St Anthony's 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 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 looked for evidence that there was an inclusive and positive culture of continuous learning and improvement that was based on meeting the needs of people who used services and wider communities. We checked that leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred and sustainable, and to reduce inequalities.

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 some shortfalls. The service did not have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not always understand the challenges and the needs of people and their communities.

Over the last 18 months, the service experienced unstable leadership, with 5 hospital directors in post during this period. This impacted the consistency in leadership oversight, strategic direction and staff confidence. Some staff reported to us that they did not feel that senior leadership clearly communicated the vision and value with frontline colleagues. Staff told us that at times, they felt confused, uncertain about their future and the frequent changes of management, created a climate of uncertainty. However, they were hopeful that the new manager, who had been in post for 3 months at the time of the assessment, would improve stability and provide clearer communication and leadership.

At the time of the assessment, the new manager was on annual leave. Staff did not have clarity on the best person to contact to address some of the issues they identified, they told us that those they were directed to did not always have clear information.

Staff reported to us that that they did not have the opportunity to contribute to discussions about the strategy of the critical care service. They said that senior leaders would not discuss nor consult with them before implementing a change to the service. For example, staff told us that all mortality cases were reviewed centrally by Spire Healthcare director of clinical services without any involvement of local teams. This aligned with allegations received before the assessment that incident harm gradings were being determined by the Director of Clinical services without multidisciplinary team agreement.

Staff also told us that there was not a culture of inclusivity and transparency. They reported a culture of blame, and they experienced leadership defensiveness when reporting concerns and incidents. They also mentioned to us that they were scared to accurately report some incidents and concerns because the senior leadership team was very defensive rather than encouraging an open discussion.

Staff demonstrated a commitment to delivering high quality care and spoke positively about supporting patients through their recovery and discharge from critical care.

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.

The service had leaders who had the experience, skills and abilities to run the service, they understood and managed the priorities and issues the service faced and the context under which they could deliver quality of care. Leaders were visible and approachable in the service for patients and staff.

Leaders told us they took incidents seriously and knew how to deal with concerns when raised in a way that promoted a positive culture in the service. However, this did not align with the information we gathered during our discussions with staff. They told us that senior leaders became defensive when they raised concerns.

Leaders told us that they went to wards and departments to assess how the service was running. Staff and patients told us that leaders were visible and approachable.

Leaders demonstrated a good understanding of the service and could clearly describe how teams worked to deliver high quality care. The critical care manager had been in post for 3 months at the time of assessment but was unavailable during our visit. During a previous vacancy, the unit was managed alongside theatre. Staff told us that management changes over the preceding 18 months had created uncertainty and a lack of clear direction. They also reported limited access to leadership development, training and other development opportunities.

The evidence showed some shortfalls. People did not always feel they could speak up and that their voice would be heard.

Senior staff in critical care were encouraged to respond to concerns and complaints at the earliest opportunity to support local resolution. Policies supporting the complaints process were current and accessible. Information on how to contact the Freedom to Speak Up (FTSU) team was displayed within the unit. While FTSU leads described an open-door approach and encouraged staff to raise concerns, some staff told us they did not always feel listened to or supported. FTSU leads also acknowledged that there were no formal arrangements to strengthen their autonomy and independence. Some staff reported concerns about bullying and inappropriate behaviour between colleagues, which they said had been raised with human resources and the FTSU team. However, they described limited feedback on actions taken and felt insufficiently involved in decisions affecting the service. We raised these concerns with the leadership team at the end of the onsite assessment.

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.

Staff were able to apply to work flexibly, taking into account for personal circumstances such as caring responsibilities and health issues.

They reported that managers implemented reasonable adjustments to support them in their roles.

The Equality Diversity and Inclusion (EDI) policy provided guidance to ensure that staff was representative of patients’ groups. We reviewed training data and the completion rate for EDI was 95%, which is above the 90% provider target.

