Darlington Memorial Hospital

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• 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.

We assessed 7 quality statements. The service did not have an agreed strategy to facilitate a shared vision and culture. The culture of the service was not based on transparency and engagement, and managers did not have autonomy to lead effectively. Staff did not always feel they could speak up and that their voice would be heard. The service did not operate effective governance processes throughout the service. They did not always share information and learning with partners or collaborate for improvement.

However, staff feel respected, supported and valued by their immediate managers. The service promoted diversity and inclusivity in the workforce. The service encouraged staff to think of creative ways of delivering equality of experience, outcome and quality.

At our last assessment we rated this key question Good. At this assessment the rating has changed to Requires Improvement.

Requires Improvement: This meant the service management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred car

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.

We scored the service as 2. The evidence showed some shortfalls. The service had a vision of where it aspired to be. However, there was no clear strategy to turn the vision into reality. The culture was not based on transparency, equity, inclusion, and engagement.

The care group aspired to align its vision with the trust’s, which was ‘right first time, every time’. The trust’s values included ‘respect and dignity, compassion, quality care, improving lives, everyone counts, working together for patients.’

Staff we spoke with knew and understood the vision and values and they were formalised and displayed for all staff to see. There was an overarching care group vision and plan for 2025/26, but no clear strategy to turn plans into reality.

Staff and managers told us they felt the trust was over focused on finance, clinical staff voices were not heard, and concerns were not listened to. They saw this presented as a barrier to the care group’s ability to deliver on its plans.

There appeared to be a disconnect between care group leaders and the executive leadership team and board. Managers we spoke with described how issues they raised with the executive team were not always well received. For example, concerns about scrutiny around safer staffing and bank and agency use reduction. They described the response received as ‘accusatory’ and they felt they were challenged by non-clinical people who did not understand the complexities of patient groups. The vacancy control processes were determined by the finance department and meant the care group was slow to respond to gaps and this ultimately affected care delivery.

Managers explained that the process for submission of business cases when they needed additional resources was protracted and ineffective. They reported that business cases were often rejected by the finance team without explanation as to why, and they were asked to resubmit an amended plan, which resulted in delayed release of funding or further non-approval.

Staff told us the trust did not demonstrate outward investment in staff, for example, by providing restorative supervision, suitable and sufficient changing facilities, and time-out spaces. They felt this impacted negatively on the ability to attract and recruit new leaders.

The care group identified ongoing cultural concerns and behaviours at all levels, that were not in keeping with trust values. Staff also shared concerns about how people communicated with each other and described examples of unkindness they had experienced and witnessed. Staff said they had observed rudeness towards colleagues from individuals and did not feel empowered to challenge such behaviour.

They described it as a culture of ‘turning a blind eye’. Staff told us that senior leaders acknowledged there was a problem with individual behaviours and the trust had hosted ‘kind life’ workshops in the last 2 years. These were received well by staff. However, staff felt there remained ‘pockets’ of individuals whose poor behaviours were enabled, and this did not meet trust values.

We scored the service as 2. The evidence showed some shortfalls. Although care group leaders understood the context in which the service delivered care, treatment and support, they did not always have autonomy to use their skills, knowledge, experience to lead effectively.

Care group leaders and managers we spoke with understood the services they managed; however, they felt they did not have autonomy and had ‘no time to have a presence’ as they were ‘constantly firefighting’. Leaders said they felt ‘micromanaged’ and ‘disempowered’. They gave examples of when they felt unable to make management decisions without executive team approval and suggested this was a continuation of the command-and-control strategy employed by the trust following the COVID-19 pandemic.

Senior managers told us they were not permitted to manage their own departmental budgets and felt they were constantly being asked to do more with less. For example, ward managers had 15 hours a week of non-clinical management time which they felt was insufficient, and worked clinically because there were not always sufficient staff. Whilst they said this gave them insight into how hard their teams worked within such constraints, managers said they did not have sufficient time to manage and felt the organisation did not support them effectively.

Managers and staff we spoke with told us they were concerned about potential for burnout and low morale. This reflected the findings of the staff survey, which showed since the last quarter of 2023/2024, a steady decrease in respondents who would recommend the trust as a place of work, and for the same period, a steady decrease in respondents who would be happy with the standard of care, if a relative required treatment. There was also a decline in the percentage of staff surveys completed. The trust confirmed action planning following the last staff survey was an ongoing piece of work.

Staff on the wards and in theatres told us they found their immediate managers and care group leaders to be approachable and visible. They felt listened to and appreciated when managers helped clinically when there were staffing shortfalls. However, staff we spoke with told us they would value more visibility by the executive team.

We scored the service as 2. The evidence showed some shortfalls. People did not always feel they could speak up and that their voice would be heard.

There was a freedom to speak up guardian who worked 22.5 hours each week trust wide. Staff we spoke with knew how to contact them when required.

The freedom to speak up policy was accessed by staff through the trust intranet. The policy stated the online module ‘Speak Up’ was mandatory for all staff to complete. This was included on the trust eLearning staff training matrix, however, mandatory training compliance data provided did not show compliance figures for this module, meaning the trust could not demonstrate that all staff had completed the training. The policy signposted staff to various options to enable speaking up, both internally and external to the trust.

The freedom to speak up guardian reported formally to board twice a year and there was a non-executive freedom to speak up sponsor at board level. In addition, the guardian met monthly with senior leaders to discuss trends and to share information for insight. However, these meetings were not minuted, and it was unclear whether the information shared was used to inform the board, and that any developing cultural issues were identified and acted upon promptly.

We scored the service as 3. The 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.

Staff accessed the equality and diversity policy on the trust intranet. Equality, Diversity and Human Rights training was a mandatory training requirement for all employees and accessed through eLearning. Compliance with this training met the 90% trust target at all sites.

