Northampton General Hospital 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
• 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.

In assessing this Quality Statement, we considered feedback from leaders, staff, people using the services and local system partners, as well as reviewing trust processes and survey results.

There was a shared group vision, mission, and values. The trust told us they engaged with the clinical teams, staff, patients, and key stakeholders to ensure the understanding the challenges and needs of people and their communities. There was recognition that further work was required in cascading and embedding the culture and vision desired.

The trust’s shared mission was to provide safe, compassionate, and clinically excellent patient care, by being an outstanding employer for staff, by creating opportunities, supporting innovation, and working in partnership to improve local health and care services. However, during our assessment we were told by staff that there was the lack of collaboration with the local trust staff to deliver this overarching mission. During our assessment, we received in-depth accounts from staff, including senior staff and clinicians, relating to poor management styles, an unapproachable executive team and detriment which had been experienced. Whilst this was a small number of staff comparable to the size of the organisation, the information given was collaborated during focus groups and was escalated to the senior team during our assessment. There was recognition during conversations with executives and within University Hospitals of Northamptonshire NHS Groups well-led self-assessment report, that further work was required in cascading and embedding the culture and vision desired within the organisation.

The trust group had ‘Our Strategic Framework 2025’, which described their vision of achieving their priorities of transforming patient care, strengthen the culture and deliver their financial plan by being “Dedicated to excellence in patient care and staff experience, and to becoming a leader in clinical excellence, inclusivity and collaborative healthcare.” Underpinning these priorities were the groups values and 10 key deliverables. The group aimed to reduce waiting time and improve patient flow by delivering national access targets in planned care and transform pathways with system partners to safely reduce the number of people accessing urgent and emergency care in our hospitals. The quality priorities included the full implementation of the Patient Safety Incident Response Framework (PSIRF), the delivery of the perinatal safety programme and the delivery of the current people plan prioritised actions for 2025, which included action to tackle bullying, discrimination, and harassment.

The trust’s values were chosen by staff and included the involvement of patient representatives. These were:

‘Courage - We dare to take on difficult challenges and try out new things. We find the strength to speak up when it matters, and we see potential failure as an opportunity to learn and improve.

Accountability - We take responsibility for our decisions, our actions, and our behaviours. We do what we say we will do when we say we will do it. We acknowledge our mistakes, and we learn.

Compassion - We care about our patients and each other. We consistently show kindness and empathy and take the time to imagine ourselves in other people's shoes.

Integrity - We are consistently open, honest, and trustworthy. We can be relied upon, we stand by our values, and we always strive to do the right thing.

Respect - We value each other, embrace diversity, and make sure everyone feels included. We take the time to listen to, appreciate, and understand the thoughts, beliefs, and feelings of others.’

Leaders aimed to have a positive, compassionate, and listening culture which promoted trust and understanding between themselves and staff, however we found the implementation of this was inconsistent across the trust and at trust Board level.

All theme scores were about the same as the national average in the 2024 NHS Staff Survey. ‘We are safe and healthy’ and ‘We are always learning’ were similar or equal to national scores. ‘Morale’ was slightly above average, supported by thinking about leaving, work pressure, and stressors, were all broadly aligned with national figures and showing improvement from 2023. ‘We work flexibly’ continued its upward trend, better than national data and 2021 results. Other themes were slightly below average, including ‘We are a team’, ‘We are recognised and rewarded’, ‘We each have a voice that counts’, and ‘We are compassionate and inclusive’. Staff engagement was also slightly below average, with motivation, involvement, and advocacy each showing small declines from 2023.

The trust evidenced the implementation of improvement actions within staff and patients with protected characteristics; network groups worked with executive sponsors to promote awareness and progression of inclusion programmes.

The trust had leaders who understood the organisational vision and strategy. Leaders had the skills, knowledge, and experience to lead effectively. However, some staff we met through our on-site assessment and individual discussions following our assessment felt that the senior executive leadership team were not visible.

Executives and non-executives told us they undertook a series of visits to services within the organisation to improve leadership visibility and ensured leaders were able to corroborate information received through the trust’s governance systems, particularly in relation to staff experience. The non-executives had a programme of planned visits they undertook usually on board meeting days. Some staff we spoke with were aware of these visits and were grateful to have the opportunity to speak with leaders. However, there were some staff who felt that any visits were infrequent and the leaders did not listen and address the concerns raised to them. This feedback reflected that presented by the trust in their own well-led self-assessment, demonstrating they had insight into how staff feel. Executives told us that physical visibility was difficult in all areas of the trust but that they were always accessible on phone and email.

Nursing staff gave positive feedback about the nursing and general management aligned to the services within the trust. Staff said they felt involved and included in the day to day running of the service and any changes that occurred. Staff said they had regular team meetings, as well as 1-1 support and supervisions, which provided opportunities for discussing any issues with the service leaders. Senior leaders spoke about the need to work collaboratively with the teams and how they were co-dependent on each other.

The trust were aware of the concerns within the leadership team, in June 2025 a report presented to the trust Board highlighted Northampton General Hospital’s Leadership Development Framework had been revised to support a more inclusive and values-driven culture. This work was aligned to a system-wide framework and integrated within the organisational development programme. The 2024 NHS Staff Survey suggested morale (5.98) and flexible working (6.30) were better than the national comparators, areas such as recognition, inclusion, and staff voice remained consistently slightly weaker than peers. Some progress had been made within staff wellbeing, we found that there may be some concerns in elements associated with psychological safety, organisational openness, and staff empowerment.

The trust had processes in place to identify and address behaviours that were inconsistent with their values. The trust’s grievance and disciplinary policies were within their review dates at the time of our assessment. There were multiple complaints about the senior leadership and management of the trust. A common theme was a reported lack of visibility from senior leaders which some staff felt impacted morale. Some staff reported that leadership appeared focused on targets and finances rather than the quality of care being delivered. Some staff were fearful of recrimination if they spoke up. Individuals were supported with coaches and development programmes, to facilitate reflection and positive behaviours, progress was reviewed in 1-1s.

The trust’s Board comprised of 12 executive directors and 8 non-executive directors. The executive team held a range of individual portfolios covering areas including quality, effectiveness, risk management, finance, procurement, and organisational development.

