The Ipswich Hospital

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

We looked for evidence there was an inclusive and positive culture of continuous learning and improvement based on meeting the needs of patient who used services. We checked leaders proactively supported staff to deliver safe, integrated, person-centred care and to reduce inequalities.

At our last inspection, well-led was rated as requires improvement. The rating for this key question remained requires improvement.

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 were skilled, knowledgeable, and experienced but some had recently been appointed to their roles. However, due to the significant issues identified, including repeated breaches and limited effective mitigation in place at the time of inspection, we did not have sufficient assurance that risks were being consistently managed.

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.
The service did not always have a clear shared vision, strategy and culture. Staff did not always feel included in key decision making but the service did foster a positive culture where people felt they could speak up, and their voice would be heard.

The service did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the most up to date information about risk, performance and outcomes. The service did focus on learning, innovation and improvement but did not always take effective action following recommendations or identified risks

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.

Staff we spoke to told us Urgent and Emergency Care (UEC) had gone through a period of transformation over the past 12 months. This included moving to a newly build department and revised leadership structure. They told us teams had worked closely during this transition period and said staff had come together to make positive changes.

Reception staff also reflected on this change but often at times felt left out of key decisions. They told us they were not always seen as part of the wider UEC team and had limited opportunity to contribute to service direction and culture. Staff we spoke to did not always know the specifics regarding the current UEC strategy but were able to give an overview of its aims.

Leaders for UEC told us they had been working closely with staff, system partners and senior leadership to help shape the future for the service. They told us teams worked well together to deliver the aim of safe care.

The service had a medium-term strategic plan for the emergency department. Their mission was, “To ensure all patients needing our urgent and emergency services receive outstanding quality, safe care in a timely, efficient manner.” However, the service’s ambition was to ensure patients were seen, treated and discharged from their ED in accordance with the 4-hour quality standard of care and ensuring smooth, safe and timely flow throughout the hospitals. Leaders were aware they were not meeting the standards.

We reviewed data obtained for the most recent staff survey results. This was undertaken in 2024 and presented to the trusts finance and performance board in June 2025. This survey was carried out across the whole division of Medicine and Community Ipswich and East Suffolk (MACIES) of which UEC staff’s response rate was 32.1%. the lowest response rate within the MACIES division. This showed that not all staff were engaging in giving feedback as employees. This meant it was difficult for leaders to pull common themes and trends if only a just under a third of staff completed the survey.

UEC had a departmental triumvirate leadership structure, with a senior and junior matron supported by an operations manager. Staff were aware of this structure and who to report to. Clinical structures were not so defined. Staff were unable to tell us who their governance leads were and told us they currently had no permanent clinical lead. However, medical staff told us they would also seek support from the matrons and operations manager if needed.

Staff we spoke to told us leaders within UEC were always accessible and approachable. They felt supported and confident to raise concerns, report incidents verbally knowing they would be supported. Staff said leaders were visible throughout the department and would often help during times of high demand. They told us they felt comfortable to approach a leader with any personal or private issues and were supported during any periods of sickness or absence. There were many long-standing experienced members of staff working within UEC and staff turnover was low.

Leaders had clear understanding of their roles and responsibilities within the department. They understood the continued challenges staff faced and considered staff’s wellbeing. They emphasized the importance of having strong nursing and medical teams. We observed good examples of clear communication with mutual professional respect. Leaders were patient and staff focused and understood the historic challenges and risks within their department and told us they had good support from senior leaders to make the improvements that were needed.

As well as the daily huddles, leaders met with staff and specialist teams to facilitate discussions and training. Staff told us leaders carried out hot and cold debriefs after incidents and signposted staff for additional emotional and mental health support if needed. De-briefing is a process of communication that takes place between a team following a clinical case. This helps facilitate discussion of individual and team level performance and identifies points of excellence as well as potential errors made.

Staff we spoke to were aware of the service’s freedom to speak up (FTSU) provision. They knew where to find the trust policy and information on the trust’s intranet. Staff told us they would normally go to their managers if they had a concern. They were confident leaders would treat their concerns respectfully and confidently. There was freedom to speak up posters in staffing areas. Leaders within the department fostered an “open-door” approach and welcomed all UEC staff to raise concerns.

The FTSU process was explained to new members of staff on their induction training and also during bank and agency familiarisation training. We saw the freedom to speak up policy which was in date and version controlled. The policy was clear on who can speak up, who to speak up to and how the issues will be investigated and resolved.

The trust 2 freedom to speak up guardians who covered all areas of the trust. They also had FTSU assistances. They told us they had not received any direct concerns from staff at Ipswich Urgent and Emergency Care (UEC). They acknowledge that the absence of FTSU concerns did not always mean there were none and following our assessment they had plans to visit the department to support staff and raise awareness of the FTSU provision.

The trust also had a FTSU steering group that meet twice a year, and the guardians meet with the non-executive directors every month. Reports are submitted for trust board papers.

Staff we spoke to told us they were treated equitably and were valued as part of the urgent and emergency care (UEC) team. We spoke to some internationally educated nurses who told us they had been given ongoing support from leaders and their peers. They told us there had been good familiarisation and induction program which considered any adjustment period and cultural differences working in the UK. They were given the opportunity to develop and aspired to progress their career within the trust.

The service also had policies and processes in place to ensure they were inclusive and fair in the way they operated. Staff received training in equality, diversity and human rights and had a good understanding of cultural, social and religious needs of patients. The mandatory training target was 90%. Medical staff were below at 78% and nursing staff achieved 98.39% compliance in equality, diversity and human rights training.

