Charing Cross 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

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. 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 last assessment we rated this key question good. At this assessment the rating has remained good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

This service scored 64 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We scored the service as 2. The evidence showed some shortfalls. The service had a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement, but not all staff were aware of it. They understood the challenges and the needs of people and their communities.

All clinical divisions within the trust aligned to the trust’s overarching trust strategy. The trust’s strategy, Better Health for Life, focused on working closely with NHS and social care partners, building on lessons from the COVID-19 pandemic, and responding to current and future challenges. It aimed to deliver high-quality, timely, and equitable care while supporting staff to provide safe, compassionate services.

However, most staff we spoke with weren’t aware of the trust’s vision and strategy, with only 1 member of staff knowing what it was. Staff we spoke with told us they had not had opportunities to take part in discussions about service strategy and couldn’t explain how their work contributed to the trust’s vision and strategy.

The division engaged with all specialties to develop their own priorities for the year. This included improving patient flow, reducing the number of patients with extended length of stays, delivering services within the trust’s financial envelope whilst maintaining quality, safety, equity through improvements, and ensuring the wellbeing and resilience of staff.

The trust’s values (Kind, Collaborative, Expert, Aspirational) were central to how staff worked and were well communicated and understood. Staff we spoke with were aware of the trust’s values and could give examples of how they applied them in their work, such as speaking up about concerns, supporting colleagues, and treating people fairly.

We scored the service as 3. 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 openness and honesty.

Leaders in the service had the skills, knowledge, and experience required for their roles. They demonstrated a clear understanding of the service they managed and could explain how their teams worked to deliver high-quality care, including managing patient flow and maintaining safe staffing levels. Leaders were visible and approachable, regularly engaging with staff on the floor, attending team huddles, and supporting problem-solving in real time.

During the assessment we spoke with 20 staff including ward clerks, nursing staff, managers, medical staff and allied health care workers. Staff we spoke with reported that accessible leadership encouraged open communication and made them feel supported in raising concerns or suggesting improvements. Leadership development opportunities were available and actively promoted, enabling staff to take on new responsibilities and lead projects such as audits, which contributed to service improvements and monitoring of quality standards.

Staff survey results showed that staff were generally positive about working in the service, with the service achieving 70% positive results on the staff survey. The survey results were higher than the trust average in all areas including compassion and inclusivity, being recognised and rewarded, each having a voice that counts, being safe and healthy, always learning, working flexibly, teamwork, staff engagement, and morale.

The service had a people’s priority action plan in place to improve staff survey results, This included improving recruitment processes; supporting international nursing and medical staff with career development and progression; supporting a more diverse, aging and agile workforce; training managers in disability awareness; and improving nursing uptake of reasonable adjustments.

We scored the service as 2. The evidence showed some shortfalls. Not all staff were aware of the freedom to speak up guardian. However, most people felt they could speak up and that their voice would be heard.

Staff could describe how concerns were reported, investigated, and followed up, with feedback shared through various forums. Local leaders maintained an open-door policy and were actively engaged in supporting and addressing staff concerns.

The trust had a Freedom to Speak Up (FTSU) Guardian who worked independently to promote a positive speaking-up culture, providing confidential advice and support to staff regarding patient safety or concerns about how issues were managed. However, staff we spoke with did not know what a FTSU guardian was, who they were, or how to contact them. Staff told us that they would not need to contact the FTSU guardian as they were able to raise any concerns with their managers. Following the site visit, a whistle blower contacted CQC as they did not feel they were able to raise concerns with senior leaders.

People and carers had opportunities to provide feedback on the service in ways that reflected their individual needs, including through surveys such as Friends and Family. Managers and staff had access to this feedback and used it to make improvements.

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.

The trust had a people priority strategy in place which included valuing and including their diverse workforce. The trust had an Equality, Diversity and Inclusion policy that set out their commitment to diversity and inclusion. Staff had access to a reasonable adjustments policy. This gave guidance about how to support staff with reasonable adjustments to enable them to work and reduce the risk of staff experiencing discrimination due to protected characteristics.

Staff had access to support from several staff network groups. These included a women’s network, a LGBT network, and a BAME network. Staff reported leaders were inclusive of all staff. One example shared was a ward blessing carried out following a serious incident, in recognition of the fact that most staff on the ward were devout Christians.

