Forest 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, patient-centred care; supported learning and innovation; and promoted an open, fair culture. At our last inspection we rated this key question good. At this inspection and assessment, the rating has changed to requires improvement. This meant leaders did not always support the delivery of high-quality, patient-centred care. The service did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes.

However, leaders ensured there was a shared vision and strategy, the service fostered a positive culture where patients felt they could speak up and their voice would be heard, the service valued diversity in their workforce and the service focused on continuous learning, innovation and improvement.

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 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 patients and their communities.

Leaders ensured there was a shared vision and strategy and that staff in all areas knew and understood these. Barchester’s purpose was to “provide a premium caring experience delivered by our great teams to those we care for”. Barchester’s values were Respect, Integrity, Passion, Empowerment and Responsibility. These values were displayed on posters at the service. Staff accessed ‘bite size learning’ on how to embed the values in their day-to-day work. The provider also had a framework outlining how staff could embed values in their behaviours.

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 at every level were visible and led by example, modelling inclusive behaviours. Staff told us senior leaders visited at least once a month and were knowledgeable and supportive. Staff told us leaders promoted an open culture that encouraged learning, reflection, and continuous improvement.

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

There was a culture of speaking up where staff actively raised concerns. Staff felt confident to speak up and that raising concerns was encouraged within the service. The provider had a Freedom To Speak up (FTSU) Guardian and speak up champions in services. No FTSU concerns had been raised about the service in the past year but staff were well versed in how to use the process.

Staff were aware of the Freedom to Speak Up Guardian and were able to identify who held this role. They demonstrated this by signposting us to the Freedom to Speak Up information displayed on the ward, evidencing staff knew how to access support if needed.

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 patients who work for them.

Leaders took action to improve where there were any disparities in the experience of staff with protected equality characteristics, or those from excluded and marginalised groups. Senior leaders took action when a staff member was subjected to racist abuse. Senior leaders supported and protected their staff from black and ethnic minority communities by seeking community support and providing taxis to and from work during the anti-immigration protests of summer 2024. Staff were supported to observe Ramadan through swapping shifts and hosting cultural days to raise awareness. 100% of staff completed equality, diversity, and Lesbian, Gay, Bisexual and Transgender (LGBT) training.

The evidence showed significant shortfalls. The service did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes.

The provider’s governance systems and processes were not always effective in identifying risks to safety and care quality. Leaders did not always ensure the safe management of medicines. Leaders did not ensure staff always met patients’ assessed care needs. Cleaning systems and monitoring were not consistently effective, meaning environmental risks were not routinely identified or mitigated and patients were not adequately protected from avoidable harm.

However, senior leaders had a central action plan from all audits which fed into governance and staff meetings which was overseen by the regional director of operations. Monthly clinical governance meetings took place at the service and regional clinical governance meetings took place every 2 months. A quality governance framework that covered all services. The following risks on the risk register: abuse of patients by staff and peers, injury to staff as a result of violence and aggression and interruption in supply of medication. The provider shared minutes from 1 Hospitals Quality and Safety Committee Meeting. Agenda items included lessons learnt, Patient and Carer Race Equality Framework (PCREF), risk register, restrictive practices, safeguarding, MHA, physical wellbeing, analysis of audit trends, patients planning, learning and development, serious incidents and regulatory inspections.

The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, so services work seamlessly for patients. They share information and learning with partners and collaborate for improvement.

Staff and leaders were open and transparent, and they collaborated with all relevant external stakeholders and agencies. We saw evidence of positive feedback from external stakeholders invited to patients’ care meetings. Feedback included receiving relevant information in good time.

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 patients. They actively contribute to safe, effective practice and research.

Staff and leaders ensured that patients using the service, their families and carers were involved in developing and evaluating improvement and innovation initiatives. Leaders told us about co‑production with staff and patients, including patients helping to shape mutual expectations, mutual help meetings, and “getting to know me” resources. Quality improvement was driven through leadership training in Positive Behaviour Support and Active Support, with a cross‑hospital project group overseeing implementation. Further innovation included adapting the NHS Culture of Care Standards and research into the NHS culture of containment, leading to improved safeguards and outcomes for patients admitted to general hospital, particularly those with dementia.

Staff were supported to prioritise time to develop their skills around improvement and innovation. One nurse told us they were keen to embed palliative care principles across the ward. They recently completed a 12‑week palliative care course and applied this learning when supporting two patients who were placed on an end‑of‑life pathway. Staff used their enhanced skills to provide individualised care, and both patients subsequently improved and were no longer on the pathway.

The service had strong external relationships that supported improvement and innovation. Staff and leaders engage with external work, including research. Leaders shared evidence of involvement and accreditation with various external networks that covered restraint reduction, health and safety and falls reduction.

Leaders told us that PCREF had not yet been formally implemented, but corporate‑level planning was well advanced, with senior leadership involvement to support effective implementation. The hospital was co‑developing an Anti‑Racism Framework and previously ensured equality and culturally sensitive care for patients from ethnic minority backgrounds. Staff received comprehensive equality and PREVENT training, holistic assessments captured cultural needs, and multiple engagement routes existed for carers and the community. A co‑produced working party involving staff, patients, and carers was being established to strengthen PCREF evidence, engagement, and data collection.