SpaMedica Truro

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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.

This is the first assessment for this service. This key question has been rated good. This meant the service was consistently managed and well-led. There were some issues around staff culture, but the service had an action plan to address.

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 evidence showed a shortfall in this area. The provider 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. Although the staff shared in this vision there were concerns around the culture. Management were aware of staff concerns and had an action plan to address.

The wider provider had 3 main objectives: patient safety, excellent care and patient satisfaction. They were centred around ensuring every patient had the best possible experience of their services, and the best possible outcome. The organisation’s values of safety, integrity, kindness and transparency encouraged staff to achieve the objectives. Staff all focused on the needs of patients receiving care and worked well together to ensure they achieved good outcomes for patients.

However, some staff told us they were unhappy with the direction of the service. Staff shared with us concerns there was increased stress amongst the staff team. There were concerns around vacant posts not being promptly advertised. Some staff told us they did not feel valued or supported by the organisation. In addition, some staff no longer felt positive around working there. They had raised concerns to senior leadership and had not felt listened to. This included the expectation to cover staff shortages at other sites and the impact this was having. Whilst staff were able to travel in work time and any extra time accrued, some staff said it was difficult to take this time back and take time for training. We found the issues with culture was not across the whole team. Some staff we spoke with were generally happy and a copy of a recent exit interview was positive around the culture and the working hours.

The provider had commissioned a ‘Great Place to Work Survey’ which was completed in October 2025. Concerns in this were around balancing home and work life and being a great place to work. Though this was balanced with some high scoring areas like management being approachable, people being treated regardless of their race and people caring for each other. There was some improvement from the previous survey in management involving people in decisions, improved trust and staff being kept informed.

Leaders understood the concerns regarding the culture. Some of the senior leadership had met with staff face to face to listen to them. Leadership had already created action plans to address concerns prior to our inspection. They had only just commenced so it was too soon to see if improvements had been made.

Although there was an issue with staff culture, this was not apparent to patients. All interactions observed with patients were positive and patients we spoke with were very positive about the team.

The evidence showed a good standard. Leaders had the skills, knowledge, experience and credibility to lead effectively. Not all staff felt that that the leaders understood the context in which the provider delivered care, treatment and support.

Leaders had the experience, capacity, capability and integrity to ensure the organisational vision could be delivered, and risks were managed. The southwest structure manager had an allocated hospital director and an area manager along with a hospital manager who is the registered manager. The registered manager is the person who is registered with CQC and is legally responsible person to oversee the daily operation. The hospital manager remained competent in clinical skills so they can assist with diagnostic tasks. They had also recently completed a leadership course. There were leadership development opportunities available and mentorship for staff. All staff had yearly appraisals with their line manager.

Some of the staff we spoke with found the leadership team supportive and approachable and aware of the challenges staff face. The staff survey had shown improvement over last years in management involving people in decisions, improved trust and staff being kept informed. There were areas for improvement in the survey, supported by an action plan. Staff said leaders were visible.

We spoke with leaders of the service including the hospital manager. They had a good understanding of the service they managed. They could explain clearly how the teams were working to provide high quality care. They also understood the difficulties staff were experiencing, and this was partly due to changes in workstreams. Leaders told us they want to address staff concerns, they had met with staff, listened to their concerns and had developed an action plan to address. They understood the challenges, but some of these were necessary to ensure business continuity.

Recently the manager has commenced a ‘Start, Stop, Continue’ exercise with the team. This should gather information on what is working well, what needs to change and what actions should be introduced. This will lead to the formation of their own hospital charter.

All staff said there were regular team meetings and information shared by the hospital manager. We looked at previous minutes from team meetings. We reviewed weekly updates and these included information about staff achievements, inclusion events, safety alerts and lots of supportive information updating staff.

The evidence showed a good standard. The provider fostered a positive culture where patients felt they could speak up and their voice would be heard.

Some of the staff felt they could speak up and be listened to. Some of the staff we spoke with said they could go to the hospital manager. There were ‘Freedom to speak up’ posters with links staff could go to if needed. There was a policy regarding Freedom to Speak Up (Whistleblowing) this encouraged staff to first speak with their line manager, though offered alternatives if that was not appropriate.

Staff were actively encouraged to speak up and raise concerns. Some staff we spoke with said they felt they could raise concerns easily and they would be investigated.

