Gloucestershire Hospitals 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.

The service 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 organisation had been through significant changes in the last three years, as well as several changes in executive roles. However, staff and leaders appreciated there was now stability across the executive team and reported the positive impact this had on the culture within the organisation, whilst recognising the challenges that remain.

Executives and non-executives told us they undertook a series of visits to services within the organisation to improve leadership visibility. Some staff we spoke with were aware of these visits and were grateful to have the opportunity to speak with leaders.

During our assessment, leaders stated the culture had changed significantly and was now much improved. They said there was improved engagement and involvement with staff and leaders across the organisation. This was supported by most staff we met on inspections. All leaders were able to articulate the organisation’s vision and strategy and cite their and their teams’ involvement in developing both. Leaders spoke about ‘Listening, Leading and Learning’ as their commitments to the organisation.

The trust had a refreshed strategy for the 5 years from 2025 to 2030 and was still early in delivery against its strategic plan. The strategy was based around the vision to ‘Deliver the best care for everyone, with a renewed focus on delivering core services as an acute and specialist hospital provider, working as a good partner to deliver integrated care for the local population’.

The trust also had strategic aims:

• Patient experience and voice: services shaped by feedback from the patients, carers and the community.
• People, culture and leadership: making the trust somewhere everyone is proud of and would recommend as a place to work and receive care.
• Quality, safety and delivery: to provide good care, which is safe, effective, inclusive and responsive.
• Digital first: helping patients and staff work together using technology and new ideas to make care better.

Leaders had also identified four golden threads that run through the strategy: health inequalities; continuous improvement, brilliant basics, and green sustainability.

The trust’s narrative in the strategy recognised the fundamentals of care were key for patients to receive safe care, a good experience, and the best possible outcomes. There were also refreshed values, developed in partnership with staff. There were measures of success built into the strategy. However, leaders recognised the strategy was not yet fully embedded, and there was a lot of work in progress. Oversight was provided through the trust’s governance framework, including board and committee oversight, performance reporting and the Board Assurance Framework (BAF), ensuring alignment between strategic priorities, risk management and operational delivery.

The culture within the trust was improving. Leaders recognised the longstanding issues within the organisation and had taken steps to show they were taking these seriously. They had listened to staff concerns, for example about corridor care in the emergency department at Gloucestershire Royal Hospital, and staffing levels that felt insufficient to safely sustain the home birth service at that time, and taken prompt steps to keep patients safe. However, it was acknowledged there were still areas within the organisation where the culture had not improved. Leaders were aware of where these areas were and had plans to engage with staff to improve the culture.

At the time of the assessment, the 2025 staff survey results had not been published. The data from the 2024 staff survey showed significant improvements from previous years, and the trust ranked 5th as most improved in 2024, with a response rate of 65% (compared with a national average of 49%). However, the trust remained below the national average on several key questions, such as ‘We are passionate and inclusive’, ‘We are recognised and rewarded’, and ‘Staff engagement’. These areas were acknowledged by Board members, and as part of the response, the trust had introduced a staff experience improvement programme, to focus on teamwork development, and tackling inappropriate behaviours.

We also saw improvements in the inpatient survey 2024 with improved and above national average scores in ‘Kindness and compassion’, and ‘Respect and dignity’. Leaders confirmed that their next areas of focus were cleanliness, involvement in discharge decision-making, and the length of time patients spent on waiting lists.

Trust leaders at all levels understood the context in which they delivered care and treatment. They supported and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

The leaders were knowledgeable about the issues and priorities for the quality and safety of services being provided.

The Board consisted of 9 Executive Directors, including the Chief Executive, of whom 2 were non-voting members. The Board also included 9 voting Non-Executive Directors, including the Trust Chair, and 2 Associate Non-Executive Directors who were non-voting members. Collectively, Board members represented a broad range of experience and professional backgrounds. The executive team held a range of individual portfolios covering areas including quality, effectiveness, risk management, finance, procurement, and organisational development.

We attended the trust’s November 2025 board meeting where we observed leaders demonstrated credible, effective and compassionate leadership. The trust took steps to ensure accessibility and supported diverse communication needs.

We met with senior leaders and found a committed, hard-working, and dedicated group of people who were focused on their staff, their community and their patients.

Staff told us there was an improved connection between leaders and front-line activities. There were good examples and accounts of departmental and organisational leadership. Staff told us they were a visible leadership team, and they would be out and about with budget holders. This allowed clinical and finance staff to have direct conversations about finance and priorities and created a better understanding between the teams.

