New Royal Liverpool University

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

At our last assessment we rated this key question as requires improvement. At this assessment the rating has changed to good.

Leaders were visible, knowledgeable, and supportive, helping staff develop in their roles. Staff felt supported to give feedback and were treated equally, free from bullying or harassment. Staff understood their roles and responsibilities. Managers collaborated with the local community to deliver the best possible care and were receptive to latest ideas. There was a culture of continuous improvement with staff given time and resources to try new ideas.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Processes

Leaders had a shared vision, strategy, and culture. This was based on transparency, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and the local communities.

Leaders were able to explain the improvement measures that had been undertaken and were able to describe future improvement plans to improve capacity and flow issues across the division of medicine. This included how they worked together and shared learning with leaders at other sites across the trust.

The trust vision and values were ‘’we work together to support our communities to live healthier, happier, fairer lives” and leaders described how this impacted the department. The focus, at the time of assessment, was to simplify complexities of the local health care system so that people could be admitted and discharged with the care they required, bringing health and social care providers together to collectively care for the patient and reduce the time spent in hospital for patients who did not need to be there.

Feedback from staff and leaders

The division of medicine was led by a management triumvirate consisting of Divisional Director of Nursing and Divisional Medical Director and Divisional Director of Operations.

The triumvirate team had oversight of the division; they were all experienced and well respected leaders. The trust had invested in leaders to identify their strengths and areas for improvement to enhance how leaders worked together.

Leaders could describe the trust improvement plan and the division of medicines part in

it. Systems were in place to ensure staff and leaders had the opportunity to share experiences

working at the trust through various meetings and feedback methods that fed into the board.

Staff told us they had good working relationships with their managers and leadership team. They reported matrons and associate directors of nursing were visible and approachable.

Staff understood and utilised reporting structures without fear. Staff and leaders were knowledgeable about risks and challenges faced by their service. Ward Managers mostly felt supported by the management team.

Processes

The trust had a Freedom to Speak Up: Raising Concerns and Whistleblowing Policy which detailed what and how staff could raise concerns and what the process and actions that would be taken were. The policy was easy to follow and well laid out and named individuals were identified as FTSU guardians. Where staff didn’t always know their names, they knew how to access them.

Freedom to speak up information was displayed throughout the division of medicine areas with details of how to contact the staff champions displayed. The 2023 NHS staff survey indicated 58.9% of staff who responded said they would feel safe to speak up about anything that concerned them across the trust; this was not specific to medical care.

Feedback from staff and leaders

Staff we spoke with told us they were aware of the FTSU process, who the guardian was for the trust, and who the champions were in the division. Staff showed us how easy it was to access the guidance and policy on the trust’s intranet. Staff indicated they had received training about FTSU processes and they felt able to use them although none indicated they had and most said they felt they could raise issues directly with managers for resolution.

Leaders fostered a positive culture where people felt that they could speak up and that their voice would be heard and were able to describe how staff reported concerns and how these were investigated, then feedback given to staff, via various forums. Leaders described an open-door policy and had an eagerness to want to help and support staff.

Feedback from staff and leaders

Leaders informed us that the trust monitored and worked with staff to improve its organisational culture through the use of listening events and feedback boards to demonstrate action. Staff we spoke with told us they had never experienced any negative behaviours around inclusivity. Leaders gave us examples of how they supported staff with additional needs to progress using reasonable adjustments.

Staff networks included Ethnic Minority, LGBTQ+, Inspiring Womens and Neurodiversity aiming to promote inclusion, raise awareness of equality in the workplace and provide advice and guidance. The trust ran the Elevate Leadership Programme which was a bespoke leadership programme for Black, Asian, and Minority Ethnic colleagues at Bands 4 – 6 and their clinical equivalents. Wellbeing initiatives and training workshops were available to staff and managers to support staff to stay well at work.

The trust gender pay gap for 2023 demonstrated a positive reduction in the pay gap and the trust could demonstrate that the gender pay gap did not stem from paying men and women differently for the same or equivalent work but rather from the roles occupied.

Processes

The service promoted equality and diversity in daily work and provided opportunities for all staff to develop. For example, the ability to self-roster to observe religious festivals. A prayer room was available in the hospital.

Policies and processes were in place to ensure the services were inclusive and fair in the way they operated. Staff received training in equality and diversity and had a good understanding of cultural, social and religious needs of patients and demonstrated these values in their work.

