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. Leaders understood and embodied the culture and values of the workforce and the organisation. They had the skills and knowledge, experience and credibility to lead well. They demonstrated their integrity and honesty which was recognised by their staff. There was a clear system of governance and risk management based around delivering safe and good quality care and treatment.

At our last assessment we rated this key question inadequate. At this assessment the rating has improved to good. This meant the service was consistently managed and well-led.

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 trust had a strategy for 2024 to 2029 of `Building Healthier Lives' with 5 key priorities but staff within emergency department were not aware of this and how this linked into their department. There were vision and values which underpinned the strategy.

There was no individual strategy or vision for the department. The site strategy had been consulted on and awaiting sign off at the time of assessment. Once this had been agreed, the specialities were to write their own strategy which linked in with the trust and hospital; this had not been done yet for emergency department. There was an emergency department and site flow action plan and trajectory for 2024/25. We saw actions were updated regularly.

At our previous inspection, we found the culture was poor, there was a lack of mutual respect and staff did not feel valued. During our assessment, nurses and doctors in the emergency department mostly spoke highly of each other and worked well as a team. One member of the medical team told us "The nurses conduct themselves professionally and strive to ensure excellent care despite the challenges." Most staff we spoke to felt respected, supported and valued. They were focused on the needs of the patients receiving care. The service promoted equality and diversity in daily work and provided opportunities for career development. We saw examples of staff who had been developed by the trust from HCA's to nursing associates and they were very happy in their role.

There was a good understanding between staff in different roles and the pressures they each faced; there was a very inclusive culture. We spoke to 71 members of staff and almost all of them spoke highly of the local team. Emergency department nurses and doctors worked well together. However, this was not the case for all staff, and there were some who felt culture was not always as good as it should be, and we fed back these specific views to the trust.

Leaders had the skills, knowledge, experience and credibility to lead effectively. They were visible and approachable in the service for patients and staff.

The leaders had the skills and abilities to run the service. The senior leadership team was led by a team of managers consisting of the matron, clinical service lead, emergency department general manager and emergency department operations managers. They were all experienced leaders with strong decision-making abilities. Managers had completed leadership training. They were supported by the management team at the hospital level. The emergency department team had good levels of operational knowledge to lead the department in pressurised circumstances. The senior leadership team met weekly. They had a set agenda and discussed quality in the department and created action plans for improvements; they had a united approach.

Leaders were supportive of their staff and caring about the service. There was a team of band 7 nurses who managed and ran the department alongside the matron. Most staff told us they were approachable, always listened and gave regular feedback. The managers were visible in the department and the staff respected the matron as they worked clinically in the department weekly. One member of staff told us the leadership team really cared and had "done wonders" for the department. We saw a dedicated and professional team across all grades. They all had respect for each other, and their roles and were proud of their team.

It was clear from most of the staff we spoke with that leaders were supportive of their staff and passionate about their service. They were aware of the pressures within the emergency department and supported the staff who worked hard to achieve good care. The medical team were supported by consultants and advanced care practitioner leads who had different roles within the emergency department. The medical team and nursing team worked well together and spoke highly of each other's abilities and support. However, we were told there were some staff who felt less valued at times, and we fed back their specific concerns to the leadership.

Children's emergency department was led by a paediatric matron and emergency consultant lead. They worked well together to support the staff and ensure safety in the department.

Staff development was encouraged. Nurses told us they were encouraged to apply for more senior roles within the department. However, advanced care practitioners told us there was little development within their role.

The service fostered a positive culture where most people felt they could speak up and their voice would be heard. Staff and leaders acted with openness, honesty, and transparency. Staff were encouraged to raise concerns with their managers. Although a few members of staff told us they did not feel they could speak up and felt concerns were not acted upon. Where staff did not feel they could do this, there were ways they could anonymously raise concerns. There was also an encrypted social media group where staff could have discussions.

There was a whistleblowing policy. Most staff we spoke to were overwhelmingly positive about the support and leadership of the service. They told us the service had an open culture where patients, their families and staff could raise concerns without fear. However, a few staff members told us while the culture had improved, there were still some challenges, and they did not always ensure staff felt supported or could speak up.

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. Staff used these to manage and deliver good quality care, treatment and support. Staff acted on the information about risk, performance and outcomes, and shared this securely with others when appropriate.

At our previous inspection we found leaders did not always operate effective governance processes. On this assessment, we found systems had been established to assess, monitor and improve the quality of care within emergency department. Governance processes were mostly effective to ensure the service was safe, concerns were acted on and patients received effective care.

