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

Critical risks regarding capacity and the ED environment had persisted since our last inspection and controls in place were insufficient to mitigate the risks. Although staff felt confident to raise concerns, they did not always feel their concerns were adequately addressed. Local leaders were caring, compassionate and inclusive. However, staff felt there was a disconnect with the wider trust leadership team.

The trust had a vision and plans to achieve it. Staff at all levels were clear about their roles and accountabilities. They had opportunities to meet, discuss and learn from the performance of the service. The service collaborated with relevant stakeholders and agencies to improve patient 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.

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 trust had a group vision to offer ‘Outstanding care, together’. The trust aimed to deliver their vision through local improvement, corporate enablers, and strategic initiatives. Staff we spoke with were not familiar with the trust group vision or strategy. However, they were aware of the urgent and emergency care (UEC) transformation programme.

The trust had developed the UEC transformation programme for 2025/26 with a focus on improving urgent and emergency care with emphasis on reducing avoidable admissions and minimising length of stay in acute settings. Key objectives included enhancing ED performance, reducing the number of patients who remained in the ED for over 24 hours for a mental health bed and reducing delayed discharges. The programme had several workstreams led by key staff members (including medical, nursing and operational staff).

However, the department had been unable to achieve the key objective of minimising the length of stay and enhancing ED performance.

Senior staff informed us they have put forward a business case to revamp the entire facility for the ED. They aimed to make the ED fully functional, relevant, and with appropriate facilities to cater for the volume of patients seen on daily basis.

Leaders understood the context in which they delivered care, treatment and support. Most leaders had the skills, knowledge and experience to perform their roles. However, staff felt there was a disconnect with the wider trust leadership team.

The senior divisional team included a divisional medical director, divisional director of nursing and divisional director of operations. The ED was supported by the clinical director, clinical lead, general manager, service manager, head of nursing and clinical matrons.

Staff were generally positive about local leadership of the unit. They felt the local leaders were visible and accessible for support. However, they felt there was a disconnect with the members of the executive team.

Leaders had not taken effective action to address critical issues around capacity and patient flow which have persisted since our last inspection in 2019. Staff did not feel well supported by the trust to address the risks around capacity in the ED.

The service fostered a positive culture where people felt they could speak up. However, staff did not always feel their concerns would be addressed.

The trust had a freedom to speak up policy which highlighted internal and external options available to staff as well as wellbeing support for staff. The trust had a freedom to speak up guardian with whom staff could raise concerns about any issues.

Most staff we spoke with reported feeling confident to raise concerns to management. However, they did not always feel confident about actions taken to address the issues raised. Staff described experiencing burnout and having low morale due to working in a challenging environment. However, they did not feel the trust proffered effective solutions to address the issues raised.

We reviewed the ED staff survey responses for St Helier Hospital in 2024. Culture and leadership themes overall scores were worse when compared with the trust average. This included questions about whether staff felt secure raising concerns about unsafe clinical practice (64%), and whether the organisation acted on concerns raised by patients/service users (57%).

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.

The service had clear responsibilities, roles, systems of accountability and good governance. However, critical risks regarding capacity and the ED environment had persisted since our last inspection and controls in place were insufficient to mitigate the risks.

The senior team used a register to manage risks. There were 9 risks reported on the ED risk register across two locations. We saw 6 risks were identified as occurring across the trust locations while 3 risks were regarding a sister location. The 6 risks pertained to issues regarding overcrowding in the ED, corridor care, violence and abuse against staff, care of mental health patients, patient safety and quality of care, and environmental ligature hazards. There were controls to mitigate the risks and the risks were regularly reviewed by senior staff.

However, controls put in place to mitigate the risks were not always adequate. For example, one of the risks on the risk register was the risk of caring for adult mental health patients in the ED. Controls included providing training for staff, increased security presence, and pilot of mental health support workers. This was insufficient to address the lack of mental health rooms in the ED. During our inspection, there were up to 3 mental health patients in the ED, but there was 1 mental health room. This meant mental health patients were not always assessed in environments free from ligature hazards. The risk register identified the adequacy of this risk as “inadequate”, and the risk level was rated as “extreme risk”.

Another risk on the risk register was the “risk of compromised patient safety and care quality due to overcrowding and resource constraints in the ED”. Controls included assignment of additional nurses for temporary escalation areas, 2 hourly intentional rounding, completion of falls bed and bed rail assessments, use of pressure air mattress among others. The risk register identified the adequacy of this risk as “inadequate”, and the risk level was rated as “extreme risk”.

Staff identified capacity issues, the ED environment and facilities as some of the top challenges faced in the department. Staff felt the risk regarding capacity was held in the ED instead of being shared across the trust. They felt the risk could be shared with speciality units by creating escalation areas on the wards. They felt the trust had not acted effectively to address the risk.

The service had a clear governance structure with defined roles and responsibilities. Regular governance meetings were held to discuss information about the service including performance, risks, incidents and complaints. Information was shared with staff through daily handover meetings, newsletters and emails. This kept staff up to date with what was happening in the trust, events, and updates on training and policies.

The trust had various steering groups to guide the direction of specific initiatives. This included paediatric mental health, dementia and delirium, and violence reduction steering groups.

The trust had a business continuity management policy for various scenarios. In addition, there were multiple incident response plans including an emergency preparedness, resilience and response plan.

There were effective arrangements for the availability, integrity and confidentiality of data, records and data management systems. Staff could access relevant information about patients’ care and treatment.

The service 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.

Staff and leaders collaborated with relevant external stakeholders and agencies. Staff and leaders worked in partnership with key organisations to support care provision, service development and joined-up care. The trust was part of a hospital group with another local trust, which allowed for joined-up decision making to benefit local people.

Staff informed us they had good working relationships with other services. They liaised with speciality teams, ambulance services, mental health services, other acute hospitals, GP practices, and community teams to care for patients.

Staff and leaders engaged with partners to share learning with each other that resulted in continuous improvements to the service. They worked closely with local mental health trusts to facilitate patient discharges. The service collaborated with psychiatric liaison team to develop policies and train staff.

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 contributed to safe, effective practice and research.

The service conducted several quality improvement initiatives and training. This included introduction of safety flashes for alerts following RCEM audits, incidents, or complaints. The service had also implemented an international medical graduate induction program for international staff. The service had study days addressing different areas of emergency care, for example minor injuries, resuscitation, and trauma.

Staff conducted improvement initiatives on a number of topics including streaming and redirection of adult minor acuity patients; enhancing mental health care and patient experience; improving care for patients with learning disabilities in the ED.

We received mixed feedback regarding the opportunities for learning and development. Medical staff were positive about the opportunities for training and development. However, nursing staff informed us there were limits on the training courses they could access due to limited budgets.