Feedback from staff and leaders

Staff demonstrated an awareness of what constituted a risk and understood how to escalate issues through the internal incident reporting system. Ward managers reported that risks could also be raised directly with leaders; for example, concerns about falls or staffing. Senior staff, ward managers and nurses were knowledgeable about the specific risks within their wards and division. They knew about ongoing initiatives to reduce these risks. The LQA helped staff feel part of this process of improvement. Leaders gave an example of falls and how meetings had increased from monthly to weekly to address concerns; and any fall received an initial review the day after by the Matron or Associate Nursing Director. Falls Champions also attended the weekly safety meetings to cascade information back to staff. This practice was replicated in other areas of risk such as complaints, pressure ulcers and staff had daily safety huddles for urgent updates.

Processes

The service had established governance, management and accountability structures with clear oversight across key areas. Risk registers were in use throughout the division and discussed weekly up to divisional level at a weekly safety meeting. Regular review of risk was encouraged and supported by leaders.

Mortality and morbidity meetings were held and learning outcomes fed back through safety first bulletins monthly.

Staff had time and resources to undertake effective governance and manage risk. There was a good range of accurate and timely data and information available to understand performance and quality and improvements were made as needed. Governance was used to learn, improve and innovate. Information held about patients was secure and protected.

There were regular and effective meetings for safety, audit, quality, and governance. These discussed and addressed key areas of performance, risk, audit, culture, and workforce. Minutes recorded areas of concern where identified and actions were taken to learn and improve. There were monthly meetings chaired by clinical governance leads. These meetings had a set agenda that included: incidents, complaints, CQC action plans and the matron’s safety reports. Quality and safety reports were produced from these meetings and fed into trust divisional meetings, then to the hospital leadership board. There was a monthly performance meeting with the division of medicine team and fortnightly finance meetings. The assistant directors of nursing led other meetings to review key concerns such as falls and pressure ulcers.

Information on governance was shared via a newsletter emailed to all staff, a poster was also displayed and there was a matron’s blog that disseminated information to staff. Staff received feedback from incident reporting and risks during nursing huddles.

Assurance reports were completed daily by the nurse in charge. These reports were used to check that daily tasks were completed, and a safe environment was maintained.

Processes

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. The leadership team understood how their staff felt about delivering care that met both the physical and mental health needs of patients.

Staff and leaders worked in partnership with key organisations to support care provision, service development and joined-up care. Partners we spoke with advised there were no concerns in relation to staff working together, inclusivity and partnership working. It was highlighted that communication on both sides could be challenging to overcome at times, but there were no performance issues of concern.

The trust’s strategy aligned to local plans in the wider health and social care economy, and services were planned to meet the needs of the relevant population.

Feedback from staff and leaders

Staff and leaders described how they worked together as a multidisciplinary team across the division to improve the service for patients, particularly when planning for discharge. Partners who worked with staff were complimentary about how they were welcomed to multidisciplinary meetings which served as a learning forum for all involved through sharing knowledge and experience.

Leaders could describe the challenges the division faced and how they were working both internally and externally to remove some of the barriers patients experienced.

Feedback from staff and leaders

Staff and leaders across the division expressed a strong and enthusiastic culture of learning, with a shared commitment to improving services for patients and their families at every level.

Staff described and understood processes in place to support learning from incidents, complaints, and even compliments, which were acknowledged by the director of nursing and shared with the relevant team or individual. These processes had some local variation from ward to ward to make them personal to that area.

Staff demonstrated awareness of ongoing improvements and innovations. Examples of recent initiatives included proactively reviewing patients in the emergency department to enable transfer directly to a ward to provide ongoing specialist care. Quality improvements initiatives were evident in services. For example, a 6 minute training video was available to staff via a virtual reality headset to inform about deconditioning. Staff described how effective the training video was and how they remembered the importance of encouraging patients to get up and dressed.

Staff had personalised the ward areas so the information was suitable for the patients that they cared for. Noticeboards were colourful and visual and patient activity areas were personalised to feel more homely.

Overall, the division demonstrated a proactive approach to quality improvement.

Processes

The division had established plans to drive learning, improvement, and innovation aimed at enhancing service delivery. The Trust used the Liverpool Quality Assessment tool to monitor and drive improvement around key areas including health acquired infections and falls.

Staff could describe learning from incidents and how changes had been implemented to improve practice. Innovation was reflected across the division and trust through many initiatives including engagement with Healthwatch Liverpool to explore needs of patients with neurodiversity. This included how to improve accessibility to the building and an engagement event with the Sight Loss Council and local support organisations to understand how best to support patients with visual impairment. Leaders encouraged staff to take time to feedback ideas and improvements through the quality improvement teams for further support and guidance on how to proceed with initiatives.