East Suffolk and North Essex NHS Foundation 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
• Environmental sustainability – sustainable development

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.

We scored the trust as 3. The evidence showed a good standard. The trust 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 trust had a clear vision and a set of values with quality and sustainability as the top priorities. There was a realistic strategy for achieving the priorities. The main strategic objectives were to:

• Keep people in control of their health;
• Lead the integration of care;
• Develop our centres of excellence;
• Support and develop our staff;
• Drive technology enabled care.

The strategy had been developed in alignment with the wider system strategy and was underpinned by several enabling strategies including clinical, people, digital, medicines optimisation and estates.

The trust measured organisational performance against strategic objectives and plans at divisional and board level. Staff at all levels identified risks to delivering the strategy including relevant local factors and had action plans in place to address them.

The trust had developed an overarching 5 year clinically focused strategy published in 2024. The strategy was underpinned by the trust values of being ‘Optimistic, Appreciative and Kind’ and the philosophy of ‘Time matters’. The strategy has been developed collaboratively with staff and external partners in care and was clearly aligned to system wide plans and national priorities. Underpinning the strategy was an annual business plan aligned to organisational objectives in line with national requirements. The trust was planning to move to the 3 year cycle as mandated by NHS England and welcomed the opportunity for more medium term business planning to support longer term projects.

There was clear alignment of the strategy to system wide plans and the trust was aware of the challenges and the needs of people and their communities. For example, there were a number of strategies focused on improving support for specific population groups and diverse communities. One of which is the well-established Armed Forces Network. The trust worked with local system partners to develop plans to tackle health inequalities and identify actions that meet the need of communities. The trust had developed strategies to support harder to reach groups based on the demographics of the area served. (see partnerships and communities for further detail)

As a key part of the strategy, the trust had implemented an electronic patient record (EPR) across both sites in line with national priorities in October 2025. Staff at all levels told us that this implementation had been the main focus of the strategy over the last 18 months to improve their ability to deliver quality care. For example, during our most recent assessment of medical care and urgent and emergency care services we found that there continued to be gaps in documentation which could have an impact on the delivery of safe patient care. Staff told us that the implementation of the EPR would improve the quality of record keeping and transparency. However, the impact of implementation had affected staff morale as some people told us that it had increased their workload and caused capacity issues as people underwent comprehensive training on the new systems.

Whilst the implementation of the EPR had been the main focus and the aspect most people spoke with us about, most staff we spoke with understood what the vision, values and overall strategy were and their role in achieving this. Senior leaders recognised that the need to maintain financial stability and the implementation of EPR represented a risk in relation to the effect on staff morale. Senior leaders took actions to minimise these risks. For example, to minimise the risk related to EPR, there had been a structured approach to implementation. The trust had ensured that there was dedicated support to teams before, during and after implementation. Staff told us that this support had been integral and well received. Despite the challenges of implementation, staff at all levels were aware of the benefits that the EPR could bring and positive about the future direction.

The trust had worked hard to achieve financial sustainability and meet financial targets agreed with NHS England. This had been achieved consistently for the last 7 financial years prior to this assessment. Whilst this was a strong display of financial management, some staff told us that the impact of rigid cost improvement plans meant that they did not always feel heard. For example, we were told that the process for ordering necessary supplies in some areas was restricted to senior leaders, which could sometimes cause delays in patient care. Our interviews with senior executive leaders and review of documentation demonstrated that the trust had processes in place to ensure that the quality of care was not impacted by financial constraints, this was discussed at monthly meetings with divisional and executive leaders. We saw examples of teams working differently and innovatively to deliver services in a more cost effective way without impacting on care and contributing to strategic objectives. At the time of our trust level assessment the trust did not have a financial strategy in place (please see governance and risk management for further details).

