Arrowe Park 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

At our last assessment we rated this key question good. At this assessment the rating has remained good.

Some staff did not feel there was a culture of speaking up openly and freely. The service did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate. There were shortfalls in governance, for example the trust had not monitored sepsis compliance across the medical wards for the last 12 months. Team meetings were held on some, but not all of the medical wards. However, staff and leaders across the division told us they shared a commitment to improving services for patients and their families.

This service scored 68 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

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.

All clinical divisions within the trust aligned to the trust’s overarching trust strategy 2021 – 2026 and vision ‘together we will, deliver the best quality and safest care to the communities we serve’. The strategy set out 6 strategic objectives which provided the framework within which all divisional priorities were developed and delivered. We were told that each division set annual strategic priorities ensuring they aligned to the 6 strategic objectives and the NHS England operational guidance planning.

The division engaged with all specialties within each of the 4 directorates to develop their own priorities for the year. These were presented at the divisional leadership board in April 2025. The divisional priorities were agreed through discussion at the leadership board and plans were in place to present these at an upcoming enabling and divisional strategic priorities event in June 2025.

The delivery and impact of priorities were monitored through strategic away days and monthly divisional performance reviews.

We observed a positive culture between colleagues, a strong team with good care aspirations. Results from the 2024 national staff survey showed that staff morale was higher in medical care compared to some other areas within the trust. Multiple staff we spoke with during the assessment stated that the culture was good and management were supportive of the team and individuals.

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.

Staff told us they had good working relationships with their ward managers who they described as approachable and visible. Staff feedback in relation to senior leaders’ visibility and helpfulness was mixed. Some staff were complimentary about leaders, especially the matrons and lead nurses but they did not always feel acknowledged by the senior leadership team. Most ward managers felt supported by the lead nurses and senior leaders within the division.

Leaders were knowledgeable about challenges and priorities for the service and could access appropriate support and development in their roles. They explained challenges such as recruitment and retention of medical staff, bed capacity, patient flow and financial sustainability.

The divisional senior leadership team were experienced and there were clear reporting structures and key roles were supported by deputies or associate roles. The division had a structure which ensured support for ward managers and associate directors of nursing.

The trust had processes to support staff and managers to develop their skills. Succession planning formed part of the trust’s wider approach to talent management, as set out in the trust’s talent management plan.

Triumvirate leaders undertook career discussions with their direct reports as part of their Q1 appraisal / check in’s. This plotted leaders into one of five categories of readiness i.e. ready now, ready in 6-12 months etc.

We scored the service as 2. The evidence showed some shortfalls. People did not always feel they could speak up and that their voice would be heard.

The trust had a freedom to speak up (FTSU) policy which provided staff with details of what they could speak up about, who to speak to and what the process would be if they did. The policy outlined the roles and responsibilities of the FTSU champions and guardian.

Most staff we spoke with told us they were aware of the Freedom to Speak Up (FTSU) process, who the guardian was for the trust and who the champions were in the division. Staff showed us they could access the guidance and policy on the trust’s intranet easily.

However, during a staff focus group 28% of staff disagreed or strongly disagreed that there was a culture of speaking up openly and freely. In addition, 28% of staff disagreed or strongly disagreed when asked if they knew of examples when speaking up had been beneficial and lead to change. Some staff members said despite providing feedback through meetings with senior staff they did not always feel heard and FTSU processes were not robust.

The staff survey highlighted that 54.2% of medical care staff felt safe to speak up about anything that concerned them in this organisation against a national comparator of 56.4%. We saw that 52.6% of staff felt that the organisation would address any concerns staff raised against a national comparator of 53.2%. These figures were worse than the national average.

Freedom to speak up level 1 training had been completed by 89% of staff with level 2 compliance at 91% against a trust target of 90%.

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.

Trustwide Workforce Race Equality Standards (WRES) for 2024 showed that the percentage of staff experiencing harassment, bullying or abuse from patients, relatives or the public in the last 12 months was 21.3% for white staff within the trust, this number was 28.2% for other ethnic groups within the trust. These figures were slightly better (lower) than the national average.

The percentage of staff believing that the organisation provides equal opportunities for career progression or promotion recorded 57.9% for white staff and 49.5% for other ethnic groups in WRES data 2024. This was about the same as the national average.

WRES data 2024 showed that the percentage of staff experiencing discrimination at work from manager / team leader or other colleagues in the last 12 months for white staff was 5.1%. This was slightly better (lower) than the national average. The percentage of other ethnic groups for the same questions was 16.9% which was slightly worse than the national average. We did not have a breakdown specifically for medical care.

Workforce Disability Equality Standards (WDES) for 2024 showed that the percentage of staff experiencing harassment, bullying or abuse from patients / service users, their relatives or the public in the last 12 months was 28.7% for staff with a long-term illness (LTC) and 19.8% for staff without LTC. These figures were slightly better (lower) than the national average.

WRES data 2024 showed the percentage of staff experiencing harassment, bullying or abuse from managers in the last 12 months for staff with a LTC was 17.7% and for staff without LTC was 8%. These figures were slightly better (lower) than the national average. The percentage of staff experiencing harassment, bullying or abuse from other colleagues in the last 12 months for staff with LTC was 24% and staff without LTC was 13.6%. These figures were slightly better (lower) than the national average.

