Guy's 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

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 good. At this assessment, the rating has remained good. This meant the service was well 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 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.

Leaders shared a vision for urgent and emergency care services across the trust, with the Urgent Care Centre (UCC) service forming part of the overall urgent and emergency care strategy. It emphasised creating a responsive and resilient emergency care environment that met the evolving needs of its community, ensuring patients received the right care in the right place at the right time. This aligned with the wider organisational strategy, which prioritised improving patient flow, reducing avoidable delays and supporting the wellbeing of staff. However, the service strategy was predominantly focused on emergency department (ED) priorities, with comparatively limited emphasis on the specific role, pathways and operational model of the UCC.

Leaders set out a consistent direction, focused on delivering safe, high quality and timely emergency care for all patients, and staff understood how their work aligned with these aims. Staff had opportunities to take part in discussions about service strategies, especially when changes were being made, and could explain how their work contributed to delivering high-quality care. Evidence showed that senior clinicians and managers were working to align expectations across Guy’s Hospital, ensuring clarity on what the UCC could safely provide. The team recognised the challenges of increasing attendance, higher acuity and public misunderstanding about the UCC’s role, and had begun targeted work with communications and wayfinding teams to address this, including improved signage and updated web information.

The culture within the service was positive. Staff described feeling part of a cohesive team and demonstrated commitment to delivering good care despite operational pressures. Staff we spoke with reflected pride in their work and in the supportive environment. They also reported strong teamwork between nurses, GPs and advanced practitioners, with an emphasis on keeping people safe while working within the service’s defined scope.

Leaders promoted a culture focused on safety and responsiveness, and staff understood the importance of keeping oversight of the waiting room and prioritising unwell or deteriorating patients. The team demonstrated awareness of local population needs, including the number of tourists, children and people attending without a full understanding of the service. Despite limitations in space, particularly around the absence of a dedicated children’s waiting area, staff used processes and available resources to help keep people safe and comfortable.

All the staff we spoke with talked openly about the culture of the service. They told us the team worked well together and they enjoyed their roles. During our time in the department, we saw staff treated each other with respect and there was a culture of mutual support across all staff roles and grades.

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.

Leaders at the UCC were visible, experienced and well regarded by staff. Evidence from meetings and staff interviews showed that the nursing leadership, consultant oversight and management presence were strong, and staff consistently described leaders as supportive, approachable and invested in their development. Staff said they felt looked after, highlighting in house training and a clear commitment to upskilling the workforce including work to grow the emergency nurse practitioner (ENP) cohort and support advanced clinical practice pathways.

There was a clear management structure with defined lines of responsibility and accountability. Local leadership was provided by an ENP lead. The service was led by a team responsible for urgent and emergency care across the trust. Leaders had the skills, knowledge, and experience required for their roles. They demonstrated a clear understanding of the service they managed and could explain how their teams worked to deliver high-quality care, including managing patient flow and maintaining safe staffing levels. Leaders were visible and approachable; staff informed us members of the directorate management team were present on the unit one day per week as a minimum. Senior management were accessible throughout the operational period, with effective communication systems in use.

Leaders demonstrated a compassionate and inclusive approach. Staff described being encouraged to speak up, request feedback and contribute to shaping service improvements. Staff survey results for the division showed an improvement from the previous year in staff reporting having compassionate leadership, although this was marginally lower than the organisation average. Leaders showed an awareness of operational pressures and took steps to protect staffing levels at Guy’s UCC when needed, drawing on support from St Thomas’ ED.

Leaders demonstrated strong oversight of governance and operational performance, and staff told us they were confident that leaders provided clear direction and were actively engaged in monitoring standards. There was evidence of leaders actively addressing risk. Senior staff could clearly describe the top risks facing the service and had processes to monitor and mitigate these. Leaders responded to concerns raised by staff. Staff felt listened to and empowered and described the leadership team as reliable.

The service fostered a positive culture where people felt they could speak up and their voice would be heard.

The leadership team made efforts to foster a positive culture where most people felt they could speak up, and their voice would be heard. Staff were encouraged to raise concerns. Formal mechanisms for reporting concerns were well established. The service had established Freedom to Speak up arrangements. The trust had a freedom to speak up guardian with whom staff could raise concerns about any issues. Staff reported that they would be listened to if they spoke up and most staff were aware of how to raise concerns but stated that they would more likely raise issues with senior members of the team. We saw evidence of this as the team's wayfinding initiatives were undertaken in response to concerns communicated by staff members to leadership.

