William Harvey 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

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 previous inspection we rated this key question as requires improvement. At this assessment, the key question has been rated as good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

We assessed all quality statements.

The service was well-led with inclusive leadership, and good governance structures. Staff felt supported and able to speak up, and equality and diversity were actively promoted through training and staff networks.

Leaders understood key risks and worked collaboratively with partners to improve care, despite capacity challenges. Regular safety meetings and risk management processes ensured oversight. Innovation and continuous learning were encouraged with examples of partnership-driven improvements. However, the vision and strategy were not fully embedded. The leaders were aware of the issues faced by demand and flow and had been working across the trust to manage teams and services and try to improve the flow through the UEC department. Despite the improvements patient flow through the department was still a challenge and temporary escalation areas were still being used by patients, often overnight.

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 evidence showed some shortfalls. The service did not have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. However, staff and leaders showed a good understanding of challenges and the needs of people and their communities.

The UEC business plan for 2026/27 was currently in draft, as it was still being developed. We were told it would form part of the wider site business plan that will be approved through the board in March 2026 to go live from April 2026.

We saw a copy of the draft strategy deliverables/priorities document which had 4 main objectives: patients, quality and safety, people, and sustainability.

The UEC care group provided examples of how improvement programmes in the service contributed and linked into the overall trust strategy. For example, the utilisation of the urgent treatment centre.

There was a trust wide strategy and vision. We saw the trust’s vision and values on display around the hospital, visible to staff and visitors. However, not all staff we spoke with were not aware of the trust values.

Senior leaders had not successfully communicated the provider’s vision and values to the frontline staff in this service.

There had been a recent redesign of acute medicine service at the hospital. The main focus was to address current system pressures, reduce inefficiencies, and improve the experience for both patients and staff. The SDEC Amber pathway was central to this transformation, developed in alignment with key principles that support a more efficient, patient-centred model of care.

Another focus was admission avoidance, achieved by building upon existing pathways to enable patients to be managed in alternative settings rather than within UEC. This included the use of advice, guidance and community redirection through initiatives such as the virtual ward, community response teams and frailty services.

Staff reported the team worked effectively together, with staff across all areas respecting each other and working together to provide the best possible care and treatment to patients. We observed positive and caring interactions between staff and their patients and their relatives who used the service. We also noted good collaboration and communication between ED staff of all grades and disciplines.

The assessment team were welcomed into the unit by all staff members. Staff were willing to talk to us and be open about what the service was like. This showed a work force who welcomed review.

We saw a process for escalating any concerns over performance issues and staff felt able to challenge each other and take ownership of the department. We saw there was a ‘no blame’ attitude to incident reporting and in response to incidents. Senior staff understood the importance of staff being able to raise concerns without fear of retribution and we saw this was embedded across the unit.

The service celebrated staff and team success and supported good practice through meetings, newsletters and team aways days.

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.

We found the ED team had good levels of operational knowledge to lead the department in pressurised circumstances. There had been some changes in the leadership team which had caused some previous instability within the department. The service now had inclusive leaders who understood the context in which they delivered care and treatment. The senior leadership team felt the executive team understood and supported their vision for service; however, they acknowledged that there had been barriers to understanding and acting on risks.

Some staff told us they would not recognise the trust CEO and said that they could not remember seeing them in the department. They did not always know how the leadership team made decisions and did not always feel involved in departmental changes. However, staff described direct line managers, matrons and local leaders as visible and approachable across the department.

The department had direct and regular access to the trust board through a series of meetings and could routinely monitor information about quality, including safety and take necessary action to improve quality.

In the event of an incident, debriefing was facilitated by trauma and risk management (TRiM) trained practitioners from both medical and nursing backgrounds with individual support and counselling services available. The TRiM practitioners were trained to deliver psychologically informed responses to traumatic events.

Leaders were supportive of their staff and caring about the service. Leaders were aware of how the ED environment and pressures in the workplace affected the welfare of their staff. The trust had focused on staff wellbeing and recruitment and retention resulting in a reduction in nursing vacancies from 19.8% in April 2025 to 7.3% in February 2026. Medical vacancies had also improved from 21.8% in April 2025 to 2.8% in February 2026.

