Queen Alexandra 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

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant the service was consistently managed and well-led.

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.

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 trust had developed a strategy "Working Together, Improving Together", that set out the trust vision, values and aims. The trust vision was "Working together to deliver excellence in care for our patients and communities." The vision a supported by the trust values of working together for patients, working together with compassion, working together as a team and working together always improving. The vision and values aimed to support the trust strategic aims of meeting the needs of the community, supporting safe, high quality patient focused care, responsibility for the delivery of care now and in the future, supporting their people to deliver the trust vision and enabling teams to deliver the best care.

During inspection both senior leaders and some staff spoke about the strategy, vision and values. All staff described how they were motivated to give the best care possible to their patients.

Most staff commented positively about the culture at a local level, describing it as supportive, with lovely colleagues and supportive managers

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.

The trust had an overarching executive leadership team. The trust managed its services through clinical divisions led by a Divisional Director, Director of Operations and Divisional Nurse Director. Most of the medical services were managed by the medicine and cancer and renal division, in which there were several care groups. This included the medicine, older persons medicine, regional heamatology and oncology and the Wessex Kidney centre (including the dialysis unit and 7 satellite dialysis units) care groups. The acute medical unit (AMU) was managed by the Urgent Care Group. Each care group was led by a Care Group Director, Care Group Manager and Senior Matron.

All staff spoke positively about the local leadership and told us they had good working relationships. On the wards and units, we observed strong clinical leadership from the ward managers and the lead nurses. Most staff said the senior leadership team was visible and supportive.

Leadership training was available for leaders, including aspiring leaders. Ward managers were committed to developing their staff. This included providing leadership opportunities to equip their staff to progress onto leadership appointments.

We scored the service as 3. 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.

The trust had a freedom to speak up process that allowed staff to speak up/raise concerns about anything that got in the way of patient care or affected their working life. The trust had recently appointed an external organisation to provide the Freedom to Speak Up Guardian service. A Freedom to Speak Up Guardian is a designated individual in an organisation who supports workers to raise concerns they may have, especially when they feel unable to do so through normal channels. The guardians act as a safe point of contact and help ensure that workers are heard, their concerns are addressed, and feedback is provided on any actions taken. Staff we spoke with knew about the Freedom to Speak Up process and how to contact the Freedom to Speak Up team.

Information provided by the service showed that staff had contacted the Freedom to Speak up Guardian for a variety of concerns and relevant advice and guidance had been given to the staff members contacting the guardian.

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.

The trust had an Equality, Diversity and Inclusion policy that set out their commitment to diversity and inclusion. Staff had access to a reasonable adjustments policy. This gave guidance about how to support staff with reasonable adjustments to enable them to work and reduce the risk of staff experiencing discrimination due to protected characteristics.

Staff had access to support from several staff network groups. These included a Disability Staff network, a LGBT+ staff and allies’ network, a race equality network and a women’s network. The network chairs produced a quarterly equality, diversity and inclusion newsletter that gave staff information about events and where to seek support and advice from.

The service provided the current ethnicity breakdown for nursing staff in the medical and older persons care group. However, this did not include any figures for previous ethnicity break down so it could not demonstrate any improving or deteriorating trends for ethnic minority nursing staff achieving senior posts in the service.

The service provided examples of the induction programme for internationally trained nurses. This included pastoral, wellbeing as well as clinical induction. However, some staff in some areas of the service expressed concern about the current induction process for internationally trained nurses. They said that due to the staffing pressures, the length of time internationally trained nurses remained supernumerary on the wards had been reduced. They explained this increased the pressure on the internationally trained nurses who were still adjusting to working in England.

We scored the service as 3. 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.

There was a governance structure with lines of accountability through wards/departments, the care groups to clinical divisions and through to the trust board. All care groups had a governance lead.

Records of governance meetings at care group and divisional levels demonstrated the quality, performance and safety of the service were monitored and reviewed. This included monitoring and review of safety incidents, risks, staffing and training.

Our review of the risk register showed risks described by staff were included on the risk register. This included risk associated with the use of Your Next Patient spaces and risk associated with the environment, including ligature risks. However, risk associated with the provision of only one oxygen and suction port between 3 patients in AMU was not detailed on the risk register. Following receipt of the draft report the service informed CQC that the risk associated with lack of available oxygen points and suction points was due to delays in planned works to resolve the issue. Detail had previously been on the risks registered and had now been re-added to the risk register. The risk of patients with a learning disability receiving inequitable care due to the lack of provision of specialist support was not included on the risk register. However, detail in one of the governance meeting records demonstrated that there was an awareness that more training and support need to be provided to staff to equip them with the skills to effectively support these patients. Details on the risk register evidenced that leaders regularly reviewed the risks and took actions to lessen them.

The service followed processes to gather information to gain assurance that staff were delivering safe and effective care that followed national guidance. This included but was not limited to matron assurance rounds, auditing of vital signs compliance, response to deteriorating patients, compliance with sepsis policy, medicine management audits and infection prevention and control audits. However, it was identified during the inspection that the service did not monitor or audit staff compliance with the NEWS2 process.

Staff did not always ensure all patient records were held securely. We observed in some ward areas that patient records were held in unlocked trolleys that had the potential to be accessed by unattired persons. Improvements could be made in this area.

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.

The service provided examples of how they were collaborating with external and internal partners to support and improve the healthcare experience of patients. This included involving estates, infection prevention and control and communication departments in the planning and working on the new endoscopy unit and working with the patient collaborative to inform changes within the older persons medicine care group.

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.

The service used the trusts quality improvement programme Delivering Excellence Every Day (DEED) to support quality improvement at all levels of the service. At the time of the inspection different areas of the service were at different stages of embedding this process into everyday practice. We saw this process was embedded into the older persons medical care group, with improvement huddles identifying small changes that could lead to further improvements.

Other innovations and improvements included the lung cancer screening programme, which since 2022 had seen improvements in early diagnoses of lung cancers. The rates had increased from 27.4% in 2021/11 to 42.9% in of lung cancers being diagnosed at an early stage with over 80% of the diagnosed cancers through this programme being at a curative stage.

Wards participated in accreditation schemes. The trust had developed an Accredited Clinical Environment (ACE) scheme which ensured a consistent approach to ward and departmental quality reviews and supported a continuous improvement pathway. It allowed recognition of best practice that could be shared to improve patient care and staff wellbeing across the services. Examples were provided by the service to demonstrate how wards had improved their quality of service after an ACE assessment had identified areas for improvement.

The Trust was undertaking a Trust-wide workstream called Transforming the Take, with one of the pillars focused on discharge. The workstreams current focus was providing enhanced support to board rounds across all inpatient wards with a view to improve discharge processes such as increased use of the discharge lounge, discharges earlier in the day, increased discharges on patients discharge ready date and improved processes regarding tablets to take home (TTO) completion.