The trust met its requirements to undertake Fit and Proper Person Tests for those in executive or other roles that met the inclusion criteria. As a health provider, the trust had an obligation to ensure only those individuals who were fit for their role were employed. At the June 2024 trust Board meeting a Fit and Proper Persons Annual Declarations were presented by the then chair of the trust. It denoted that the trust secretary had undertaken fit and proper person checks, from which no issues had emerged. A trust chair is ultimately responsible for discharging the requirements placed on the trust to ensure that all directors meet the fitness test. The trusts’ chair at the time, provided the trust Board with assurance that all members of the Board met the Fit and Proper Persons requirements. The Trust provided additional information following our inspection that evidenced that a 2025 Fit and Proper Persons review was presented to the Board in June 2025.

During our assessment, a sample of 6 files were provided to us for the executive and non-executive team. Evidence was provided to demonstrate all the non-executives understood their responsibility with regards to this regulation, as there was a report fit and proper persons sat with the trust secretary. During interviews with the executive team they demonstrated the appropriate skills and qualifications to complete their role.

The December 2025 trust Board papers noted that the Audit Committees upward assurance to trust Board had categorised a reasonable assurance level for the fit and proper persons framework. A ‘reasonable assurance’ level was described as ‘There is evidence of a good understanding of the matter or issue to be addressed; there are plans in place and these are being delivered against agreed timescales; those that are not yet delivered are well understood and it is clear what actions are being taken to control, manage or mitigate any risks; where required there is evidence of independent or external assurance.’ The committee acknowledged the assurance given by the fit and proper persons policy and standard operating procedures, and that there had been work completed to better present the fit and proper persons framework work to external reviewers, such as CQC.

Some staff did not always feel they could speak up, and that their voice would be heard. There was evidence of a continued anxiety among some staff of being fearful about speaking up. The trust had an executive and non-executive lead for Freedom to Speak Up, Guardians and champions. The trust had a policy, and a new group wide policy was under review at the time of our assessment. This trust did not have a strategy or mandatory Freedom to Speak Up training in place. Leaders told us they encouraged staff to speak up and raise concerns, however, recognised the Freedom to Speak Up provisions required further development to provide an effective service for all.

The Freedom to Speak Up Guardians told us there was a lack of protected time, in essence capacity, to undertake their role. The trust had responded to this with plans to change the model of speaking up. Other concerns included multiple changes within the executive leadership team, perceptions of a “culture of micromanagement,” and a lack of transparency. A few respondents said they did not trust the Guardians, with a few respondents stating they had been warned “not to trust anyone.” This feeling of lack of trust was corroborated within the University Hospitals of Northamptonshire NHS Groups well-led self-assessment report.

During our assessment staff gave mixed feedback about their confidence in the Freedom to Speak Up service. Most staff were aware of the Guardians, however, some staff who raised their concerns about the culture with us, did not feel comfortable with approaching the Guardians and were not confident any action would be taken even if they did speak with them. This lack of confidence in the Freedom to Speak Up process aligned with the increase in anonymous Freedom to Speak Up cases and concerns relating to detriment, further suggesting that psychological safety and trust in formal reporting mechanisms may not be fully embedded.

The Guardians presented the Freedom to Speak Up 2024/25 Annual Report at the August 2025 trust Board meeting. Freedom to Speak Up cases rose to 135 in 2024/25, up from 82 in 2023/24, with more anonymous and detriment cases reported (detriment refers to staff experiencing disadvantageous or demeaning treatment because of speaking up). This represented the highest volume to date, with statistical data indicating that nursing staff raised most concerns (31.8% across the group; 33.3% within the trust). Themes of concerns were reports of wellbeing and worker safety were the most common at Northampton General Hospital NHS Trust (48.9%), inappropriate behaviour (46.7% at the trust), with 3% of individuals raising concerns at the trust indicating they had experienced some form of detriment. While this represents an increase from zero cases in 2023/24, two of the four detriment cases related to historic concerns from previous years that were disclosed during 2024/25.

Board papers evidenced discussion and actions to be taken from the presentation. There was recognition amongst executives and within the University Hospitals of Northamptonshire NHS Groups well-led self-assessment that the Freedom to Speak Up champions were stretched across the trust.

The trust Board also requested the Guardian to present the quarterly report summarising highlights and exceptions from Freedom to Speak Up activity. The latest report January to March 2025 reflected the numbers of staff raising concerns via the trust’s Freedom to Speak Up process had increased since the previous year. The trust Board indicated their continuing concern regarding reports of incivility, bullying, harassment, and discrimination. The trust Board acted upon this knowledge by requesting additional assurance from the People Committee. Following this the trust had reviewed the Rethinking Racism programme and development of a performance dashboard for organisational development and inclusion.

The Guardians were trying within their capacity to raise the profile of the service. As part of Freedom to Speak Up month, Guardians held out of hours drop in events, focus group discussions, and participated in joint equality, diversity and inclusion events, such as the Black History Month fireside chats. There was a 2025-2026 Freedom to Speak Up Engagement Plan.

The trust had an executive and non-executive leads for Freedom to Speak Up. The trust had a Freedom to Speak Up policy. Considering wider organisational governance changes, a consultation was underway on a new group‑wide policy due to conclude in October 2025. The policy was to be updated to reflect changes in guidance from the National Guardian’s Office. The policy explained the processes when speaking up including escalation to a non-executive director and chief executive if individuals felt concerns had not been addressed. We were told a Freedom to Speak Up strategy was being co-designed with the group staff but there was no strategy in place at the time of our assessment. There was no mandatory Freedom to Speak Up training, we were told plans had been agreed at People Committee to implement training.

During our assessment process we received correspondence from whistleblowers who worked at the trust. The themes of concerns raised included a lack of action from the trust on concerns raised, no confidence in the Freedom to Speak Up process, no acknowledgement of staff feeling anxious or wellbeing support offered during the transformation process. Staff also raised concerns with us that they had been instructed to accept the ongoing transformation with the trust or find employment elsewhere, this comment was corroborated during a focus group where senior clinicians were present.