The trust people strategy (2024-2027) was aligned to the NHS workforce plan (2023) and focused on 4 strategic objectives. The strategic objectives related to all trust staff including volunteers, and are workforce planning, resourcing and retention, staff experience, system working and leadership education, training and development. Each people objective was clearly aligned to the overarching strategic objectives and the board assurance framework. One of the key areas the trust was working on related to culture and staff experience. Senior leaders were aware of the work that needed to be progressed in this area to ensure that people felt their concerns were heard (see Freedom to speak up section for details). Progress against each of the people strategic objectives was monitored at committee level and escalated to the board appropriately.

The trust had a comprehensive estates strategy which was aligned to local and national strategies. The strategy focused on managing the complex portfolio to maximise efficiency and increase capacity and was underpinned by the trust values. Senior leaders acknowledged that the variation of estates meant that some areas (particularly at Ipswich Hospital) presented more challenges in terms of maintenance and expansion. This is highlighted in the corporate risk register and monitored at board level.

The trust medicines optimisation strategy was focused on ensuring that patients received the right medication at the right time. Our interviews with staff at all levels demonstrated that whilst the strategy would be effective, it was not being fully realised due to under resourcing in the pharmacy department. Staff also told us that the lack of clinical pharmacy input on wards was having an impact on patient safety and experience. At the time of our assessment the medicines optimisation strategy had been extended for a year as the original strategy (2019-2024) had expired in May 2025. Some staff felt that the implementation of the electronic patient record had taken priority over the need to invest in the key clinical area of medicines optimisation.

We scored the trust as 2. The evidence showed some shortfalls. The trust had leaders who generally understood the context in which they delivered care, treatment and support. Leaders worked to embody the culture and values of their workforce and organisation. However, leadership visibility and effectiveness were not consistent across the organisation, and sometimes slow to take effective actions to address safety risks.

Leaders generally had the skills, knowledge and experience they needed on appointment and this was assessed on an on-going basis. Our review of documentation and interviews with senior leaders demonstrated that the trust had effective processes to meet the requirements of Regulation 5: Fit and proper persons (Health and Social Care Act 2008 (regulated activities) Regulations 2014).

All leaders we spoke with understood the context in which care was delivered in the trust and the challenges they faced. However, leaders were sometimes slow to take effective actions to address safety risks. For example, we issued S29A warning notices for both locations after we identified significant patient safety risks. Our review of documentation and interviews with leaders confirmed that leaders were aware of these issues however the actions taken had not sufficiently minimised the risk of avoidable harm to people using services. 

Staff told us that executive leaders were not always visible across the organisation. Our interviews with executive leaders confirmed that there was a structured programme for non-executive directors to visit various parts of the organisation over a 12 month period. Executive leaders told us that they regularly visited various areas of the organisation. Some divisional leadership teams were situated within departments and wards and were visible and approachable for all staff. The chief executive officer held a weekly call for all leaders and a quarterly all staff call hosted by the executive leadership team.

Leaders tried to ensure that there was a culture of openness and transparency. This included ensuring that senior leaders modelled behaviours that were in line with the trust values. Whilst we observed professional behaviours in line with the trust values during our trust level assessment, prior to our trust level assessment some staff told us that they did not always feel that this was consistent.

Senior leaders generally worked collaboratively internally and externally to identify actions to address challenges. For example, the trust had developed a delivery plan to improve the care for patients with mental health illness in April 2024. This involved working collaboratively with stakeholders including patients, other local trusts and local authorities. Progress on the delivery plan was monitored regularly and we saw evidence of improvements including more specialised staff and working with system partners to support people receiving care in the right place at the right time. Despite the trust efforts, senior leaders acknowledged that there were still system-wide improvements to be made to minimise lengthy delays for patients with mental health illness in inappropriate areas such as emergency departments. The issue of lack of available mental health beds is a national issue and senior leaders were committed to working with system partners to drive improvements for people with mental health illness.

Leaders worked collaboratively internally and externally to address challenges. There were identified senior lead roles across the organisation to support the delivery of strategic objectives. This included a lead for safeguarding, learning disability and dementia. Each senior lead was supported by an executive member of the team who had overall responsibility of delivery.