The trust had a Workforce Race Equality Standard (WRES) and the Workforce Disability Standard (WDES) and the Gender Pay Gap annual reports. These reports set out an overview of the race, disability and gender equality work carried out of the past year by the trust. Alongside these reports were action plans with clear objectives and timescales for achieving them. These documents were published on the trust’s public website annually. In addition, the trust also had a current Addressing Health Inequalities Strategy 2022/26 and an Equality, Diversity and Inclusion Strategy 2025/29.

The UEC department had performed well in the 2024 staff survey. There were 81 staff that completed the survey of which 80% agreed or strongly agreed that the organisation acted fairly with regards to career progression / promotion, regardless of ethnic background, gender, religion, sexual orientation, disability or age. On all equality and diversity matrix for UE, from the 247 staff, 33% of these that took part in the 2024 survey their scores reflected a positive and inclusive culture.

The trust had also achieved the accreditation of Disability Confident Employer.

The service had recently undergone a restructuring of its operational and governance structures. The local leadership team was made up of a senior matron, junior matron and an operations manager. This team worked closely together and had experience in leadership. They were accountable to the divisional leadership within the Medicine and Community Ipswich and East Suffolk group (MACIES)

The divisional management team (DMT) had the skills, knowledge and experience to perform their roles. The DMT was formed of divisional directors, divisional director of nursing, divisional director of operations and a vacant associate director of nursing post. This team had oversight of 4 clinical delivery groups (CDG): CDG 1 urgent and emergency care; CDG 2 and 3 Specialist services /pathways which covered the medical care and older people’s services and CDG 4 community. Each CDG 3 and 4 comprised of a Head of Therapies, general managers and senior matrons who reported directly to the DMT. Senior leaders had the qualifications and experience in leadership for the roles.

Medical teams expressed their concerns over their inconsistent management structure. They told us senior management structures were undefined and often had conflicting priorities, there was not always a clear plan, and medics were not always included in key decision making. Medical staff recognised the pressures on the service, but UEC often seemed separate from the rest of the hospital and wider medical support was not always readily available.

Leaders understood but did not always have the resources to manage the demand and pressures on the service. Risks were discussed at safety huddles with staff each day and capacity and flow meetings following their escalation framework. Leaders acknowledged that at times of high demand and high acuity the service did not always achieve the good care standards. They told us patients would be waiting longer for triage; they would have to place people in corridor care spaces, patients could have delays in observations and treatment, and people could experience extended lengths of stays in the department.

During our assessment we were not assured that current oversight and monitoring systems ensure that people were always safe. Staff did not always follow trusts policies and procedures in line with national guidance. Staff were not always completing NEWS which meant there could have been missed opportunities to identify and respond to patient deterioration. Outcomes for patients were not always positive, consistent and did not always meet expectations, such as national standards. For example, long waits in the department led to untimely care and potential harm. Risk assessments were not always completed, for example people at risk of harm and absconding from the department with mental health concerns needs were not always met.

The service did not have monitoring and audit systems in place to provide assurance that care standards were being met. They were unable to demonstrate that leaders had clear oversight on current and ongoing risks within the department. Leaders did acknowledge they had gaps in oversight but gave assurance the new electronic patient record system would enable greater audit and monitoring of real time acuity and risk.
Processes were in place to escalate issues to the hospital leadership team. We saw the risk management policy which was in date and version controlled. The policy was clear on everyone’s duties and responsibilities, the risk management process, assessing, rating risks, recording and the monitoring of those risks. Risks were captured on a divisional risk register and were rated in terms of risk level, likelihood and consequence. However, some risks had been on the register for some years, one risk was logged in 2017 remained.

Leaders acknowledged there were long standing risks for UEC and that these related to capacity and flow, lack of real-time information and lack of digital care records. They gave assurances that the new electronic patient record system would enable them to review these risks.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Nursing staff we spoke to told us they felt able to contribute to learning and improvement of the service. They told us recent changes within the department had made a difference and the environment had improved from their previous location. They were able to voice their ideas at their appraisal and felt listened to by leaders.

Leaders within UEC worked well together and shared the same priorities. A key focus was development and improvements to the service, and they empowered their workforce to contribute and be part of future service changes. Recent changes included corridor harm reviews, extended length of stay checklists and a health care assistant being located in the public waiting area 24/7.

We requested evidence and examples of learning, improvement and innovation with the service. We were provided with a detailed list of quality improvement projects carried out over the last 12 months, this included research into patient presenting to UEC with a rare but severe spinal condition, project for improving the care for patients presenting into the department with suspected neutropenic sepsis and improving documentation of ankle fractures improve patient outcomes. These projects gave details of research outcomes and recommendations. It was not clear recommendations were acted and embedded.

They also provided evidence of external medical publications these included management of septic arthritis in adults, putting patients at the centre of care and advocating for professional advocates in nursing and midwifery. However, we were not provided with evidence these research papers had positively impacted care within UEC.

During our assessment and data reviewed showed lessons had not always been learnt from our previous assessment in 2020. For example, previously we found effective processes were not in place to indicate when equipment was clean and ready for use, staff did not always identify and quickly act upon patients at risk of deterioration. Early warning scores were not always taken and acted upon correctly and leaders did not always operate effective governance processes throughout the service. Therefore, we were not assured leaders had taken effective action against previous areas of concern.