We discussed the Freedom to Speak Up service during our executive conversations and fed back concerns about the provisions at the end of our assessment. Leaders had engaged with the trusts Freedom to Speak Up service and were working to implement the 22 recommendations from the February 2025 external review, however, recognised progress had been slow. Most executives recognised the Freedom to Speak Up provisions required further development to provide an effective service for all.

NHS Staff Survey, WRES/WDES indicators, Gender Pay Gap, and Freedom to Speak Up cases, demonstrated that challenges remained around equality, diversity and inclusion (EDI). Although executives appeared committed to improving the experiences of patients and staff, it was recognised that more work was needed to provide equal opportunities for career progression and experiences of discrimination. The trust were in the process of agreeing a We Belong Strategy, reflecting University Hospitals of Northamptonshire NHS Group as a single organisation and a fresh plan for the out-of-date equality, diversity and inclusion strategies. The trust lead for workforce inclusion presented at the trust’s People Committee and directly at the trust Board.

The equality, diversity and inclusion vision statement encompassed the improvement in equity and inclusion in the workplace: ‘enhanced belonging and experience: attract and retain diverse talent and promote leadership at all levels’.

There was a commitment to supporting equality, diversity and inclusion through peer-to-peer networks. The trust had several staff network groups to support equality, diversity and inclusion. The networks included: REACH (race, ethnicity and cultural heritage) Network, Armed Forces Network, DAWN (disability and wellness) Network, and Pride (lesbian, gay, bisexual, transgender, queer/questioning, and other community members) Network and a Gender Equality Network. We met with leaders representing staff networks, the teams expressed the collaborative working with executive representatives, all members within the networks were involved in the shaping and planning of process and policy. There was evidence where group actions and drive had assisted members of their networks for example: the DAWN had recently implemented the development of recruitment initiatives and inclusive interview questions. There had also been a collaboration with the estates team to implement single sex spaces in line with recent government ruling.

The trust equality metrics revealed both progress and ongoing challenges for the trust. At the October 2025 trust Board the annual Workforce Race Equality Standard (WRES) and Workforce Disability Equality Standard (WDES) reports were presented for the Boards’ receipt, prior to submission to NHS England and publication, along with progress against action plans contained within the People Delivery Plan. WRES and WDES results highlight persistent disparities for ethnic minority and disabled staff, including higher reported bullying and harassment and lower perceptions of fair career progression. However, 2024 NHS Staff Survey WRES indicators showed improvements from 2020 for staff from ‘all other ethnic groups’ in 3 measures (though gaps remain), and workplace adjustments for disabled staff had improved to above the national average. The trust Board approved the WRES and WDES action plans for the 2024 reports at the October trust Board meeting. The action plans considered REACH network feedback, and the trust Board highlighted their commitment to embed equity and inclusion objectives into safe and effective patient care, leadership and sustainability within teams; and to participate in the launch of the ‘We Belong’ Strategy during November 2025. WRES and WDES data and action plans were available on the trusts webpage for all to access.

The NHS WRES is an essential tool in supporting the NHS to be an inclusive and fair workplace. It helps evaluate progress and identify areas where further improvement is needed. The standards have 9 indicators measured through the 2024/25 survey for staff from all other ethnic minority groups combined and is compared nationally. The survey showed an increase in professional development identified and completed by staff from all ethnic groups combined. The trust maintained the same indicator as the previous year for staff experiencing harassment and bullying from colleagues, managers, team, patients, and relatives experienced by staff belonging to specific equality, diversity and inclusion networks. While White staff at the trust scored better for all 4 of the metrics, indicating worse experiences for staff from all other ethnic minority groups.

The 2024 NHS Staff Survey, electronic staff record workforce data and disciplinary records for Northampton General Hospital NHS Trust included data relevant to the WRES. WRES data monitors disparities between ethnic minority and white staff. Key indicators include harassment, bullying, or abuse from patients or staff; discrimination by managers or colleagues; and perceptions of career progression fairness. However, the trust’s data was unavailable in the right format to generate a full WRES indicators port.

In 2024, 10.6% of respondents reported discrimination from patients or the public (national average 8.75%). This showed an improvement from 10.89% in 2023 but remained above 2020 levels (8.18%). Although this was a modest improvement from 2023, it remained significantly above the national average, suggesting continued challenges with patient-facing interactions for ethnic minority staff. Discrimination from managers or colleagues was reported by 10.47% (national average 9.35%), a small improvement from 12.81% in 2021.

Results from the 4 NHS Staff Survey WRES questions (indicators 5 to 8) showed some improvement for staff from ‘all other ethnic minority groups’ since 2020, in 3 of the indicators, although disparities with white staff remain on three indicators. On the fourth measure (staff accessing non-mandatory training and continuing professional development), white staff reported worse experiences than staff from other ethnic minority groups, contrary to the overall pattern. These findings suggested progress in some areas but indicated that inequalities in experience persist.

The WDES is a set of measures which enabled NHS organisations to compare the workplace and career experiences of disabled and non-disabled staff and ensure disabled staff received fair treatment in the workplace. The May 2025 trust Board papers included testimony from the DAWN, illustrating barriers to reasonable adjustments, particularly in recruitment. In response, the trust Board committed to actions, such as advance access to interview questions and improved managerial support. It was unclear whether these measures had yet been embedded or whether their impact had been experienced by staff. These concerns were considered alongside the 2024 NHS Staff Survey and WDES results, which showed that while disabled staff reported lower satisfaction with feeling valued, there was an improvement in the proportion of colleagues with a disability who felt pressurised to come to work when unwell, indicating progress in this aspect of staff experience. However, there remained a need for more inclusive and supportive practices across the organisation.

The 2024 NHS Staff Survey captured differences in experience between disabled and non-disabled staff:

• 32.47% of disabled staff reported harassment, bullying or abuse from patients or the public (26.69% for non-disabled; national average for disabled staff: 29.37%).

• Harassment from managers was 15.07% for disabled staff (8.36% for non-disabled), slightly worse than the national average (15.10%).

• Harassment from colleagues was reported by 28.33% of disabled staff (17.06% for non-disabled), worse than the national average for disabled staff (25.24%).

• Reporting harassment: 47.83% (non-disabled 50.98%, national disabled 51.82%), a decrease from 53.10% in 2023.

