St Helier Hospital and Queen Mary's Hospital for Children

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

Leaders had set a clear direction for medical care, and staff understood the priorities for improving safety and care and treatment quality. Leaders were visible, approachable and promoted supportive culture where staff felt able to raise concerns.

There were established governance structures to provide oversight of quality, safety and performance but these were not applied consistently across all wards and departments. There was strong partnership working with community teams and external agencies, supporting coordinated discharge and wider system integration.

The service was committed to learning and improvement, with active quality improvement projects, structured learning from incidents and involvement in national programmes such as the frailty improvement collaborative.

However, governance and performance processes were not applied consistently across all wards. Sustained bed pressures and ineffective flow through the acute medical unit also created operational risks that leaders were still working to address.

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.

Leaders in medical care had set a clear direction for their services, and staff understood the priorities for improving safety, patient flow and care for older people. Staff described a shared focus on managing capacity pressures, supporting safer discharge processes and strengthening frailty‑informed practice. Leaders reinforced these priorities through regular walkarounds, ward discussions and daily operational meetings, which staff said helped maintain visibility and communication.

We observed a culture that encouraged openness. Staff told us they felt able to raise concerns, and they were aware of the Freedom to Speak Up routes within the service. Concerns raised by medical care teams were taken through formal oversight processes, and leaders shared learning from incidents and whistleblowing cases during meetings and clinical updates. Staff said leaders were approachable and responded constructively when issues were escalated.

Local leaders worked on addressing several service challenges. This included work to improve discharge processes, respond to delays in therapy provision, manage higher patient dependency on frailty wards, and strengthen documentation standards. Leaders also monitored ward pressures, staffing gaps and the impact of boarding patients on ward culture and safety. Teams described active work to stabilise staffing, support new starters, and improve confidence in using the electronic patient record.

Leaders were open about ongoing pressures, including bed capacity issues, high numbers of medically fit patients who could not be discharged and the sustained strain on the acute medical unit. Communication from local leaders emphasised teamwork, mutual support and maintaining safe care during challenging periods.

Leaders in medical care were compassionate, inclusive and engaged. They understood the challenges affecting their teams and were working to address them.

Medical care was led by a clear leadership structure that included a divisional triumvirate of Divisional Medical Director, Divisional Director of Nursing, and Divisional Director of Operations. Each ward and clinical area had a matron or ward manager, supported by senior sisters/charge nurses and medical leads. Staff understood who their leaders were and how to escalate concerns within this structure. Leaders were visible in clinical areas and attended bed meetings, safety huddles, and ward walk‑arounds, which helped maintain direct contact with teams and patients. However, some staff on the acute medical unit and elderly care wards said they saw limited presence from non‑clinical managers and felt their concerns, particularly about therapy provision and discharge delays, were not always heard.

Leaders understood the pressures facing medical care, including high patient dependency on frailty wards, delays in therapy input, inconsistent documentation and risk‑assessment practice, and challenges with patient flow through the acute medical unit. Local leaders were actively working on these issues. Examples included monitoring daily risk‑assessment compliance, supporting staff struggling with electronic patient record use, addressing gaps in enhanced care staffing and reviewing how physiotherapy and occupational therapy could be prioritised for patients waiting to be discharged.

Leaders showed compassion and support for staff. Teams described occasions when leaders checked on wellbeing after difficult shifts, addressed concerns raised about behaviour or workload and encouraged staff to speak openly in handovers, safety meetings and escalation discussions. Staff told us leaders promoted respectful communication and supported a culture in which concerns could be raised without fear of negative consequences.

Leaders also took steps to promote inclusion within medical care. Staff understood expectations around respectful behaviour, fairness and openness. Leaders acknowledged feedback around wellbeing, workload and team culture and used this to guide local priorities.

Staff in medical care told us they felt able to raise concerns and understood the routes available to them, including the Freedom to Speak Up (FTSU) Guardian and local escalation processes. Staff said they could approach their ward managers, matrons or divisional leaders with concerns about workload, behaviour or safety, and felt these issues were taken seriously. Leaders encouraged openness during ward walkarounds, handovers and daily operational meetings, which helped reinforce psychological safety.

We heard that staff increasingly raised concerns about delays in patient flow, pressures on frailty wards, inconsistent documentation and staffing gaps. These concerns were escalated through formal divisional processes and into wider organisational oversight groups when required. Staff described recent examples where concerns had been acted on, including issues relating to enhanced care staffing, gaps in electronic record use and environmental risks such as cluttered spaces or missing safety equipment.

The service had processes that supported speaking up. Leaders used safety huddles and incident reviews to encourage staff to share learning and reflect on practice. Staff reported that leaders responded constructively when issues were raised and provided feedback on the outcome of concerns. Staff who had been involved in incidents told us they were supported by senior staff and were encouraged to discuss what had happened during debriefs and handovers.

