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 changed to requires improvement.

Governance was not robust with a lack of insight into ED staffing, access and flow / continuous flow, privacy, dignity and safety, medicines management, equipment and environment, and infection prevention and control. Staff experiences with raising concerns were mixed. The service was in breach of legal regulation in relation to the governance of the service.

We found leaders and executives were visible and supportive, and staff development was encouraged through various progression opportunities. The service demonstrated a strong commitment to diversity and inclusion.

This service scored 61 (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.

The acute division aligned with 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 trust-wide strategy set out six strategic objectives, which provided the framework within which all divisional priorities were developed and delivered. We were advised that divisions set annual strategic priorities to ensure ongoing alignment to the trust's six strategic objectives and the NHS England operational planning guidance.

The division engaged with all specialties within each of the four directorates in the division to develop their own priorities for the year. These were presented to, and discussed with, the rest of the ED divisional team in the divisional leadership board in April 2025. The priorities for the division were agreed through discussion at this Board and would be presented at the Enabling and Divisional Strategic Priorities event in June 2025.

Delivery and impact were to be monitored through bi-annual strategic awaydays, where the ED divisional team would reflect on delivery against strategic priorities and refresh them as needed. As well as during monthly divisional performance reviews, where progress would be discussed and triangulated with other key metrics to ensure grip and assurance.

We observed a positive culture between colleagues, a strong team with good care aspirations. However, the staff survey highlighted that staff morale was lower in the emergency department than any other area of the trust. Multiple staff spoken with during the assessment stated that the department culture was really good. Management was really 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.

ED structure consisted of the divisional triumvirate which is the divisional director, divisional director of nursing and the associate medical director.

Staff told us that both the matron and divisional nurse were visible, undertook walkarounds and were approachable. The executive team were also said to be visible, and the CEO recently held a breakfast club with ED staff. Staff said that despite how busy the department could be (up to 70 people in the waiting room alone) the department culture was positive with supportive managers.

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 in place that was due for review February 2026. The document linked to other policies such as Standards of Business Conduct policy, Bullying and Harassment policy, Disciplinary policy, Grievance procedure and Equality, Diversity, Inclusion and Human Rights policy.

The was a Freedom to Speak Up Guardian and a number of FTSU Champions who worked across the trust, within their work areas, promoting the importance of speaking up and signposting staff to support options available. However, some staff we spoke with were not aware that there were FTSU champions within the department.

The staff survey highlighted that 38.9% of ED staff felt safe to speak up about anything that concerned them in this organisation against a national comparator of 56.4%. We saw that 27.8% of staff felt that the organisation would address any concerns staff raised against a national comparator of 45.1%. These figures were worse than the national average.

Freedom to speak up training level 1 training had been completed by 89.2% of staff and level 2 compliance was 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 were working towards an inclusive and fair culture by improving equality and equity for people who work for them.

The trust received 54 responses to their ED staff survey. All topics fared worse or slightly worse for ED that the trust as a whole. The topic ‘We are safe and healthy’ scored 4.75 against an organisation score of 6. ‘Morale’ scored 4.55 against an organisation score of 5.72 and ‘we each have a voice that counts’ scored 5.25 in the ED against an organisation score of 6.48.

Trust wide 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 is 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 the ED.

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) and19.8% 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 the ED.

We scored the service as 1. 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, or share this securely with others when appropriate.

The trust's governance systems did not always operate effectively to identify and address risk within services and areas for improvement. We found areas requiring improvement in:

1. 1. ED Staffing
2. 2. Access and flow / continuous flow
3. 3. Privacy, dignity and safety
4. 4. Medicines, equipment and environment
5. 5. Infection prevention and control

These had not been consistently identified and addressed through the trust's internal governance processes.

