Herefordshire and Worcestershire Health and Care NHS Trust

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

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 Outstanding. 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 care.

The service was in breach of regulation 17 as we identified that the provider’s governance processes were not always effective. The provider did not have robust systems and processes in place to effectively identify and manage health and safety risks within the environment.

This service scored 61 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service did not always have a shared vision, strategy and culture that is based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding and meeting the needs of people and their communities.

There were 5 core values across the workforce: Courageous, Ambitious, Responsive, Empowering and Supportive. The trust’s vision was “Working Together for Outstanding Care.” Most staff we spoke to were aware of the trust’s organisational values and told us they could find further information on their intranet. The vision and values were displayed on boards in the nurse’s offices.

Most staff on Cottage ward and Cherry Orchard ward told us that there was an open culture on the ward where they felt safe to raise concerns. However, the provider did not foster a positive culture for staff on Lickey ward. Although staff told us they would feel confident to raise concerns about patient safety, 1 staff member on Lickey ward added that they did not feel that concerns about staff conduct would be dealt with promptly. Staff told us the provider’s values were not always upheld by the management team, and we observed that staff morale was very low, with some staff members visibly upset when speaking with us. Staff sickness and staff turnover were higher than other wards across community hospitals and several staff told us they did not feel listened to or supported by the provider. Staff demonstrated motivation to deliver a good standard care, and we observed staff working in a dedicated way despite the challenging circumstances.

Leaders were aware of the poor culture on Lickey ward and had held several meetings to discuss this prior to our assessment. A meeting was held on the day of our visit whereby senior leaders, ward level management and ward staff were given time to raise their concerns. Senior leaders informed staff that support measures were in the process of being embedded to address several concerns raised by staff. This had been communicated to staff via a staff bulletin in August 2025, however, 1 staff member said that they did not feel this was sufficient.

The service did not always have inclusive leaders at all levels who understood the context in which they delivered care, treatment and support. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively and do so with integrity, openness and honesty.

Leaders had effective support and opportunities to develop and maintain their skills. The roles of staff and leaders were clear, and they understood their roles and responsibilities.

Staff understood the reporting structures and leaders understood their key roles and responsibilities. Leaders were able to demonstrate how they worked as part of a multidisciplinary team within the service. Leaders were present at a multidisciplinary team meeting we attended on Cherry Orchard ward.

Most leaders were visible in the service and approachable for staff. However, some staff told us that leaders were not always visible and approachable on Lickey ward. Leaders we spoke to were aware of the significant concerns raised by staff on Lickey ward and were already taking steps to address this prior to our assessment. Lickey ward had developed an action plan for several concerns identified on this ward and “leadership” was documented as an action point. The trust was providing further support to leaders on Lickey ward and was now managing this through the usual management and clinical supervision process.

The provider had made the decision to close Apple Orchard ward prior to our assessment and full closure of Worcester City Inpatient Unit is planned for 2027. Staff were mostly positive in relation to how the provider and senior leaders had supported them through this period of transition. However, we were told by staff that initially this news had not been delivered sensitively and in a way that they would have expected. Since this had been shared, staff told us they felt supported by ward level management.

The service mostly fostered a positive culture where people felt that they could speak up and that their voice will be heard.

Although we identified concerns with the culture on Lickey Ward, the provider ensured that there were processes in place to enable staff to raise concerns confidentially. The trust had a Freedom to Speak Up guardian and an established process for staff to raise concerns. All staff we spoke with about this topic told us they were aware of how to use the Freedom to Speak Up process or knew where to find further information on this process. Staff told us they would feel comfortable raising concerns through this process; however, most staff we spoke to told us they would raise concerns directly with their manager.

We saw the freedom to speak up policy. The policy was clear on who can speak up, who to speak up to and how issues would be investigated and resolved. The trust had developed a report for 2024/2025 which looked at key themes across community hospitals and action points to address these concerns, including a freedom to speak up action plan which was ongoing between 2025 and 2028.

The service valued diversity in their workforce. Staff worked towards an inclusive and fair culture by improving equality and equity for people who work for them.

The trust had a range of staff networks, including ENRICH (Equality Network for Race Inclusion and Cultural Heritage,) Staff Disability Network and the Carers Staff network.

Staff could apply to work flexibly and flexible working arrangements were in place to account for personal circumstances such as health issues. Staff told us that leaders had put reasonable adjustments in place for staff members to help them carry out their role.

The trust has an Equality, Diversity, Inclusion and Equity Strategy (EDIE,) called “Harmony in Diversity: Creating a Community for All.” The strategy included action points from the trust’s CQC Well-Led inspection in June 2023, that identified minimal actions taken by the trust to address equality, diversity and inclusion issues felt by staff. The strategy sets out 6 objectives with measures of success and timeframes for completion, including increasing the diversity of their workforce.

Equality and diversity training was part of mandatory training available to staff. We found that compliance levels were above 90% across all 3 wards we visited.

The service did not have clear responsibilities, roles, systems of accountability and good governance to manage and deliver good quality, sustainable care, treatment and support. Staff did not always act on the best information about risk, performance and outcomes.

