Goole & District 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 assessed 7 quality statements from this key question. We looked for evidence there was an inclusive and positive culture of continuous learning and improvement based on meeting the needs of people who used services and wider communities. We checked leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred and sustainable, and to reduce inequalities.

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. Leaders and the culture they created promoted high-quality, person-centred care.

At this assessment we identified a breach of regulation in relation to Regulation 17 (Good Governance).

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.

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.

Staff and leaders could not tell us about the vision for the hospital. During our assessment the vision was being updated, due to the merger of two providers into the NHS Humber Health Partnership. Staff told us the trust wanted to extend Goole and District Hospital outpatient provision to patients. Staff and leaders were all complementary of the culture in the service. The service had produced their own vision based around a sunflower. All staff showed us the sunflower posters.

Leaders had displayed a partnership mission statement in the ward manager’s office.

We reviewed the Patient Services Care Group Clinical Strategy 2025-2030. This identified the vision, challenges and key opportunities.

We reviewed the outpatient’s strategy which was 2 years out of date.

Leaders could tell us the outpatient’s strategy for the service. They had refreshed the digital strategy for outpatients which aligned with the NHS 10‑Year Health Plan. This aimed to support patients through digital technology, and to work with primary care to develop a new advice‑and‑referral‑based model.

Outpatients had a comprehensive transformation programme aligned to each specialist clinical service who used outpatient clinics.

A new staff charter was in place, shared with staff and available within the department.

Staff could tell us about NHS England’s 6Cs; Care, Compassion, Competence, Communication, Courage, and Commitment and how they related to the service.

Staff and leaders had worked with the strategic team, ICB and the public to create a ‘save our hospital’ local group. This group consultation had formed an ‘options appraisal’ with lots of ideas on how to keep the hospital open and maximise use and capacity. For example, leads worked with a regional partnership for greater service and community diagnostics expansion.

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.

Staff were very positive about the ward manager and matron. They were capable, compassionate and inclusive and had an open door policy. They could provide examples such as being visible, listened to and supported.

The service matron visited the department at least weekly, and the site matron visited daily.

Leaders described how they worked together to provide cover to support staff. They provided regular updates to staff in a newsletter. The service had their own internet page to share information.

Leaders described the training and development they had received. This helped them undertake managerial duties and provide specialist input for patients. We spoke with staff who received opportunities to help them develop their roles.

Leaders clearly explained how teams worked to provide high quality care. They provided examples of audits, learning from trust wide safety events and quality improvement.

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.

Patients and carers had opportunities to give feedback on the service they received in a manner that reflected their individual needs. We saw examples both on site and as part of our assessment. We saw ‘you said we did’ posters, the most recent friends and family survey results, the patient confidential comment box and how to complain posters onsite.

Patients told us about the ‘Save Goole Hospital’ campaign which many were part of. This had provided the opportunity to speak to senior leaders about the future of the service.

New staff told us how welcoming the team had been, and how they felt able to make suggestions and were listened to.

Staff and leaders were aware of the freedom to speak up process, and how to contact the freedom to speak up lead. However, they had not needed to do so.

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.

90% of staff were trained in Equality, Diversity and Human Rights.

The trust had numerous staff networks, including Black, Asian and Minority Ethnic (BAME), Disability and LGBTQ+, Women’s and Staff Equality.

However, we saw no posters within main reception or the service informing staff of these networks. Staff were not aware of any equality and diversity groups at the Hospital.

The provider undertook equality monitoring of staff within the service. This ensured it was diverse in its make-up and representative of the patient group.

Staff and leaders could provide examples of flexible working arrangements. These had been put in place to account for personal circumstances such as caring responsibilities and health issues.

We scored the service as 2. The evidence showed some shortfalls. The service did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

Leaders used a framework at the monthly outpatient clinical governance meetings attended by the ward manager. This ensured essential information was shared and reviewed. The service’s governance structure was up to date.

All staff attended the daily huddle which had a framework. However, the monthly staff agendas did not include all the essential information such as learning from safety events and complaints, risks, health and safety or quality improvement.

Leaders told us risks to the service were minimal. They said risks related to clinic access and follow up appointment backlogs, staffing, delay in clinic, loss of services owing to failing equipment, and the service closing.

We reviewed the risk register for the service. There were no individual risks for the service identified. Patients delayed over 60 minutes in clinic was not a risk on the outpatient department risk register. Leaders told us about paperless notes, but this was not yet available at the service. They told us nursing staff had nowhere to write their notes. This was not on the risk register. This meant we could not ensure leads were aware of all key risks which affected their service, and what was being done about them. We were not assured the service, or the trust had fully captured or understood all key risks to the service. We saw no evidence leaders reviewed, maintained or mitigated any identified risks, despite the fact the trust had moved some outpatient services to their other sites. This is a breach of regulation 17, Good Governance.

We reviewed health and safety minutes for the 6 months before our assessment. The outpatient service had not been discussed. This meant we could not evidence that health and safety risks specific to the department were routinely reviewed through this forum nor were we assured of potential measures in place to reduce the service’s risks of health and safety issues.

The service had reported one safety event in 12 months using the electronic patient safety system. Leaders shared a recent safety event from a neighbouring service with staff promptly.

Staff understood the arrangements for working with other teams within the Hospital to meet the needs of the patients. They could describe times when this has occurred.

We reviewed the Standard Operating Procedure for Goole Site Cover. However, this was out of date. Leaders told us policies were out of date as they were awaiting alignment under the new NHS Humber Health Partnership. This was formally established in August 2023.

Staff told us they could access equipment and information technology to fulfil their role. Only two out of 15,815 patients were cancelled in the past 12 months due to equipment failure.

Leaders told us they had access to information to support them with their management role. This included information on service performance, staffing and patient care.

Information was in an accessible format, timely, accurate and identified areas for improvement. We viewed evidence of this whilst on site.

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. They share information and learning with partners and collaborate for improvement.

The hospital’s potential closure had enabled staff, leaders and patients to work collaboratively with commissioners to review the continuation of services and to plan for growth.

Patients told us the community’s strength of feeling at potentially losing the hospital. Staff and leaders said this had fostered an increase in community feeling and keeping service local.

Leaders told us how they had worked with the commissioners to produce an options appraisal. They presented this to the commissioners and hospital trust Board.

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 compliance lead told us the service had a quality improvement programme. This encouraged staff to train and design their own projects for development. However, staff and leaders were not aware of any quality improvement projects other than reducing the use of protective paper to cover examination couches.

When we spoke further with staff, we found small improvements to the service had taken place, but staff did not recognise these as quality improvements.

Leaders told us each specialty had reviewed their activity and capacity to expand and maximise the clinics. Leaders had met with primary care to ensure GPs had access to the correct clinics at the service.

Leaders told us the service had recently implemented Dr Doctor, a digital patient engagement platform. Patients told us how much they liked Dr Doctor. One benefit of this platform was the number of did not attend appointments had reduced, but cancellations had risen.

Staff told us they had not received any formal quality improvement training but would discuss with the ward manager anything they felt could improve the service.