showed that 32.4% identified as White, 25.9% as Asian, 7.1% as Black, 2.5% as Mixed, 14.5% as Other ethnic backgrounds and 17.6% had not specified their ethnicity.

However, the evidence showed that EDI-related policies and support arrangements were not consistently experienced or applied at local level. Staff feedback identified variation in support, communication, wellbeing arrangements, flexible working, reasonable adjustments and inclusive leadership practice. This limited assurance that inclusion arrangements were consistently embedded in day-to-day management practice.

Compliance with mandatory EDI and human rights training was below the 95% target in several areas. Compliance was 94.7% for wards, 69.7% for theatres, 50.0% for POA and 80.0% for pharmacy, although physiotherapy achieved 100%. This showed staff had not consistently completed the training intended to support equality, diversity, inclusion and human rights in care delivery. Managers had access to training on inclusive leadership, unconscious bias and reasonable adjustments. However, staff feedback identified variation in how support, communication, reasonable adjustments and inclusive leadership were experienced at local level.

Flexible working and reasonable adjustment policies were in place to support staff needs. Policies and management training emphasised adapting working arrangements where appropriate, including remote access, to support individual circumstances such as health needs or personal responsibilities. However, staff feedback indicated that these arrangements were not applied consistently within the department. This limited assurance that EDI principles were consistently embedded in day-to-day management practice or experienced consistently by staff across the service.

The service had established governance, risk management and sustainability processes. However, these arrangements did not consistently provide clear ownership, timely follow-through or assurance that risks, actions and learning were embedded across the service.

The service had governance structures to support oversight of quality and safety. These included ward and theatre meetings, Safety Quality and Risk Committee meetings, Medical Advisory Committee (MAC) meetings, departmental assurance reports, risk register reviews, audit reporting and action logs. These forums reviewed incidents, complaints, risks, audit results, patient experience, mandatory training, safety alerts and learning from investigations.

Review of ward and theatre meeting minutes, governance committee records and MAC minutes showed that governance processes did not consistently support timely completion or embedding of actions. Ward meeting minutes from October and November 2025 recorded that incidents were discussed, but action plans and learning following serious incidents were still awaited. The same minutes recorded no outstanding actions and no risks for escalation, despite issues recorded in the minutes including unplanned admissions and cancellations.

Theatre meeting minutes from January to March 2026 showed that performance metrics, audit results, risks, governance communications and learning from incidents were standing agenda items. However, recurring actions remained subject to reminders, spot checks or ongoing monitoring. These included fire evacuation arrangements, documentation standards, World Health Organisation (WHO) checklist completion, drug chart entries, use of current forms and maintenance of incident reporting system for overruns, late starts and near misses. The minutes also recorded an outstanding Patient Safety and Quality Review (PSQR) action relating to the recovery sluice and continued monitoring of departmental risks, including cancellations linked to staffing skill mix, financial loss from late cancellations and old equipment.

Governance committee records also showed outstanding Patient Safety and Quality Review (PSQR) actions, overdue AMaT audit actions and incident actions, governance meeting evidence gaps, outstanding policy review forms, low compliance in some audits and quality improvement work that had not yet been established or progressed. MAC minutes identified ongoing governance risks, including incomplete medical records, delays in clinical correspondence, wrong laterality on booking forms, General Data Protection Regulation (GDPR) risks, consultant behaviour concerns and outpatient staffing issues. Actions for these risks often required further review, escalation or monitoring at later meetings.

The MAC had established processes to oversee doctors with practising privileges. These included initial granting, scope of practice review and ongoing monitoring through incident reporting, audits and peer review. Risks relating to consultants were identified through governance systems such as incident reporting, safety checks and risk registers, with actions assigned and monitored through governance structures. The committee also worked with the responsible officer and associate medical directors to support appraisal, revalidation and, where required, restriction or withdrawal of practising privileges based on performance concerns. However, documentation showed that governance of practising privileges depended on standardised review cycles. Most consultants were subject to biennial review, with annual oversight for higher-risk practitioners or those identified as outliers. This provided a structured process, but routine assurance of practice could extend over longer periods.

Risk management systems were in place but were not always fully effective in practice. The service maintained a risk register that included key risks such as mandatory training compliance, incomplete patient records, delays in care and diagnostic equipment limitations. These risks were generally rated as medium and had defined controls, actions and senior management oversight. However, some staff reported that frontline concerns were not always reflected or escalated through formal risk processes. There were gaps between ward-level concerns and the risks recorded on the register, and some risks were not fully mitigated. This included delays in improving training compliance due to the absence of a learning management system and inconsistencies in record keeping. This reduced assurance that risks were consistently identified, escalated and mitigated effectively.

The service used audit, performance and information governance systems to monitor safety and quality. Staff participated in regular clinical audit activity, with audits completed at defined intervals and reviewed through governance meetings, rapid response forums and quality committees. Audit findings informed changes to documentation standards, safety processes and clinical pathways. Additional monitoring processes, including peer review, spot checks and audit tracking, supported oversight of clinical quality. Managers also had access to information about staffing, patient care and service performance.