• 48.98% of disabled staff perceived career progression as fair (53.83% non-disabled; national average for disabled staff: 51.30%), a slight decline from 50.76% in 2023.

• Workplace adjustments showed improvement: 75.78% of disabled staff reported reasonable adjustments were made (69.56% in 2022, 74.63% in 2023, above the 2025 national average of 73.98%).

The 2024-25 Gender Pay Gap Report for Northampton General Hospital NHS Trust showed modest improvement in mean pay disparity (18.1%) but persistent inequalities in pay, bonus awards, and representation in higher pay quartiles.

The median pay gap remained 4.9%, with women still overrepresented in lower pay quartiles. Bonus disparities were significant, with median bonus pay 31.9% lower for women and eligibility rates markedly lower (0.3% versus 2.3% for men), largely attributed to legacy Clinical Excellence Awards. The trust’s action plan focused on implementing “Mend the Gap” recommendations, improving data analysis, flexible working, inclusive recruitment, and bonus structure fairness.

Perceptions of equal opportunity for career progression were also below comparators: 52.52% felt opportunities were fair, lower than the national average (56.02%) and down from 54.21% in 2023. The Equality Act 2010 requires organisations with more than 250 employees to publish an annual gender pay gap report. The gender pay gap is the difference between the median or mean hourly rate of pay to male and female staff. The mean pay gap is the difference between average hourly earnings of men and women. The median pay gap is the difference between the midpoints in the ranges of hourly earnings of men and women. The trust reported its 2024-25 pay gap using a snapshot date of 31 March 2024. The median gender pay gap was 4.9% and the mean gap was 18.1%, a 2.6 percentage point improvement from the previous year.

Women remain overrepresented in lower pay quartiles despite gains in senior roles:

• Upper quartile: 68.1% women

• Upper-middle: 83.3% women

• Lower-middle: 77.9% women

• Lower quartile: 77.7% women

The bonus pay gap remains significant:

• Median bonus pay for women was 31.9% lower than men

• Mean bonus pay was 20.7% lower (improved from 26.2% in 2023-24)

• Bonus eligibility was 0.3% for women compared to 2.3% for men

These measures indicated in every measure that male staff were receiving a significantly higher proportion of pay than females.

Evaluating data across the NHS Staff Survey, WRES/WDES indicators, Gender Pay Gap, and Freedom to Speak Up cases, it suggested a consistent picture: staff reported variable confidence in raising concerns, with higher rates of bullying and harassment particularly among disabled staff, gender pay disparities, alongside WRES and WDES data, indicated that challenges remain around equality and inclusion, which can influence organisational culture. It was recognised amongst conversations with executives that more work was needed in the areas of equal opportunities for career progression, experiences of discrimination and representation on the executive trust Board.

The June 2025 trust Board papers highlighted that Northampton General Hospital’s Leadership Development Framework had been revised to support a more inclusive and values-driven culture. This work was aligned to a system-wide framework and integrated with organisational development programmes, although outcomes were not yet reported.

The co-produced We Belong Strategy was due to be presented in the November 2025 trust Board meeting. This was a strategy to reflect University Hospitals of Northamptonshire NHS Group as a single organisation and represent a refresh of the previous Equality, Diversity and Inclusion Strategy. The strategy included key performance indicators including workforce race and disability equality scheme indicators, staff survey results, and gender pay gap metrics. During our assessment, executives explained that the strategy would be a live document co-produced in line with a series of education directives, with the aim to be where every University Hospitals of Northamptonshire NHS Group colleague feels respected, valued and integral to the organisation.

The trust had an established relationship with staff side representatives and met with them regularly. Staff side reported that they did not feel leaders always communicated effectively and described the trust’s approach as reactive rather than proactive.

Concerns were raised about staff wellbeing and morale, which staff side representatives felt were deteriorating. They reported an increase in managers approaching them for support, often expressing fear about raising concerns themselves. This suggested a lack of psychological safety and confidence in internal escalation processes.

The trust Board needed to demonstrate assurance of learning from governance processes and how this was implemented consistently across the trust. Some executives recognised the needs to improve areas of governance, for example infection, prevent and control, and finances. It was recognised that there needed to be further development of the trust Board assurance framework. The trust were in the process of improving systems, but this was not complete or embedded. The trust had clear responsibilities, roles, and systems of accountability, however, there was some confusion amongst staff about roles due to the group model.

Northampton General Hospital NHS Trust had operated within the University Hospitals of Northamptonshire (UHN) NHS Group with Kettering General Hospital NHS Foundation Trust since 2020. In 2024, UHN began a formal collaboration with University Hospitals of Leicester NHS Trust (UHL.)The three trusts shared a number of group leadership roles, including a Group Chair, Group Chief Executive Officer, Group Chief Nurse and Group Chief Digital Information Officer, supported by a signed collaboration agreement and a joint committee of the three Boards (the Partnership Committee.)Whilst this assessment focussed solely on Northampton General Hospital NHS Trust, it is worth noting that until fully merged and restructured, there remained separate financial teams and separate financial systems.

Due to the group model, there was some confusion amongst staff about who was the Chief Executive Officer and Chief Nursing Officer, as there was both a group and trust designated role. Whilst there was a group and trust Chief Executive Officer this was not true for the Chief Nurse role which was at group level only.

Five Divisional Directors were appointed across all for University Hospitals of Northamptonshire NHS Group sites. The services were responsible for developing a joint strategy and vision, defining standards, and working across the group to collaborate in partnership. However, during our assessment we were told that staff felt learning was not disseminated effectively across the sites and some of the clinical team leads felt implementation of clinical developments were not established within the Northampton General Hospital NHS Trust site.

The trust had not fully implemented the PSIRF, in line with national requirements. PSIRF is designed to support a more compassionate, systems-based approach to learning from patient safety incidents. The trust had a Patient Safety Incident Response Policy dated February 2024 developed using that national NHSE template, with review in 2027. The policy acknowledged that the trust was committed to the principles of a strong safety culture, but that more work was required to ensure all staff were adequately trained in PSIRF principles and the safety incident plan should be reviewed 12 to 18 months to ensure their focus remained up to date, we did not see evidence of this.