Patients and carers had opportunities to provide feedback on the service in ways that reflected their individual needs, including through surveys such as Friends and Family. Managers and staff had access to this feedback and used it to make improvements.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

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.

Leaders had established governance systems that provided consistent oversight of risk, quality and performance across the urgent and emergency care directorate. Formal governance structures were well established, including weekly and monthly quality improvement and patient safety, senior management team and division management meetings, risk register reviews and regular escalation processes, ensuring that leaders-maintained sight of emerging issues within all trust urgent and emergency care service including the UCC. Systems were well established to monitor actions through structured forums. Minutes demonstrated that meetings were well attended by senior clinicians, operational leaders and governance staff, with clear agendas covering quality, safety, incidents, policy updates, and service pressures. These structures ensured governance remained visible and enabled consistent discussion of performance, risks and improvement priorities.

There was a range of data and information available to understand performance and quality within the service. Information relating to performance against key quality, safety and performance objectives was monitored and cascaded to staff through team meetings and newsletters.

Leaders demonstrated good understanding of the most significant risks to the service and used the risk register to support oversight. Risks were reviewed, updated or closed during meetings, and leaders frequently sought assurance that actions were progressing. We found that risks identified within our inspection such as a lack of a dedicated children’s waiting area were identified and recorded on the service risk register. Leaders described appropriate control measures to mitigate risks such as using one of the consulting rooms or the holding bay as an area for children to wait. This created a safe, child-friendly space that limits hazards and supports children's wellbeing while they wait for care.

Staff had access to a range of policies, procedures and guidance which was available on the provider’s intranet. Staff we spoke with had a good awareness of governance processes and knew how and where to escalate their concerns. Leadership was visible and accessible within the UCC. Staff described the directorate management team as approachable and responsive, with regular presence within the service through walk-arounds.

The service clearly understood and carried out their duty to collaborate and work in partnership, and services worked seamlessly for people. They always share information and learning with partners and collaborate for improvement.

The provider worked effectively with a wide range of partners and community organisations to help meet the diverse needs of people using the service. Evidence showed effective relationships with the GP provider, the local ambulance service, and specialty teams, which supported safe pathways and timely transfers. Staff described strong communication with paediatrics and mental health teams, ensuring people received the right care in the right place.

There were good examples of collaboration to improve patient flow and reduce re-attendance. For instance, working with a local GP practice to secure dedicated wound-care slots, which helped to reduce return visits for dressings. The team used a citywide digital shared care record to obtain and share information between services. Staff could call medical staff at St Thomas’ ED for advice, supporting safe streaming decisions and reducing unnecessary waits where there were questions about redirection.

The service collaborated closely with the Community Health Inclusion Team, a multidisciplinary service supporting people experiencing homelessness, asylum seekers and refugees. This partnership enabled timely information-sharing, joint discharge planning and appropriate follow-up for vulnerable people who may have difficulty accessing primary care services. For example, homeless people, refugees, asylum seekers or people with addictions.

A broad range of voluntary and community sector organisations were available to support people with complex social, emotional and psychological needs. Staff used established directories to signpost people to trauma-focused services, domestic abuse support, counselling, youth activities, community food provision and legal advice, helping people maintain wellbeing beyond the hospital environment. These included organisations offering culturally specific support, activities for families, interpreting, mental health groups and specialist services for survivors of abuse.

The service contributed to system-level partnership work through an Urgent and Emergency Care board across Lambeth and Southwark. This included shared planning and winter preparedness discussions with partner trusts, primary care, the ambulance service and local authority colleagues. These forums supported coordinated responses to pressures, improved patient flow and strengthened cross-agency communication.

The trust’s mental health strategy also set out commitments to working collaboratively with partners across the voluntary and community sector, using shared training, outreach and engagement to improve crisis pathways for diverse groups including young people, older people, refugees and LGBTQ+ people.

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 demonstrated a commitment to learning and continuous improvement. Staff described a culture where they were encouraged to reflect on practice, test new ideas, and share learning across teams. Leaders supported innovation and gave teams the time and tools needed to improve patient experience and safety. Improvement programmes for urgent and emergency care were implemented trust-wide to ensure consistency and to raise standards across hospital sites.

The service also developed new approaches in response to complex or emerging risks. For example, a pilot of restorative practice with the aim of reducing violence and aggression and self-endangerment incidents and a pilot of e-registration which was in development.

Leaders encouraged innovation and participation in research. The service took part in national research to support patients. We saw evidence of collaboration with external partners to support improvement. This included joint work with primary care networks, the ambulance service, local smoking cessation services and community health teams.