The Care Quality Commission (CQC) has rated leadership at The Princess Alexandra Hospital NHS Trust in Essex as requires improvement, following an inspection in January.
The Princess Alexandra Hospital NHS Trust (PAHT) provides general acute, outpatient and diagnostic services to a local population of 350,000 people, extending to 500,000 across Harlow, Epping, Bishops Stortford, Hoddesdon, Cheshunt and Broxbourne. The trust employs approximately 4,000 staff across three sites: The Princess Alexandra Hospital, Herts and Essex Hospital, and St Margaret’s Hospital.
This inspection looked at how well-led the trust is and to follow up on themes identified during recent inspections of the trust’s medical care services, surgery services, and urgent and emergency services.
CQC gives NHS trusts a single trust-level rating focusing on leadership and culture that replaces all other ratings at that level. CQC consulted on this approach and used feedback gathered to ensure this well-led key question at NHS trust level is appropriate for the new innovative, complex and integrated models of care being created.
Sarah Ivory-Donnelly, CQC deputy director of hospitals in the east of England, said:
“During our inspection at The Princess Alexandra Hospital NHS Trust, we found that leaders had clear ambition and the trust had a well-articulated strategy. However, these were yet to be fully embedded across the organisation to create a positive culture, improved staff experience and delivery of better care for people.
“It was concerning that staff told us their confidence in the organisation’s response to concerns remained low, and that staff felt they hadn’t been given a clear rationale for decisions made during the recent restructure. More than a third of staff who spoke up told us they’d had a negative experience as a result of doing so, and they didn’t always feel their concerns were acted on. Some staff on visas were reluctant to raise concerns at all because of worries about their immigration status.
“When staff don’t feel safe to speak up, opportunities to learn and stop poor care from happening again can be missed, which puts people’s safety at risk.
“However, there were areas of strength. Leaders had made real improvements since our last inspection through significant changes to the board, and stakeholders described the trust’s leadership as open, honest and transparent.
“Partners described the trust as open, constructive and willing to collaborate. The trust’s patient panel was also an exceptional example of community engagement, receiving national recognition including the Queen’s Award for Voluntary Service.
“The trust also demonstrated good progress on environmental sustainability, including a refreshed green plan and successful bids for external funding to improve energy efficiency.
“We have told leaders at The Princess Alexandra Hospital NHS Trust where improvements are needed and recognise that they have been responsive to these concerns and have taken actions, we will continue to monitor the trust closely to ensure this happens.”
Inspectors also found:
- Leaders weren’t doing enough to create an inclusive workplace, and staff networks for different groups of staff were still underdeveloped.
- Leaders had implemented organisational change at a pace and in a way that had adversely affected staff morale.
- The board’s arrangements for managing risks and responding to concerns raised by staff needed further development to provide consistent and effective oversight.
However:
- The board had been significantly strengthened since 2021, with a new Chair, Chief Executive, Chief Nurse, Medical Director and Chief Operating Officer, and stakeholders described leaders as open, honest and transparent.
- The trust had also made tangible progress on performance, clearing its entire 78-week waiting list and reducing its 65-week waiting list from 583 people to just 17.