The trust had some systems in place to capture and review patient safety events, however, there were gaps in how learning from incidents was disseminated and acted upon. Between 30 June 2024 and 24 June 2025, Northampton General Hospital NHS Trust reported 7,128 incidents via the LFPSE system. Of these, 18% were categorised by the reporter as ‘very concerned’. Thematic analysis revealed recurring risks in communication, interdepartmental handover, inappropriate ‘do not attempt cardiopulmonary resuscitation’ (DNACPR) decisions, conflict between staff, delays in treatment, and inconsistent adherence to policies. Some of these themes were corroborated within staff focus groups. Five specialties accounted for just over 50% of all submissions, elderly medicine (26.4%), paediatrics (31.2%), general surgery (26.4%), and general internal medicine (27.3%) had notably high proportions of their incidents marked as ‘Very concerned’, with midwifery also elevated at 20.3%. While most incidents recorded no or low harm, 7% of those with physical harm recorded moderate to fatal outcomes. The trust Board papers demonstrated quantitative monitoring of incidents, however, did not consistently show qualitative assurance of themes, learning or measurable improvement when things went wrong, including learning from serious incidents. It is insufficient to present numbers of instances but no themes or learning and evidence of subsequent change. The trust were in the process of strengthening the incident reporting process to better highlight learning and actions to support a proactive safety culture. For example, Patient Safety and Incident Response Framework training plans were being finalised for roll-out in September 2025.

The trust had governance processes to prevent and control infections that complied with the requirements of the National Infection Prevention and Control Manual for England. For example, the trust monitored established infection prevention and control compliance through governance and audit arrangements, such as hand hygiene monitoring, and used escalation processes where non‑compliance was identified. However, during the assessment, we visited various departments to speak with staff. We observed examples of infection prevention and control non‑compliance, such as staff wearing stoned jewellery in clinical areas. We raised this with an executive who reported that trying to achieve staff adherence with the infection, prevention and control policy was a difficulty throughout the trust. The trust’s Board received an annual and mid-year infection prevention and control report. In 2024/25, the trust recorded 94 C.difficilecases against an objective of 93 (exceeding trajectory by 1 case). The trust reported that changes to UKHSA admission/apportionment definitions contributed to additional cases being apportioned and believed that without this definitional change the site would have remained below trajectory.The trust participated in regional and systemwide collaborative forums to reduce C.difficile (including the Midlands C.difficile task and finish group) and reported ongoing joint work across system partners. These findings indicated that the trust had governance processes to prevent and control infections, but these were not consistently effective in driving compliance.

There were processes to manage the financial resources and sustainability of the trust. The trust Board had strong financial skills and experience within the group of non-executive directors. The chair of the Audit Committee was a qualified accountant and both internal and external audit leads were complimentary in respect of the workings of the committee. Whilst the chair of the Finance, Investment and Performance Committee was not a qualified accountant, they had significance commercial experience. The trust had demanding financial plans agreed with NHS England for 2025/26, during our assessment there was evidence financial improvements were on an upward trajectory.

The trust accounting officer had no managerial line to the overall Group Chief Executive Officer, who was the accountable officer and signs off the accounts for the trust. Evidence was not provided to demonstrate a robust oversight system was in place to ensure effective group finance working structures.

During focus groups, staff raised the lack of executive visibility and their feelings that money had become the priority for the trust. The trust were able to demonstrate and give examples of quality impact assessment when considering cost savings. The trust Board considered communication and engagement strategies to publicise this, whilst emphasising the need for productivity and efficiency improvements.

It was recognised that there needed to be further development of the trust Board assurance framework (BAF), which was being revised December 2025. A BAF is a strategic tool used by NHS trusts and other healthcare organisations to help Boards identify, assess, and manage risks that could impact the achievement of their key objectives. The structure of the BAF listed how assurances to judge any residual risk to objectives being achieved were gained. The trust were in the process of aligning the risk management strategy with the BAF, this would allow new corporate objectives and risks to be further embedded with the framework and provide improved assurance and service improvement. The trust used the NHS 7 levels of assurance model, which was embedded into the BAF risk process and was consistently referenced in meeting papers to provide the appropriate level of assurance. This framework is a set of activities designed to sustain and improve healthcare standards. The trust’s BAF was described as a “living” or “dynamic” document that was designed to be updated when anything contained within it changed. It was therefore, considered at the trust Board committees in the relevant areas for ongoing assurance. The BAF was consistently referenced throughout the Board papers we reviewed, supporting effective oversight and assurance.

We noted in the quality of care and patient experience BAF matrix how the recent national adult inpatient survey had been discussed in detail at the Quality and Safety committee. The discussion was reflected through into the BAF with associated actions.

The trust participated in the Learn from Patient Safety Events (LFPSE) national reporting system. Analysis of the trust’s incident data from July 2024 to April 2025 showed that there had been a marked reduction in the number of incidents recorded. During our assessment period we were told by NHS England these findings were explored to ensure patient safety events were recorded and escalated effectively.

Northampton General Hospital NHS Trust Board meetings meet with other organisations within the group model, setting strategic direction and holding executive teams accountable for delivery, assuring performance against objectives and plans, ensuring high-quality, patient-focussed services, effective financial stewardship, appointing and appraising executives and building relationships and confidence with the public.

The integrated leadership team met weekly, allowing sufficient time for the executive team to analyse and summarise the information received and escalate key matters for attention to the trust Boards' assurance committees. Board committees meet regularly to provide assurance and oversight for their areas of responsibility and decision-making.

During our assessment we attended a finance meeting, governance meetings, and reviewed meeting minutes. These included the Quality Committee, the People Committee, and the Finance, Investment and Performance, and Digital Committee. In all meetings we saw leaders acting with effectiveness and credibility. We were told by the staff groups that meetings supported diverse communication needs and ensured meetings were accessible. Staff with mobility issues explained how meeting venues had been changed to enable them to attend.

The Senior Independent Director (SID) was a non-executive director appointed by the Board of Directors and in consultation with the Council of Governors’ Appointments and Remuneration Group. This was in accordance with the Standing Orders for the Practice and Procedure of the Board of Directors. The SID had a key role in advising and supporting the chair in leading the Board of Directors.