However, governance information was not always communicated or used consistently at local level. Staff feedback and governance evidence showed that outcomes from audits, incidents and reviews were not always shared in a timely or consistent way. Evidence also showed delays, unclear communication routes and limited clarity about how some issues were progressed. This limited staff awareness of performance and reduced engagement in improvement activity.

The service worked with internal teams and external partners to support governance and service delivery. There was evidence of multidisciplinary team working, structured communication processes and escalation routes to support patient care. Governance arrangements supported collaboration between clinical teams, governance leads and external stakeholders, helping risks being reviewed and managed through established pathways.

The service also considered sustainability and environmental impact. Data provided by the service showed actions to improve safety and sustainability, including installing 406 solar panels, upgrading fire alarm systems and fire doors, introducing segregated waste and recycling schemes with around 50% of waste recycled, and using a building management system to reduce energy use. However, the governance evidence set out above limited assurance that risks, actions, learning and improvement were consistently owned, communicated, followed through and embedded across the service.

The service demonstrated established partnerships and engagement with patients, staff and external organisations, although this was not always consistent or fully embedded across all areas.

The service had established a range of partnerships and engagement arrangements with external stakeholders, patients, and the wider community. Senior managers engaged with system partners, including the North East London Integrated Care Board (ICB), through regular bi weekly meetings where contractual activity, performance, concerns, and learning were discussed. There was also ongoing collaboration with NHS providers, including work to support waiting lists, which demonstrated that senior managers were working with external organisations to meet patient demand and plan services effectively.

The service engaged with a range of partners to support safety and service delivery. This included joint working with organisations such as the Metropolitan Police for counter‑terrorism training and the London Fire Brigade for emergency preparedness, including familiarisation visits and drills. These partnerships supported staff readiness and contributed to maintaining a safe environment for patients and staff.

Patients and carers could give feedback through multiple channels, including patient forums held twice yearly, complaints processes, surveys, QR codes and other accessible feedback routes. Patient forums gave people opportunities to discuss their care pathway and experiences directly with staff and senior managers. These arrangements enabled senior managers to hear directly about patient experience, identify areas for improvement and use feedback within governance and learning processes.

The service also demonstrated engagement with the local community through charitable activities and initiatives. Staff supported community charities and health awareness campaigns, which contributed to community engagement and promoted wider health and wellbeing outcomes beyond the hospital setting.

There was evidence of external clinical engagement through governance structures such as the Medical Advisory Committee (MAC), which included representation from a broad range of clinical specialities. The MAC worked collaboratively with senior managers and external professional networks to provide advice, support oversight of clinical practice and contribute to service development and strategy. This demonstrated a level of partnership working to maintain quality and safety.

However, engagement with partners and communities was not always fully embedded or consistently used to drive improvement. Wider Well-led evidence showed variability in how feedback from patients, staff and external stakeholders was used to inform change. The evidence did not consistently show that feedback was translated into timely or sustained improvements across all teams. In addition, while structures for engagement were in place, inconsistency in communication and follow-through meant leaders could not demonstrate that partnership feedback was used effectively to shape services, monitor impact and address variation.

The service had structured approaches to learning, quality improvement and innovation, but these were not always consistently embedded or used to drive sustained improvement across all areas.

Staff were supported to take part in quality improvement work across clinical areas. Projects focused on improving safety, efficiency and patient experience, including reducing avoidable cancellations, improving pathology processes, standardising theatre practice and reviewing patient pathways to reduce length of stay. These examples showed staff could identify issues and use recognised improvement methods to make changes to care delivery.

Senior managers provided staff with time, tools, and resources to support improvement activity. The service used a structured quality improvement approach, enabling teams to test changes, review impact and embed improvements over time. Staff worked across departments to deliver changes in a coordinated way, which supported better service performance and patient care.

The service used practical and engaging approaches to share learning. Tea trolley teaching and scenario-based learning, including “court room drama”, helped staff reflect on real situations and apply learning in practice. Learning was also shared through daily huddles, walkarounds and structured meetings, which gave staff opportunities to discuss issues, review risks and agree actions in real time.

Performance information was used to identify themes, prioritise improvement work and monitor whether actions were making a difference. Audit findings, emerging risks and improvement actions were reviewed through weekly rapid response meetings and quarterly safety and quality committees. These forums supported oversight of trends, agreement of actions and monitoring of progress. External accreditation and benchmarking activity provided additional assurance and helped the service compare practice with recognised standards.

There were also examples of innovation in sustainability and service delivery. Improvements in waste segregation, recycling and environmentally sustainable products supported safer practice and reduced environmental impact. The service’s involvement in initiatives such as the Gloves Off campaign showed how innovation was used to improve resource use while maintaining patient safety. However, the service could not always demonstrate how the longer-term impact of some improvement initiatives had been reviewed to ensure changes remained effective and sustainable.

The service had some arrangements in place to support innovation, learning and improvement, including participation in benchmarking, accreditation schemes and national audits. While involvement varied across departments and there was limited evidence of routine staff participation in formal research activity, teams were able to demonstrate examples of learning and service development aimed at improving practice.