There were priorities for ensuring sustainable, compassionate, inclusive and effective leadership. There was a leadership strategy and development programme in place which included succession planning. Our interviews with senior leaders and review of documentation confirmed this. For example, we saw that the succession planning strategy was discussed at board level and at relevant committees. Bespoke trust leadership courses had been developed collaboratively with the trust organisational development team and higher educational institutes.

We scored the trust as 2. The evidence showed some shortfalls. People did not always feel they could speak up and that their voice would be heard.

The Freedom to Speak Up (FTSU) framework and approach was established within the trust. However, we were made aware that some people still do not feel that their voices are being heard or that it is safe to raise concerns. Some staff felt that the FTSU arrangements were not effective in practice. The trust was aware of this and senior leaders were identifying actions to encourage and empower staff to raise concerns.

The dedicated FTSU guardian had been in post since 2016 and was well known to staff at all levels. There was a deputy FTSU guardian and assistant FTSU guardians throughout the trust. The trust had a FTSU policy in place and the guardian was supported by the chief nurse, chief medical officer and a non-executive director (NED) member of the board to ensure that themes from concerns were escalated to board level. The guardian delivered annual and 6 monthly reports to the board and had direct access to the chair and CEO of the trust. Whilst FTSUG access to senior leaders was seen by many staff as a positive factor in raising concerns some staff felt that this was a weakness in the process. Some staff told us that they would not feel safe to raise concerns about executive leaders behaviours as there was a perception that confidentiality would be breached through direct access to the CEO and chair. Senior leaders told us that FTSU guardian access to the CEO and chair was to enable oversight and management of any cases related to the board or members of the executive team. Our review of documentation and interviews with senior leaders demonstrated that there was appropriate review of the FTSU processes in line with national guidance.

From April 2024 to March 2025 there were 196 cases reported to the trust's FTSU guardian. The main themes were worker safety (n83 – 43.9%), patient safety (n74 – 39.1%) and bullying or harassment (n52 – 27.5%). Some of the concerns were raised as individual concerns but some were raised by representatives of groups of staff which means that the numbers of concerns does not accurately reflect the numbers of people affected. Within the cases there were a small proportion which suggested an element of discrimination against staff with protected characteristics. The trust had taken actions to address this by working with the staff equality networks to identify equality network members who would become assistant guardians. Leaders told us this was to foster a more comfortable and safer environment for people with a protected characteristic to feel able to raise concerns through the network.

Leaders we spoke with acted with openness, honesty and transparency and were committed to ensuring that staff felt safe to raise concerns. There was an acknowledgement that whilst the FTSU processes were well established there were still areas for improvement. This was also reflected in the NHS staff survey results and the trust’s response to the staff survey. One of the actions identified by the trust is to improve staff’s confidence in raising concerns through all channels including line managers and the FTSU process. In May 2025, the trust had re-introduced the FTSU steering group which had representation from each of the staff equality networks. The board had also endorsed the FTSU vision:

‘We encourage our staff to raise concerns openly, or anonymously if they prefer, safe in the knowledge they will be supported if they do, to make our trust a positive and trustworthy place to work and receive care.’

There were more plans to strengthen governance and confidence in relation to raising concerns and speaking up. This included formally recording meetings between the FTSU guardian and lead NED so there was a clear audit trail of conversations. The trust had also reviewed their leadership training programmes and updated the training in management of concerns raised by staff. The focus being on staff feeling safe to raise concerns to their line managers and supporting managers to listen and act on feedback. Leaders acknowledged that this would take time to embed. Actions taken were monitored through the people and organisational development committees and the FTSUG met with the director of people and organisational development on a monthly basis to discuss progress and themes from cases.

We scored the trust as 2. The evidence showed some shortfalls. The trust did not always demonstrate that diversity is valued in their workforce. They were working towards an inclusive and fair culture and improving equality and equity for people who work for them.