Most staff felt supported and stated that the challenges they experienced in delivering services were understood by senior leaders. Staff we spoke with told us where they had been consulted on changes within the organisation and confirmed their views and opinions had been considered.

Leaders were generally visible and approachable to most staff. The leadership triumvirate was proactive in engaging with staff at all levels. Good relationships with partners were evidenced. ‘We’re Listening’ events run by the finance team were fostering an open culture and discussions with staff across the organisation to understand how finance/ budgets affected operational delivery.

The organisation had introduced a 'License to Lead' initiative to build a consistent, compassionate and connected leadership culture aligned to the trust's strategic ambitions. Staff and leaders described a range of leadership development opportunities designed to support the organisation's future leadership capability. However, there had been ongoing vacancies for maternity services within the trust. Leaders told us they were waiting to recruit the right people for the vacant roles.

The trust’s governors who were elected or appointed members of the public, staff and local organisations, stated there had been a lot of changes at executive and non-executive level and there had been improvements in relationships. They reported they were encouraged to feedback honestly and with transparency, and the executive team were keen to hear both positive and negative feedback. Governors reported a willingness to be listened to by leaders, and actions were taken when concerns were raised. For example, they had identified the need for a lithotripsy service (a non-surgical method to treat kidney and uretic stones) in Cheltenham, which was subsequently approved. The governors stated they were working collaboratively with the executive team, with a focus on improvements for patients.

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. We reviewed 6 recruitment files for the executive and non-executive team. Evidence was provided to demonstrate all the non-executives understood their responsibility with regard to this regulation. During interviews with the executive team, they demonstrated the skills and qualifications to complete their role.

Most staff we met felt confident they could speak up, and their voice would be heard and how this had improved from a time when this was not always the case. The trust had an executive and non-executive lead for Freedom to Speak Up guardians and champions.

Staff were aware of the Freedom to Speak Up process and knew who the guardians and champions were.

During recent inspections at Gloucestershire Royal Hospital and Cheltenham General Hospital, staff reported a strong focus on supporting a safe speaking up culture, supported by senior leaders. Staff felt comfortable to raise concerns and told us they would be dealt with appropriately.

At the time of the assessment, the organisation had 2 people performing the role of the Freedom to Speak Up guardian, one full time, and one 0.4 whole time equivalent. There were champions across the organisation. There was a network of 23 champions across the trust who supported staff to speak up. The number of champions in the trust had been increasing. At the time of the inspection, the subsidiary organisation held a vacancy for a separately appointed Freedom to Speak Up Guardian, but staff had access to the Trust’s Freedom to Speak Up arrangements and associated speaking up routes.

Non-executive directors had undertaken the National Guardian’s Office online Freedom to Speak Up training and met with the guardian and heard about lived experiences of colleagues using the service. However, during the assessment, leaders could not describe the themes being raised by staff.

The annual Freedom to Speak Up board paper had been presented at the trust board meeting in May 2025. Themes raised by staff included inappropriate behaviours, concerns about systems and processes, patient safety or quality concerns and bullying and harassment. However, there had been a significant decrease in the number of anonymous reports, from 47% in 2020/21 (relating to around 60 reported cases) to 9% in 2024/25 (relating to 230 cases), which showed staff felt more comfortable to identify themselves when raising concerns.

We saw there had been a trend of improvement with staff feeling confident to raise concerns throughout the FTSU process from 44% in April 2023 to 59% in January 2025, however, this had decreased to 51% in July 2025.

Leaders expressed their commitments to listening without defensiveness. They had introduced a ‘Report, Support and Learn’ in July 2025 to address organisational risks arising from fragmented reporting arrangements and inconsistent responses to staff-to-staff discrimination, bullying, harassment, sexual misconduct, and incivility. A report to the board in January 2026 identified strong engagement across the organisation. It had also identified the need for a line manager development programme to ensure managers were equipped with the skills and tools to respond to concerns raised by staff.

Leaders also could evidence improvements made through listening to staff concerns. Improvements included strengthened staffing, reducing registered nursing staff vacancies from 15% to 4.5%, as well as reduced reliance on bank and agency staff. Daily executive-led incident response safety huddles had also been introduced.

