The Princess 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

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 assessed 7 quality assessments.

The service had a shared vision and strategy and was taking action to improve its culture. Leaders worked with external partners to support service development and improve access and outcomes for patients.

Staff were welcoming, friendly and supportive. They liked working at the hospital and felt valued and supported. The service provided enhanced induction and supervision arrangements for overseas nurses to support cultural transition and safe practice. Leaders had the skills, knowledge and experience to lead effectively and staff described them as compassionate, visible and approachable.

Medical care had a clear leadership structure; the divisional triumvirate was supported by senior clinical and operational leaders. Governance arrangements were effective, with regular meetings to review quality, safety, risks and performance.

Leaders understood the needs of the local population, including health inequalities, and worked closely with system partners to improve access and outcomes. Managers raised and escalated risks appropriately and leaders maintained an up‑to‑date risk register that was reviewed and reported through the divisional and trust governance structures.

The service promoted a culture where staff felt able to speak up. Staff knew how to access freedom to speak up support and concerns raised were reviewed and acted on, although some issues relating to staff behaviours had not yet been fully resolved. Staff survey results showed improvement compared with the previous year, with positive trends in bullying, harassment and staff experience, although perceptions of equal opportunities for career progression remained below national averages.

Leaders operated robust systems to manage incidents, learning and improvement. They used audits, incident reviews and performance data to monitor safety and quality. The service worked openly with partner organisations and had made progress towards more joined‑up care through system‑wide governance arrangements. Leaders encouraged continuous learning, innovation and research, and staff actively participated in national research studies and daily improvement activity to drive better outcomes and patient flow.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant the service was consistently 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 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 service had a 4-year vision and strategy published in 2022 for what it wanted to achieve and objectives to turn it into action. The medical care vision aligns with the trust vision to be modern, integrated and outstanding. The medical care strategy was aligned to 5 priorities:

• Transforming our care.
• Digital health.
• Our culture.
• Our new hospital.
• Corporate transformation.

This vision and strategy was adopted by medical care and an action plan to achieve it was developed for each priority. The division worked with external partners, such as primary care, community health services, ambulance services, mental health providers and local authorities. Partnerships were embedded in the service’s strategy and helped to provide service development and improved access and treatment of patients.

Staff we met were welcoming, friendly and helpful. Staff told us they liked working at the hospital, they felt supported and valued. We observed most staff working together as a team to provide care and to positively impact patient experience. Staff we spoke with were positive about the service and the changes that had been made. One staff member described the induction and extended supervision support the service had put in place for overseas nurses, which provided additional support for the cultural differences in working.

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.

Medical care services sat within the medical division and had a trust level leadership team also known as the triumvirate. The triumvirate consisted of the divisional director, associate director of operations and the associate director of nursing. They were supported by a range of other staff, including the head of nursing, the clinical director and leads, service managers and matrons.

Leaders had the experience, skills and ability to run the service. There had been a recent change in nursing leadership since our last inspection. Staff told us senior leaders were approachable and “very visible”. Two staff commented they had seen the interim chief nurse on units to support less senior staff when matrons and ward managers were away.

The service held weekly divisional leadership meetings but did not provide meeting minutes. We reviewed an agendas and meeting minutes for 3 meetings for the patient safety and quality meeting and found the meetings were well attended. The meetings covered key topics such as divisional risks, quality and safety, including patient harm and complaints, and operational aspects.

Leaders understood the differing needs of the local population. They understood how health inequalities affected treatment and outcomes for patients from ethnic minority and disadvantaged groups in their local population. They worked closely with various stakeholders, such as the Integrated Care Board (ICB) to monitor outcomes and develop greater access to treatment.

Managers and matrons in medical care raised risks appropriately; recording and escalating risks such as overcrowding, unsuitable environments, staffing pressures, infection prevention and control concerns, and the use of non-designated clinical areas to deliver care.

There were clear lines of reporting from the site leadership team, the triumvirate and the board. The service held monthly meetings to discuss key topics, such as updates on improvement, patient experience and local, national and regional updates.

The evidence showed some shortfalls. People did feel they could speak up and that their voice would be heard. However, actions to address all concerns had not taken full effect.

The trust had a freedom to speak up policy to guide staff in who they could speak with, the process to follow and how concerns will be used. The service had a freedom to speak up (FTSU) guardian and ambassadors appointed to further support staff in speaking up. Most staff said they knew how to access the FTSU staff.

Staff had raised 15 concerns to the FTSU guardian in the 8 months before our visit. These concerns were primarily related to behaviours and bullying or harassment, and then less so to patient safety, processes and staff well-being. The service identified most behaviours reported related to civility between staff members. They developed actions to improve staff behaviours and monitor the effectiveness. However, we saw this was still an issue during our visit.

The service’s NHS staff survey results for 2024 showed an improvement since the 2023 survey and results for medical care were better or the same in 7 out of the 9 areas surveyed. Actions to improve had been identified and were monitored through divisional review meetings.

This evidence showed a good standard. Staff felt valued and respected. There was a narrowing discrepancy between different staff groups regarding bullying and employment prospectives.

Staff we spoke with felt valued and respected by other staff and reported having positive working relationships. We also observed positive multidisciplinary working onsite. However, one staff member told us they had occasionally faced discrimination from people using or visiting the service. The staff member said they were supported when this happened and action was taken to address the comments with the person making them. Staff and leaders, we observed onsite, were not representative of the population of people using the service. There was a greater diversity in junior staff than the population served by the service.

