Good Hope 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 rated well-led as good which was an improvement from inadequate at the previous inspection. We reviewed 6 quality statements during this assessment.

There was a shared vision, strategy and culture which was based on transparency and equity and where staff felt they could speak up. Leaders were mostly inclusive and embodied the culture and values of the organisation. Staff worked collaboratively with partners. Staff actively contributed to the safe, effective and research within the service.

However, governance processes were still not always effective in driving improvements and recording risk.

This service scored 68 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, understanding challenges, and the needs of people and their communities.

Staff were generally aware of the trust’s strategic aim to always put the needs and care of people first and to “build healthier lives”. There were vision and values which underpinned the strategy and staff training included the trust strategy.

The service did not have their own strategy or vision at the time of our assessment. However, staff told us about a hospital strategy which was being completed which would provide a clear direction for staff.

Staff and leaders demonstrated a positive, compassionate, listening culture that promoted trust and understanding between them and patients. Most staff told us the culture had improved since our previous inspections, and they now felt they were valued and respected. Staff told us they believed their concerns and views were listened to and most staff felt they could raise their concerns freely without any fear of reprisal.

Unlike during our previous inspections, most staff told us when they escalated concerns around staffing, this was taken seriously, and action was taken. Staff no longer felt they were “left to get on with it” and no longer feared for their professional registrations. Staff were noticeably more positive when we spoke with them and when we observed the care and treatment being delivered within the wards and departments. However, there were still pockets of dissatisfaction and low morale which staff told us had continued since our previous inspections despite escalating this to senior leaders.

Staff at all levels had a well-developed understanding of equality, diversity and human rights and they prioritised safe, high quality and compassionate care. There were no concerns raised within the service about any types of bullying, harassment, or discriminative behaviours. We asked for a copy of a recent staff survey, but the information provided related to the NHS Staff Survey from 2023 as the results for the 2024 survey were not available at the time of our request.

Nevertheless, the 2023 results identified most areas except wards providing specialist endocrinology and diabetes care reported they had not experienced any discrimination from their colleagues or managers. It was noted there were some areas within the medical service which had a low response rate, therefore the responses could not be used information.

Staff told us the response rate for the 2024 staff survey was much higher and therefore the results would be more representative across all medical areas. The 2023 staff survey identified many areas where the service was performing above the trust average which included staff feeling confident the organisation would address concerns about unsafe clinical practice and feeling trusted to their job.

However, there were some areas which were highlighted as a concern. This included the not insignificant number of staff who reported feeling worn out at the end of their shift. Also, the number of staff who had experienced physical violence from patients, their relatives or other members of the public. Furthermore, staff had been the target of unwanted attention of a sexual nature from patients, their relatives or members of the public. Although this selected set of results included the emergency department responses, these areas of concerns were representative of the whole service.

The service mostly 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.

Most leaders had the experience, capacity, capability and integrity to ensure the organisational vision could be delivered and risks were managed well. Staff told us the leadership of the hospital had improved since the restructure within the trust. This had seen each hospital establish an executive team and a service leadership team. They had direct oversight of the services being provided at this hospital rather than multiple locations. All staff we spoke with told us of the benefits in this structure and the improvements they had seen to the running of the service. However, some staff raised concerns about leaders in some departments making decisions without any clinician involvement.

Most leaders at every level were visible and led by example, modelling inclusive behaviours. Staff told us most leaders including the hospital executive team were visible and supportive, and demonstrated behaviours which they looked up to. However, there were some staff who were experiencing difficulties with some of their immediate managers and the behaviours they were exhibiting.

Leaders were alert to examples of poor culture that had the potential to impact the quality of care and detrimental to staff and tried to address this quickly. Most staff told us any concerns raised to their managers and leaders was managed appropriately and swiftly. However, there were some examples shared by some staff of how the culture locally had at times negatively affected the quality of care provided to people. Despite escalating this, this was still an area of concern for them.

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

Staff and leaders mostly acted with openness, honesty and transparency. Most staff we spoke with told us their leaders acted in ways which they believed was honest and transparent and this empowered them to behave in the same way.

Staff were encouraged to raise their concerns and those who did, were supported and did so without fear of detriment. The culture within the medical services when it came to speaking up had improved since our previous inspection. Most staff told us they had no concerns about speaking up regarding any patient or staff safety issues and no longer felt there would be any detriment to them if they raised their concerns. However, there were still some staff within the service who were still reluctant to raise their concerns whether this was directly to their leadership team or with the Freedom to Speak Up service.

When something went wrong, patients received a sincere and timely apology and were informed of any actions being taken to prevent the same happening again. Staff were generally open and honest with patients in their care and gave them and their families an apology and a full explanation if things went wrong.

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 still had areas where governance systems were not as effective in driving improvement and recording risk. However, the service had improved responsibilities, roles, systems of accountability from the previous inspections.

Leaders told us the implementation of the new hospital structure had helped to shape the governance processes which the service used to maintain oversight of the quality of the care and treatment being provided. Staff told us about the structure of meetings held to support the governance processes. Meetings had a standardised agenda which ensured a consistent approach. We requested information in relation to the governance meetings to review the information which was shared during these meetings. Most of the minutes provided identified thorough review of pertinent governance and performance.

Not all meetings followed a standardised agenda but did cover all important topics. Most had clear actions identified within the minutes and areas which required further escalation. In addition to regular governance meetings, the service provided quality and safety newsletters which included key lessons learnt, updates about safety issues including any safety alerts which were received and updates for any policies and procedures.

