King's Mill 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 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.

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 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.

There was a good safety culture where managers investigated incidents and learning was embedded to promote good practice. Staff said raising concerns was encouraged and valued. Staff felt listened to. Staff told us that sharing the learning occurred in many ways including emails, at safety huddles or handovers and via a secure messaging app. We saw examples of learning being shared through most of these channels.

Staff and leaders demonstrated a positive and compassionate culture with a focus on learning and improvement. The trust values were named CARE. This included C - Communicating and Working together, A - Aspiring and Improving, R - Respectful, Inclusive and Caring E - Efficient and Safe. These were displayed around the trust and department. We saw staff in ED lived these values. We heard staff describe the culture as “all one team” and “all are our patients”. We saw numerous examples of this whilst on site.

Leaders had a shared purpose and strived to deliver and motivated staff to succeed. There were high levels of satisfaction across all staff, despite the challenges they faced. Staff told us that they would bring a family member to be treated in the department.

Staff were helpful, welcoming and professional in their communication with each other, patients and their relatives. Leaders described a positive and compassionate culture. Staff and leaders embodied a positive, compassionate, listening culture. We saw that this culture promoted trust and understanding between staff, leaders and people using the service.

The leadership were focused on resolving the issues with an overcrowded ED and had had several organisations review the practices within the department to assist them to learn and improve. The team had yet to develop their vision and strategy for the department in a formal sense. The senior team had aligned work programmes to develop a strategic approach. These fell into performance improvement, staff wellbeing, supervision and development, and implementing a quality improvement programme. The senior team and the wider ED staff understood the challenges of their population and were fully aligned, working with partners in the wider health economy, and there was a demonstrated commitment to system-wide collaboration and leadership. For example, working with system partners on alternative pathways to avoid ED attendances.

The trust had access to community hospitals which allowed them to increase the flow through the hospital. Services in the community had been developed to support people in their own homes including working with care homes and the ambulance services.

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 service had inclusive leaders at all levels who understood the context in which they delivered care. Leaders were aware of the issues that the department faced and used national programmes to assist them to resolve or manage these issues. We found that staff and leaders were aligned on the issues that the department faced.

There were processes to support staff and promote their positive wellbeing. Staff we spoke to felt proud to work in the service. Multiple staff told us they felt well supported by their line managers. Line managers made a point of speaking to each area of ED at least 2 or 3 times per shift and to check in on staff wellbeing. Data provided by the trust showed that the staff turnover rate was below 10% for the previous rolling 12 months. Medical staff turnover was just over 7% and nursing turnover was 3.6%. This was a positive indicator of staff satisfaction.

Following the staff survey in 2024 leaders commissioned a “you said we listened” to provide feedback to staff. This highlighted the areas for focus for the coming year. These included recognition of staff, opportunities for flexible working, relief from burnout and stress, and having resources to undertake their roles. As highlighted above the service nominated several individuals and groups for the staff awarded and the urgent and emergency care department won 4 awards.

There was compassionate, inclusive and effective leadership at all levels. Leaders demonstrated the high levels of experience, capacity and capability needed to deliver excellent and sustainable care. There was a deeply embedded system of leadership development and succession planning, which aimed to ensure that the leadership represented the diversity of the workforce. This was across the whole workforce. Staff spoke about being confident to approach any member of the ED team to obtain both professional and wellbeing support.

There were clear reporting structures and key roles were supported by deputies or associate roles to support succession planning. Staff understood their immediate reporting structures and leaders understood their key roles and responsibilities. Staff told us the departmental leads and senior managers were approachable, visible and provided them with good support.

Leaders demonstrated how they worked as part of a multidisciplinary team within the service and how they worked with external stakeholders, such as the local and regional commissioners, integrated care boards and local NHS ambulance and mental health trusts. They said they worked well together and there was regular engagement to review performance and identify improvements to services.

All staff had opportunities to develop including for future leadership roles. There was inclusive recruitment and succession planning for the future. The trust had effective recruitment processes and ongoing checks to ensure all staff met the legal requirements to work in the trust.

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

Staff and leaders actively promoted staff empowerment to drive improvement. The culture supported staff to speak up without fear of detriment. Leaders encouraged staff to raise concerns and promoted the value of doing so. Staff told us that they felt comfortable to raise any concerns and were confident that their voices would be heard and demonstrable action taken.

