St Richard's 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 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 our last assessment we rated this key question outstanding. 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 at all quality statements for this key question.

The department and staff were well-led by strong leaders who embodied the cultures and values of their workforce. There was improved governance and risk management, and a positive culture. The service worked well with others in the Integrated Care Board to meet the needs of people. They empowered staff to lead change and improve the quality of service to children and young people.

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 service had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion. The service engaged, and understood the challenges and the needs of people and their communities. Leaders had undertaken “The big Conversation” to involve staff in the direction and culture of the organisation. Staff demonstrated the values held by the trust, in that they were very patient, focused and worked well together as a team. The values of the organisation were redefined on the merger of the three previous trusts. This occurred following the feedback of over 3900 staff. In 2025 following further consultation with staff the values were put into three statements: We are compassionate, we communicate and act with kindness, we are inclusive in our teams work collaboratively, we are respectful we behave professionally. Staff understood these values and leaders demonstrated them. Following the big conversation the local team held listening events to involve the staff in contributing towards the new vision and strategy for the trust.

Staff and leaders demonstrated a positive and compassionate culture with a focus on learning and improvement. There was a shared culture of learning and improving to enhance the patient experience. This culture ran from the top to the bottom of the service. We heard from every specialist we spoke with about how they had provided learning to staff to enhance patient care. This included the patient safety lead, the youth support worker and those whose primary function was not for training. The senior leaders were passionate about getting services right for children and young people and this cascaded down the organisation to everyone we met.

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 felt supported by all levels of their leadership team. Staff spoke positively about their immediate managers and matrons and the way they supported them. Matrons and senior leaders spoke with emotion about how proud they were of their teams, their dedication and compassion to deliver good care. Staff knew who the executive leaders were and told us they sometimes visited the ward.

The leaders were available when they were needed and led by example. They were knowledgeable about the issues and priorities in the children’s and young people’s service. They were keen to harness the improvement suggestions made by staff. They understood the challenges within the services and sought to address these through improvements in education. This included training to maintain competencies of nursing staff in procedures which they undertook on a less frequent basis. They focused on staff wellbeing and ensured a culture promoting good practice, good quality, and safe care and treatment.

Staff told us leaders in the service were approachable and responded to any concerns raised. Staff also told us leaders modelled the values of the trust. We saw leaders approached incidents with calm and a supportive manner. There was a no blame culture which was evident through an incident in which the patient had suffered harm. The response of the service was to ensure training and development and ensure staff competencies were up to date. Staff were aware of the senior leadership team but saw more of the Women’s and Children’s directorate team than the executives. They found the directorate team approachable and would share their thoughts with the team if needed.

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 people felt they could speak up and their voice would be heard. Staff at all levels of the organisation were available to support people who had a concern.

Ward and departmental staff said that their managers were available if they had any concerns. They felt listened to and that action would be taken to address the issue raised. Staff who had raised concerns in this manner were able to tell us about the concern and the action taken. This included being able to address challenging behaviour from children and young people and their families. There was a process available to staff, children and young people and those close to them to raise concerns and we heard that these were listened to and addressed by the team.

Martha’s rule had been implemented and there had been only one call from parents and carers to this support line. Martha’s Rule is a patient safety initiative to support the early detection of deterioration by ensuring the concerns of children and young people, families, carers and staff are listened to and acted upon. Parents and carers felt able to raise issues with the ward staff and that they would be listened to.

The service had established Freedom to Speak (FTSU) up arrangements. Information about the guardian and how to contact them was available on the both the internet and the intranet. Telephone numbers and email addresses were included in the information along with a national helpline for whistleblowing. Both services were available 24 hours a day every day. Staff were aware of how to raise concerns but stated that they would more likely raise issues with their line manager as action would be taken by them in a supportive manner. Leaders were able to cite how one concern raised through the freedom to speak up process and the engagement of staff following this. The FTSU report provided information at hospital level and directorate level. In August there had been two cases from staff in the women’s and children’s division. These related to bullying and harassment and staff feeling safe. However, we could not link this to St Richards Hospital

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 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 number of networks which included those for LGBTQI+, Disability, Black, Asian and minority ethnic, carers and armed forces. All staff could join these networks. There was a cultural calendar on the trust's website, but staff were aware of the religious festivals of most of their patient groups. There were many opportunities for staff to attend staff networks including BAME; Armed Forces; LGBTQIA+; Disabled Staff; Carers; Women’s; Trans, Non-Binary & Intersex; Religion & Belief, Menopause Café and resources, financial aid for lower-paid staff, as well as the Health & Wellbeing Network for all staff.