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.

Whilst there were established governance structures and processes to provide oversight of key risks and pressures, these were not applied consistently across all wards and departments. For example, issues, such as inconsistent documentation, varying levels of compliance with assessments and long lengths of stay, indicated that governance systems were not fully embedded across all wards.

Leaders in medical care had a governance structure that supported oversight of quality, safety, and performance. The group quality governance architecture was clarified in April 2025 and included site‑ and group‑level organograms, which helped define reporting lines and leadership accountability within medical care. Governance meetings such as the patient safety and quality group (PSQG) and Divisional Finance and Performance reviews provided regular forums to monitor risks, incidents and operational pressures.

Risk management processes were in place. Clinical and equipment risks were recorded and reviewed, including the cardiology risk relating to 24/7 consultant cover. Risks were logged on the divisional risk register with clear descriptions of the potential impact, existing controls, and actions required to reduce the level of harm. Controls included staff awareness, daily safety huddles, environmental checks and escalation to senior teams where issues persisted. Risks were reviewed regularly, with updates recorded on mitigation progress, target ratings and review dates.

Safety alerts, such as the national patient safety alert regarding medical beds, trolleys, and bed rails, were discussed at governance meetings and resulted in actions to procure appropriate equipment and update policy. Leaders monitored incident themes, including gaps in pressure‑ulcer documentation and the significant drop in falls risk‑assessment compliance, and took actions to address these issues.

Performance and flow were overseen through daily and fortnightly structures. Leaders reviewed daily lists of medically fit patients or those with no criteria to reside, and daily transfer‑of‑care huddles included external partners. A fortnightly complex discharge panel reviewed all patients with a length of stay greater than 35 days. Metrics on stranded and super‑stranded patients, non‑elective length of stay and discharge delays were routinely monitored. Workforce KPIs, including vacancy, turnover and sickness absence, were included in formal reports.

Medical care had strong relationships with external partners, which supported coordinated care and safe discharge. Daily transfer‑of‑care huddles included social care and community teams, and leaders worked with external agencies during the fortnightly complex discharge panel to resolve delays for patients with long lengths of stay. These arrangements helped maintain oversight of barriers to discharge and ensured shared responsibility for progressing care.

The service worked with community partners to support continuity of care after discharge. Following learning from a pressure‑ulcer incident, a skin‑damage leaflet was distributed to nursing homes and external nursing staff were invited to training, demonstrating a collaborative approach to improving safety across the health and care system.

Partnership working was also embedded in strategic models. The integrated neighbourhood model associated involved community teams in supporting patients with frailty shortly after discharge. This included linking people to proactive care teams and supporting early intervention to reduce readmission risk.

Leaders demonstrated openness to partnership working with other NHS providers. Plans to collaborate with South-West London partners on a peer review of respiratory services showed willingness to benchmark practice and learn from others. Medical care teams also contributed to public health initiatives, including updates on blood‑borne virus (BBV) opt‑out testing across both sites.

These partnerships supported more coordinated and person‑centred care for patients moving between hospital and the community. The level of engagement and collaboration indicated that medical care worked effectively with system partners.

There was evidence of active learning and improvement work, supported by structured processes and staff involvement.

The service had systems that supported learning and improvement, although the consistency of improvement varied across the medical wards. Quality improvement projects (QIPs) were active across the division, and a formal list of projects was maintained, including antimicrobial stewardship work and a project to increase early and safe mobilisation in the acute medical unit to reduce deconditioning and length of stay.

Learning from incidents contributed to service improvement. Pressure‑ulcer learning identified that documentation on admission and discharge required strengthening, leading to actions such as improving photography at admission and ensuring care plans were documented clearly on discharge letters. A PSIR (Patient Safety Incident Response) incident panel resulted in a skin‑damage leaflet being shared with nursing homes and external staff being invited to training, demonstrating learning that extended beyond the hospital.

Staff were also involved in initiating improvement. A sepsis assessment project in the acute medical unit responded to data showing that 41% of nurses would not have assessed for sepsis when clinical indicators were present. This reflected a culture where staff concerns informed improvement work and helped to shape safer processes.

The service adopted innovative approaches. The HomeFirst model integrated virtual wards, frailty beds, urgent community response and discharge‑to‑assess functions, offering an acute‑level care option at home and supporting earlier discharge.

Leaders sought external learning to guide improvement. Plans were in development to arrange a peer review of respiratory services across South-West London, demonstrating an openness to benchmarking and external scrutiny. Participation in the National Frailty Improvement Collaborative provided a national framework with measurable goals for improving flow and outcomes for people living with frailty.