Furness General 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.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good.

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.

We have a shared vision, strategy and culture that is based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding and meeting the needs of people and our communities.

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.

Staff knew and understood the provider’s vision and values and how they were applied in the work of their team. Senior leaders were able to articulate how their role aligned with the trust’s Purpose, Visions, Values and Strategy.

Staff told us the trust senior leadership team were not always effective in their communication regarding strategic changes and gave an example of a recent initiative from the local NHS ambulance trust regarding ambulance handover times. Whilst the divisional leadership, were able to give examples of how they had communicated and engaged with staff, this did not appear to have been fully effective.

Staff had the opportunity to contribute to discussions about the strategy for their service, especially where the service was changing. We were given examples of how staff were given the opportunity to ask questions regarding plans for the future and the trusts overall strategy.

Staff could explain how they were working to deliver high quality care. All staff could articulate the trust values and how they fitted into delivering high levels of patient care.

We have inclusive leaders at all levels who understand the context in which we deliver care, treatment and support and embody the culture and values of their workforce and organisation. They have the skills, knowledge, experience and credibility to lead effectively and do so with integrity, openness and honesty.

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.

Nursing and medical staff across the emergency department understood the key risks to patients within the department. Staff told us the emergency departmental leads and senior managers were approachable, visible, and provided them with good support but not all staff thought that communication was effective.

Staff understood the reporting structures and leaders understood their key roles and responsibilities. Leaders also fully understood the key risks and challenges faced by the emergency department. Leaders were able to demonstrate how they worked as part of a multidisciplinary team within the service and how they collaborated with partners such as the local NHS ambulance trust. They told us they worked well together and there was regular engagement to review performance and identify improvements to services.

Leaders had the appropriate range of skills, knowledge, and experience to carry out their roles. There was a triumvirate leadership structure at departmental and divisional level with medical, nursing, and operational leads.

Leaders had effective support and opportunities to develop and maintain their credibility and skills. All staff had opportunities to develop including for future leadership roles. There was inclusive recruitment and succession planning. The trust had effective recruitment processes and ongoing checks to ensure all staff met the legal requirements to work in the trust.

We create a positive culture where people feel that they can speak up and that their voice will be heard.

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.

The department had a Freedom to Speak Up (FTSU) champion who was known to all staff. Staff were aware of the policy and how to use it. A poster was on display in the staff room to alert staff of FTSU and how they could act on concerns.

Leaders fostered a positive culture where people felt that they could speak up and that their voice would be heard. They were able to describe how staff reported concerns and how these were investigated, then feedback given to staff, via various forums. Leaders described an open-door policy and had an eagerness to want to help and support staff.

The trust FTSU Guardian was an appointed individual who worked independently and had a key role in helping to enable a positive speaking up culture in the organisation. They provided confidential advice and support service to staff in relation to concerns they had about patient safety and/or the way their concern has been managed.

We value diversity in our workforce. We work towards an inclusive and fair culture by improving equality and equity for people who work for us.

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

The service promoted equality and diversity in daily work and provided opportunities for staff to develop. The trust had implemented a divisional triumvirate leaders development programme. The programme had been designed to increase trust, encourage healthy challenge, and drive commitment and accountability within the triumvirate.

Policies and processes were in place to ensure the service was inclusive and fair in the way it operated. Staff received training in equality and diversity and had a good understanding of cultural, social and religious needs of patients and demonstrated these values in their work.

The trust staff inclusion networks encouraged staff to join them if they identified with the group or as an ally. The networks included BAME (Black, Asian, and Minority Ethnic), Carers, Disability, Armed Forces, LGBTQ+ and Women Leaders.

We have clear responsibilities, roles, systems of accountability and good governance to manage and deliver good quality, sustainable care, treatment and support. We act on the best information about risk, performance and outcomes, and we share this securely with others when appropriate.

We scored the service as 3. The evidence showed a good standard. 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 act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

Monthly governance meetings were held to discuss governance, risk, and performance. Risk registers were reviewed during these meetings. The governance and reporting processes enabled leaders to understand the key risks and challenges to the service and to identify improvement actions to address key risks, such as capacity and flow issues. Processes were in place to escalate issues to the hospital leadership team, we saw evidence of effective escalation from the department to senior leaders and then to the executive team. We also noted that information was effectively disseminated from the executive level to the department.

Daily safety huddles and bed management meetings enabled sharing of information and escalation of patient risks and capacity and resource issues. Risks were discussed at safety huddles, board rounds and bed management meetings and staff and leaders were proactively managing and escalating any concerns.

Leaders understood but did not always have resources and space to manage the priorities and issues the service faced. Capacity constraints within the services and across other parts of the hospital impacted on patient flow in the emergency department.

Risks were captured on a divisional risk register and were rated in terms of likelihood and consequence. The trust had risk management processes which meant that risks were escalated appropriately from the emergency department up to board level when required.

Staff and leaders at all levels demonstrated a good understanding of the risks within the emergency department and the action being taken to mitigate or remove risks. We discussed the top risks for the service with the leadership team and reviewed the emergency department risk register. We saw that the main risk was that patients in department were held in the ambulance handover area due to increased volume of attendances, acuity of patients and a lack of inpatient beds which impacted on patient flow.

Trust leaders engaged with improvement programmes and sought external advice. There were business continuity plans for emergencies and natural disasters..

We understand our duty to collaborate and work in partnership, so our services work seamlessly for people. We share information and learning with partners and collaborate for improvement.

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.

Leaders understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement. The leadership team understood how their staff felt about delivering care that met both the physical and mental health needs of patients.

Staff and leaders worked in partnership with key organisations to support care provision, service development and joined-up care, such as the local NHS ambulance trust. Partners we spoke with informed us although communication between services was challenging there were no performance issues, and the teams worked well together.

The trust’s strategy aligned to local plans in the wider health and social care economy, and services were planned to meet the needs of the relevant population.

We focus on continuous learning, innovation and improvement across our organisation and the local system. We encourage creative ways of delivering equality of experience, outcome and quality of life for people. We actively contribute to safe, effective practice and research.

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.

Staff told us they were given the time and support to develop opportunities for improvements and innovation and this led to changes in care delivery. Practice educators worked with staff in the department to develop skills and also to support patient care delivery, freeing up staff. Staff were given the time and support to develop opportunities for improvements and innovation and this led to changes in care delivery. We saw that the department had introduced a minor treatment unit that was designed to stream patients to the most appropriate area which would improve patient flow.

Staff had opportunities to participate in research.

Staff participated in national audits relevant to the service and learned from them.

The Trust collaborated with Lancaster University looking at why people attended the emergency department exploring ways to manage the demand on services more effectively. The study identified ways to reduce unnecessary visits and signpost appropriate patients to same day emergency care.