The service undertook equality monitoring of staff within the service to ensure that there was a representation of different patient groups including the Race Equality Network and LGBTQ2+ through events such as the pride month, equality race, women international day and black history month There were processes to prevent bullying and harassment at all levels and for all staff, with a clear focus on those with protected characteristics under the Equality Act and those from excluded and marginalised groups.

Leaders undertook equality monitoring of staff to minimise bias from practices and improve equality opportunities and experience within the critical care workforce. Managers reported that they monitored staff experience and acted where disparities related to protected characteristics were identified.

The evidence showed a good standard. 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 act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

There was a clear framework of what must be discussed at a ward, team or directorate level during meetings to ensure that essential information, such as learning from incidents and complaints, were shared and discussed.

Governance meetings included the hospital local governance meetings, quarterly and national governance meetings, operational safety quality and risk committees (SQR) and clinical governance meetings. Data and information such as clinical indicators, incidents, risks, exception reports and quality were discussed and used to benchmark departmental and overall performance across the provider’s hospitals and informed the development, monitoring and implementation of action plans where improvements were needed.

Key information on governance was shared with staff via newsletters, feedback Friday bulletins, handovers, daily huddles, team meetings, emails, information displayed on boards and new colleagues’ forums.

Managers and staff understood their roles, responsibilities and accountabilities in the management and delivery of good and sustainable care, treatment and support. Managers had access to accessible and accurate information on service performance and patient care, which supported oversight and service improvement. Information governance arrangements included policies to protect the confidentiality of patient’s records.

Staff undertook local clinical audits, which provided assurance and informed improvements where required. The service-maintained risk registers at ward and directorate level, and staff could escalate concerns through the incident reporting system or an anonymous reporting mechanism.

The hospital risk register showed that risks were regularly reviewed and used the Patient Safety Incident Report (PSIRF) to support learning from incidents, identify themes and opportunities for improvement.

The service had business continuity plans in place and worked closely with local NHS hospitals for emergency situations such as adverse weather and outbreaks.

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.

Directorate leaders engaged with external stakeholders and collaborated with relevant external stakeholders including local NHS hospitals, local authorities, and agencies to improve care and treatment for patients using the service

Some senior leaders were part of regional Spire Healthcare networks to understand the needs of the community and the provider ambitions. Leaders and staff actively and openly engaged with patients, staff, equality groups, the public and local organisations to plan and manage services. For example, the director of clinical services attended the local adult and children safeguarding board and partnership meetings to ensure strong external partnership work with local authorities to identify local safeguarding priorities, understand emerging risks, share learning and best practice.

The evidence showed a good standard. 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 contribute to safe, effective practice and research.

The provider focused on fostering continuous learning, improvement and innovation through evidence-based best practice and sharing learning across services at local and national levels. The service compared clinical and operational performances against the national standards to benchmark their performance and to identify gaps, and best practices. We saw evidence that action plans were in place to address organisation wide learning and were told that a bi-monthly ‘Project Pulse’ meeting was attended by MDT representatives from across the hospital to collaboratively address key patients experience issues.

The service had a patient experience and engagement process in place to ensure that they deliver an inclusive environment for patients to actively participate in the improvement of their care pathways. Themes and actions they identified through surveys were monitored via the Patient Experience Group (PEG).

The service used reward and recognition schemes to encourage quality improvement initiatives with measurable improvements.

Staff told us that they had the time and support to develop opportunities to improve and change the delivery of care in the critical care unit. However, they did not see innovations taking place as a result of staff suggestions. They also took part in audits relevant to the critical care service and learned from them.

Staff and leaders were committed to excellence centred on the patient experience. Where they identified a need, they worked together to find a solution. For example, the service implemented Parasternal block administration in order to reduce postoperative requirements of opioid by approximately 20mg. This improved early pain control during the critical postoperative period, particularly for elderly patients.

The service won the Independent Healthcare Providers awards 2026 for their contribution to preventative care in reducing the incidence of venous thromboembolism in post-surgical patients.