The trust ran a variety of celebration and awareness events including National Inclusion Week, East and Southeast Asian Heritage Month, Black History Month, and World Menopause Day to recognise and celebrate its diverse workforce.

We scored the service as 2. 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, or share this securely with others when appropriate.

There was a governance structure with lines of accountability through wards/departments, the care groups to clinical divisions and through to the trust board. All care groups had a governance lead.

There were monthly local and divisional governance meetings that followed a set agenda. Records of governance meetings demonstrated the quality, performance, and safety of the service were monitored and reviewed. This included discussions on learning from serious incidents or complaints, the risk register, performance, national and local clinical guidance, policies and procedures, audit results, safeguarding, and training, however these were not always effective. For example, minutes did not show that safeguarding training had been highlighted as a concern following two serious safeguarding incidents that had occurred at the service.

Our review of the risk register showed risks described by staff were included in the risk register, including risk to patient flow, the use of temporary escalation areas, and estates and refurbishment. However not all risks were included in the register. For example safeguarding training was not included in the register, despite 2 serious safeguarding incidents occurring within the service over a 2 month period. This meant service risks were not always regularly reviewed.

Staff had a systematic method of auditing and reported a range of data to facilitate leaders’ understanding of performance, key risks, and any quality improvements. Leaders undertook audits for the compliance of completion of risk assessments for key elements of patients’ needs such as documentation, medicines management, and venous thromboembolism (VTE) prevention. We saw action was taken to improve performance, for example improving documentation around the insertion of indwelling devices and pain assessments.

We saw that patient records were maintained on the electronic patient record and each person logged off systems when not using them to maintain confidentiality. Patients on the ward had a board behind their bed which displayed the patients preferred name, dietary information, and any risks such as if a patient was at risk of falls. The boards did not display any personal confidential data.

We scored the service as 3. 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 trust worked with commissioners and stakeholders and the local system and there were positive relationships. We saw evidence of regular meetings with other stakeholders to discuss pathways and any areas of concern. There was an aim to develop a shared understanding of the challenges in the system and identifying ways to improve.

There was evidence of engagement with staff and stakeholders and patients to develop pathways and improved care and patient outcomes. The trust had a strategic lay forum, consisting of lay partners who ensured trust plans and developments were person-centred, and that the trust had listened to, understood and responded to the needs and wants of patients and local communities. Lay people were current or past patients, or people who lived in the local community.

Staff reported ongoing challenges with the timely provision of external equipment and delays caused by partner organisations determining which agency would fund ongoing care for patients with complex needs at discharge. These issues contributed to delayed discharges and had a negative impact on patient flow throughout the hospital. We saw equipment delay issues raised at the board round and escalated to leaders and partner organisations. We saw evidence of improvements made through patient and stakeholder engagement. For example, the recent trial of increased visiting hours to ensure a more consistent, person-centred approach to visiting.

We scored the service as 3. 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.

The organisation had a service wide Quality Improvement (QI) program. Leaders were able to describe areas of improvement already achieved. For example, the trust had introduced the Faster Moves initiative to improve hospital flow, collaborative working with other specialties, and prepare for the upcoming winter summit address performance targets.

The service was involved in education and research activities, including thematic reviews of patient cases, which were presented to the wider team to support learning and improve patient outcomes.

Leaders and colleagues were also encouraged to share appreciation and gratitude, with initiatives such as the Daisy awards, which were staff awards helping to build a positive and supportive culture. Nominations were submitted across the trust by patients, relatives, and carers, and recognised nurses and support workers who provided extraordinary and compassionate care. Several staff members working within the service had received these awards.

The service operated a Pathway to Excellence programme, which promoted a positive practice environment that supported professional empowerment, visible leadership, and recognition of compassionate, high-quality care. The Pathway to Excellence framework was embedded through Leadership Councils, Shared Decision-Making Councils (SDCs), and engagement initiatives such as Thrive Thursdays. Thrive Thursdays provided protected time for nurses and healthcare support workers to participate in learning, reflection, and self-care, and staff reported they regularly took part

The service had 3 shared decision-making councils that allowed direct-care nurses to influence decisions and lead local improvement projects. For example, the day room enhancement project on 8 South Ward that improved the patient and relative environment.