Gloucestershire Royal Hospital

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• 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 service leadership, management and governance assured high-quality, person-centred care, supported learning and innovation and promoted an open, fair culture.

At our last assessment we rated this key question Good. At this assessment the rating has remained 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.

We scored the service as 3. 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 clear and well‑established vision, strategy and culture that were understood and upheld by staff across the medical division. The five‑year strategy (2025–2030) had been developed through engagement with staff and the communities the trust serves, ensuring it reflected local needs and priorities. Staff consistently described the organisation’s ambition to “deliver the best care every day for everyone”, and we found this aligned with the provider’s stated values.

Staff and leaders demonstrated a positive and compassionate culture that promoted learning, improvement and openness. There was a strong focus on embedding improvement initiatives, supporting innovation, and investing in research and sustainability projects to improve care in the longer term. Staff we spoke with said they felt informed about the direction of the service and understood how their roles contributed to delivering high‑quality, person‑centred care. The leadership team stated the culture of the organisation had “come a long way” in the last 18 months and that it was now moving into a good place. They were monitoring the culture of staff using a range of feedback mechanisms.

The service actively sought patient feedback to support ongoing learning, and staff described how this shaped service improvements. People told us staff were respectful, supportive and demonstrated a professional and caring manner.

We scored the service as 3. 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.

Leaders were consistently visible and approachable for both service users and staff. They demonstrated a strong focus on staff wellbeing and promoted a culture of good practice, high-quality care and safe treatment. Leaders carried out regular ward visits and walk‑arounds, enabling them to engage directly with teams, understand day‑to‑day pressures and provide timely support. Staff we spoke with said they felt supported.

Leadership development opportunities were available. There was an internal medicine training programme to support doctors and develop future leaders. The Matrons attended away days for training and learning purposes as well as a leadership development programme and mentoring and coaching. We spoke with staff who had been supported in their career progression within the trust who spoke positively about the support they received.

The trust had improved its overall results in the NHS Staff Survey, where it was recognised as the fifth most improved trust nationally. This improvement reflected the leadership team’s sustained focus on strengthening staff culture and wellbeing. The service had engaged external organisations to support in areas where teams were experiencing challenges, and staff surveys were tailored to specific local issues. This enabled leaders to gather meaningful feedback and take targeted action in response to the learning identified.

There were inclusive and diverse recruitment practices 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. Staff had been supported to develop into leadership roles.

We scored the service as 3. The evidence showed a good standard. The service fostered a positive culture where people felt they could speak up and their voice would be heard.

Staff at all levels of the organisation were available to support people who had a concern. Staff could report any concerns anonymously using an electronic platform that was similar to raising incident reports. This platform was used when staff had any concerns about attitudes or behaviours. Staff felt comfortable to raise concerns and knew that they would be dealt with appropriately.

The service had established Freedom to Speak up arrangements. We were told the division had a strong focus on supporting a safe speaking up culture which was supported by the senior leadership team. The trust had had a Freedom to Speak up week during October 2025. The medicine chief of service held quarterly open drop-in sessions for staff, where they could express any concerns or raise any improvement ideas. We were told staff were encouraged to report concerns to their line managers. Staff we spoke with said they felt safe to report concerns to their line managers.

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.

We scored the service as 2. The evidence showed some shortfalls. The service did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

The service did not always have good governance structures to ensure staff were adhering to IPC standards and there had not been any significant action taken to ensure bathroom facilities were adequate. Emergency equipment governance procedures did not ensure equipment was checked daily.

However, there was a clear framework outlining the information to be discussed at ward, team and directorate meetings, which ensured learning from incidents, complaints and deaths was shared consistently. Each service line held their own weekly meetings and monthly governance meetings. Issues raised at these meetings fed into either the divisional board or quality board.

Morbidity and Mortality meetings were held for each service within the division and fed into the divisional quarterly meeting. These meetings were used to improve patient safety and quality of care through the analysis of adverse events.

Leaders maintained clear oversight of risks, including safeguarding, staffing, medical provision, funding and information governance. Each service line held its own risk register and if these risks were graded above a certain level, these risks were elevated to the divisional and overall risk register for the provider.

Contingency plans were established for business continuity, including managing adverse weather, increased demand, staffing pressures and system disruptions such as fire. The service had emergency plans which were recently enacted. For example, service had recently faced a fire in the Tower block where these plans were utilised to keep people safe. No service users during this incident came to harm, although several staff members were treated for smoke inhalation.

Information governance systems ensured confidentiality, with clear policies for the secure storage and appropriate retention or destruction of records. Information was accessible, accurate and timely, and was used to identify risks and drive continuous improvement through dashboards and regular reporting to senior leaders and the board.

We scored the service as 3. The evidence showed a good standard. 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.

The service worked effectively with a wide range of system partners, including the local community trust, ambulance service, GPs, social care teams and the integrated care board (ICB). Collaborative working with the ICB was evident, with an ICB representative regularly attending trust site meetings to support joined‑up decision‑making. Social care teams also participated in multidisciplinary team meetings on the elderly care wards, helping ensure that care planning was coordinated, information was shared promptly, and all teams were fully briefed on people’s needs and any emerging issues. This partnership approach supported more seamless, integrated care across organisational boundaries. There was a focus at multidisciplinary team meetings for people who were awaiting care packages.

There was a strong culture of sharing good practice and learning across both hospital sites and with external care partners. The trust had identified that safeguarding alerts were not always being shared consistently between different electronic recording systems, and work was underway to ensure this information was transferred reliably across all providers.

We scored the service as 3. The evidence showed a good standard. The service focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

Leaders encouraged staff to speak up with ideas for improvement and innovation and actively invested time to listen and engage. Staff we spoke with said they had been able to raise ideas for improvement with their line managers.

There was a clear and systematic approach to improvement, underpinned by recognised quality‑improvement methodology. We saw several strong examples of innovation, focused on enhancing patient care and supporting safe, timely discharge. This included a silver‑level quality improvement project led by Nursing Practitioners on the elderly care wards, where staff used 4 structured questions to ensure people understood their condition, the expected length of their hospital stay, the actions being taken to support their discharge, and what was required to enable them to leave safely. Staff reported this helped to care for the patient.

We also saw effective discharge‑focused initiatives on the respiratory wards. In these areas, once a clinician identified a patient as medically fit for discharge, the ward team had a 1‑hour window to complete all necessary paperwork, notify the discharge lounge and porters, transfer the patient, and identify appropriate people from outlier wards, Acute Medical Unit or Emergency Department to move into the vacant bed. This process supported efficient hospital flow and helped ensure that beds were available for those who needed them most