Most staff told us there were regular ward meetings as well as daily staff huddles where important information and learning was shared. Staff from some areas told us the ward meetings were not as regular as other wards due to absences of senior leaders from their wards. However, other managers had tried to ensure staff were not disadvantaged as a result of this and tried to ensure important messages were passed on. We reviewed a selection of minutes from ward meetings and found these contained details around learning and important notices related to the ward. However, there appeared to be no consistent approach to these meetings. In some areas, key information was shared among staff in the form of a newsletter and not a more formal route.

Staff used a system to manage current and future performance and risks to the quality of the service and took a proportionate approach to managing risk. Staff from each specialty maintained their own risk registers. These mostly reflected the risks which staff discussed with us during our assessment. Staff from all areas told us their biggest risk was patients being moved under the ‘Push’ process. However, this was not reflected within any risk registers. This was a similar finding to our previous inspection where risk registers did not reflect staff concerns.

The trust had completed a trust-wide risk assessment for the implementation of the Push process which was introduced to reduce the pressures and risk within the emergency department. However, staff provided many examples where there had been significant risks associated with this process which was individual to their areas. Staff told us they continued to raise their concerns about this process with the leadership team.

Therefore, there was limited assurance around the processes to drive improvements in the performance against dashboard metrics, which ultimately improved the patient outcome and experience.

The service used a clinical dashboard to monitor real time performance and used this data to recognise where improvements should be made without delay. Within this dashboard was information on ward performance for a range of metrics which included completion of falls risk assessments, administration of antimicrobials, administration of enoxaparin, administration of background insulin and administration of non-antimicrobials. During our previous inspections, the dashboard data showed many wards were rated red for the metrics and we were not assured there were processes to drive improvements.

Information provided at this assessment showed there continued to be a large proportion of red ratings for care and treatment performance across many metrics including missed antimicrobials, missed non-antimicrobials, blood glucose on admission and malnutrition assessments. Other metrics reviewed showed some improvements made. However, the performance was inconsistent. For example, performance around missed enoxaparin both therapeutic and prophylactic administration.

Governance meeting minutes did not always indicate where challenge had been made around the performance against the dashboard.

Staff understood their role and responsibilities. Managers were accountable for their actions, behaviours and performance of staff. There were clear and effective governance, management and accountability arrangements. Staff and leaders told us they had worked hard to update and improve their governance processes since our previous inspections.

Staff submitted data and notifications consistently to external organisations as required. This included but was not limited to national audit information, surgical site infection data, numbers of alert organism infections and notifications of Deprivation of Liberty Safeguard applications.

Staff used most audit information beyond the dashboard data to effectively to monitor and improve quality of care. The service had an effective audit programme which included both national and local audits, the results of which were used to make improvements to patient care. Staff also used incidents, complaints, and information from mortality and morbidity meetings to improve patient care. Staff shared examples of where they had used this information to make local improvements. Information in relation to the top 5 themes from incidents raised showed there were processes to monitor the concerns and develop learning which was shared across the specialty.

The service understood its duty to collaborate and work in partnership, so services worked seamlessly for people. Staff shared information and learning with partners.

Staff and leaders were open and transparent, and they collaborated with all relevant external stakeholders and agencies. Following the last inspection, the leaders from the medical service worked together with the key stakeholders to ensure the improvements required were completed.

Staff and leaders worked with key partners and organisations to support provision, service development and joined up care. Information provided after the assessment identified therapy leads met regularly with local care homes and the Integrated Care Boards (ICBs). This covered the localities where the hospital operated to develop further pathways to support early discharge. In addition to this, the service leads were working with 1 of the ICBs to expand the ‘virtual ward’ to the area they covered. A virtual ward allows some patients to receive care and treatment at their own home often with the use of technology.

The service focused on continuous learning, innovation and improvement across the organisation and local system. Staff actively contributed to safe, effective practice and research.

Staff and leaders had a good understanding of how to make improvements happen. Following our previous inspections in 2022 and 2023, the leadership team had worked hard to learn from the areas of concern and enforcement reported on. Staff devised an action plan of all areas which required improvements and through their governance processes monitored the progress of the action plan and improvements made.

Examples of where improvements had been noted was in relation to the management of medical patients who were not admitted to medical wards (outliers). There were clear processes for staff to follow to ensure these patients had the same standard of care regardless of which ward they were admitted on and where any escalations were required. These were completed and staff reviewed patients without delay.

Another area of improvement was in relation to nursing and healthcare assistant staffing. Since our previous inspection, the service had undergone significant recruitment to ensure all areas were now safely staffed to meet the needs of patients.

Staff followed processes to ensure learning happened when things went wrong and from examples of good practice. The service reviewed deaths at regular mortality and morbidity reviews and used any areas of good and poor practice to improve their practice and service they provided patients. There was the opportunity for staff to share relevant learning from incidents and complaints to improve the service they provided.

Leaders encouraged staff to speak up with ideas for improvement and innovation. Staff told us they were encouraged to participate in quality improvement projects which aimed to improve elements of the service being provided. Information shared showed the service had a number of ongoing quality improvement projects with a range of different staff members involved. An example was in relation to the introduction of the electronic system within the same day emergency care and medical assessment unit making the referral system paperless and more effective for patient care. This was also in line with the NHS long term plan aiming for a paperless system.

Staff and leaders engaged with external work including research. The hospital had its own dedicated research team and had a recent investment in the facilities. The service participated in a number of research projects which included a highly recruited study for respiratory medicine.