Chippenham 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.

This is the first assessment for this registered service. This key question has been rated 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 that was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding and meeting the needs of people and our communities.

There was a vision, clear strategy, and a continuous development culture. This was underpinned by a clinical strategy and framework that promoted “changing community health for good" by shifting the focus from traditional, prolonged hospital stays to targeted, outcome-driven rehabilitation.

Senior leaders demonstrated a good understanding of patient needs and local community challenges.

The service’s strategic framework was around their core purpose of "Changing Lives by Transforming Health and Care." It focused on shifting care delivery from hospitals to local communities, modernising digital services, and driving sustainable, outcomes-based healthcare.

Leaders told us how they supported and developed staff, so they felt valued and proud to work in the service. While targeting services to reduce health inequalities, which also included many examples of innovation and partnership working. However, some of the staff feedback we received as part of this assessment did not reflect this. Staff told us they did not always understand the service’s vision and values and how they were applied in the work of their teams. Some staff were still feeling unhappy with the recent service transformation and did not always feel they had the opportunity to contribute to discussions about the strategy for their service.

The registered manager was open to this feedback and agreed improvements were needed in how leaders and managers communicated the service’s vision and values going forward to the frontline staff in this service. The local community-based care transformation was still ongoing, with work taking place in phases.

The service’s strategic objectives were;

• Focus on prevention and early intervention
• Fairer health and wellbeing outcomes
• Excellent health and care

The service did not always have leaders at all levels at all times. However, senior leaders understood the context in which they delivered care, treatment and support and they did embody the culture and values of their workforce and organisation.

Senior managers had the skills, knowledge, experience and credibility to lead effectively and did so with integrity, openness and honesty.

There had been significant senior leadership changes over the previous 12 months, as part of the local community-based care transformation. As a result, leadership approaches, expectations, and behaviours were still being embedded and consistent, inclusive, and values-based leadership was not yet fully established.

This was supported by evidence from meeting minutes, staff interviews, and governance documents. The BSW adult quality and safeguarding committee minutes highlighted executive and senior leadership changes, reflecting a prolonged period of operational transition.

Staff across the wards described confusion linked to interim leadership roles and unclear leadership structures. Some staff reported leaders were not always visible, which led to uncertainty about decision‑making, accountability and escalation routes.

Despite these challenges, there was evidence of positive leadership practice by senior leaders and the service. We received positive feedback from the Integrated Care Board (ICB). This is the statutory NHS organisation responsible for planning, commissioning, and managing local health services and budgets.

During the assessment, matrons were visible and approachable, and managers demonstrated a strong commitment to compassionate and inclusive leadership, fostering supportive team environments. However, some staff reported limited access to senior managers.

Most staff had a clear understanding of their roles, responsibilities and reporting arrangements within their wards. However, some staff members said they were not clear on reporting arrangements due to long term sickness. Managers assured us the provider had implemented an interim management cover for the wards, and this had been communicated to all staff.

The registered manager described actions to improve leadership visibility, including recruiting new roles in the quality team, increasing feedback sessions to hear back from the wards and working together with staff to resolve the issues.

We saw evidence of leadership support for workforce development, including succession planning, leadership study days, specialist training pathways and educator‑led development programmes.

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

Staff described an open culture, where they felt confident to raise concerns and speak up without fear of negative consequences. Most staff told us they understood how to escalate concerns and felt their views were taken seriously.

Staff had access to the trust’s Freedom to Speak Up (FTSU) Guardian and local champions and most were aware of these roles and how to contact them. We observed FTSU information displayed on the wards.

Most staff described some managers as visible and approachable and said they felt supported when raising concerns. However, some staff reported challenges with communication and feedback during the current period of change and said they would welcome clearer updates and more reassurance from senior leaders.

The service encouraged staff to share their views through multiple feedback routes, including regular staff upskilling workshops and the staff survey and we saw evidence of this.

The service did not always value its workforce. However, they work towards an inclusive and fair culture by improving equality and equity for people who work for them.

Some staff spoke positively about the workplace culture and did not report discrimination or negative behaviours. However, some staff did tell us the recent community-based care transformation had impacted them negatively. This indicated respect and inclusion still needed to be embedded in practice on the wards.

The registered manager provided us with assurances and confirmed the organisation had a zero-tolerance for discrimination and more work was going to be undertaken with staff to ensure they felt supported and valued. A recent listening event had taken place with staff; whereby senior leaders heard how staff had felt during a recent transformation. Staff were able to voice their concerns and the impact the transformation has had on them. The leadership team had created a reset programme which was focused on improving communication with their staff on the back of this.

The provider operated a refer a friend scheme, which supported organic recruitment, strengthened workforce diversity and reduced reliance on agency staffing.