The Trust recognised that further work was required to improve workforce equality, diversity and inclusion and had developed actions to address identified disparities. Staff did not always work towards an inclusive and fair culture by improving equality and equity for people who work for them.

The Workforce Race Equality Standard (WRES) report 2024/2025 showed Gloucestershire Hospitals NHSFT had made progress in six of the nine WRES indicators. The Workforce Race Disability Standard (WDES) report 2024 showed the trust had made notable progress, with improvements in 9 of the 14 metrics. However, leaders acknowledged further improvements needed to be made. Following the publication of this data, the leaders produced a WRES and WDES action plan, and the report to the board clarified the requirements for a strategic focus.

Workforce Race Equality Standard data showed that if you were white and applied for a role at the organisation, you were twice as likely to be appointed than if you were from ethnic minority groups, and this had declined since the previous year. However, we saw that all staff were equally as likely to enter the disciplinary process and had equal access to non-mandatory training and continuing professional development. Staff from ethnic minority groups were more likely than white staff to experience discrimination from colleagues or patients, relatives and the public.

Workforce Disability Equality Standard data showed that if you were not disabled and applied for a role at the organisation (22%), you were more likely to be appointed than if you were disabled (17%). Disabled staff were more likely than non-disabled staff to experience discrimination from colleagues or from patients, relatives and members of the public. They also felt less assured the trust provided equal opportunities for career progression, and less likely to feel their work was valued by the trust.

There was recognition that further work was required to improve diversity within senior leadership roles. Executives and Non-Executive Directors discussed actions to support a more diverse leadership pipeline and to strengthen inclusive recruitment and development opportunities for leadership roles at Band 8a and above. The organisation needed to improve data collection around workforce demographics, as they held ethnicity data on 89% of staff and disability data on 83% of staff.

There were 6 Royal College of Nursing (RCN) cultural ambassadors within the trust, with plans to increase this number. These individuals played a role in promoting inclusive practice, challenging bias and representing the lived experiences of ethnic minority and disabled staff.

The report also noted current recruitment processes did not consistently hold panel members accountable for ensuring fair and equitable recruitment processes. There was also no process for monitoring and evaluating the fairness of recruitment practices.

The action plan also identified staff network co-chairs were often the voice for ethnic minority and disabled staff, representing lived experiences and advocating for inclusion. However, many co-chairs had expressed the need for additional support to build confidence, leadership capability and influence strategy. The trust had introduced a co-chair development programme which included modules on strategic influencing and leadership within the NHS, and public speaking and presentation skills.

There had been investment in equality, diversity and inclusion at board level, including a facilitated board development programme focused on inclusion. The organisation had a sponsor for equality, diversity and inclusion (EDI) at board level, and board level sponsorship of each staff network.

The organisation had identified clear responsibilities, roles and systems of accountability to support good governance. The oversight of trust’s subsidiary organisation who support in the delivery of its activities required improvement to improve collaboration.

Leaders told us the governance processes had been much improved over the last eighteen months. The business planning process had become more inclusive and effective. Leaders told us governance systems were aligned with system partners across urgent care, planned care and workforce to drive broader improvements for patients.

In some areas within the organisation, staff were not always clear on the governance processes and reporting structures, and there was not always clear alignment across the organisation. For example, we found the organisation had not made sufficient progress in improving maternity services at our inspection in September 2025. We found the governance structure within maternity services did not always support decision-making processes. Feedback from other stakeholders was the trust was slow to implement improvements and sustain them despite having external support to address this.

Although further work was required to embed governance improvements consistently across the organisation, we found the Trust had credible plans to embed new processes into day-to-day operations, including the refresh of quality governance arrangements and portfolios due in the weeks following the inspection. We recognised the significant progress made to governance processes and that continued work was required to ensure these were fully embedded across all areas.

The trust maintained a corporate risk register to identify, record and manage risks and mitigating actions. This was presented to the board covering both clinical and corporate divisional risks scoring over 15. The trust’s risk register was comprehensive and aligned with the risks and concerns identified by staff and leaders.

Headline and key performance data was mixed. The organisation had made significant improvements in patients waiting for consultant led treatment within 52 weeks. The trust had also been one of the worst performing organisations for ambulance handover in the emergency department in 2023, with some handovers taking over two hours. This had reduced to 21 minutes at the time of this inspection.

Performance data for cancer, diagnostics and referral-to-treatment pathways was variable, with some indicators improving, some deteriorating, and others remaining unchanged over time. There was good oversight in board papers which outlined highlights, areas of concern and required actions to improve services for the local population.