The trust had implemented a staff disability and long-term conditions policy, health passport for staff, staff networks, menopause policy and clinics including a Q&A drop-in session for menopause staff with consultant gynaecologist and a listening event for non-white staff. There was also a flexible working approach embedded to support the wellbeing of the workforce. We did not have a breakdown specifically for medical care.

We scored the service as 2. The evidence showed some shortfalls. The service had clear responsibilities, roles, and systems of accountability. However, there remained significant shortfalls in good governance and improvement following post audit action plans.

Leaders were sighted on some of the areas for improvement in the service through auditing. However, there remained significant issues and risks in the service requiring further action from leaders. Recent audits flagging with low compliance included NEWS2, medicines management, DNACPR, MCA and DoLS. Our assessment found most audits had an action plan.

We requested evidence of monitoring sepsis compliance across the medical wards for the last 12 months. However, Trust did provide sepsis data for a period of 7 months.

The service faced additional risks due to low compliance rates with specific modules of mandatory training.

The medicine division risk register was regularly reviewed. However, not all updates, mitigations or action progressions were dated. The highest scoring risks on the risk register were clinical, quality, safety and access risks associated with poor patient flow, stroke consultant vacancies, lack of junior doctor cover and sufficient oversight of when gaps are occurring and risks of discontinued non-invasive ventilation machines across the respiratory service.

Leaders attended governance committee and divisional committee meetings. The governance structure was underpinned by 2 key meetings, the divisional quality board (DQB) and divisional leadership board (DLB). The division was split into 4 directorates that grouped specialties together. Each directorate had a manager, clinical director and associate director of nursing. Directorate performance reviews were held bimonthly. There was a series of monthly divisional meetings such as infection, prevention and control, health and safety, access and performance and fundamentals of care. Information from these meetings was escalated to the DQB and DLB. Information from the DQB was escalated to the patient safety quality board which was chaired by the trust Medical Director. Information from the DLB was escalated to the executive risk and assurance committee which was chaired by the trust Chief Executive.

Learning from deaths meetings were held monthly where mortality indices were reviewed. There was senior executive representation as well as clinical staff from the trust divisions. Mortality indicators were presented and reviewed at these meetings.

Team meetings were held on some, but not all of the medical wards.

Staff we spoke with understood what their individual roles and responsibilities were, what they were accountable for and to whom they were accountable.

There were daily system overview meetings, trust wide. These monitored information such as numbers of patients who did not meet the criteria to reside and were awaiting packages of care in the community.

Senior leaders were able to describe their top risks which were access and flow, bed occupancy and medical staffing.

Senior staff in the division used data to review performance of their wards. This provided oversight of patient safety and patient experience. Support could be given to areas where it was needed. This was disseminated to matrons and ward managers.

There was data available to ward managers that provided the outcomes of the ward accreditation outcomes. These formed the basis of the action plans for improvement for each ward which were monitored at division level.

Staff received training on information governance (IG) as part of their mandatory training, and the compliance rate across the division was 88%. Nonetheless, IG training compliance met the trust standard for 11 months of the last 12-month period. Compliance was missed on one month within the division of Medicine by 0.05%. This training meets national standards in relation to management of patient information and secure storage. However, in the 6 months prior to assessment, there were 39 incidents reported for the medical wards relating to breaches of information governance.

We scored the service as 3. 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.

People’s views and experiences were gathered and acted on to shape and improve the services and culture. This included people in a range of equality groups. People who used services, those close to them and their relatives were actively engaged and involved in decision-making to shape services and culture.

Leaders 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. Staff and leaders worked in partnership with key organisations to support care provision, service development and joined-up care.

The trust attended the Wirral unscheduled care programme board which focused on urgent and emergency care system performance and no criteria to reside. The board consisted of the integrated care board (ICB), local authority and local NHS ambulance, community and mental health trusts. Meeting minutes showed there was a focus on ambulance handover, access and flow, bed occupancy and patient length of stay.

We were told the trust included the local NHS ambulance trust in the planning and review of any proposed service changes, including pathway redesign, SDEC development, and changes to front-door models. The feedback was said to be essential in ensuring that services aligned with pre-hospital needs and support safe and effective handover.

The trust attended a weekly executive discharge cell meeting which focused on those patients with the longest number of days on the no criteria to reside list.

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 and leaders across the division told us they shared a commitment to improving services for patients and their families. Each month the division contacted 50 patients who had received care and treatment in an assessment area within the medicine division to gather patient feedback and identify areas for improvement.

The division had established plans to drive learning, improvement and innovation aimed at enhancing service delivery. The trust had plans to focus on priority areas such as managing deteriorating patients and C. Diff infection rates.

Senior leaders told us about changes they had implemented in cardiology to provide cardiology support to the emergency department each day. The division had set up an ambulatory heart failure service supported by lead consultants and heart failure nurses who could administer intravenous antibiotics to patients as a day case without being admitted.

We were told that the trust community respiratory team which was part of virtual wards had won an award for the work they had done in improving accessibility to services for patients with drug and alcohol problems. In addition, a pleural service had been set up lead by a nurse consultant providing medical arthroscopy to patients as a day case avoiding hospital admission.

The ‘Improvement for All’ model was being implemented with a planned launch across the trust in July. The model was developed to improve services to benefit staff and patients. It was based upon evidence from NHS IMPACT (Improving Patient Care Together) and feedback from staff. The NHS Staff Survey demonstrated that staff did not always feel empowered to make changes and improvements in their working areas.