All Board members shared corporate responsibility for formulating strategy, ensuring accountability, and shaping culture. They also shared responsibility for ensuring that the Board operates as effectively as possible. However, there were distinct roles for different members of the boards, reflecting their organisational responsibilities and aligned to each of the Boards and management committees. Each executive Board member was responsible for leading implementation of strategy in their functional areas and took principal responsibility for providing accurate, timely and clear information to the Boards.

Across the leadership of the organisation from the trust Board through the clinical divisions, there were clear responsibilities, roles, and systems of accountability. The trust Board governance structure was clear and covered all aspects of the trust’s responsibilities and services, including new and future planned services. The trust Board met every 2 months in public with a full set of papers and presentations. Invited staff presented to the trust Board around their areas of responsibility and expertise.

Each member of the trust Board had a clear delineated portfolio of responsibilities, and these overlapped between executives and non-executives as expected. For example, non-executive directors chaired the Board committees and executives and other staff with responsibility for certain areas presented to and held accountable to the Board committees.

The non-executive directors we met were confident their role in holding the trust Board to account. If they were to challenge information at the Board or committee, this was given respect, and they felt heard. They said this had notably improved in more recent years. They felt they were able to act as an independent voice and used their time visiting patients and staff to get a broader understanding of the organisation. They found the staff they met open and honest and staff we met told us they appreciated seeing them and having the chance to share their experience.

Northampton General Hospital NHS Trust senior leadership team members recognised they retained authority and accountability for patient services and to maintain a clear reporting line within the hospital services. University Hospitals of Northamptonshire NHS Group executives understood they held personal devolved accountability from the Boards and required a performance management framework and meeting structure within which to receive assurance in standards and processes between another NHS trust and Northampton General Hospital NHS Trust. Work was ongoing to align these processes between the sites.

The group Board agreed a set of priorities for the organisation in 2025/26. These were supported by 10 key deliverables to improve quality, safety, productivity and integration across the hospital group by delivering national access targets, major digital change, collaborative service models, workforce and people plan commitments, pathway transformation with system partners, increased research activity, and a strengthened learning culture that empowers teams to continuously improve care and outcomes.

Committees were structured and promoted a joined-up approach to assurance. The trust had an internal audit plan, with reports reviewed by the Audit and Risk committee. Findings were considered by other committees, such as finance, investment and performance for follow-up and management. The Audit Committee was a subcommittee of the trust Board of directors which oversaw the trusts financial reporting, risk management, and governance arrangements. Executive and non-executive directors were invited to engagement sessions to review proposals before presentation to the Audit Committee and trust Board for endorsements.

The trust had an Accountability and Continuous Improvement Framework which was the trusts performance management tool. The Accountability and Continuous Improvement Framework was a system used to hold both clinical divisions and corporate directorates to account for their performance and to ensure improvements and processes that supported the delivery of the trust’s strategy.

The trust had systems to ensure the Board’s committees had performance data relevant to their areas of focus. The trusts integrated performance report provided data on performance metrics aligning to the Care Quality Commissions 5 key questions. The integrated performance report were used within the clinical and corporate divisions using the Accountability and Continuous Improvement Framework.

The trust had effective governance and oversight of the staff use of the Mental Health Act. The trust was registered with the Care Quality Commission to detain patients under the Mental Health Act. There were appropriate measures to ensure that peoples’ rights were respected and that the powers were used correctly to keep people safe.

Leaders at the trust invested time in building relationships, understanding perspectives, and engaging with partners within Integrated Care Boards, place-based partnerships, provider collaborative sand other relevant forums, including primary and social care partners.

The NHS Northamptonshire Integrated Care Board was the organisation responsible for planning and coordinating local health services, while Northampton General Hospital was the local hospital that provides acute and emergency care. The trust had a plan to improve health across Northamptonshire by collaborating with partners, including the local Integrated Care Board, to ensure equitable access to care.

Northamptonshire Integrated Care Board and Northampton General Hospital NHS Trust work with the Equality Delivery System 2022 to ensure the development and improvement of services to promote the needs of patients, service users, communities, and staff. The Equality Delivery System is a system that helps NHS organisations improve the services they provide for their local communities and provide better working environments, free of discrimination, for those who work in the NHS, while meeting the requirements of the Equality Act 2010.

The trust was in the process of strengthening internal governance mechanisms in response to oversight needs. Actions included updating committee terms of reference, reviewing Board sub-committee alignment with system-level governance, and contributing to the group-wide Green Plan.

Improvements were ongoing to develop partnerships with the local authorities and the voluntary sector. The trust had a group strategy with a wide range of local partners with a common goal: to improve the health and wellbeing of people across Northamptonshire.

The trust stated that partnerships and collaboration would support in the following ways:

• Patients

We will collaborate with patient groups to ensure that patient and public insight informs all levels of decision-making. We will embed co-production in service improvement efforts and co-design care models that genuinely reflect the needs, values, and experiences of patients.

• Communities

We will act as an anchor institution, working with communities and local partners to address the physical, social, and environmental drivers of poor health. We will continue to integrate prevention into service delivery and engage proactively with underserved groups to tackle health inequalities.

• Health and care partners

We will work closely with Integrated Care Boards, general practice, community, and mental health providers, local authorities and the voluntary sector to deliver joined-up care. Together, we will develop integrated teams that deliver the right care, in the right place, at the right time.

• Academic partners

We will build on our strong relationships with universities and research institutions, continuing to contribute to national and international research networks. Our ambition is to keep University Hospitals of Northamptonshire NHS Group at the forefront of discovery, learning and innovation.

• Digital and commercial partners

We will strengthen our long-standing relationships with strategic digital partners including Nervecentre, while developing innovative new commercial collaborations that enhance our ability to deliver digital care.

• Organisational and clinical networks

We will participate in our regional and national networks, including the East Midlands Acute Provider Collaborative and specialty-specific clinical networks. Through these platforms, we will share best practice, collaborate on service development, and, where appropriate, co-create regional strategies for specialist care.’

The trust had strong connections and collaborative working through regional partnerships, including the East Midlands Cancer Alliance, the East Midlands Radiotherapy Network, and the University Hospitals of Northamptonshire NHS Group Cancer Collaborative. These collaborations promoted mutual aid, resource sharing and clinical coordination, both within the trust and across neighbouring providers.

