Blackpool Victoria 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

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to 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 service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

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.

At the last inspection the service was in breach of good governance, at this inspection the service was no longer in breach of this regulation.

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 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.

The service had a shared vision, strategy and culture which had been developed though consultation with staff before its launch in 2022. 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 vision was to provide an outstanding experience for their patients, their families and the people who work for and with them. The trust set out priorities through their vision and mission statement which was to deliver safe, effective and sustainable care for everyone, every day. Their vision was to improve the lives of people who live, work and volunteer on the Fylde Coast and beyond. We spoke with staff who were aware of the trust visions and priorities.

New starters received a comprehensive overview of the trust behaviour framework through their welcome packs and induction process.

Further embedding of values and behaviours occurred within the targeted leadership development programmes where participants engaged in exploring organisational culture, its significance and the individual roles in influencing and shaping it.

Staff reported that the team worked effectively together, respecting each other to provide the best possible care and treatment to patients. We also noted good collaboration and communication between different specialities.

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.

Staff told us they had good working relationships with their ward managers who they described as approachable and visible. Staff feedback in relation to senior leaders’ visibility and helpfulness was mixed. Some staff were complimentary about leaders, especially the matrons and lead nurses but they did not always feel acknowledged by the senior leadership team. Most ward managers felt supported by the lead nurses and senior leaders within the division.

Leaders were knowledgeable about challenges and priorities for the service and could access appropriate support and development in their roles. They explained challenges such as recruitment and retention of medical staff, bed capacity, patient flow and financial sustainability.

The divisional senior leadership team were experienced and there were clear reporting structures and key roles were supported by deputies or associate roles. The division had a structure which ensured support for ward managers and associate directors of nursing.

Leadership development opportunities were available to staff. Furthermore, the trust facilitated a ‘growing your own’ programme over the past three years, with nurse apprentices and nursing associates successfully applying and progressing.

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 service fostered a positive culture where staff felt they could speak up and their voice would be heard.

The trust had a freedom to speak up (FTSU) policy and a dedicated FTSU guardian who was available should staff want to raise any concerns. Staff we spoke to were aware of who this was and told us they felt they could raise concerns without fear of reprisal.

Staff had access to the freedom to speak up policy which provided information on how to speak up and what to expect to happen during the process.

Staff gave us examples of concerns they had raised with their managers. They told us these were treated sensitively and seriously, and managers worked with the members of staff to resolve the concerns.

The annual divisional staff survey achieved a 30% response rate for Integrated medicine and Emergency Care. The score for the question on safety and speaking up had decreased from 56% (2023) to 53% (2024) for staff feeling safe to speak up concerns in the organisation. The trust ‘People Promise’ score for ‘we each have a voice that counts’ was 6.5 out of 10 in 2024. Survey’s findings highlighted areas to celebrate and areas for development.

The evidence showed a good standard. The service valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who work for them.

Staff were able to apply to work flexibly, for example flexible working agreements to account for personal circumstances such as caring responsibilities and health issues. We also spoke with several international staff who praised the multicultural integration into their role.

The trust had their ‘Our People Plan’ 2023-2026, the plan set out their ambitions to support the trust in achieving the core objectives from the strategy of four key drivers which were ‘looking after our people, belonging in the NHS, growing for the future and new ways of working and delivering care by engaging with staff, supporting health and wellbeing, embedding inclusive practices, promotion of inclusive environments, grow apprentices within, increase undergraduate places, increase clinical placement capacity, upskilling and career progression.

The trust supported and encouraged several staff networks and forums, and these details were provided to all staff joining the trust in their welcome packs.

However, the data from the 2024 staff survey with a low response rate of 30%, in relation to workforce race equality standard (WRES), ethnic minorities staff experiencing discrimination from staff in the last 12 months was at 27% an increase from the 2023 data of 17%. The data from the 2024 staff survey with a low response rate of 30%, in relation to workforce disability equality standard (WDES) overall showed a decrease in staff satisfaction compared to 2023 staff survey data.

The evidence showed some shortfalls. The service had clear responsibilities, roles, and systems of accountability. However, there remained shortfalls in effective good governance.

We found breaches of regulation in the safe key question safe care and treatment and premises and equipment. Despite programs of auditing and checklists for example, around infection prevention and control, fire safety, legionella checks and medical consumables, we identified risks on two of the wards we visited, which demonstrated governance processes were not always effective, in addressing areas of poor practice and compliance. This is reflected in the safe environments and equipment quality statements in the safe key question.