The trust was working towards an inclusive and fair culture. This included developing an anti-discriminatory approach to continually review and improve the culture of the organisation in relation to equality and diversity. However, the trust had not made significant progress since our last well led assessment and over the last 5 years and senior leaders acknowledged that there were further improvements needed. This was recognised and articulated at board level and linked to the board assurance framework.

The NHS staff survey, Workforce Race Equality Standards (WRES) and Workforce Disability Equality Standards (WDES) 2024/25 results confirmed that staff from a black and minority ethnic background or those with a long-term condition/illness continued to have a worse experience at the trust than others. This was also highlighted within the trust’s WRES and WDES annual reports.

The trust had an equality, diversity and inclusion (EDI) strategy and associated work programme which was led by the Chief People Officer.  A part of the EDI strategy is to improve the experience for staff based on the WRES and WDES results. Since our last assessment the trust had continued to identify actions to address the areas for improvement in WRES and WDES. This included developing recruitment processes and strategies and mandating EDI training tailored to roles and responsibilities. However, the impact of these actions were variable, with some improvements but in some areas metrics had deteriorated. The EDI Strategy work programme had a number of different workstreams such as ‘Our patients’, ‘Our talent’ ‘Improvement and innovation’, and ‘Living our values. Each workstream had a number of topics with identified actions for each topic. Actions and targets were monitored through the people and organisational development department and associated committees. Actions included reverse mentoring and an external engagement programme with local communities about careers in healthcare to increase representation. Our interviews with senior leaders and review of documentation demonstrated that leaders were committed to working collaboratively internally and externally to improve the culture in relation to equality and diversity.

There was some evidence of the trust taking actions to prevent and address bullying and harassment. However, we heard the impacts/benefits were not yet being experienced by all staff and the experience for black and minority ethnic staff was worse than that of their white colleagues. This was reflected in the NHS staff survey, WRES and WDES data and referrals to the freedom to speak up guardian. The trust introduced a sexual safety charter in March 2024, and introduced focused training for all line managers to support holding performance conversations with staff in October 2025.

The trust was taking actions to better understand the experience for different staff groups by capturing data and information to monitor the actions taken. Our review of documentation submitted to the people and organisational development committee demonstrated that whilst the trust was taking action to address workforce inequalities, this would take more time to demonstrate that the actions taken were driving improvements in workforce equality.

We scored the trust as 2. The evidence showed some shortfalls. The trust 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. However, the trust did share relevant information securely with others when appropriate.

There were generally effective governance systems in place and processes to manage risk and performance. However, these systems did not always interact effectively to support the delivery of quality sustainable services. This was demonstrated at our most recent assessments of medical care and urgent and emergency care at Ipswich and Colchester hospital sites. We found significant concerns in these areas that should have been identified through the trust own governance and risk management processes and actions taken to protect people from potentially avoidable harm.

The trust board assurance framework (BAF) highlighted the risks that the trust faced in delivering the strategic objectives. There were 10 risks highlighted on the BAF, one of which related to the trust having assurances that they were delivering safe quality care. The trust also had a corporate risk register where divisional risks that were at a high level were escalated for board oversight. Our review of documentation and interviews with senior leaders confirmed that whilst there were systems to link quality issues on the corporate risk register to the BAF. There was still a lack of visibility at board level of some of the risks faced by some of the services. 

Equally some risks that we had identified during our assessments of urgent and emergency care and medical care had not been effectively escalated. For example, evidence had been presented to the trust quality and patient safety committee in October 2024 focusing on the need to improve adherence to food and hydration needs of patients. This fundamental standard of care was not escalated as a corporate risk or linked to the BAF. We found significant concerns in this area on our assessments of medical care in May 2025. This demonstrates that whilst the trust had identified the risk this had not been appropriately escalated and effective actions had not been taken to address the risk in a timely manner. After our assessments, where possible, the trust took immediate action to address the concerns raised and; from July 2025 introduced a fundamentals of care board to monitor the implementation of the longer term actions with executive oversight to help improve performance and provide assurance to the board in this area and other areas of care such as falls prevention and skin integrity.

