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 inadequate. At this assessment the rating has changed to good.

This meant the service was well led. Leaders had the skills, knowledge and experience to lead effectively. They understood the service's challenges and priorities and worked with staff, partners and other organisations to improve care for people.

Since the last assessment, leaders had strengthened the culture, governance arrangements and oversight of the service. Staff described leaders as visible, approachable and supportive, and told us teams worked well together to provide care. There was a clear vision and strategy which staff understood, effective partnership working with external organisations, and a strong focus on learning and improvement. Leaders used performance information, incidents, risks and feedback to support improvement, and staff were involved in a range of local and trust-wide initiatives to improve patient safety and patient flow. The service had also received national recognition for its improvement work.

However, some improvements were still needed. Governance systems had not always been effective in addressing concerns relating to staffing, mandatory training, appraisal compliance and the management of escalation areas. Workforce vacancies and reliance on temporary staff continued to present challenges, and leaders could not always provide assurance that all staffing and competency requirements were consistently met. These issues resulted in a breach of staffing. Despite this, leaders understood these risks, had plans in place to address them and demonstrated a commitment to continuous improvement.

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 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 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.

Leaders had the skills, knowledge and experience to perform their roles.

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 patient flow, crowding in the ED and staffing.

Staff told us that leaders were visible in the service and approachable for patients and staff. They felt that leaders understood the risks and priorities within the service

The divisional senior leadership team were experienced and there were clear reporting structures and key roles were supported by deputies or associate roles.

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

The service fostered a positive culture where people 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 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.

FTSU training compliance at the time of inspection was below the trust target at 73% medical staff and 87% nursing. However, staff we spoke with knew how to raise a concern and where they could find the policy and information on the process.

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 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.

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 service did not always have good systems or governance. They did share important information with securely with others when appropriate.

In urgent and emergency care, governance arrangements had not ensured that risks associated with escalation areas were consistently mitigated. Workforce planning remained a significant challenge. The department reported substantial registered nurse vacancies and gaps within the substantive medical workforce across several grades. While leaders had implemented mitigation measures, including the use of bank and agency staff and alternative staffing arrangements, the service was unable to provide assurance that its planned staffing establishment was consistently achieved as did not monitor fill rates for nurse staffing.

Leaders monitored mandatory training compliance and this had been captured on the trust risk register in October 2021. However, mandatory training compliance rates across a number of subjects remained below the trust target of 95%. This included adult resuscitation, paediatric life support, sepsis recognition and management, care of the deteriorating patient, and moving and handling training. The low compliance rates indicated that governance actions had not yet been fully effective in achieving the required level of workforce assurance.

Although leaders described processes to ensure appropriately trained staff were rostered within the paediatric area, including the use of electronic rostering systems and escalation procedures, they were unable to provide supporting compliance data for some key competencies. This limited the assurances available regarding the effectiveness of these controls.

Workforce planning remained a significant challenge. The department reported substantial registered nurse vacancies and gaps within the substantive medical workforce across several grades. While leaders had implemented mitigation measures, including the use of bank and agency staff and alternative staffing arrangements, the service was unable to provide assurance that its planned staffing establishment was consistently achieved as did not monitor fill rates for nurse staffing.

Reliance on temporary staffing remained significant, particularly within the medical workforce, highlighting ongoing sustainability risks and challenges in maintaining a stable substantive workforce.

Performance management processes had identified concerns regarding appraisal compliance. The trust acknowledged declining compliance rates and had developed an improvement plan; however, compliance within the Emergency Department remained substantially below trust expectations at the time of inspection.

The issues relating to training compliance, appraisal completion, workforce vacancies, and staffing assurance demonstrated limitations in the effectiveness of governance and workforce oversight arrangements. These concerns resulted in a breach of staffing.

Staff we spoke with understood their individual roles and responsibilities, what they were accountable for, and to whom they were accountable. Staff demonstrated a clear understanding of their contribution to the safe and effective running of the department and the wider patient pathway.

There were daily trust-wide and operational flow meetings which reviewed key performance indicators across the organisation. These included ED attendances, ambulance handover delays, waiting times, patients awaiting admission, and patients who no longer met the criteria to reside but were awaiting packages of care or onward placement in the community.

The department had effective systems in place to share information with external organisations and partner agencies in a timely manner. Incidents, safeguarding concerns, and statutory notifications were reported to the relevant authorities, including the Care Quality Commission, where required.

Processes were in place to ensure the secure management of sensitive patient information. These supported the maintenance of patients’ privacy, dignity, and confidentiality whilst enabling appropriate information sharing to facilitate safe and effective care.

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.

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 a divisional director of medicine, a divisional director of nursing and a divisional director of operations.

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, ambulance services, local authorities and mental health providers.

We saw joint work with the local mental health trust to reduce delays for patients requiring mental health support in the ED.

We received limited feedback from partners for the service but the feedback we received was positive and included 'we have strong working connections throughout the organisation, both clinical and non-clinical teams working together from the front line receptionists to the Executives', 'staff are often friendly and approachable this can be impacted by the business of the department and the strain often felt by the team, however our team share that they know who to escalate concerns too and that they are often heard when doing so', 'we have systems in place that supports joint working in response to the need of the people. There are joint safeguarding procedures in place across our organisations’.

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.

The Emergency Department took part in trust-wide improvement programmes and worked with other teams to improve care for deteriorating patients. Staff tested new ways of working, including improved escalation processes, the use of patient wellness questions and plans to introduce electronic observations. The department was also involved in testing Martha’s Rule as part of a national patient safety initiative.

Staff spoke positively about improvement work and described the department as committed to making services better for patients. Leaders used data, staff feedback and learning from improvement projects to identify where changes were needed and to monitor progress. The ED held a monthly safety training day dedicated to patient safety, patient care, and local service improvement issues. The programme included presentations from external stakeholders, including the local HM Coroner and a ketamine specialist. Staff were provided with protected, paid time to attend these sessions, ensuring widespread engagement with learning and quality improvement initiatives.

The service also took part in wider work to improve patient flow and reduce delays. This included the trust’s ‘Reducing Time Away From Home’ programme, which aimed to improve discharge processes and reduce long waits in the Emergency Department. Staff continued to look for opportunities to improve care and patient experience.

Although service pressures sometimes affected staff availability for training and improvement activities, leaders and staff remained focused on learning and improving the service.

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.