Practice Plus Group Hospital, Southampton

On this page

• 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

At our last assessment we rated this key question good. At this assessment the rating has remained the same. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

Leaders were visible, approachable and promoted a positive culture where staff felt supported and able to raise concerns. Staff and leaders worked collaboratively with partners, communities and external organisations to improve access to care and people's experiences of treatment. The service demonstrated a commitment to learning, improvement and staff development. However, governance systems were not always effective in ensuring learning, risk management and compliance with expected standards were consistently embedded across the service.

The service was in breach of Regulation 17 (Good governance).

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.

Leaders used a range of approaches to promote the organisation's vision and values and reinforce expected behaviours. The organisation had a vision and strategy supported by four values that underpinned the delivery of care and treatment. During the inspection, we saw posters displaying the hospital's vision, strategy and values in different areas of the service. Staff we spoke with were aware of the organisation's vision and told us it was discussed during team meetings. Service leaders described how they embedded the organisation's values through training, meetings and day-to-day leadership. Leaders told us they used the values to guide behaviours and expectations and addressed occasions where staff behaviour did not reflect the organisation's values.

The organisation recognised and celebrated behaviours that reflected its values. Through the Healthcare Heroes programme, staff could nominate colleagues who demonstrated behaviours linked to the organisation's values, including people-focused care and going above and beyond in their roles. Leaders reviewed nominations monthly and shared examples of positive practice across the organisation.

Staff had opportunities to share their views and contribute to service improvements. Leaders gathered staff feedback through annual staff surveys and staff nominations. Senior leaders reviewed survey findings, identified key themes and developed action plans in response. Departments also developed local actions to address issues identified through staff feedback. Leaders told us progress against these actions formed part of management objectives and appraisal discussions. Staff described how the organisation's vision and values were discussed during team meetings and gave examples of how their roles contributed to meeting patient’s needs.

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 were visible within the service and used a range of methods to engage with staff, understand operational challenges and respond to feedback. Staff told us leaders were approachable and regularly present within clinical areas. For example, the Head of Nursing and Clinical Services visited clinical areas each morning and met regularly with staff. Leaders also carried out monthly departmental spotlight visits, which included informal discussions with staff, gathering feedback and sharing outcomes through "You Said, We Did" initiatives. Following staff survey feedback about leadership visibility, members of the senior management team met with different staff groups each month to discuss organisational updates, service developments and operational challenges. Leaders documented actions arising from these discussions and shared progress with staff. Topics discussed included planned changes to the hospital site, call management systems and support for staff managing difficult or abusive telephone calls.

Leaders demonstrated a good understanding of the service and the issues affecting staff and service delivery. They described actions taken in response to concerns raised by staff and explained how they monitored progress through action plans and regular review meetings. Staff told us they felt able to raise concerns with leaders and seek support when required.

Leadership development and support arrangements helped leaders develop their skills and respond to the needs of staff and the service. Managers received regular one-to-one support from senior leaders to discuss performance, objectives and development needs. Leaders also participated in corporate forums where they shared learning, discussed challenges and exchanged good practice with colleagues from other sites. During the inspection, leaders gave examples of changes made in response to staff feedback. For example, managers received additional training on giving constructive feedback after concerns were raised about communication with 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.

Staff had access to formal and informal routes for raising concerns. Staff told us they knew how to raise concerns and speak with their managers when required. The service had an up-to-date Freedom to Speak Up policy that outlined how staff could raise concerns and access support. The hospital had several Freedom to Speak Up champions who worked alongside the organisation's Freedom to Speak Up Guardian. Information about the champions was available to staff and champions attended regular meetings with the corporate Freedom to Speak Up Guardian to discuss themes and learning.

Leaders monitored concerns raised by staff and reviewed themes to identify areas requiring action and support. Freedom to Speak Up data showed staff used the process to raise concerns. Staff raised 3 Freedom to Speak Up concerns during the 2025 to 2026 calendar years. 

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 promoted inclusion through recruitment practices, staff networks and initiatives that supported people with different backgrounds and experiences. The service had an up-to-date Equality, Diversity and Inclusion (EDI) policy that provided guidance for staff and leaders. Leaders told us equality, diversity and inclusion formed part of the service's recruitment approach and recruitment processes focused on identifying the most suitable person for the role through inclusive practices. Staff had access to a corporate neurodiversity network, and the service supported initiatives relating to South Asian Heritage Month, menopause and endometriosis.

Leaders worked with external partners to create opportunities for people with different needs and experiences. The service worked with local colleges to support students with neurodiverse conditions to gain workplace experience. Leaders told us they worked with education providers to tailor placements to individual needs, including identifying suitable roles and support arrangements. The initiative had supported two cohorts of students, and one participant had secured employment with the organisation following completion of the placement. Leaders told us this work had increased understanding of neurodiversity within staff teams and highlighted the importance of adapting support to meet individual needs.

We scored the service as 2. The evidence showed some shortfalls in governance and oversight. Existing governance systems did not always ensure learning, risk management and compliance with expected standards were consistently embedded. However, leaders were taking action to improve identified areas of concern.