The trust had appropriate committees and steering groups; however, some senior leaders we spoke with were unable to describe how the effectiveness of committees was measured. Following the appointment of new non-executive directors (NEDs), the trust made changes to committee chairing where NEDs rotated to chair different committees. Whilst this appeared to be a way to get ‘fresh eyes’ at committees and share learning, this also could introduce reduced non-executive challenge from a subject matter expert. It was not clear how the trust was measuring the effectiveness of this rotation to ensure it was achieving the objectives. Following the inspection, leaders told us that the trust made permanent changes to committee chairing and were not rotating committee chairs.

Our interviews with non-executive and executive leaders and review of documents demonstrated that the right information was generally escalated through the relevant committees and sub-committees to board level and actioned appropriately.

The trust reviewed their governance processes and systems on an annual basis and in line with statutory requirements. This included risk management systems and processes. Our review of documentation and interviews with senior leaders confirmed that changes were made when indicated to improve governance and risk management arrangements. For example, the trust had re-introduced a risk oversight committee (ROC) in January 2023 after an external review of quality governance. The ROC was introduced to improve assurances that risks were given sufficient coverage at executive level and there was appropriate triangulation of risks to minimise duplication and assure that the highest levels of risk were effectively escalated.

There were well established divisional accountability meetings (DAM) for each clinical division group. The DAM was held monthly and was chaired by an executive staff member. Divisional leaders were responsible for providing assurances in a number of areas including quality, risk, finance and performance.

There were systems in place to review performance metrics against all national standards. This included an integrated performance report, DAMs and relevant oversight and assurance groups. The trust performance against national key performance indicators was generally in line with the regional and national levels. Our review of documents and interviews with senior leaders confirmed that the trust had effective system in place to monitor, measure and improve performance in all areas including referral to treatment (RTT), cancer diagnosis and treatment, diagnostics and urgent and emergency care.

The financial governance arrangements at the trust were well established and there were control measures in place to balance quality of care with cost effectiveness. At the time of the assessment, there was no financial strategy in place, although it was recognised that the Trust was working on developing its medium term plan submission, as per the national guidance issued in October 2025. However, this represented a short-term risk in that it impacted the ability to plan for sustainability. For example, the estates strategy required major investments over 10 years and with the absence of a finance strategy it would not be possible to triangulate affordability of the plans. Senior leaders acknowledged this and were confident that the financial strategy would be updated soon and in line with updated NHS England guidance.

There were systems in place to ensure that data and information was reliable, accurate and kept securely in line with data protection legislation.

We scored the trust as 3. The evidence showed a good standard. The trust understood their duty to collaborate and work in partnership, so services work seamlessly for people.

The trust continues to develop strong system partnerships and is an active partner in the development of Integrated Neighbourhood Teams in both Suffolk and North East Essex. Work is ongoing to align more closely with primary care and mental health services to improve joined-up, person-centred care, supported by effective use of estates, technology and education resources. Integrated community services are strengthening care closer to home, with community hubs, virtual wards and urgent care response services helping to avoid admissions and reduce ambulance conveyance.

Leaders at the trust invested time in building relationships, understanding perspectives, and engaging with partners within Integrated Care Boards, provider collaboratives and other forums including primary, mental health and social care partners. 

The trust continued to strengthen its partnerships across the health and care system and was an active partner in the development of Integrated Neighbourhood Teams across Suffolk and North East Essex. Work was ongoing to align services more closely with primary care and mental health providers to improve joined-up, person-centred care. This collaborative approach was supported by the effective use of estates, technology and education resources.

Integrated community services supported care closer to home through community hubs, virtual wards and urgent community response services. These initiatives helped to prevent unnecessary hospital admissions, reduce ambulance conveyance and support timely discharge. Virtual wards enabled people to return home and maintain their independence while receiving ongoing monitoring and support, demonstrating the trust's commitment to providing integrated care within the community.