When something went wrong, patients received a sincere and timely apology and were told about any actions being taken to prevent the same happening again.

The evidence showed a good standard. The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

The provider had recently launched an equality, diversity and inclusion strategy. This was a 3-year plan to create an inclusive environment where everyone feels safe, valued and respected. Equality and diversity and human rights training was part of the mandatory training programme. All current staff were up to date with training regarding this. Leaders acted to continually review and improve the culture of the organisation in the context of equality, diversity and inclusion.

In the recent staff survey, one of the most positive responses was ‘people here are treated fairly regardless of their race.’ The leadership mentioned various networks of support for staff. These included LGBTQ+ and Menopause as well as celebrating more local events like St Piran’s Day (National Day of Cornwall).

The evidence showed a good standard. The provider 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 and effective governance, management and accountability arrangements. Staff understood their role and responsibilities. Managers could account for the actions, behaviours and performance of staff. There was a well-led and effective clinical governance structure with clear systems and processes. Each region had a governance lead who supported the hospital manager with compliance.

The service had effective systems, such as audits and risk assessments, to monitor the quality and safety of the service. There was a comprehensive audit schedule of clinical and non-clinical audits set by the corporate team. Leaders took additional steps to ensure good governance and compliance and had their own monthly CQC compliance audits, average compliance was 97.4%.

The service had a risk register; this included risks such as fire and stock levels, it had last been reviewed in October 2025. It was not clear what actions had been taken since being added to the risk register, though we were advised it was reviewed monthly by the hospital manager.

Staff understood and actively contributed to the risk management strategy. Patient outcome data was submitted to the National Ophthalmology Database Audit to benchmark their performance against other service providers.

Surgical staff performance was regularly monitored for all the surgeons at Truro. The senior leadership team shared a quarterly dashboard with outcomes for surgical staff. For optometrists, alongside the performance review, an additional audit was carried out to ensure consistency and high standards. Where shortfalls were identified, an action and support plan was developed.

There were suitable arrangements for the availability, integrity and confidentiality of data, records and data management systems. Information was used effectively to monitor and improve the quality of care.

Policies and procedures were developed and reviewed nationally. Staff were sent a weekly update email which included new policies and any tasks needing to be actioned. These were also discussed at monthly team meetings.

The service conducts peer review audits, where another manager from another site would conduct an audit. We reviewed a peer report from mid-2025 for Truro. Some issues identified were infection control issues regarding staff, gaps in some audits and some issues regarding medication. Areas for improvement had been identified; any outstanding actions were added to the site’s action plan. Other audits undertaken included clinical timings audits to support implementing plans to improve patient flow and experience theatre quality review as well as a Health and Safety audit.

The service had an up-to-date business continuity plan should a major event interrupt the provision of care and treatment.

As part of sustainability of the business, they were looking at diversifying by providing additional ways to support the local community with expanding eye-care services including potential Age-related Macular Degeneration initiatives. Other sustainable measures include managing costs such as moving to digital records, reducing postage and printing as well as improved stock rotation.

The evidence showed a good standard. The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

The local integrated care board (ICB) commissioned NHS work for the provider with key performance indictors to meet. The ICB confirmed there were no quality or patient safety themes identified.

The provider had links with local ophthalmic and NHS providers. However, there was no evidence of regular meetings. The provider said they would only be contacted by the local NHS provider if there were concerns.

SpaMedica had community champions across their hospital sites since March 2025. These roles were a key enabler to maximise fundraising as part of their partnership with the Macular Society as well as supporting other fundraising events like ‘Feel Good Friday’ and St Piran’s Day. SpaMedica supports the Macular Society to support not only raising funds and signposting but by improving information for patients with Age-related Macular Degeneration.

The evidence showed a good standard. The provider 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.

Leaders demonstrated a commitment to improvement. Performance was used to promote learning and learning was shared across the organisation. The senior leadership team and staff shared a wide range of innovation and research across all locations.

We saw examples of innovative ways of working for the benefit of patients. An example was the remote access slit lamp consultation/examination due to the limited number of ophthalmic practitioners within the local area. This helped reduce travel time, local costs and made their service more efficient. The provider was planning to introduce virtual clinics.

The provider had a standard operating procedure for an alternative nurse pre-operative assessment to be used in the event of nurse staff shortage. This procedure helped reduce appointments being cancelled and patients received their surgery in a timely manner.