The department does not currently operate a formalised four-monthly wellbeing survey specifically for resident doctors within the department. Resident doctor wellbeing was monitored and supported through several structured and embedded processes within the department and trust. For example, educational supervisor meetings. Supervisors provided both pastoral and professional support, and escalated concerns that resident doctors may have.

All staff had access to onsite counselling sessions. Staff could attend walk in joint sessions or book in for 1-1 sessions.

Staff were offered a ‘return to work’ meeting following any period of absence. We were told wellbeing was discussed and if any additional support was needed. For example, referral to occupational health or other well-being services.

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.

Staff told us they felt able to speak with leaders about difficult issues and when things went wrong. Staff told us when practice needed to be improved there was a no blame culture and they were supported to learn and develop within their roles. Staff we spoke with knew how to contact the freedom to speak up guardian and understood their role. We were given examples where staff had resolved issues by approaching managers and felt safe and supported to do so.

There had been 9 referrals to the guardian service in past 10 months. Themes included behaviour and relationships, management issues, bullying and harassment and systems and process.

Workload and working hours were monitored through rota oversight and exception reporting with input from the trusts Guardian of Safe Working. Emerging themes were reviewed at departmental and governance meetings.

Patients and carers were involved in decision-making about changes to the service. We saw posters detailing ‘you said…we did’ explaining how patient feedback was used to make changes within the department. For example, more plug sockets being available in the escalation areas for patient use (to charge mobile phones).

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 department worked with system partners and service user groups to better understand the needs of service users from diverse groups and to co-produce improvement.

There were equality and diversity champions within the service. The campions facilitated discussions within the UEC. These included respect, micro-behaviours, and allyship, helping to respond to issues that can affect belonging and psychological safety. They also held workshops to raise awareness of the Trust’s Sexual Safety Charter.

The provider undertakes equality monitoring of staff within the service to ensure it is diverse in its make-up and representative of the patient group. Internationally recruited staff members held nearly half of the leadership roles.

Staff had diversity awareness training with a compliance rate of 95% across the service and staff had a good understanding of the cultural, social and religious needs of patients and demonstrated these values in their work.

The results of the 2025 NHS Staff Survey were generally close to the national average for staff from all other ethnic groups at the trust. For indicator 5 the percentage of staff experiencing harassment, bullying or abuse from patients or service users, their relatives, or the public in the last 12 months EKUFT scored in line with the national average of 28.89%. However, for indicator 8 the data showed that white members of staff had experienced discrimination from colleagues 8.16% compared to 14.9% of staff who reported this discrimination from ethnic groups.

The evidence showed some shortfalls. The service did not always have clear responsibilities, roles, systems of accountability, or good governance. They did not always act on the best information about risk, performance, and outcomes.

The leaders were aware of the issues faced by demand and flow and had been working across the trust to manage teams and services and try to improve the flow through the UEC department. Despite the improvements, patient flow through the department was still a challenge and temporary escalation areas were still being used by patients, often overnight.

Leaders spoke of an evolving department that encouraged new initiatives and ways of working through quality improvement and audits. 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. Despite acknowledging that delays were often due to specialities response time after a decision to admit, there were still challenges from some specialties to prioritise the UEC department. For example, the same patient awaiting specialty review had been in UEC department for 3 days. This was mentioned at the bed meeting on both days, but no solution was found. We also saw that there were 2 patients with pressure ulcers in the temporary escalation corridors that remained there on both days of assessment and being highlighted at the bed meetings.

Staff concerns matched those on the trust risk register. The department had a risk register specific to the UEC but also contributed to the trust wide risk register. The top 4 trust wide risks were identified as: misalignment between demand and capacity across the trust’s urgent and emergency care pathway, risk that patients attending with mental health needs who present at the department will be there for long periods, the risk that patients who stay in the department for over 24 hours may not receive appropriate assessment and review, and the risk to patient safety, privacy and dignity and experience due to overcrowding and delivery of care in non-care spaces in the department.