The trust also worked in partnership with education providers to develop the local workforce and create opportunities for people within the communities it served. In partnership with the local university, the trust had successfully delivered a Medical Doctor Degree Apprenticeship programme, providing places for individuals who may not previously have had the opportunity to train as a doctor. The trust had also established a Diagnostic Training Academy in Clacton in partnership with Colchester Institute, providing training opportunities for 133 local residents to prepare for employment within the healthcare sector. These initiatives demonstrated the trust's commitment to developing local talent and supporting the sustainability of its future workforce.

As part of its health inequalities strategy, the trust works closely with community health providers to improve access to healthcare services for underserved populations. In partnership with a community transport provider, the hospital charity funded an additional hospital hopper bus, helping patients from more deprived areas attend healthcare appointments. The trust also delivers targeted community outreach programmes in areas of higher deprivation, working collaboratively with GPs and community partners to promote healthy lifestyles and improve health outcomes. These initiatives include smoking cessation support, asthma management for children and young people, advice on screening programmes, and the promotion of vaccination uptake

However, there were areas where partnership arrangements had not yet consistently resulted in timely and effective care. Although the trust worked collaboratively with the local mental health trust to support people presenting with mental health needs, at the time of our assessment, there were delays in accessing specialist mental health support for people experiencing a mental health crisis in the emergency department (ED). Staff told us that some patients waited for prolonged periods in the ED while awaiting assessment or appropriate mental health support from external mental health services. Staff also told us they did not feel sufficiently trained or confident to meet the needs of people presenting in mental health crisis during these extended waits. The trust had recognised these challenges and had escalated concerns regarding the capacity and responsiveness of the mental health service through the appropriate commissioning and system oversight channels. However, despite established partnership arrangements, delays in accessing timely specialist mental health support continued to impact the experience of people in crisis and placed additional demands on ED staff and services.

We scored the trust as 2. The evidence showed some shortfalls. The trust did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people.

Leaders we spoke with were focused on continuous learning, innovation and improvement across the organisation and the local system. Leaders advised that the trust had adopted a single quality improvement (QI) methodology, the Model for Improvement, which has been the agreed approach for several years and is embedded within training materials. A range of supporting QI tools were also used alongside this methodology depending on the nature of the improvement work being undertaken. However, during the inspection, we did not see consistent evidence of the QI methodology being applied across the organisation or examples demonstrating its use in driving improvement activity at Trust level.

The trust had introduced several improvement programmes, including the ‘fundamentals of care’, ‘every bay, every day’ and enhanced frailty services, and was continuing to develop its ward accreditation programme across wards and divisions. At the time of our assessment, 2 wards had achieved silver accreditation and 2 had achieved bronze accreditation within the MACIES division, with other wards working towards bronze accreditation. Ward governance reports demonstrated an intention to engage staff and empower local leaders to improve standards and the quality of care.

There were examples of innovation and learning being used to inform changes to care delivery. For example, the diabetes specialist nursing team had undertaken a trial to enable patients to administer their own insulin following feedback that patients felt disempowered when admitted to hospital. The service also changed its multidisciplinary model to provide younger adults with diabetes with a named nurse or clinician to provide greater continuity of care. Staff had also introduced initiatives in response to learning from incidents, including bay tagging and the yellow sock scheme to reduce falls. These examples demonstrated that staff were able to identify opportunities for improvement and, in some areas, translate learning and patient feedback into changes in practice.

The trust also participated in national audits to support learning and improvement. For example, cardiology services participated in the National Heart Failure Audit, National Audit of Cardiac Rhythm Management and Myocardial Ischaemia National Audit Project (MINAP), as well as assessments against NICE guidance. Other services participated in audits examining the appropriateness of CT head requests following inpatient falls. These audits identified areas for improvement, including sub-optimal use of the adult post-falls flow chart and omissions in neurological observations and Glasgow Coma Scale assessments. However, there was a lack of assurance that audit findings were being effectively translated into sustained improvements in practice. For example, while the falls audit had identified areas for learning and improvement, a repeat audit had not been undertaken to provide assurance that the actions taken had been effective and that the improvements had been sustained.