We found improvements had mostly been made in relation to concerns raised at our previous inspection. For example, at our previous inspection, we found there was poor safeguarding training and processes, staff did not have appraisals, the department was understaffed for both nurses and consultants and the mental health assessment room did not meet safety requirements. At this assessment we found the staff nurses vacancies had been fully recruited into, staff had their appraisals and safeguarding training compliance was 93%. However, not all concerns had been fully addressed. There were still not enough consultants to meet the national recommendations for 16 hours. This was on the risk register and the risks were mitigated with long term locum consultant presence. The mental health assessment room had improved.

Staff had time and resources to undertake effective governance and manage risk. Regular audits were completed to assess and monitor the quality of care and results were fed back to staff to make improvements. There was a good range of accurate and timely data and information available to understand performance and quality and improvements were made as needed. Governance was used to learn, improve and innovate. Information held about patients was secure and protected.

Quality and safety of the service was discussed within governance meetings, directorate meetings and care quality monthly assurance meetings. The matron also produced a monthly quality assurance report. In October 2024, it was decided that to broaden the sharing of information, staff would hold a cross-site emergency department clinical governance meeting each quarter with the leadership of the two other emergency departments. There was a fixed agenda, which included incidents, the risk register, complaints, feedback and clinical effectiveness and standards. 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. Managers were able to escalate information up through divisional quality and safety meetings. Good practice was recognised and celebrated.

However, it was not clear that actions were taken from mortality and morbidity meetings. We saw actions were documented but there was no evidence of discussing previous meeting actions and ensuring they had been completed.

There was a system of localised audit and review. The band 7 nurses completed a weekly care quality audit, which was assurance they were providing care within the 5 CQC key questions. Results of this were shared with staff through email, the communications folder and in their closed social media account.

There was a paediatric newsletter. We looked at the latest 3 issues and found key learning points, important reminders about certain assessments, such as a self-harm assessment, bruising in under 1-year-olds, minor burns and the Royal College of Emergency Medicine safety flash updates.

There were strategies and protocols for managing the poor flow within the department. The managers actively discussed the flow and it's challenges daily and were proactive to move patients through the department when possible. We saw action cards for ambulances at risk of breaching 6 hours, protocols for ambulance delays and department full capacity protocols. To support discussions regarding flow between emergency department and acute medicine, the teams had recently started a monthly joint leaders meeting.

There was a departmental risk register which was discussed during the leaders meetings and emergency department clinical governance meetings. It was reviewed monthly. There were 9 risks on the register and 4 were high risks on the register which included:

• Emergency access delays due to demand, acuity and hospital flow.
• Increased ambulance offload times resulting in risk to patients in the community and on trust site.
• Failure to identify bed support for mental health patients in emergency department resulting in suboptimal care.
• Multiple information and communication technology and registration systems impacting on ED safe management of patient care and flow.

The paediatric risk register contained 7 risks with 2 high risks including:

• Lack of educator/sepsis training for paediatric emergency department could lead to failure to recognise deteriorating patients.
• Non-compliance with paediatric emergency department 'did not wait' process leads to patients not appropriately managed.

There were actions for both risk registers to reduce the risks. However, actions were due end of January 2025 for the paediatric risk register and these had not been updated with their progress.

The staff understood their duty to collaborate and work in partnership, so services worked seamlessly for people. Staff shared information and learning with partners and collaborated for improvement. Information was shared across the trust through different meetings such as safeguarding, quality assurance and governance to ensure learning. Managers had a directorate meeting monthly with other hospitals in the trust and they presented key information at this meeting.

The service worked closely with the local NHS ambulance trust and staff to ensure joined-up care. Managers met with the local ambulance trust managers with an aim to improve working relationships and review any incidents that had been raised.

The managers met with the local GP leads and local hospital project lead to discuss site priorities and how they can support.

There was a weekly operational meeting with the integrated care board and their local urgent treatment centre (UTC) provider. This led to the UTC temporarily moving on site and subsequent expansion in acceptance criteria as well as a planned trail to change the referral process.

The service focused on continuous learning and improvement across the organisation. Staff actively contributed to safe and effective practice. We found the managers and staff had made many improvements within the department to improve safety and the care for patients since our last inspection. They recognised risks and tried to mitigate them, they learned from incidents, complaints and they worked hard in a crowded, high-pressured environment to provide safe and effective care.

However, long waiting times in the emergency department had been an issue for a long time without much resolution. This was a national system-wide issue and a significant concern across most emergency departments. We saw the service worked to try and create solutions such as opening new areas for trolleys, rapid assessment with the development of a second rapid assessment cubicle underway and plans to adapt the waiting area but the department was still overwhelmed daily with high volumes of patients and a lack of flow into the hospital.