Great Western 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

We looked for evidence that there was an inclusive and positive culture of continuous learning and improvement that was based on meeting the needs of people who used services and wider communities. We checked those 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 as good. At this assessment, we rated this key question as good. This meant there was good service leadership across all levels. Leaders and the culture they created assured the delivery of high-quality 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.

The service embraced the trust vision, values and underlying priorities for care. These were defined as:

Vision – Great services for local people at home, in the community and in hospital, enabling independent and healthier lives.

Values – Service, Teamwork, Ambition, Respect (STAR)

Priorities – Outstanding Care, Valued Teams, Better Together, Sustainable Future

Throughout the inspection, both senior leaders and some staff described the vision and values. All staff described how they were motivated to give the best care possible to their patients. Meetings, posters and initiatives were all centred around the trust priorities and used the individual priorities as subject headings in reports produced for meetings. For example, governance or team meetings.

Staff commented positively about the culture at local department and ward level, describing it as supportive, with lovely colleagues and supportive managers. We observed the friendly and respectful interactions between staff of all grades and disciplines.

Leaders told us they wanted staff to feel safe and raise concerns. They also spoke about being responsive to staff and managers by listening to their views and then feeding back to staff to make sure the improvements were made.

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.

All staff spoke positively about the local leadership and told us they had good working relationships. Most staff said the senior leadership team was visible and supportive. However, some staff said they felt senior leaders did not always visit their area.

On the wards and departments we visited, there was strong clinical leadership from managers and lead nurses. Staff told us leaders were approachable, friendly and had an open-door policy for staff to approach them.

The trust had an overarching executive leadership team. The trust managed its services through divisions. Most of the surgical services were in the Surgery, Women and Children’s Division.

The local leaders were available when they were needed and led by example. They were knowledgeable about the issues, challenges and priorities in the surgical service. They were keen to harness the improvement suggestions made by staff.

There was inclusive recruitment and succession planning for the future. Staff told us they had opportunities to develop, including for future leadership roles. Ward boards highlighted where individual staff were allocated specific lead roles. These staff would attend relevant workshops and feedback to others on their learning. They would support other members of the team to develop their knowledge and improve patient care.

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

Staff told us there was a culture of speaking up, they felt safe and supported in doing so, and without fear of detriment. Staff gave us examples where they had raised concerns with their managers. We were told these were treated sensitively and seriously, and managers worked with the member of staff to resolve the concern. Staff we spoke with were happy with the outcome and felt comfortable to raise concerns again.

The trust established mechanisms to foster an open and supportive culture to encourage staff to raise concerns about patient care, quality, or safety. Central to this was the trust's Freedom to Speak Up (FTSU) Policy, which was aligned with the guidance from the National Guardian’s Office.

In March 2025, the trust appointed a Lead FTSU Guardian and currently had 9 volunteer Guardians. The trust was actively working to expand this network. The Guardians provided advice, support, and directed individuals to the most appropriate channels to ensure concerns were addressed professionally and lead to clear outcomes.

Staff in these roles told us they were proud to be chosen for these roles and felt they contributed to the wellbeing of staff in a unique way. They told us they were provided training to support them.

Information provided by the service showed staff used the Freedom Speak Up service. The top themes of concerns raised with the Freedom to Speak Up team included attitudes and behaviours of staff, staff safety and well-being.

Call 4 Concern, a patient safety initiative where a special team at the hospital could be contacted when it was felt patients were not receiving adequate clinical attention and there were concerns, was available to patients, relatives and staff. Details of this service were displayed throughout the department.

The service valued diversity in their workforce. Staff work towards an inclusive and fair culture by improving equality and equity for people who work for them.

Staff came from a variety of ethnic backgrounds and there was an inclusive culture observed when we visited the location. Staff told us they felt like part of a family and they were recognised for their contribution by both their managers and their peers.

The trust had an Equality, Diversity and Inclusion policy that set out the trust’s commitment to diversity and inclusion in their services for patients, visitors and staff. The trust monitored and reported on gender, ethnicity and disability pay gaps.

The trust analysed scores from the annual staff and quarterly pulse surveys. The results we used to form actions to improve scores. For example, there had been a recent focus on civility at work, led by Equality, Diversity and Inclusion Champions within each division.

At the service level, international nurses spoke positively about the support they received both when they initially commenced employment and with their ongoing development. Staff reported improvements had been made, leading to empowerment of international nurses and doctors to progress their careers.

