East Surrey 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 assessed a total of 5 quality statements from this key question. We have combined the scores for these areas with scores based on the rating from the last inspection, which was outstanding. Our rating for this key question changed to requires improvement.
The service had a vision for what it wanted to achieve and a strategy to turn it into action. The vision and strategy were focused on sustainability of services and aligned to local plans within the wider health economy. However, leaders had not effectively communicated the vision with staff for them to understand and have clarity. Staff did not always feel respected, supported or valued by senior leaders. There were some gaps in leadership skills, knowledge, experience and credibility to lead effectively. Not all leaders were visible. The trust did not have a Freedom to Speak up guardian to foster a culture where people felt they could speak up and that their voice would be heard. Governance and management systems were not effective and although risk, performance and outcome data was collected it was not always used to drive improvement. The service actively contributed to research.
 

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The medicine division operational manager, clinical director and divisional chief nurse worked together to support and manage all aspects of the medical service division. As a triumvirate they were a new team and were working out how to deliver the vision for the division as outlined in the 2024 Clinical Strategy. They recognised that the service was in a state of flux, due to staff changes at matron level and above, and as a team they needed to provide stability, a positive culture and support to the medical service teams to deliver the divisions strategic vision and priorities.
Staff felt leaders both at division and executive level had not communicated their vision and strategy for the medical care service or the wider hospital effectively which made supporting organisational changes difficult and hard to understand. Some staff had concerns that the emphasis of the hospital had shifted from putting patients first to saving money.
Staff could tell us the values of the organisation but felt these were not always being followed by senior managers and the executive team. Staff wanted to provide an excellent service to their patients, however, they felt they were no longer listened to or involved in decision making. This was having a negative effect on staff morale and trust in leadership, resulting in a negative culture in some areas of the medical care division.
Feedback shared by the trust post inspection from the 2024 Staff Survey, which included clinical specialty-level insights, showed a degree of variation, with some teams reporting positive experiences and strong confidence in their leaders, their voice, and their ability to raise concerns. The trust also stated that there was no evidence that the organisation had deprioritised patient care in favour of financial targets.

The trust had published its five-year strategic objectives in September 2023. This set out the goals the trust were aiming to achieve during the lifetime of the strategy, to deliver safe high-quality services which put people first. The strategic objectives had been developed also thinking about the long-term objectives for health and social care and the need to change the way the trust worked in order to future proof services for the local population.
The clinical strategy for 2024 supported the trust’s 5-year strategy and set out the service-level aspirations for the 4 clinical divisions, medicine, cancer diagnostics, surgery and women children. The strategy explained which services sat in which division, the division’s vision and priorities, and how the division would work with the community and system partner collaborations to deliver its strategy.
The medical care services sat in the medicine division. How the division was meeting its vision and priorities was monitored at divisional meetings which fed into the board.
 

Staff spoke well of ward managers and said they demonstrated supportive leadership. Ward managers had a good understanding of the issues, challenges and priorities of their service. However, they did not have the tools easily available to them to monitor performance and outcomes. Ward managers said they were supported by the matrons who were seen on the wards regularly. However, many of the matrons were new in post and were still embedding themselves into their departments.
The medicine division senior management team were new as a team and had recognised they needed to be more visible to staff in the division to establish better communication within the teams and understanding of the services.
Staff were not positive about the trust executive management team, stating there was a lack of visibility, especially on the wards. Staff felt they were no longer one team which was one of the trust’s values.

The service and wider hospital offered management and leadership training. Where new management teams were being formed additional training and coaching was available to enhance skills, knowledge, experience and credibility to lead effectively.

Most staff felt confidence to raise concerns with their line manager without fear of detriment and said concerns would be acted on if possible.
Staff were aware of a freedom to speak up guardian (FTSUG) but did not think freedom to speak up was effective at the trust. They did not see it as a route to drive improvement. It was seen more as a way to raise disputes in the workplace between staff.
Staff that had raised concerns through the FTSU route felt their worries had not been address and it was not an effective way to raise concerns at the trust.
 