The service had established Freedom to Speak up arrangements. Information about the guardian and how to contact them was available the intranet. Whilst not all staff knew the name of the trust’s Freedom to Speak Up Guardian, they knew how to raise a concern. However, they didn’t feel that they would use this route as internally within the department they felt that they could raise anything with leaders. Staff could give examples of issues raised and action taken.

When something went wrong, patients received a sincere and timely apology and were told about any actions being taken to prevent the same happening again. Staff were aware of their responsibilities under the duty of candour regulations.

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.

Governance arrangements were reviewed and reflected best practice. A systematic approach was taken to working with other organisations to improve care outcomes. Governance was used to learn, improve and innovate.

Structures, processes and systems of accountability, including the governance and management of partnerships, joint working arrangements and shared services, were clearly set out, understood and effective. Staff were clear about their roles and accountabilities. Audits were undertaken and action plans devised to drive improvement and compliance with national guidance. The service complied with the 3 audits commissioned each year by the Royal College of Emergency Medicine, which included the administration of time-critical medicines.

The service had policies and procedures for escalation and care of patients to mitigate the main risks from crowding. The hospital had processes to monitor performance and quality against national targets and standards.

Data systems enabled a good oversight of performance as evident in meeting minutes and in our discussions with staff. The service had developed a ‘Non-Elective Self-Service’ Dashboard, which not only looked at performance but at the qualitive factors such as patient feedback. This was helpful in identifying themes and trends to drive improvement. Leaders tracked the risks in the ED effectively using the risk register and had oversight of the risks and their mitigations through governance meetings.

Managers attended monthly emergency medicine clinical governance meetings. These discussed and addressed key areas of performance, risk, audit, culture and workforce. Minutes showed areas of concern were identified and actions were taken to learn and improve. Changes had been made when needed to improve the service. This included the extended opening of the paediatric department in December 2025. Good practice was recognised and celebrated.

Information held about patients was held in paper and electronic copy. We saw that staff did not always remove their access cards and anyone could use the computer to access patient records. Staff were reminded when we raised this in the department. Paper records were stored in slots, alphabetically, behind the nurse or doctor station. Staff were aware of the issue of leaving ID cards in computer terminals and removed them promptly when they returned to the terminal. Staff were part of the emergency preparedness network, and they had the strategies and guidance to respond to major incidents.

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.

Staff told us they felt listened to and heard by the relevant stakeholders and external partners. They were supported by clinical partners. For example, there was a partnership with the local NHS mental health trust providing support to patients with mental ill health in the ED. ED staff said they were responsive and supportive.

The trust worked in partnership with the local system. This included the local community trust, the local ambulance trust, GP’s and the Integrated Care Board (ICB). They met to discuss system initiatives to ensure processes and schemes were joined up as well as to discuss responses to issues raised. There were positive and collaborative relationships with external partners to build a shared understanding of challenges within the system and the needs of the people. The ambulance service corroborated this when we spoke with them about the relationship and effective working with the emergency department. Staff reported positive relationships with the local police force, mental health providers and the ambulance service.

The service focused on continuous learning, innovation and improvement across the organisation and local system. Managers encouraged creative ways of delivering equality of experience, outcome and quality of life for people. However, response to patient complaints was slow.

There was a systematic approach to improvement, which made consistent use of a recognised quality improvement (QI) methodology. The trust used a quality improvement methodology. All leaders were involved in improvement projects, and some had been celebrated at national conferences.

Leaders encouraged staff to speak up with ideas for improvement and innovation and actively invested time to listen and engage. Staff were supported to prioritise time to develop their skills around improvement and innovation. Staff told us they were able to influence change and contribute to decision-making in the department. Leaders empowered frontline staff to drive initiatives to improve quality and safety. For instance, in response to an increase in patients with a type 2 respiratory disease, band 6 nursing staff had received training to take arterial blood gas samples to ensure timely assessment and treatment. Similarly, nursing staff had designed the mental health observation and screening tool because of noticing the increasing use of 121 nursing care. This checklist assisted staff to assess patients and had reduced the number of patients requiring 121 care.

Another leader was implementing nursing staff obtaining arterial blood samples in patients within the resuscitation area. All improvement projects followed a Plan, Do Study and Act (PDSA) cycle. Using PDSA cycles enables organisations to test out changes on a small scale, building on the learning from these test cycles in a structured way before implementation.

Medical staff had undertaken improvement projects with their junior staff encouraging the frailty lead to provide a learning workshop for staff. They had also undertaken workshops on point of care delivery of ultrasound for patients to ensure timely diagnosis. Work with the ambulance trust on conveyancing had resulted in 70% of calls to the service not requiring conveyancing.