Leaders used apprenticeship levy funding effectively to support learning and development opportunities, enabling staff from diverse backgrounds to access training and career progression.

The provider established career development pathways that enabled staff to progress from band 2 to band 7 roles.

Staff told us they were able to access flexible working arrangements, including flexible hours and job‑sharing, to support personal circumstances such as caring responsibilities and health needs.

Managers implemented reasonable adjustments, including modified shift patterns and occupational health support.

The provider promoted equality, diversity, and inclusion in daily operations, ensuring all staff had fair opportunities to develop and progress. We saw that policies and processes supported an inclusive, respectful, and safe working environment.

The service had clear responsibilities, roles, systems of accountability and good governance 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 was a governance structure with lines of accountability through the wards and through to the service’s governance quality boards.

The provider implemented the Patient Safety Incident Response Framework (PSIRF), and staff acted on learning from deaths, incidents and patient safety reviews.

Leaders maintained oversight of risks, issues and performance. These were reviewed regularly through the monthly Quality and Safeguarding meeting. The committee monitored quality assurance action plans, the clinical audit programme, incident reviews, patient safety investigation reports, safety alerts, and The National Institute for Health and Care Excellence (NICE) provides national guidance and advice to improve health and social care (NICE) guidance and policy reviews.

There were local and divisional governance meetings that followed a set agenda. Records of governance meetings demonstrated the quality, performance, and safety of the service were monitored and reviewed. This included discussions on learning from serious incidents or complaints, the risk register, performance, national and local clinical guidance, policies and procedures, audit results, safeguarding, and training.

Staff used a systematic approach to auditing and reported a range of data to support leaders’ understanding of performance, key risks and quality improvement needs. Leaders carried out audits to monitor compliance with key processes, including the completion of risk assessments, documentation and medicines management.

We saw action was taken to improve performance. For example, for the interim period, prior to the introduction of electronic care planning, steps had been taken to improve documentation on the wards.

We saw patient records were maintained. Patients on the ward had a board behind their bed which displayed the patient's preferred name, dietary information, and any risks, such as if a patient was at risk of falls. The boards did not display any personal confidential data.

The service had plans for emergencies. For example, adverse weather or a flu outbreak. Managers planned for staff to have access to equipment and information technology needed to do their work.

The service understood their duty to collaborate and work in partnership, so their services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

The service impact report confirmed collaboration with the NHS, local authorities, and the voluntary, community, faith and social enterprise (VCFSE) is strong in places, but inconsistent and not always supported with effective cross-system pathways. The provider had identified that clearer structures for engagement were needed. They were doing this by adapting how they worked together and by establishing new ways of working against the renewed service outcomes and objectives.

Leaders and staff demonstrated a clear understanding of their responsibility to work collaboratively across the local health and care system and actively engaged with community stakeholders, commissioners and partner organisations to improve patient pathways.

Staff promoted coordinated care and effective communication with local authorities, social services, integrated neighbourhood teams and ambulance services. Positive examples included securing support for patients with complex needs and working with the voluntary sector and social care to support safe discharge and continuity of care.

Staff demonstrated the ability to track referrals and coordinate with social workers, supporting timely discharge planning.

Quality board discussions highlighted system‑wide actions to reduce avoidable emergency department conveyance, particularly for care‑home residents and frail patients.

The service also collaborated with neighbouring partners to share learning and support continuous improvement across the region.

The service focused on continuous learning, innovation and improvement across the organisation and the 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.

Staff and leaders focused on continuous learning, innovation and improvement, and were committed to developing new and creative ways to improve patient experience, outcomes and quality of life.

Staff used recognised quality‑improvement (QI) methods and understood how to apply these in practice. The wards participated in national audits and accreditation schemes, with learning used to inform service development. For example, the provider was leading the community care transformation programme across the local system. They adopted the Design Council’s 4D model of transformation – Discover, Define, Develop and Deliver. This was developed to support product and service innovation and used due to its emphasis on learning.

There were multiple examples of innovation and improvement across the organisation. For example, in partnership with NHS commissioners, the service delivered a large-scale onboarding and workforce wellbeing programme, supporting 3,306 staff across Bath and North East Somerset, Swindon and Wiltshire, Surrey, and Leicester and Rutland to transfer into the service. Building on learning from previous transfers, the initiative included an onboarding app, in-person and virtual welcome events, redesigned induction, and a flexible manager development framework. The result was smoother onboarding, reduced stress, improved morale, and stronger operational readiness, all contributing to a safe and seamless service transition for patients. The programme provided a scalable model for onboarding staff while protecting wellbeing and service delivery.

Provider-wide activity included analysis of Friends and Family Test feedback, patient surveys and experience reports. Staff were working to integrate compliance measures into new performance dashboards, supporting continuous improvement cycles, with leaders reporting improvements in patient experience.