Whilst the service had systems and processes to monitor governance, these did not always ensure expected standards were consistently achieved. Training records showed compliance with some safety-critical subjects remained below the service target, including National Early Warning Score 2 (NEWS2), venous thromboembolism (VTE), safeguarding and life support training. Audit data showed VTE assessment compliance had reduced to 80% in April 2026. During the inspection, we found one person whose VTE assessment had not been reviewed following admission in line with local requirements. Leaders were aware of these findings and had implemented action plans and increased monitoring.

Learning was not always embedded across the service when risks were identified. Leaders identified an increase in surgical site infections (SSI) and completed a thematic review to identify contributing factors and actions. However, some staff were not aware of the increase in infection rates or the actions being taken. This did not demonstrate that learning had been consistently embedded across staff groups.

Leaders did not always ensure medicines information and guidance remained up to date. During the inspection, we found out-of-date British National Formulary (BNF) reference materials in clinical areas and pharmacy. Theatre staff referred to local guidance; however, the review date for this guidance had expired and part of the document included information from a previous edition. These issues had also been identified during a previous inspection.

The service held bimonthly governance meetings where leaders reviewed incidents, complaints, risks and safety learning. Governance information was shared with staff, corporate teams and external partners. Leaders also reviewed performance through management meetings, departmental meetings and board-level scrutiny processes.

Leaders monitored risks through local and corporate governance processes. Staff could identify and escalate risks through departmental risk registers. Leaders reviewed risks regularly and escalated higher-scoring risks to the hospital risk register and corporate teams. Risks discussed during the inspection included information technology resilience, financial pressures and delays accessing pathology results for people living outside the local area.

Leaders used audits to monitor performance and identify areas requiring action. The service completed a programme of local and corporate audits, including infection prevention and control, hand hygiene and NEWS2 audits. The pre-assessment lead also reviewed pre-assessment documentation and monitored calls each month, with findings reported through governance processes.

We scored the service as 4. The evidence showed a good standard. Leaders proactively worked in partnership with healthcare organisations, community groups and other stakeholders to improve access to services, reduce barriers to care and support positive outcomes for people. The service shared learning with partners and used these relationships to improve people's experiences of care and treatment.

Staff and leaders worked closely with external partners and stakeholders to support people's care and treatment. Leaders described well-established relationships with commissioners, local trusts, community services and healthcare providers. The service held monthly meetings with commissioners and maintained regular contact between meetings to discuss service delivery, performance and opportunities for improvement.

The service worked collaboratively with partner organisations to ensure people received coordinated care across different services. Staff worked with community learning disability teams, veterans' services, GPs, mental health services and prison healthcare teams to support people before and after treatment. Leaders described increasing demand from people receiving care through the Isle of Wight prison service and worked with prison healthcare teams to coordinate treatment and support continuity of care.

Leaders actively engaged with local communities to improve health literacy and increase awareness of healthcare services. The service developed relationships with local faith groups, community organisations and community leaders and regularly attended community events, including visits to temples, gurdwaras and other community groups. Healthcare professionals and physiotherapists delivered information sessions and provided opportunities for people to ask questions about health conditions, treatment options and available services. Leaders told us this work helped improve understanding of healthcare services and supported people from diverse communities to make informed decisions about their care.

The service also worked in partnership with local government organisations and charities that support young adults with learning disabilities and autistic people into employment. Through this work, leaders developed a better understanding of the barriers some people experienced when accessing healthcare services and shared this learning across the organisation. Staff used this knowledge to help improve people's experiences of care and make services more responsive to individual needs. The service also demonstrated its commitment to supporting veterans through partnership working and information available throughout the hospital to help people access relevant support services.

Leaders developed partnerships with healthcare organisations to support service delivery and continuity of care. The service worked with local trusts through service level agreements and referral pathways and arranged transfers to NHS hospitals when people required specialist care or treatment that could not be provided by the service.

We scored the service as 3. 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.

Staff introduced changes to pre-assessment pathways to improve patient's experience and support more efficient care. The pre-assessment lead reviewed existing processes and introduced joint assessment days for patients undergoing hip and knee surgery. Patients attended a single appointment where they received blood tests, pre-operative assessments and an anaesthetic review. This reduced the need for patients to return for multiple appointments. The service also planned to introduce an electronic pre-assessment system in October 2026 aligned to National Institute for Health and Care Excellence guidance.

The service supported staff development to enhance skills and contribute to improvements in care delivery. Staff had access to mandatory and role-specific training, apprenticeship opportunities and professional development programmes. Leaders gave examples of staff undertaking Nursing Associate and Registered Nurse Degree Apprenticeship programmes. Staff also completed additional training to support the recognition and escalation of deteriorating patients.

Leaders supported changes in practice and service development. Staff described being involved in changes to pre-assessment processes and gave examples of improvements introduced within their areas. One staff member told us they would like to introduce additional service developments in the future, although implementation could take time.