Fleetwood 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

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 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 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 Trust had a five‑year strategy, titled ‘Our Strategy 2022–2027’, which set out how it planned to prioritise improvement, promote equality, and ensure fair access to support and services. The strategy was shared with new staff during induction and that workshops were provided to support staff understanding and engagement with the strategy.

Leaders described a clear vision and purpose for the outpatient service, focused on delivering safe and compassionate care and fostering a positive, multi-skilled environment where staff were trained to meet patient needs. The vision included developing a sustainable and forward-thinking outpatient service that maximised staff potential, supported a range of specialties and enhanced patients’ choice and access to care. This demonstrated a clear direction for the service and a commitment to continuous improvement and high-quality outcomes.

The service promoted a strong set of values that were embedded in daily practice. These included treating people with kindness and compassion, placing patients, families and carers at the centre of care, and ensuring that everyone was respected, valued and had equal access to high-quality services. Leaders encouraged open communication, supported colleagues and promoted a culture that valued teamwork, engagement and professional development.

Staff described a positive and inclusive working environment where they felt supported and able to contribute to service improvement. The emphasis on equality, fairness and inclusivity supported a culture where staff and patients were respected and where concerns could be raised. This approach demonstrated that leaders were committed to maintaining a transparent, supportive and patient-focused culture.

When asked, staff were able to demonstrate awareness of the strategy and describe how it informed their work and the delivery of services.

The outpatients department usually operates on one nurse and one healthcare assistant. A band 6 nurse manager oversaw the department, including line management of nursing staff, estates issues and day-to-day operations.

Staff informed us that band 7 from Blackpool Victoria outpatients department attends weekly and will attend if a safety concern is escalated. Staff told us about a positive culture within the team and felt confident about escalating safety concerns.

When we spoke with managers, they told us several members of the senior team were off work. There were arrangements in place to make sure staff continued to receive support and line management. During this assessment we saw examples of staff actively supporting one another across roles and specialties. This is good teamwork, displaying integrity, openness and honesty.

Staff working at the outpatients department told us they felt supported and the management team provided a good culture.

The Trust had a Freedom to Speak Up policy in place, which provided guidance for staff on how to raise concerns.

When we spoke with staff working in the outpatient department at Fleetwood Hospital, they were unable to specifically identify a Freedom to Speak Up Guardian or champion for their area. Staff told us there was no designated Freedom to Speak Up champion based within the outpatient department. However, staff consistently told us they felt confident to raise concerns directly with their line managers or senior staff if issues arose.

Staff told us they knew how to access the Freedom to Speak Up process through the trust intranet if needed. At the time of our assessment, there was no information displayed in the outpatient department about the process.

Leaders acted to improve where there were any negative experiences for staff with protected equality characteristics. Leaders took steps to remove bias from practices to ensure equality of opportunity and experience for the workforce within their place of work, and throughout their employment. There were good working relationships with Occupational Health services and workplace action plans were in place to support staff who required them.

Staff told us they had opportunities to apply for project work, new roles and to undertake external studies through an open application process.

The service acted to prevent and address bullying and harassment at all levels and for all staff, with a clear focus on those with protected characteristics under the Equality Act and those from excluded and marginalised groups. Staff felt everyone was treated fairly and that they would be able to report behaviour or attitudes which were negative in style.

There were equality champions and staff forums available to staff across the trust network. These provided opportunities for staff to engage with equality, diversity and inclusion initiatives and to raise concerns or seek support related to protected characteristics.

The outpatient department at Fleetwood Hospital had not experienced any never events or incidents resulting in serious harm. Over the previous six months, 12 incidents had been reported. Of these, 1 was recorded as low harm and the remaining 11 resulted in no harm to people using the service.

We reviewed the service risk register, which contained 17 open risks. All identified risks had comprehensive action plans in place. One of the risks discussed during the assessment related to the implementation of a new electronic computer system to replace an outdated system that had been in use for approximately 30 years. Leaders told us this new system would improve integration between systems, resulting in improved booking processes and follow‑up care for patients. The system was being implemented over a 12‑month period, and training had been provided to specialty teams to support its safe and effective adoption.

Another risk related to the storage and management of patient records at the reception area. Administrative staff oversaw the movement of paper records in and out of the department for specialty teams. In their absence, this responsibility passed to nursing and specialty staff. This risk had been recorded on the risk register, with actions identified to reduce the potential impact.

Monthly governance meetings were held at directorate level, along with ad‑hoc meetings to discuss specific incidents or concerns relating to Fleetwood Hospital’s outpatient department. Learning from patient safety events was shared across sites and the trust to support improvement and consistency of practice.

Fleetwood Hospital provided a range of services to meet the needs of the local community. The management team told us they worked closely with several partner organisations, including local housing services, colleges and Macmillan Nurses, to support people using the service.

Leaders and staff working within the outpatient department demonstrated a good understanding of the needs of the population they served. Staff explained how they worked collaboratively with other teams and external organisations, including charities that provided support for people experiencing issues related to drug and alcohol misuse and smoking cessation.

Leaders liaised with commissioners and specialist teams to increase appointment capacity where required to manage demand and meet waiting time targets. This flexible approach supported timely access to outpatient services and helped ensure the service was responsive to the needs of the local community.

Staff were committed to continually learning and improving services. We spoke with a nurse working within a nurse‑led dermatology clinic who told us about their clinical competencies, which were aligned with standards set by the British Nursing Group. The Trust told us it was in the process of reviewing and formalising competencies required to undertake this procedure. This would provide clear evidence that the Trust was supporting staff to deliver safe, effective and evidence‑based care and treatment.

We spoke with the management team, who told us about a range of quality improvement projects that were ongoing across sites in collaboration with specialty teams.

There were processes for learning when things went wrong or of good practice, either locally or nationally. Staff we spoke with had a good understanding of quality improvement methods and had been trained in this area of work. We were told about some of the areas of work which they had focused on, which included an

ongoing quality improvement project aimed at reducing the number of people who did not attend (DNA) their outpatient appointments. The project commenced in 2023, when DNA rates were at their highest at 41%. By 2025, this figure had reduced to 13%. Leaders attributed this improvement to a trust‑wide media campaign, the introduction of a new booking system, and the use of text message appointment reminders.

Within the Fleetwood postcode area, the rate of missed appointments remained higher than other areas, at 23%. Work to address this continued to be monitored and was ongoing

At the time of the assessment, there were no quality improvement projects specifically led by the outpatient department at Fleetwood Hospital. However, the trust continued to support improvement work across outpatient services. Other community services using the outpatient department as a clinical base were undertaking projects to reduce repeat attendances, and specialty teams were completing their own quality improvement initiatives. Staff at Fleetwood Hospital’s outpatient department supported these teams to facilitate and enable this work.