There were equality and diversity champions within the service, for example, LGBTQ+, and black, Asian, minority and ethnic (BAME). Staff we spoke with told us they felt the care group was inclusive and that there were equal opportunities for all.

Staff were able to apply to work flexibly for example through, flexible working agreements to account for personal circumstances such as caring responsibilities and health issues.

The trust monitored staff within the service to ensure it was diverse in its make-up and representative of the patient group.

We scored the service as 2. The evidence showed some shortfalls. Governance systems and processes were not always effective. They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

Responsibility for management of operations was held within the care group and corporate directorates. Associate Directors and Clinical Directors were expected to take action to achieve the care group and directorate objectives and to manage risks to their achievement, escalating risks where necessary to the executive team.

However, managers and staff told us they were concerned the current governance framework and oversight was ineffective. This concurred with the findings of an external independent governance review commissioned by the trust in 2025, which showed existing escalation frameworks were not used effectively to manage risk or drive improvement.

For example, audit activities were inconsistent across the care group at all sites, and not always sufficient to provide the trust with assurance. Not all audits had comprehensive action plans to drive up compliance.

Following an incident in theatres at another site, the theatre safety checklists were recently redesigned and subject to an implementation review in September 2025. However, this had not been completed at the time of our assessment.

Theatre managers across the sites worked in isolation and there appeared to be a reluctance to provide cross-site cover. This resulted in inconsistencies of practice and learning following incidents. For example, managers we spoke with were not all aware of issues noted by inspectors, such as the lack of completed swab count boards in some theatres across the service.

Key ‘Getting It Right First Time’ (GIRFT) metrics from the NHS England Model Health System were displayed for surgery specialties at either trust or site level. This was where trust-wide performance was flagged as either not achieving the national benchmark, being in the worst performing quartile nationally, or showing deterioration over time.

Trust board reports for May 2025, noted concerns around the performance of breast cancer services were voiced since 2019, when a GIRFT report highlighted several areas of concern including low rates of reconstructive surgery and high re-excision rates. The subsequent investigation remained ongoing at the time of our assessment.

Managers maintained risk registers at care group level. Staff we spoke with told us they escalated risks to managers; however, they did not know whether these risks were on the risk register.

In addition, risks we identified on our assessment were not on the risk register. For example, including but not limited to, risks associated with suboptimal staffing, risks associated with lack of documentation audits and poor record keeping, and risks associated with policies that were not up to date. This meant there was insufficient management oversight of all risks in departments and that potential patient risk was not suitably and sufficiently mitigated.

The care group had developed business continuity plans for emergencies, for example, adverse weather or influenza outbreak. There were no current risks associated with surgical care group business continuity on its risk register.

Staff had access to the equipment and information technology needed to do their work. Information governance systems included confidentiality of patient records. However, compliance with information governance training at DMH and BAH combined (staff who worked across both sites) for administrative staff was 57% and for medical staff, 41%. Compliance for medical staff who worked solely at DMH was 80%, against the trust target of 90%.

The trust acknowledged governance required a ‘reset’ and this was a priority for the newly appointed executive team. The trust continued to work with stakeholders, including the North East and North Cumbria Integrated Care Board (ICB), and was taking action to address the risks identified by us and other partners. Progress was monitored through quality meetings and a Quality Improvement Group, which included CQC, NHS England and the ICB.

We scored the service as 2. The evidence showed some shortfalls. The service did not always collaborate and work in partnership, so services work seamlessly for people. They did not always share information and learning with partners or collaborate for improvement.

There was a significant backlog of discharge letters to GPs and other referrers, within the surgery care group. As of November 2025, discharge letters not sent (trust wide) stood at 2184 and dated back to July 2024.

The executive team had requested care group action plans with a trajectory for recovery of backlog to be developed and a business-as-usual plan to manage discharge summaries in a timely manner going forward. However, the surgery care group action plan was still outstanding. It was unclear how the trust was assured that partners, such as GPs and adult social care providers, received comprehensive and timely information to enable seamless transition and joined-up care after discharge.

Leaders engaged with external stakeholders such as commissioners, Northern Cancer Alliance, Healthwatch and regional partners. In addition, they engaged with national voluntary and charity partners.

We scored the service as 2. The evidence showed some shortfalls. The service did not always focus on continuous learning, innovation and improvement across the organisation and local system. However, they encouraged staff to consider creative ways of delivering equality of experience, outcome and quality of life for people.

The service did not always focus on continuous learning and quality improvement, particularly following patient safety events, as referenced under the Safe key question.

The trust and care group worked with education training partners, such as local and regional universities and colleges, to facilitate placements. Students we spoke with said their experience was positive. Resident doctors we spoke with told us they had protected time for teaching and learning.

Staff had access to a comprehensive programme of training courses and learning opportunities. All available training and learning resources were available to staff in the ‘Lifelong Learning Directory’, reviewed and published annually. There were library facilities at UHND and DMH and staff could access up to date national journals and resources online.

Managers we spoke with told us about innovative work to improve health literacy in the local population. They recognised many people struggled to understand health information, and in response, patient outpatient and admission letters were reviewed and redesigned with the Regional Health Literacy Team to ensure clarity, appropriate reading level, and inclusion of critical information, such as travel access, health passports, and smoke-free messaging. The letters were due to ‘go live’ in 2026, and further work was ongoing with each specialty to review any specialty-specific letter inserts, to ensure a health literate approach. In addition, the trust worked to improve the readability of the ‘Waiting Well’ patient information resources, which were available for teams to give out to relevant patients.

To drive up improvement with IPC, the trust implemented the Building Relationships with Infection Control and Clinical Staff (BRICCS ) project trust wide. This was a local initiative which aimed to build relationships between IPC and ward teams to improve sustainable IPC practice.