The trust’s workforce race and disability equality standard data for 2024-2025 showed there were significantly more black and minority ethnic staff at band 5 level due to international recruitment. This was starting to translate to higher positions (bands 6 and 7) within the organisation, which had 36% to 48% black and minority ethnic staff. This data was representative of the trust as a whole and not specific to medical care services.

The findings showed in 2024, a lower percentage of staff with a long-term condition or illness (LTC) experienced harassment, bullying or abuse from staff than staff without an LTC. However, there was a slight increase (from 3% to 4%) of staff declaring a LTC compared. Figures for staff who experienced harassment, bullying or abuse from patients, relatives or the public also show a decrease for staff with a LTC, compared with 2023 figures, to 49%. This was below the NHS average.

Less than 60% of white staff and 50% of staff from other ethnic groups believed that the organisation provided equal opportunities for career progression or promotion. Similar figures applied to staff with and without long-term conditions or illnesses and these fell below national trends for both groups of staff.

The trust had an Equality, Diversity and Inclusion (EDI) Strategy 2023–2030 setting out its plan to build an inclusive and fair culture for staff and patients. The strategy was led and monitored by the Equality, Diversity and Inclusion Steering Group. The Trust employed around 3,500 staff serving a diverse population. The strategy focussed on respecting all protected characteristics, removing barriers, and making sure everyone felt valued and supported. 

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.

Medical care leaders operated effective governance processes, throughout the service and with partner organisations. The governance team was made up of the service’s triumvirate members and other senior staff, such as clinical leads and patient safety managers.

Data submitted by the service showed that they held monthly multidisciplinary patient safety and quality group meetings and used reports from different areas of the service to review the safety of patient care that occurred within the service. Information from this meeting was reviewed together with service reviews for each specialism, finance and medical establishment, by the divisional board each month.

Staff at all levels were clear about their roles and accountabilities and had opportunities to meet, discuss and learn from the performance of the service. We reviewed the patient safety and quality group meeting minutes for June and November 2025 and found the meetings to be well attended and comprehensive. The meeting had standing items for discussion, which included but was not limited to patient incidents, performance, and governance and risk.

Leadership staff maintained a risk register to monitor the service’s biggest risks and they were able to confirm the top risks for the service. These included the cancellation of clinic appointments at short notice, wait times for lung function testing, complaint response times, and staffing issues in specific areas. Leadership staff met monthly to discuss risks and report up to the trust board through divisional board and divisional review meetings.

The trust monitored incidents and had a clear process for incident investigation. Managers reported that they reviewed incidents submitted by staff via an incident reporting system regularly to review the information and the level of harm. Managers then investigated incidents and identified if the incident could be closed and used for learning or escalated to the weekly patient safety incident response framework (PSIRF) panel. The panel identified whether a patient safety incident investigation (PSII) was required.

The service reported that all PSII reports were presented to the patient safety executive review group (PSERG) for approval of findings and recommendations. At the time of our visit there were no open PSII investigations.

Managers and staff carried out a comprehensive programme of repeated local audits to check improvement over time. Local audits included but were not limited to infection prevention and control, records completion and environmental checks.

The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, so services work seamlessly for people.

Staff and leaders were open and transparent, and they collaborated with relevant external stakeholders and agencies. Staff worked with local providers and the Integrated Care Board to discuss and agree priorities for population health and resource sharing, resulting in joint plans for combined service delivery.  

The trust Board approved a host/lead provider framework in June 2025, placing the trust as the lead organisation for multi-partner contracts. This change enabled smoother governance and coordinated care pathways across acute, community, and primary care services. These actions showed progress toward joined-up care and improved patient experience, resulting in safe and more coordinated care pathways, reduced delays in discharge and better support for patients with complex and long-term conditions.

The evidence showed a good standard. The service focused on continuous learning, innovation and improvement across the organisation and local system. Staff actively contribute to safe, effective practice and research.

Leaders encouraged innovation and participation in research. Staff in the service collaborated with NHS England and primary care networks to use pathways for medical conditions, such as breathlessness, heart failure, chest pain and palpitations. More than one pathway had helped to reduce patients’ admission to hospital, while maintaining clinical support in the community and a decrease in referral times to specialist review.

Staff working in the medical care division took part in National Institute for Health and Care Research (NIHR) supported research and clinical trials. Medical care was involved in 16 research studies, all of which were multi-centre, national and UK wide trials. These included a study to look at medical care for older people during their entire visit to the hospital for surgery. This was because there was unequal access for older surgical patients (nationally) and the aim of the study was to determine whether a cost effective assessment can be put in place for these patients.

Staff and leaders engaged with external work, including research, to embed evidence-based practice. The service collaborated with regional organisations, such as the Integrated Care Board, where these organisations supported research ideas.

Another study looked at how to effectively restart medicines in patients that had developed drug induced liver injury during treatment for tuberculosis and which treatment option following this is safer for patients.

Medical care leaders attended an improvement huddle each morning to look at each area, where issues lay and what could be done that day to improve. Staff told us the meeting idea came from thinking about what they could do to connect improvement work with what was happening on a day-to-day basis.

Wards had individual targets to achieve, relevant to that specific areas, such as the number of discharges. Targets were updated weekly before being cascaded back to ward staff to continue working on. For a ward focussed on improving the number of discharges, this may mean recognising the need to discharge patients earlier in the day and looking at ways to do this.