Staff had access to several staff network groups. These included networks for staff with physical disabilities, long-term health conditions, special needs and mental health challenges, for ethnically diverse staff, for LGBTQ+ and for international doctors.

The service had clear responsibilities, roles, systems of accountability and good governance. Staff used these to manage and deliver good quality, sustainable care, treatment and support. Staff 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 divisions and through to the trust board. Each division had a governance lead.

Governance was used to learn, improve and innovate. We reviewed minutes from the divisional governance meetings. There was a good range of accurate and timely data and information available to understand performance and quality. There was evidence of challenge and scrutiny, and improvements made as needed.

There were clear service performance measures, which were recorded and monitored by the service and wider hospital. Data collection was detailed. This included monitoring of referral to treatment times, monitoring of cancellation on day of surgery rates, review and learning from incidents, patient feedback and review of the risk register. Areas of good and poor performance were highlighted and used to challenge and drive forward improvements. Monthly reports were produced and discussed at the relevant governance meetings.

Where relevant, performance was tracked over time to highlight unexpected variations in performance which warranted investigation. This meant staff could identify at a glance, areas of increased performance or areas that required investigation and improvement.

There were regular and effective meetings led by consultants and nurses who were leads for safety, audit, quality and governance. Teams discussed and addressed key areas of performance, risk, audit, culture and workforce in these meetings. 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. Good practice was recognised and celebrated. There was effective workforce planning including for managing major incidents or emergencies.

The service took part in national clinical audits which enabled them to have oversight of clinical performance and outcomes in these specific areas.

There were clear and effective processes for identifying, recording, managing and mitigating risks. The surgical service operated a local risk register which was reviewed at the clinical governance meeting. New risks were added to the register and risks already on the register were monitored and managed. Our review of the risk register confirmed risks, as described by staff, were included on the risk register. For example, storage of equipment in theatres, bed capacity on trauma ward and achievement of cancer treatment targets. Detail on the risk register evidenced leaders regularly reviewed the risks and actions were taken to lessen the risks.

Staff followed process to ensure all patient records were held securely and only accessed by authorised members of staff.

The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. Staff share information and learning with partners and collaborate for improvement.

The service understood their duty to collaborate and work in partnership, so services work seamlessly for patients. Staff shared information and learning with partners and collaborated for improvement.

The trust was a partner in the BSW Hospitals Group (Bath, Swindon Wiltshire), working as a part of a wider health and care system. The system was comprised of multiple providers including NHS organisations, local authorities and voluntary sector organisations working together across the BSW region.

The service recognised its role within the overall partnership and leaders could describe how they were contributing to achieving better outcomes for patients. For example, providing surgical services in the community where possible. These included some audiology, gynaecology and urology services.

Additionally, the service worked in collaboration with other NHS acute providers in the BSW region to deliver mutual aid and improve wait times for patients.

The service focused on continuous learning, innovation and improvement across the organisation and local system. Staff encouraged creative ways of delivering equality of experience, outcome and quality of life for people. Staff actively contribute to safe, effective practice and research.

There was a fully embedded and systematic approach to improvement. This made consistent use of a recognised quality improvement (QI) methodology. The trust provided a quality improvement toolkit to staff based on their agreed approach.

Improvement methods and skills were available and used across the organisation, and staff were empowered to lead and deliver change, for example, the pressure damage prevention strategy in place on most wards we inspected. Consultant nurses were often used to support QI projects and undertook several of their own. Innovation was celebrated. There was a clear, systematic and proactive approach to seeking out and embedding new and more sustainable models of care. There was a strong record of sharing work locally and nationally.

Staff told us their investment in a digital pre-assessment software, supported staff as well as patients. The idea was generated from patient feedback and continuous engagement with staff. Staff said the software allowed for the capture of the majority of patient information and medical background. Patients therefore did not have to repeat this at their pre-assessment appointment, allowing time for more in depth discussion. Leaders and staff told us this had improved (lowered) the rate of cancellations and postponements.

Teams with the colorectal cancer service were undertaking research into specific hereditary genetic conditions that may relate to certain cancers. They were in the process of creating a dataset which they believed would support a framework for trusts across the country. It was hoped this innovation will improve cancer pathways for patients. It was further recognised that staff involved in the project would benefit individually from education, which they would be able to take forward in their careers.

Leaders empowered frontline staff to drive initiatives to improve quality and safety. For example, we were told of nurses who had special interests to become nurse champions to promote innovation and drive improvements in that area.