The care group completed a monthly quality report which detailed performance against safety metrics. This was shared at care group governance meetings and at the monthly care group quality governance forum.

A new integrated system of checking resuscitation trollies had been implemented in the department. The system provided managerial oversight of missed checks and identification of critical missing items. This formed part of a service improvement initiative to strengthen governance, oversight, and assurance of resuscitation equipment checks.

The resuscitation service team reviewed the dashboard daily to confirm that checks had been completed.

We also saw a clear escalation plan if capacity was impacting patient care. On day 1 of our assessment the service was in OPEL 4 status. OPEL 4 (Operational Pressures Escalation Level 4) is the highest level of alert in the NHS, signifying a hospital or health system is experiencing severe pressure, unable to deliver comprehensive care, and patient safety is at risk. It indicates high demand, bed shortages, and potential for emergency care delays. This was reviewed 3 times a day during site meetings. On the second day of assessment the decision was made to announce a critical incident due to the demand on the service. There was a clear SOP for this action including arranging additional support from neighbouring hospitals and communication with all system partners.

There was a clear framework of what must be discussed at a ward, team or directorate level in team meetings to ensure that essential information, such as learning from incidents and complaints, was shared and discussed.

Information governance systems included confidentiality of patient records.

We found the trust board and leaders very responsive. They took the feedback from the inspection seriously and put in immediate actions to rectify safety issues that we found.

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.

Directorate leaders engaged with external stakeholders such as commissioners and partner organisations. We saw good collaboration of several services to run the urgent treatment centre. The governance around this unit was clear and accountability was set out so all parties knew what they were responsible for.

The service participated in the Sit-and-Wait Service which commenced in 2025. The service ensured the safety, care, and timely processing of individuals detained under Section 136 of the Mental Health Act. Section 136 of the Mental Health Act 1983 allows police in England and Wales to detain a person in a public place who appears to have a mental disorder and needs immediate care, taking them to a "place of safety" for assessment. This detention can last up to 24 hours, with a possible 12-hour extension.

Under this arrangement, the hospital provided a safe environment, clinical oversight, initial physical health assessment, and support such as comfort breaks and nicotine replacement. The external service team provided a three-member team to safely manage the sit-and-wait process. This collaborative approach ensured patients detained under Section 136 received a coordinated, timely, and safe care within the ED, in line with legal and regulatory requirements.

Patients and staff could meet with members of the provider’s senior leadership team and commissioners to give feedback.

The evidence showed a good standard. The service focused on continuous learning, innovation and improvement across the organisation and local system.

Despite the pressure on the department, we saw several examples of quality improvement projects and staff felt able to suggest new projects. Staff were given the time and support to develop opportunities for improvements and innovation and this led to changes in care delivery.

Leaders encouraged staff to contribute ideas for improvement and innovation, fostering a culture of continuous learning and service development. Staff were supported in identifying areas for enhancement, and the service actively pursued technological advancements to improve patient care and operational efficiency. Examples included a recent study was conducted in the department which included all staff groups titled ‘Evaluation of moral injury related to Emergency department overcrowding and corridor care’. It showed a strong commitment from staff to protect patients and staff against the impact of corridor care in escalation areas.

Another initiative aimed to streamline ED assessment and management of acute spinal presentations, particularly suspected Cauda Equina Syndrome (CES), CES is a rare, surgical emergency caused by severe compression of nerve roots at the base of the spine, often from a herniated disc, tumour, or injury. The Rapid Access Spine Pathway (RASP) project this aimed to improve efficiency and outcomes in acute spinal pathology by optimising patient flow, safety, and reducing pressure on tertiary neurosurgical services.

The department had also worked hard to address the gaps in workforce and staffing standards. This incorporated a nursing education programme mapped against Royal College of Nursing (RCN) competencies. The project had been a great success reducing staff turnover, supporting international recruitment and local recruitment. Staff we spoke with were passionate about the project leads and felt well supported and educated.