West Cornwall 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, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

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 some shortfalls. The service did not have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement.

While some staff described a positive culture and working environment, we also heard examples of cultural challenges.

Leaders acknowledged a recent restructure, including a new operating model for clinical divisions, had impacted staff. They reported ongoing efforts to improve morale and ensure staff felt more included. Clear lines of accountability for surgical services had now been established, supported by the presence of an on-site clinical matron. We were told the new model would help them create their own vision and identify their “gold standard.”

Leaders also recognised the team had become somewhat fragmented and were taking steps to address this. Initiatives included the use of personality assessments to support better team management, alongside plans for a cultural review and an Insights review. In response to identified cultural concerns, an external review was also commissioned.

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 demonstrated the skills, knowledge and experience required to carry out their roles effectively and had a clear understanding of the services they managed. They were able to clearly describe how their teams worked to deliver high-quality care. Leaders expressed confidence in their roles and felt well supported.

Leaders were visible and approachable. They were taking proactive steps to address cultural challenges and ensure staff felt supported and listened to. Staff reported feeling supported by their line managers, saying their door was “always open.”

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 were aware of the Freedom to Speak Up (FTSU) process and understood how to raise concerns.

We reviewed recent FTSU themes and found concerns were listened to. Actions included escalation to the senior leadership team, supportive meetings to discuss issues, and ongoing contact and visits from the FTSU Guardian to support staff members. Leaders were working on plans to increase the visibility of the FTSU Guardian through more regular visits, so they would become a familiar presence to staff.

The staff survey gathered data on whether staff felt safe to speak up and confident concerns would be addressed. We were told the results would inform a trust-wide action plan. Also, under the new divisional structure; cultural reviews were being commissioned to develop improvement plans.

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.

The trust collected Workforce Race Equality Standard and Workforce Disability Equality Standard data, both of which are mandatory under the NHS Standard Contract. These measures aim to promote race equality and diversity within the workforce and to improve the working and career experiences of disabled staff across the NHS. This data was grouped by seniority for both clinical and non-clinical staff, and enabled the trust to monitor inclusivity in the workplace.

Staff received training in equality, diversity and human rights. The service’s leadership team actively promoted an inclusive and supportive working environment.

The evidence showed a good standard. The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment, and support. They act on the best information about risk, performance, and outcomes, and share this securely with others when appropriate.

Structured multidisciplinary team meetings and governance huddles were effectively used to monitor and review performance, risks, training, staff wellbeing, as well as complaints and compliments.

Monthly governance meetings were held to address matters relating to quality, clinical governance, and risk management, providing assurance to the trust regarding the effectiveness of governance and risk management at peripheral sites.

The service maintained a risk register, which identified current risks and outlined mitigation measures. This was regularly reviewed during weekly governance huddles.

A programme of audits was implemented to monitor performance. Findings demonstrated strong team engagement, and consistent completion of checklists.

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 department had established local procedures to support patient safety and adhered to trust policy when transferring deteriorating patients to the main acute site.

Staff reported patients were provided with ongoing care and follow-up information upon discharge, with access to specialist services if required, including a regular pain management clinic.

The trust was introducing a new single electronic patient record system to replace current digital and paper-based records. This will allow patient information to be accessed instantly across the hospital and partner sites, helping improve patient flow coordination and more efficient scheduling, including in areas like operating theatres.

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 reported leaders actively encouraged them to put forward ideas for improvement. Examples of innovation included an interactive team safety and culture event focused on learning from incidents, and a multidisciplinary quality summit designed to share intelligence and agree coordinated improvement plans where concerns, variation, or opportunities for development had been identified.

The Patient Safety Team had scheduled regular visits with joint working across St Michaels Hospital and West Cornwall Hospital.

The trust was implementing an electronic patient record system to replace previously unlinked systems, enabling patient records to be accessed across hospital sites. Trained ‘superusers’ will be available on wards to support staff during the transition.

Plans were also established for West Cornwall Hospital to engage with a local surgical hub to learn from its success in increasing patient feedback responses, with the aim of adopting similar improvements.