The trust had recognised that as University Hospitals of Northamptonshire NHS Group they needed to improve their focussed collaboration to improve patient care and satisfaction. They were in the process of addressing actions to provide enhanced accountability and governance.

The trust had a service level agreement with the local NHS mental health trust. This included a protocol for joint working and helped to ensure patient pathways were effective and monitored. The trust had a designated head of safeguarding, who oversaw a safeguarding portfolio. Within this portfolio were responsibilities for the following areas: learning disability, autism, and the Mental Capacity Act. The trust had a designated safeguarding team which could provide advice, guidance, or training on areas around learning disability or autism, to enable staff to fully support service users.

There was limited evidence to show how the trust were learning from incidents and other adverse events at trust Board level, despite having processes to ensure learning happened when things went wrong. The trust understood the development of continuous learning, innovation, and improvement. Staff and leaders understood how to make improvements happen. Staff were supported to develop their skills and were encouraged to contribute to innovation.

Although the trust had a systematic approach to improvement, improvement was not fully embedded across the hospital. There were mitigating systems, including cross‑site quality improvement coaches, to support shared learning. One example of a cross-site quality improvement project was the implementation of decaffeinated drinks. However, staff told us about the challenge within the group organisation which presented difficulty in sharing learning across the group’s hospitals. This created a lack of consistency in sharing learning which was evident in our incident reviews.

Whilst there were some systems and processes in place, these were not always operated effectively to assess, monitor, and improve the quality and safety of the services provided. Low level incidents or instances of harm did not appear to be effectively collated, reviewed and learned from for the benefit of the greater patient safety/experience. Never Events are defined as serious patient safety incidents that are wholly preventable when national guidance or safety recommendations are followed. There had been 4 reported Never Events between July 2024 and July 2025 via the Strategic Executive Information System, including 2 wrong site procedures, a retained surgical item, and a case of medication administration via the wrong route. The trust was able to demonstrate some learning and risk reduction following these never events. An incident of a retained foreign object after surgery had led to a review of the checking system and adherence to the World Health Organisation checklist within the theatre environment. The Never Events highlighted the continued need for adherence to safety protocols across the relevant pathways.

There was a system in place to learn from deaths, which was outlined in the Mortality Review Policy. A Mortality Review Group met monthly to consider themes, trends, and patterns so they could learn from and prevent deaths. The work of the review group had resulted in some positive outcomes in some areas of the trust where engagement with this work and learning from deaths was not robust.

Northampton General Hospital NHS Trust participated in the Learning Disabilities Mortality Review programme as part of its engagement with national clinical audits during 2024/25. Data collection was reported as ongoing throughout the year, demonstrating alignment with national requirements and a commitment to system-wide learning. However, the 2024/25 Quality Account and the Board papers reviewed for 2025 did not set out findings from the Learning Disabilities Mortality Review programme or describe any resulting local learning or quality improvement actions. While participation in the programme was recorded, there was no evidence within these documents of how learning had been translated into quality improvement during this period.

Between 1 June 2024 and 30 June 2025, 2 Prevention of Future Deaths reports linked to Northampton General Hospital NHS Trust highlighted concerns in care escalation and medication safety. One case involved a failure to act on abnormal test results, while the other cited incorrect insulin administration timing attributed to staffing issues and gaps in training. Although the trust reported remedial actions, the absence of outcome data limits assurance on their effectiveness. Overall mortality remained within expected levels at the trust, outlier diagnosis groups and coroner reviews suggested variability in care quality. In April 2025, the Quality and Safety Committee noted in their report to trust Board that the trust had received a prevention from future deaths letter from the coroner, it reported a ‘reasonable’ assurance level with assurance provided to the committee on the responsive actions. There was no subsequent updated provided to the trust Board in 2025.

The trust group had university hospital status and maintained academic partnerships with local universities. The training programmes shaped new NHS clinicians. However, the 2025 GMC Trainee Survey indicated a decline in educational experience at Northampton General Hospital NHS Trust, with 8 of 18 indicators scoring worse than the national interquartile range. This deterioration followed prior improvements in 2024, suggesting that progress made between 2023 and 2024 had not been sustained. Declines in key domains, such as clinical supervision, feedback, and induction, may suggest challenges within the learning environment. Emergency medicine was 1 of the few specialties where trainee indicators were better than the national interquartile range, however, trainer feedback for the specialty remained among the lowest across both 2024 and 2025. Respiratory medicine, gastroenterology, and trauma and orthopaedic surgery also had trainee scores worse than the national interquartile range. The trust had previously been subject to enhanced monitoring, and these results suggested continued challenges in the learning environment and educational governance.

There had been an improvement with all the services we assessed, several have been rated good on their first assessment. We reassessed the emergency department that had been served a section 29a Warning Notice in March 2025 and found that all improvement actions had been addressed. This gave assurance the trust were aware of how to implement learning and make improvements happen.

The trust Board had developed plans to improve staff experience, with a focus on fostering a sense of ownership and pride among teams. Early feedback from divisional accountability meetings indicated positive signs of progress. The trust had implemented initiatives around enhancing safety and wellbeing, including structures around sexual safety and civility. A civility campaign was launched which aimed to reinforce staff engagement and feedback mechanisms. Northampton General Hospital NHS Trust was participating as a pilot site for Martha’s Rule. This is an NHS England initiative that allows patients, families and carers to request an urgent review by a specialist clinical team if they consider a patient is deteriorating. The trust were monitoring the progress of Martha’s Rule through the children’s and young person’s improvement plan, which was developed in response to the 2024 CQC Children and Young Peoples Survey, published May 2025. At the time of reporting, no trust-level findings from Phase 1 of the pilot had been published.

The trust understood the necessity for stable leadership behaviours and the importance of living the organisation’s values, whilst encouraging a culture of innovation and learning; the Pathway to Excellence framework was identified as a valuable tool to support staff experience improvements and accelerate cultural change. However, staff told us some senior leaders’ behaviours did not consistently reflect the organisation’s values.

Several initiatives to encourage staff feedback had been embedded within the trust. These included “We Value Your Voice” and the “You Said, We Did” campaign. However, as several members of staff from all levels told us they felt intimidated from speaking up, further work was required to improve the effectiveness of these initiatives.