A trust wide governance structure was in place with all individual services feeding into it. We saw information was documented in unit and divisional meeting minutes and was cascaded up and down. There was a clear framework of what must be discussed at a ward, team or directorate level in team meetings to ensure that essential information was shared and discussed.

The trust had developed a risk register for “Countywide Community Services” which included all community hospitals within the trust, including those we visited as part of this assessment. The risk register described the risk and any controls, assurances and gaps for management of each risk. The risk register included digital, environment, finance, quality, workforce and clinical safety risks. For example, 1 risk identified on the risk register related to the carpet in some areas of Worcester City Inpatient unit. It was documented on the risk register that the carpet would not be replaced, but controls and assurances were documented, including increased cleaning schedule.

However, concerns we identified onsite did not always match those identified on the risk register. For example, we had concerns with the security on Cottage and Lickey wards as there were minimal controls to enter and exit the ward. Leaders on the ward had attempted to mitigate this risk by using a piece of paper to cover the exit button, however, we observed 1 patient leave the ward twice during our visit. This is particularly concerning for those patients who are subject to DoLS. The security of the wards was not documented as a risk on the risk register, so we are not assured that the provider has the appropriate mitigations in place to manage this risk.

We reviewed integrated governance meeting minutes for Countywide Community Services and found that the meetings followed a standard agenda, including safeguarding, patient safety and staffing. We found that although risks had been identified, timely action was not always taken to address this. We reviewed meeting minutes for August 2025 and found that the trust had identified that there was a gap in safety intervention training for staff and that this would be added to the risk register. Although leaders had arranged training for staff, this had not been added to the risk register dated October 2025. The trust had therefore not taken timely action to ensure appropriate oversight of this risk.

The trust’s systems and processes were not always robust in identifying and managing concerns relating to safety of the environment, including concerns that we identified during our visit. For example, we observed that several automatic fire-door closers were not in working order during our visit to Cherry Orchard ward, increasing risk to patients if there was a fire at the service. This had been identified as needing repair and recorded in the service’s maintenance book several times. Leaders on the ward told us that this had been raised with the provider’s internal maintenance team on several occasions over several months, however this had not been actioned at the time of our visit. The provider had also completed internal fire-door closer checks, however this reported that there were no concerns, which contradicted both the maintenance records and our observations. The provider did not always have the processes in place to provide assurance or illustrate that they acted on concerns when needed.

We were not assured that the provider had the appropriate systems and processes in place to ensure that fire drills and evacuations were routinely carried out. For example, leaders told us that there were no recorded fire evacuations or walkthrough of evacuation methods for 12 months preceding our assessment across all 3 wards we visited. The most recent health and safety audit for Worcester City Inpatient was completed in November 2024; however, this was not identified as a potential area of concern. We were not assured that staff were familiar with evacuation procedures and could safely evacuate patients from the building in the event of an emergency.

Patient records were stored securely on an electronic records system. However, we struggled to find the information we needed in electronic patient records in relation to Mental Capacity Assessments and DoLS Applications as documents were located across different areas of the record system. The trust confirmed that a request for development of this system has been submitted with the intention of making uploading of documentation clearer to staff.

Although safe staffing levels were met, staff told us these were not sufficient to meet all patients’ needs, and we observed impact on patient care during our assessment. Whilst the trust had conducted a safe staffing audit, we were not assured that this reflected the varying levels of support required across services. Staff morale was notably low, and we observed a lack of clinical supervision, which may further impact staff feeling supported by management and the quality of care provided.

The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They shared information and learning with partners and collaborated for improvement.

The service provided examples of how they were collaborating with external and internal partners to support and improve the healthcare experience of patients. Directorate leaders engaged with external stakeholders, such as commissioners and Healthwatch. Leaders told us that they had engaged with funding authorities to ensure standardised referral information as part of their Length of Stay Programme.

Staff told us they could meet with members of the provider’s senior leadership team to give feedback. We attended a meeting during our visit to Lickey ward and found that senior leaders discussed concerns raised by staff and discussed this in collaboration. However, 1 staff member told us that this was not regular practice.

The service focused on continuous learning, innovation and improvement across their organisation and the local system. Staff encouraged creative ways of delivering equality of experience, outcome and quality of life for people. Staff actively contributed to safe, effective practice and research.

The trust had quality improvement training available for all staff (Quality, Service Improvement and Redesign (QSIR) programmes) to support quality improvements at all levels. Staff could apply for introductory, intermediate or advanced level training and could further information of quality improvement initiatives on the intranet. The leadership and management training also had a module on quality improvement.

The trust had quality improvement leads who were working to engage community hospitals in quality improvement work, as they had identified a gap in willingness to engage. Prior to our assessment, the quality improvement team held a “roadshow” to connect with staff and gather ideas to drive change.

Innovations were taking place at the service. A range of quality improvement initiatives had taken place preceding our assessment, including those directly relating to Cottage, Lickey and Cherry Orchard wards. For example, reduction in the use of therapeutic observations in community hospitals and the implementation of end-of-life comfort boxes in community hospitals.

The trust had an initiative called “Transformation Tuesday” which was an opportunity for staff to share stories of positive change and drive further improvements. Successful quality improvements were actively celebrated by the trust.