The Care Quality Commission (CQC) has rated Gloucestershire Hospitals NHS Foundation Trust as good, following an inspection of its leadership in February.
CQC now gives NHS trusts a single trust-level rating focusing on leadership and culture that replaces all other ratings at that level.
Prior to the trust wide well led inspection, towards the end of last year CQC also inspected several services provided by the trust. These inspections were carried out to understand how leadership strategy and risk management aligns with frontline services:
- Medical care at Gloucestershire Royal Hospital has been rated as good following an inspection in December 2025.
- Urgent and emergency care (UEC) at Gloucestershire Royal Hospital has been rated as requires improvement following an inspection in December 2025. This inspection identified eight breaches of regulation. These breaches related to delays in flow through the hospital from UEC, low mandatory training rates, failure to ensure timely nursing risk assessments, poor sepsis care and the safety of the hospital environment. CQC has told the trust to submit a plan showing what action it is taking to make immediate improvements in response to these concerns.
- The rating for Maternity services provided at Gloucestershire Royal Hospital has been rated as requires improvement following an inspection in September 2025. Safety and leadership of maternity at the hospital have also been rated as requires improvement with caring, effective and responsive rated as good.
- CQC has upgraded the maternity services rating at Stroud Maternity Hospital from requires improvement to good overall and across all five key questions following an inspection in September 2025.
CQC imposed conditions upon the trust in 2024 to ensure the safety of care at Gloucestershire Royal Hospital’s maternity department. These remain in place and the trust continues to report to CQC monthly in line with the requirements of those conditions.
Catherine Campbell, CQC deputy director of hospitals, secondary and specialist care for the South-West, said:
“When we inspected Gloucestershire Hospitals NHS Foundation Trust what really stood out to us was the change at the top of the organisation. We rated the trust’s leadership as good overall, following a period of instability with several changes in executive roles over the past three years.
“Staff told us they now feel there’s stability in the leadership team, and it’s making a genuine difference. Leaders are getting out and about, visiting wards and services, and staff said they feel heard when they raise concerns.
“That said, this cultural shift hasn’t reached every corner of the organisation yet. Some staff, particularly in maternity, told us their senior leaders were less visible, and described a blame culture rather than a focus on learning. Leaders themselves acknowledged this and know where the gaps remain.
“We saw real signs of progress in maternity services at Gloucestershire Royal Hospital, which have improved from inadequate to requires improvement. Women told us the care they received from midwives was often excellent, with staff described as calm, professional and compassionate, even during traumatic births.
“One woman told us staff took the time to listen to what she wanted and how she felt. But we also heard from women who felt let down. Some described feeling overwhelmed and unsupported after birth, with one telling us she didn’t get help with feeding and another saying her repeated pain complaints were dismissed.
“Staffing pressures were behind much of this. Midwives were working hard, often going above and beyond, but low staffing levels meant wards became overcrowded and important things were sometimes missed. Safeguarding training compliance was also below target, which the trust needs to address urgently.
“In urgent and emergency care at Gloucestershire Royal, we found similarly mixed experiences. People told us staff were kind and treated them with dignity, but overcrowding meant their privacy wasn’t always protected, and some people struggled to get anyone to listen when they raised concerns.
“We're encouraged by the direction of travel and the honesty we found among leaders about where things still need to improve. We’ll continue to check on their progress and make sure people are safe whilst further improvements are made.”
Trust Leadership – inspectors found:
- The trust reduced registered nursing vacancies significantly, from 15% to 4.5% reducing pressure on existing staff.
- Leaders introduced a new process to tackle bullying, harassment and discrimination.
- The trust introduced daily executive-led safety huddles which supported a better understanding of the frontline issues departments were facing.
- Leaders launched a new initiative to build a more consistent, compassionate leadership culture.
- However, the trust didn’t appoint disabled applicants as often as non-disabled applicants, and disabled staff reported more discrimination.
- The trust hadn’t closed gaps in its ethnicity data, with records held for only 89% of staff.
Urgent & Emergency Care - inspectors found:
- The trust didn’t manage safety in the emergency department effectively, with sustained crowding and one of the highest rates of delay-related harm in the region.
- The trust didn’t provide people with suitable conditions during extended waits, with noise and draughty corridors making it difficult for them to sleep and meet their hygiene needs.
- Staff couldn’t always protect people’s confidentiality when speaking with them because of overcrowding.
- Staff treated people with kindness, discretion and respect despite pressure. One staff member arranged a British Sign Language interpreter for a person who was hard of hearing.
- Staff introduced a new checklist to identify homeless people’s needs, now part of mandatory documentation, improving equity of access.
- Leaders stayed visible and approachable and were honest with staff about ongoing challenges.
- The trust set out a five-year strategy prioritising a return to the four-hour waiting standard
At Gloucestershire Royal Hospital maternity – inspectors found:
- Leaders weren’t ensuring that the triage pathway was consistently safe and effective. On some occasions, staff discharged women from the triage unit before their test results were available and asked them to wait at home for the results.
- The trust didn’t fill some maternity vacancies, putting increased pressure on existing staff.
- However, staff held twice-daily induction of labour meetings to review every woman individually, assess risks and prioritise care according to clinical need. This allowed teams to work together and coordinate care effectively.
- Specialist staff provided high-quality bereavement support with dedicated bereavement midwives delivering sensitive and comprehensive care to families experiencing baby loss, supported by a purpose-designed bereavement suite.
At Stroud Maternity Hospital maternity – inspectors found:
- Trust leaders worked with the Stroud Hospitals League of Friends to improve maternity facilities and expand support for new mothers, using community funding to provide free yoga and singing sessions alongside upgraded environments.
- Trust leaders secured the maternity service’s participation in a national pilot, helping bereaved families access independent support and ensuring their experiences were heard following serious incidents.
Medical Care – inspectors found:
- Staff treated people with kindness, empathy and compassion; national survey data showed people felt listened to.
- The respiratory ward ran a quality improvement pilot to support early discharge, freeing up beds sooner.
- Staff collaborated well across teams, holding bed meetings three times a day to manage flow through the department.
- The trust didn’t keep two bathrooms on elderly care wards in use, leaving one out of use since May 2025 forcing staff to wash people at their bedsides. Staff also used both bathrooms to store equipment.
- Leaders didn’t ensure staff checked emergency medicine trolleys regularly, so staff couldn’t be confident that medicines were fit for use in an emergency.
- The trust didn’t secure a suitable specialist community or mental health placement for a person with an eating disorder, leaving them on an acute medical ward for four months.
- Staff didn’t consistently support a person with a hearing impairment to understand her care, leaving her feeling that she was missing out on what was happening.