The trust had an ‘Improving Together’ 5‑year Improvement Strategy, approved in August 2024 and co‑produced with over 1,000 clinical colleagues. The trust was in the first year of the strategy which set out the trust ambition to create a vibrant culture and continuous improvement in all teams.

Summary Hospital-level Mortality Indicator (SHMI) is the ratio between the actual number of patients who died following hospitalisation at the trust and the number that would be expected to die, based on average figures across England. The most recent SHMI data covered the period from July 2024 to June 2025. During this period, the trust’s SHMI was 0.9421, which was categorised as “as expected.” The value is stable compared with the previous reporting period, August 2023 to July 2024, when the SHMI was 0.9491, indicating there had been no deterioration or unexplained fluctuation in mortality performance.

The trust had a medical examiner function in place which scrutinised all deaths occurring within the trust. This process ensured that deaths were accurately certified and referred to the coroner where appropriate. The medical examiner service provided an additional layer of oversight and contributed to the trust’s governance of mortality.

The trust showed evidence of effective practice through research and group hospital and national programmes, such as Getting It Right First Time and implementation of robotic laser surgery procedures. We were also provided evidence that identified that there had been additional innovations that had resulted in a 56% reduction in falls, £88k savings and 21% reduction in therapy duration, and 12‑minute reductions in stroke door‑to‑needle times.

The trust was in the process of strengthening their learning and research improvements through collaboration with the overarching University Hospitals of Northamptonshire NHS Group system.

Leaders were aware of the trust’s impact on environmental sustainability. They 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.

In October 2020, the NHS became the world’s first health service to commit to reaching a carbon footprint of net zero by 2040 for the emissions it controlled directly. The ambition is to reach an 80% reduction by 2028 to 2032. For those things the NHS can influence rather than directly control, the target is net zero by 2045 (80% is the ambition by 2036 to 2039). This was embedded into legislation in July 2022. The NHS Long Term Plan included commitments related to health and the environment, including around climate change, reduction in use of plastics, particularly single use, improving air quality, and minimising waste and water use.

To deliver this ambition, NHS trusts were required to focus on 2 primary actions:

• Enable and produce direct interventions to reduce waste and carbon dioxide emissions within estates and facilities, travel and transport, supply chain and medicines.

• Take actions to improve levels of waste and emissions, accelerate sustainable models of care (such as care closer to or at home), workforce impacts, networks and leadership commitments, and funding and finance mechanisms.

The trust had a Green Plan to reduce its environmental impact in line with the NHS Green Plan. The Green Plan was published in 2022. The executive lead for the plan was the Director of Strategy, who was supported by a head of sustainability. The Green Plan focussed on 9 core areas, which included among others: Sustainable care models, medicines, estates and facilities, digital transformation, travel and transport.

Northampton General Hospital had the following broad aspirations within its Green Plan:

• ‘Reduce our scope 1 and 2 carbon emissions in line with the Net Zero 2040 target.

• Improve our resource efficiency.

• Reduce air pollution from trust operations.

• Embed wider social value aspirations within our operations.

• Ensure our staff are more informed about the environmental impact of healthcare and that are premises and care patterns are prepared to deal with a changing climate.

• Adapt our models of care to low carbon pathways and utilise new innovations and digital solutions.’

Staff and leaders understood the threat from climate change and were taking action to reduce the impact on the environment of healthcare activity. The individuals we met to discuss the subject of environmental sustainability showed commitment and enthusiasm. The group Director of Strategy was appointed as trust Board lead for Sustainability. Sustainability was discussed at trust Board, in August 2025 that Sustainability Plan 2025-2028 was presented for University Hospitals of Northamptonshire NHS Group which clear aims for all the workforce to commit to environmental, financial and social sustainability.

Sustainability plans were discussed at a multidisciplinary Sustainable Development Committee, and the trust was represented at the Northamptonshire Integrated Care Board Sustainability Meetings. We heard that the Sustainable Development Committee had a ‘bottom up’ approach, enabling sustainability champions to bring all ideas to the table. There were wider sustainability groups and networks within the trust, and non-mandatory training was available to all staff. The trust were working with local sporting facilities to provide training and opportunities in environmental sustainability. The networks were passionate regarding the delivery of low carbon care for patients and staff, with the awareness of reducing air pollution and improved health outcomes, such as lower rates of cardiovascular and respiratory disease. The trust had a head of estates who had taken the lead in procurement and tried to use local businesses to support building and repairs.

Patients, visitors and staff frequently experienced long waits for parking enhancing CO2 emissions. This was exacerbated by a lack of sustainable transport options, as well as disrupting service flow. The trust Board recognised energy performance across the estate required improvement and the trust’s constrained sites and capacity limitations added to operational pressures.

In 2022, the trust was awarded £20.6 million through the Public Sector Decarbonisation Scheme to implement energy efficiency measures. The project, now completed, included replacing the existing steam heating system with a low-temperature hot water system powered by electricity and supported by solar panels.

The estate at the trust varied significantly in age and condition, its 40-acre site was built across multiple eras dating back to its opening on its current site in 1793. Some buildings and infrastructure elements presented challenges for environmental sustainability. For example, engineering systems were aged or at end-of-life.

The trust was proud of a number of initiatives. In December 2024, the trust received Green Accreditation through the national Investors in the Environment scheme, recognising efforts to reduce carbon emissions and waste. Achieving a Green Accreditation means the hospital demonstrated it was focused on sustainable development and carbon emission reduction and had delivered a minimum of 2% efficiency improvements year-on-year. Strong evidence the trust were recognised for was the proactive management of carbon reductions across the use of electricity, gas, water, waste, vehicle use and anaesthetic gases; and staff engagement through the Green Team Challenge demonstrating annual environmental, financial and time savings. The were further plans described with associated timelines, for example, by the end of the year removing anaesthetic gas to save money and offset the trusts impact on the environment by 500 tonnes of CO2.

Leaders praised the Hand Therapy Team’s Green Team project which was shortlisted in the HSJ Awards 2024 Towards Net Zero Award category. Recognising 2 therapists who were shortlisted for the national award for developing a new way of supporting patients’ post-surgery, that also cut carbon emissions.