We reviewed the risk register for the ED department. The top 5 risks were failure to recognise deteriorating patient in the ED waiting room, risk of holding ambulance crews beyond 15 minutes due to poor egress from ED, a risk of harm to care quality and patient experience caused by slow egress from the emergency department, urgent and emergency care upgrade programme (UECUP) construction impact on clinical service delivery, and UECUP contingency budget allocation. The division were familiar and aware of the risks, scoring and mitigations in place.

We saw governance and performance systems in place, but they were not always effective. The ED directorate held monthly governance meetings. Other meetings included bi-monthly executive meetings, patient forums, Patient Safety and Quality Board (PSQB) clinical governance meetings, executive assurance committee risk discussions, and check and challenge discussions. Feedback was shared with staff through the triumvirate governance meetings and other various routes such as forums and direct discussions with medics and nurses. There were also consultant meetings, and meetings with trainees in place.

Weekly ED triumvirate meetings were attended by the clinical director, clinical lead, divisional manager, and associate director of nursing (ED lead nurse). The ED department held a divisional management board (DMB) once a month. The divisional director of nursing also held meetings with staff groups within the department, but these were not minuted. There was previously an emergency department governance newsletter. However, this had not been produced for the past few months due to staff absence, but managers told us they had plans to recommence in June.

Mortality and morbidity reviews formed part of the ED clinical governance meeting; and were allocated to a consultant for review. The trust had identified areas for improvement from mortality reviews and were working to address them.

Records showed that there were 14 information governance breaches over a 7-month period in ED.

There were no Information Commissioner's Office (ICO) reportable incidents for ED during the past 6 months.

The trust had a plan to respond to emergency situations and major incidents. This linked to wider trust plans to address major incidents and other issues impacting on business continuity.

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.

The trust had links with external stakeholders and agencies. We saw that meetings were held frequently for the ED Operational Management Group which consisted of 4 trusts with alternating responsibility to chair the meeting. The meeting looked at UEC (urgent and emergency care) Improvement Plans, no criteria to reside (NCTR) reduction plans, new guidance, policy reviews, Urgent care / walk-in centre utilisation and action log updates.

The trust attended the unscheduled care programme board in partnership with Wirral Place ICB, Wirral Borough Council, Department of Adult Social Services, Wirral Council, NHS England ICB, the ambulance trust and local community trust.

The trust had developed a strong working relationship with Place colleagues as well as colleagues outside of Place, which included, the Cheshire & Merseyside Police and ambulance trust.

Weekly and monthly operational and strategic meetings and forums were in place with the ambulance trust and other system partners. The forums reviewed ED performance, allowed partners to escalate concerns, and aided the delivery of improvement plans for the system. Real-time escalation and communication were established to enable escalation pathways that allowed ambulance crews, operational managers, and hospital flow teams to raise issues in real time. This was supported by daily reporting through flow meetings, visibility of site position and huddle structures.

The trust had previously facilitated surveys for ambulance colleagues to understand the ease of access to services outside of ED. The feedback from these surveys allowed the system to respond in addressing the gaps with future improvement projects.

We were informed that 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. Their feedback was said to be essential in ensuring that services align with pre-hospital needs and support safe and effective handover.

The ambulance trust alongside other provider leads, attended the urgent and emergency care Board meetings where performance reports were shared. These meetings provided an opportunity for attendees to offer feedback on urgent and emergency care metrics and receive updates on how any performance shortfalls were being addressed or how improvements were being achieved.

We scored the service as 2. The evidence showed some shortfalls. The service did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome, and quality of life for people. They did not always actively contribute to safe, effective practice and research.

The trust did not have a quality improvement methodology in place at the time of the assessment although was due to launch this shortly after. 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.

Clostridioides difficile (C. diff) Improvement Programme showed a reduction in the number of cases of C. diff across the trust following the development and sharing of a change bundle to standardise processes improved staff, patient, and relative education.

The “Martha’s Rule” national pilot was rolling out at pace including in the ED reverse cohort area. Additional questions had been added to the triage process to include Martha’s Rule.