There were examples where improvement initiatives had produced positive changes, but the trust did not always have evidence to demonstrate that these improvements had been sustained. For example, work to improve communication of medication changes to GPs following discharge showed improvement in June 2024. However, we were not provided with data demonstrating the longer-term impact of the improvement work, and incidents and complaints indicated that this remained an area of concern. Similarly, the introduction of the yellow sock scheme and bay tagging demonstrated that staff were responding to increased falls. However, these measures were not consistently implemented. We observed patients at high risk of falls who were not wearing yellow socks, and patients in a tagged bay were not always observed because staff were required to provide personal care behind curtains and staffing levels did not allow another staff member to maintain observation. This demonstrated that improvement initiatives were not always supported by the staffing and resources required to make them effective in practice.

Although there was a clear strategic focus on quality improvement, our findings from the assessment service groups inspections identified inconsistencies in the extent to which continuous learning, innovation and improvement were embedded across the organisation. Staff did not always encourage creative ways of delivering equality of experience, outcomes and quality of life for people, and staff did not always actively contribute to safe and effective practice and research. The trust recognised that there were opportunities to strengthen its QI capacity and capability, and our findings indicated that this remained an area requiring further development, particularly in relation to providing staff with the time, support and resources to undertake improvement work.

There was evidence of repeated concerns across successive assessments, which raised questions about the effectiveness of organisational learning. During our previous assessment in November 2022, we identified 7 breaches, including mandatory training, safe staffing, completion of venous thromboembolism (VTE) risk assessments and safe storage of patient records. During this assessment, we identified repeated breaches relating to mandatory training compliance, VTE risk assessments and other aspects of safe care. This indicated that learning from previous assessments and identified risks had not always resulted in sustained and embedded improvement.

The trust had introduced several systems since 2024 to strengthen learning from incidents and complaints. However, these were not always effective in addressing repeated risks identified through incidents, audits and complaints. For example, following an inquest in 2024, leaders introduced a template for recording pressure ulcer damage to improve oversight and learning. Despite this, pressure ulcers remained the highest reported incident type, with 936 patient safety incidents relating to pressure and skin damage reported in July 2025. Audit findings continued to identify that pressure ulcer risk assessments were not always completed on admission or updated following significant change, and our review of patient records identified similar concerns. This suggested that the introduction of a new system had not, in itself, resulted in consistent changes in practice or reduced the underlying risk.

Similarly, there was an increase in Section 42 safeguarding concerns requiring local authority investigation into potential abuse or neglect of adults. The action log provided did not demonstrate that divisional leaders were taking timely and effective action in response to this increase. Leaders told us that changes had been made to safeguard patients on care of the elderly wards; however, these changes were not fully embedded. Staff we spoke with were not able to describe the incidents or the changes that had been implemented in response to the action plan. Clinical and non-clinical staff were not aware of the changes that had been introduced, and several actions were not yet fully implemented or embedded.

There were also gaps in how learning from incidents was communicated and understood by frontline staff. Learning was shared through a range of mechanisms, including newsletters, huddles, team away days and emails. However, staff we spoke with were not aware of recent medicines-related events or safeguarding concerns within their wards. This meant that, although there were multiple mechanisms for communicating learning, leaders could not always demonstrate that learning had reached frontline teams or resulted in changes to behaviour and practice.

The use of data and audit to drive improvement was also inconsistent. Audits of the fundamentals of care identified that nutrition and hydration charts and ReSPECT forms were not consistently completed in accordance with policy. Although actions had been taken, performance had not improved sufficiently to meet the trust standard of 95%. We were therefore not assured that audit and governance systems were consistently effective in driving sustained improvement.