Staff told us that they were able to work flexibly to consider personal circumstances such as caring responsibilities. Managers would put reasonable adjustments in place for staff members. The trust carried out equality monitoring of its staff to ensure the diverse make up and representation of the patient group.

The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

Staff undertook effective governance and managed risk. We reviewed presentations from the governance meeting. There was a range of accurate and timely data and information. This assisted with the understanding of performance and quality and improvements were made as needed. Governance was used to learn, improve and innovate. Information held about children and young people was kept secure and protected. Senior leaders met with ward leaders to discuss the issues in their areas in a supportive way to drive improvements.

There were monthly meetings of the divisional board where issues and performance from both areas within the women’s and children’s directorate. We reviewed the presentation found that this addressed relevant points of good governance. We also reviewed audit reports across a number of areas. These included the better care programme which demonstrated that the service was above the organisational averages across a range of measures.

There were regular and effective meetings led by patient safety leads and the quality team regarding safety, audit, quality and governance. A Quality Governance Forum ran which looked at making sure the service was safe. This discussed and addressed key areas of risk, audit, culture and workforce. The presentation we saw showed where an incident had occurred and improvement was identified, and actions were taken to learn and improve. Changes had been made when needed to improve the service. Good practice was recognised and celebrated. There was effective workforce planning which occurred daily across the hospital however, within the children’s and young person’s service on site the staff worked across areas as necessary.

Ward huddles occurred several times a day and included patient safety events and learning. Staff understood the arrangements for working with other teams, both within the provider and external, to meet the needs of the children and young people. All staff we spoke with were aware the relevant clinical nurse specialist and who to contact for continuing care at home for children and young people. Relationships at this micro level were well established and good. The risk register was reviewed as part of the governance meeting and risks were mitigated and rated appropriately. However, it was not always possible to identify where the risk was an issue as the site was not always listed. This made it difficult to know which risks were across the service and which pertained to the St Richards Hospital site.

The service clearly understood and carried out their duty to collaborate and work in partnership, and services worked seamlessly for people. They always share information and learning with partners and collaborate for improvement.

The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. There was a large piece of work being undertaken to evaluate the current experience of young people transitioning to adult services. There were currently about 12,000 outpatients’ appointments for 16 and 17 year-olds who were transitioning to adult services. Due to this number the Clinical Director worked with several different providers to streamline and standardise transition services. There was exceptional engagement with the consultant body in both adult and children services to ensure that the transition pathway was as smooth as it could be for all young people. Everyone recognised that adult services could not provide the level of input the children’s services could. However, everyone was keen to provide a tailored service which met the needs of the individual young person. They shared information and learning with partners and collaborated for improvement.

The hospital worked well with local partners to support the care of individual children. We heard about the demands of the non-accidental injury assessment on the local healthcare providers. The service offered to run this service so that the children did not experience long waits. However, due to the success of this piece of work the service now provided this service alongside their current workload.

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 had a good understanding of how to make improvement happen. Staff felt empowered to make simple and quick improvements to the service. An example of this was the acquisition of a box for the outpatient department which contained fiddle toys for restless or neurodiverse children to keep them entertained during the wait to be seen. However, there is a formalised approach for bigger projects such as the improvement of the outpatient’s department, whose environment was no longer fit for purpose. The approach is consistent and includes measuring outcomes and impact. Staff and leaders ensured that children and families were involved in developing and evaluating improvement and innovation initiatives. We heard that young people were involved in developing training activities for the staff so that it clearly matched their needs and that staff understood how young people felt.

There were processes to ensure that learning happened when things went wrong, and from examples of good practice. Leaders encouraged reflection and collective problem-solving. An example of this was an incident involving a split cannula. The patient safety lead reviewed the incident with the staff involved. A no blame culture was adopted and learning through training packages and reassessment of competencies implemented to reduce the risk of this occurring again. This demonstrated that staff were supported to prioritise time to develop their skills around improvement and innovation. Also, that there was a clear strategy for how to develop these capabilities and staff were consistently encouraged to contribute to improvement initiatives.

Leaders encouraged all grades of staff to speak up with ideas for improvement and innovation and actively invest time to listen and engage. There was a strong sense of trust between leadership and staff. Staff told us that they felt very comfortable talking to their line managers and were supported through this conversation. The service had strong external relationships at all levels that supported improvement and innovation. An example of this was that the trust responded to a request to support a third-party organisation in the assessment of non-accidental injury cases. The service saw this as an important piece of work which they could assist with providing to ensure the safety of children and young people of the community.