We also found a breach of staffing. There were various levels of life support training specific for adults and children for their role and the overall compliance was 80.21% which was below the trust compliance target. Staff appraisal of poor compliance was reported to the Workforce Assurance Committee in October 2025 with an improvement plan trajectory to be in line with trust targets by March 2026.

Information discussed within various committees and groups fed into the clinical governance committee and to the trust board. The division of medicine was led by a triumvirate which consisted of one divisional director of medicine, one divisional director of nursing and one divisional director of operations.

Clinical Governance Meetings were held monthly. We reviewed the medical governance meeting minutes for the months of August, September and October 2025. The agenda included divisional updates, performance, incidents, health and safety, complaints, risks and patient safety reviews. Each department also held their own monthly governance meetings where they carried out morbidity and mortality reviews and area reports with learning points and themes which had been identified. There was senior executive representation as well as clinical staff from the trust divisions.

Team meetings were held on the medical wards and documentation was shown on the wards visited.

Staff we spoke with understood what their individual roles and responsibilities were, what they were accountable for and to whom they were accountable.

There were daily, trust-wide system overview meetings. These monitored information such as numbers of patients who did not meet the criteria to reside and were awaiting packages of care in the community.

Senior leaders were able to describe their top risks which were access and flow, bed occupancy and medical staffing. Ward leaders were able to describe their top risks from regular auditing, patient feedback and reporting processes.

Senior staff in the division used data to review performance of their wards. This provided oversight of patient safety and patient experience. Support could be given to areas where it was needed. This was disseminated to matrons and ward managers.

There was data available to ward managers that provided the outcomes of the ward accreditation. These formed the basis of the action plans for improvement for each ward which were monitored at division level.

The department operated systems to ensure they shared information with external organisations effectively, in a timely way, for example, accidents and incidents were reported to the relevant authorities, including the Care Quality Commission.

There were procedures to safely manage sensitive data which allowed them to maintain people’s privacy, dignity, and confidentiality.

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.

The department collaborated and worked in partnership with stakeholders to support the delivery of the service and support joined up care, such as the care coordinator team, frailty team, mental health team, assessment and rehab centre (ARC), the district nurse team, ambulance trust work for rapid release, specialist palliative care and end of life care service provision for Fylde Coast. They shared information and learning with partners to improve the service.

The transfer of care hub held a daily call with partners in the community Monday to Friday.

The trust worked in collaboration with Healthwatch, who support independent surveys for trust-based services. The Patient Engagement Team worked closely with Healthwatch Blackpool, who visited the trust and collect impartial feedback on a monthly basis. The Patient Engagement Team identified areas for Healthwatch to speak to patients, based on patient feedback within the previous month.

In November 2025, the Patient Experience Team attended a Community of Practice, Co-production event with local Stakeholders and linked with a charity, who are supporting Service Users facing homelessness, drug and alcohol addiction and how they can work together with the trust to support non-judgemental pathways for medical care, based on service user feedback. The team have also taken action to link with a community organisation who can provide support in widening engagement with Blackpool’s local Roma and Eastern European Communities.

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 and leaders across the division told us they shared a commitment to improving services for patients and their families. Each month the division worked with system partners to gather patient feedback and identify areas for improvement. Staff participated in ‘Fundamentals of Care’ celebration days.

The division had established plans to drive learning, improvement and innovation aimed at enhancing service delivery. The trust had plans to focus on priority areas such as managing deteriorating patients and unexpected end of life events.

Ward 25 and a consultant worked on improving the recognition of delirium in patients, to support earlier detection and intervention. This aimed to improve outcomes by reducing harm, shortening length of stay and preventing physical and cognition deconditioning.

Wards participated in a focus on reduction of falls with the use of visual cues and patient liaison to reduce falls. Staff participated in national audits relevant to the service and learned from them. We observed staff taking the lead on improvement initiatives and learning drives with their colleagues to reduce the number of falls patients were experiencing, a reduction in the number of pressure wounds on patients’ skin and promoting self-movement and repositioning. And mindfulness exercises, eating well and making healthy choices through information sharing.

The trust implemented a self-referral pathway for all patients with musculoskeletal health needs.

The trust came highly commended in the Health Service Journal (HSJ) patient safety awards in the category of deteriorating patients and rapid response initiative of the year, as well as being a finalist for the patient involvement in safety awards and a finalist for developing a positive safety culture award.