Staff had access to Quality Improvement (QI) training and there were examples of staff using QI methods to improve services. However, staff told us they did not always have sufficient time to undertake QI projects alongside their existing workload. Staff reported being understaffed on wards on a daily basis, which affected their ability to consistently deliver high-quality care and undertake improvement activity. As a result, QI training uptake by staff was low. Mandatory training compliance for medical staff was also below the trust target of 90% across all topics. In addition, although there had been a focus on Mental Capacity Act training, we found gaps in training completion and documentation demonstrating that appropriate ethical and legal decisions had been made for patients lacking capacity. This indicated that training and development opportunities were not always translating into safe and effective practice.

Overall, the trust had established a number of structures and programmes intended to support learning, innovation and improvement, and there were examples of positive innovation, patient involvement, QI activity, national audit participation and ward accreditation. However, our findings demonstrated a gap between the trust's strategic ambition for continuous improvement and the consistent delivery and embedding of that improvement at service level. Repeated findings across assessments, ongoing themes from incidents and complaints, incomplete implementation of action plans and limited evidence of sustained improvement from audits meant that we were not assured that learning was consistently translated into effective and measurable changes in practice.

Leaders recognised that the trust needed to strengthen its QI capacity and capability. Further development was required to ensure that improvement activity was supported by clear measures of impact, effective follow-up and repeat audit, sufficient staffing and protected time for staff, and robust governance arrangements to confirm that changes had been implemented and sustained.

We scored the trust as 3. The evidence showed a good standard. The trust understood any negative impact of its activities on the environment and strived to make a positive contribution in reducing it and support people to do the same.

The trust recognised its responsibility to reduce the negative environmental impacts associated with healthcare delivery and to support staff, patients and local communities to make sustainable choices. Leaders described environmental sustainability as an important component of the trust’s wider strategy and were committed to developing sustainable models of care that supported better health outcomes while reducing the environmental impact and, where possible, costs associated with healthcare provision.

The trust had made progress in embedding sustainability within the way it delivered services. An example was the Community Diagnostic Centre (CDC) in Clacton, which had delivered approximately 61,000 tests and scans within its first six months of operation. By providing diagnostic services closer to where people lived, the centre had reduced the need for patients and visitors to travel to other hospital sites, with an estimated reduction of more than 211,000 miles of travel. This demonstrated how changes to service configuration could improve access and patient experience while also contributing to the trust’s environmental sustainability objectives. A further CDC was planned for Ipswich, in line with the direction of NHS 10 year plan, providing an opportunity to further embed the principle of delivering care closer to people’s homes.

The trust was also using digital technology to support more sustainable ways of working. The implementation of the EPIC electronic patient record (EPR) system was contributing to improved efficiency and sustainability through reducing reliance on paper-based records, printing and the physical movement and storage of documentation. Leaders identified the digital transformation programme as an opportunity to further reduce resource use while improving access to information and supporting more efficient clinical pathways.

The implementation of virtual wards was another example of sustainability being incorporated into models of care. Virtual wards enabled appropriate patients to receive monitoring and support closer to, or within, their own homes, reducing the requirement for some hospital attendances and associated travel. This approach supported patient independence and continuity of care while reducing some of the environmental impact associated with traditional hospital-based care. Sustainability was therefore increasingly being considered alongside quality, access and patient outcomes when developing clinical pathways.

In January 2024, the trust board approved the second iteration of its Green Plan for 2024 to 2027. The plan reaffirmed the trust’s commitment to achieving a carbon net zero future and set out its strategy and ambitions for reducing the environmental impact of its activities. It included an aspiration for the trust to maximise environmental benefits, improve health outcomes, reduce costs and become an exemplar for sustainable healthcare, supporting its ambition to be an attractive organisation in which to work and receive care.

The trust had established governance arrangements to provide oversight of its sustainability agenda. Sustainability performance was monitored by the trust board through the annual report, and a Non-Executive Director provided oversight and strategic direction where required. This provided board-level visibility of the trust’s progress against its environmental objectives and demonstrated that sustainability was recognised as a corporate responsibility rather than solely an estates or operational issue.