Queens 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

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.

This was the first inspection for this service. This key question has been rated good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

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 that leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred and sustainable, and to reduce inequalities.

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.

Staff told us that they worked well with teams at Royal Derby Hospital and the community hospitals within the trust. They had worked hard to build strong links and often collaborated to ensure services ran smoothly. There was a clear shared vision, strategy and culture which appeared to be embedded within most areas.

Staff were engaged and passionate about the service that they provided, with a clear focus on the patient and delivering safe care. They worked in line with the organisation’s 3 values of compassion, openness and excellence.

We observed positive working relationships, and staff confirmed that they enjoyed their work. This was reflected with a low turnover of staff.

Staff in most areas told us that morale was good, however, this was not consistent throughout all areas with a small number of staff reporting that within their teams morale was the lowest they had ever seen it. Despite this, most staff we spoke with said they enjoyed their roles.

Not all leaders understood the context in which the service delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation.

Not all staff felt well supported by leaders within the service. Some staff told us they did not feel managers were available or approachable when they needed support. They also reported concerns about staffing levels, explaining that they did not believe the service had enough appropriately skilled staff and felt that leaders did not always acknowledge or act on these issues.

In some areas of the department, staff described a lack of visible leadership. Due to management absences, some teams were unsure who was responsible for overseeing some areas on a day to day basis and we observed this on the day of our inspection. We requested to speak to the person in charge of one area and staff were unable to tell us who this was. Staff said this made it difficult to escalate concerns or seek timely support. Staff in these areas reported that they felt leaders lacked compassion during difficult times.

However, in most areas there were clear management structures and staff felt supported. Most leaders were visible, approachable and supportive and most had an open-door policy to allow staff to seek support and raise concerns when needed.

Staff were supported to develop and there were opportunities for progression, and we spoke to staff who had progressed through the service. There were regular learning events in the within imaging departments which provided valuable insights into other areas where staff may end up working across the hospital.

Leaders had the skills, knowledge and experience to perform their roles. Managers knew their services well including performance, quality and safety and were competent to undertake their roles.

People did not always feel they could speak up and that their voice would be heard.

The trust had policies and procedures in place to support staff to speak up formally and staff were able to raise concerns either in person or anonymously. There was a freedom to speak up guardian; and champions throughout the trust who were accessible to staff. Staff told us that they were aware of the freedom to speak up process, and we saw information and contacts displayed for staff who wished to raise concerns.

Data reviewed as part of this inspection showed that in the 12 months prior to the investigation 4 concerns from staff working across diagnostic imaging had been raised through the freedom to speak up with the main theme being inappropriate attitudes and behaviours from other staff members.

Most staff told us that they felt confident that they could approach their direct leaders to raise concerns. However, data from the annual staff survey indicated that only 59% of staff felt safe to speak up and only 45% felt confident that these concerns would be addressed.

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

There were equality and diversity champions within diagnostic imaging, and equality networks within the trust such as EMBRACE (Ethnic Minorites Broadening Racial Awareness and Cultural Exchange) Colleague Network, ThisAbility and Long-Term Conditions Colleague Network, Pride Colleague Network, Gender Equality Colleague Network, Age Positive Colleague Network, Armed Forces Colleague Network and the Carers Colleague Network who helped promote an inclusive working environment. There were policies in place to ensure that the services were inclusive to staff and patients accessing the service. These policies contained action plans to ensure inclusive recruitment, progression and a diverse representative workforce.

Staff were able to request flexible working arrangements to accommodate personal circumstances such as caring responsibilities or health needs, and where possible managers accommodated reasonable adjustments to support staff in carrying out their roles effectively.

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 acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate.

Staff understood their roles and responsibilities and what they were accountable for. Staff in most diagnostic imaging areas that we spoke with had a good awareness of governance processes and knew how and where to escalate their concerns. They told us teams met regularly to discuss incidents, audit results and provide updates. However, there was no evidence provided of staff meetings taking place in the MRI department. This was raised with leaders who confirmed that meetings were going to take place going forward and evidence was provided to support this.

Staff had access to a range of policies, procedures and guidance which were available on the provider’s intranet. Staff understood the arrangements for working with other teams within the hospital.

Several specialist committees were in place. These included the radiation protection group, imaging ionising radiation group, optimization committees and most individual departments regular meetings. Regular clinical governance meetings were also held. As part of the inspection we reviewed the minutes which showed that discussions around learning from incidents and complaints took place and showed clear recorded actions to monitor and improve quality and performance.

The imaging business unit provided monthly governance reports highlighting governance and compliance issues. These reports included a summary of training, safeguarding, medicine management, incident, complaints, learning, patient experience, audits, radiation compliance and quality improvement. These reports highlighted issues and included actions and mitigations taken as a result.

There was a programme of clinical and internal audit to monitor quality, processes, and systems to identify where action should be taken. The audits were reviewed at the relevant committee meetings and reported to the overarching governance committees, such as the radiation protection group and the imaging ionising radiation group.

There was an up to date risk register, and leaders within diagnostic imaging were able to clearly describe the risks relevant to their services. The risk register outlined key risks and the control measures in place to mitigate them. Documentation within the register, along with the governance minutes we reviewed, demonstrated that risks were regularly reviewed and mitigation actions considered

Staff received information governance training as part of the trust’s mandatory training programme and had access to the equipment needed to carry out their roles. The trust had a standard operating procedure to support good practice and compliance with information governance requirements. During our visit, we observed that patient records were stored securely.

The service understood their duty to collaborate and work in partnership, so services work seamlessly for people.

Service leaders engaged with external stakeholders as well as working with areas of the wider trust. Patients and staff could meet with members of the provider’s senior leadership team to give feedback.

The service shared information and learning with partners to collaborate and ensure patients were safe. The trust was part of the East Midlands Imaging Network (EMRAD). This was an imaging sharing system which allows NHS clinicians to access diagnostic images of their patients regardless of where the image was taken. The images could be accessed through the hospital information systems by clinical teams within hospitals for instant management of patient conditions and so that second opinions could be sought.

The service focused on continuous learning, innovation and improvement across the organisation and local system.

Leaders and staff demonstrated a commitment to continuous learning, improvement and innovation. Staff took part in quality improvement projects across the service, and the service actively sought ways to enhance care and respond to individual patient needs.

Staff across departments told us they had access to a range of learning opportunities. They spoke positively about training and the chance to work across different areas of the service. Imaging departments held regular learning events, which staff found valuable for gaining insight into other parts of the hospital where they might work in the future. Within the MRI control room there was a ‘pride improvement’ board where the team could document problems, share learning and identify ‘quick wins’. Staff told us that this board had been a useful tool to drive improvement however due to recent work pressures it was not being used to its full potential.

There was clear oversight of imaging services through the trust‑wide ionising radiation group and radiation protection group. The meeting minutes we reviewed were detailed and demonstrated effective monitoring of imaging‑related risks.