The trust had a Policy for Speaking Up (raising concerns). This policy explained how staff could raise concerns and the processes involved. As per NHS guidelines, the trust had a Freedom to Speak Up Guardian (FTSUG) position and used freedom to speak up (FTSU) ambassadors. These were staff members who on top of their normal duties volunteered to raise awareness and signpost people to speaking up routes and promote a positive culture.
However, the Freedom to Speak Up Guardian post had been vacant for 8 months at the time of the inspection. A FTSU ambassador was acting as a conduit between the staff and management, but they did not have the necessary training or registration with the national guardians office to fulfil the FTSUG role.

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.

Staff at ward level told us performance and quality measures were monitored by the matrons and was their responsibility. Any issues or changes in practice needed would be cascaded down to them via the matrons and discussed with them at handovers and ward meetings. However, not all staff understood the meaning of governance and the systems and structures in place at the hospital.

Not all matron’s we spoke with understood their role and accountability regarding governance and risk management due to being new in post.
 

The trust used a divisional governance model to give more responsibility and control to the division themselves. Divisional senior leaders told us this had led to a huge workload which at times had become overwhelming and led to the divisions in the trust becoming siloed and had made knowledge sharing harder. The division had different meetings to cover different areas, such as clinical effectiveness, safety, quality and experience and finance and workforce which fed into the weekly divisional board meeting. These meetings fed into the wider trust’s governance system. Meetings minutes were planned, structured and followed a set agenda.
The medical division held its own risk register. Risks were reviewed at the divisional safety, quality and experience meetings where control measures were agreed.
Performance was measured by the collection of data of various metrics, such as patient satisfaction and experience, clinical quality indicators, operational efficiency and regulatory compliance. However, there was no dashboard for senior staff and ward managers to visually monitor key performance indicators to provide a real-time overview of performance and patient outcomes to quickly identify areas of improvement or potential issues before they escalate. Senior staff told us they had to gather performance information from different systems to produce their reports for the various meetings they attended, which could be time consuming and difficult to collate into a usable format.
Audits were used to monitor quality of patient care against established standards. The medical division used internal and external audits. Clinical audit practices had been standardised across all divisions due to the use of clinical audit facilitators. Audit results were reviewed at the medicine division’s safety, quality and experience meeting and only seen as complete once the findings were presented and an action plan in place. However, follow up against the action plan could not be followed up as the system used to do this lacked the module for this purpose. Therefore, it was unsure if improvements had been made following negative audit findings.
Senior divisional leaders explained all governance processes at the trust, including meeting framework, information systems used and staff understanding, were currently being reviewed as it had been highlighted there were gaps in its current ways of working and there was a lack of integration between the divisions.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Senior staff told us the service and wider trust was on a journey of improvement to deliver its strategy and had significant programmes of work in place to support service recovery post COVID pandemic, this included a focus on quality, safety, length of staff and sustainability. However, most staff at a ward level could not relate changes being made to improvement of services or improved patient care and treatment.

Staff told us about trust initiatives that had been brought in to reduce hospital acquired pressure ulcers and the Let's Get You Home (LGYH) scheme. This was a programme to reduce the number and length of delayed discharges for people residing in hospital. Staff were engaged in these initiatives but were unable to tell us the impact they were having for patients. The trust told us the LGYH scheme included a ward accreditation scheme, a program to improve the quality of care provided on hospital wards. Ward accreditation schemes have been shown to engage staff and empower leaders to improve standards and quality on wards and services. However, when we talked to staff they saw the LGYH scheme as an initiative which focused on ensuring patients had a safe and timely discharge from hospital and not an internal process aimed at improving ward standards and quality of care through a structured framework of assessments and improvements.

There were processes in the medical care service and wider hospital to support learning, improvement and innovation. This included SASH+, an improvement methodology to help promote a culture of continuous improvement in the hospital; an active programme of research with a dedicated research delivery team and departmental divisional mortality and morbidity meetings to learn from deaths. However, staff we spoke with during the inspection did not mention these areas of work at the hospital.