The trust’s wholly owned subsidiary company provided facilities management services to the trust. Although leaders had oversight of this service, this needed to be improved. For example: two actions relating to recruitment following audits in 2023/24 had not been completed, and there had been delays in updates on the actions at the time of the inspection. While there was recognition both organisations needed to work together collaboratively, at the time of the inspection, there were governance arrangements and improvement actions in place to strengthen collaboration between the Trust and its wholly owned subsidiary, although further work was recognised to embed and evidence progress.

At the time of the assessment, the trust had refreshed its board assurance framework (BAF) and strategic risk template, to be used as a live document to support effective oversight by informing strategic decision-making. The Board Assurance Framework highlighted emerging risks that might require changes to either strategy or delivery plans, supporting prioritisation of resources and investment as well as providing evidence of robust governance. It was proposed that from Quarter 1 of 2026/27, the BAF would be reviewed and updated three times each year for approval by the Board of Directors. Board committees would continue to review strategic risks within their remit on a regular basis and seek assurance as to the effectiveness of controls and the action plans to mitigate risk. The BAF outlined:

• Strategic risks identified by the executive team and approved by the Board of Directors, including the strategic themes affected by each risk.
• Links between each risk and a strategic theme.
• Risk scores (initial, current, and target) and mitigation measures.
• Assurance types for each control, assessed against their effectiveness.
• Actions to address any weaknesses in mitigation.

The trust had maintained a breakeven financial position and members of the finance committee felt it remained in a strong position to date. Leaders explained that the next challenge was to maintain breakeven, with a focus on sustainability.

The finance team were well embedded throughout the organisation, with each member of the finance team being part of a peer group with clinical and non-clinical groups across the hospital, regularly attending performance meetings. This had allowed the finance team to better understand local risks, as well as improving communication about finance across the organisation. Staff described the relationships they had across the organisation as open and transparent.

We saw that the finance team had a voice at corporate board level, and the team were invited into all the executive reviews which oversaw changes to governance systems, service redesign or other large-scale changes within the organisation.

The trust understood its duty to collaborate and work in partnership, so services work seamlessly for people, and staff shared information and learning with some external partners and collaborated for improvement. The trust worked effectively with some groups within the community and understood the health and care system landscape as an integrated trust with acute, community and primary care services within its service provision. However, some community groups felt they were not heard, or that concerns raised were not addressed.

There was recognition of further work required to reach patients in the most deprived areas, and further work to do to gather patient data regarding ethnicity and disability. Work was under way to support staff to improve collecting data.

However, there were good examples of partnership working with some community groups. For example, the equality, diversity and inclusion team had linked clinical staff with a local charity supporting Deaf people to improve access to British Sign Language (BSL) interpreters. Accurate communication needs alerts have been added to patient’s care records, stating that they are Deaf BSL users. The charity had also provided signed videos for patients.

The trust evidenced some strong partnership working beyond the organisations, such as working with local police, fire and ambulance services for agreements for shared electric vehicle charging points. This had not gone live at the time of the inspection but was planned.

The trust’s strategy was aligned with key One Gloucestershire Integrated Care System priorities and was developed to support delivery of system objectives whilst also meeting the duties of the Trust Board as a provider organisation. The Integrated Care Board’s key strategy around population health and wellbeing (Integrated Care Strategy) was published in December 2022. Trusts were required to align their annual plans with those of the joint forward plan (JFP). Governors reported good working relationships with commissioners, but the executive team felt aligning the trust strategy to that of the ICS was challenging in practice due to differing priorities.

Partnership working was included within the Board Assurance Framework, recognising the risk to the organisation if partnership working was not effective. A new engagement strategy was to be developed in 2026.

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

We saw examples of how leaders adjusted their delivery of financial engagement events in response to feedback, which led to an integrated business planning process. Staff told us they felt empowered to make decisions. The leadership triumvirate felt the leadership team, and most staff were much more open and responsive than in the past. They acknowledged that some of these things were in relatively early stages of development.

The executive team were proud of the introduction of the ‘Clinical vision of flow’ to make tangible differences to patients and colleagues. This focused on improving how staff and leaders minimised wait times, reduced bottlenecks across all services and improved the quality of care delivered to patients. This initiative had four workstreams: the emergency department; short stay attendances; specialties; and frailty.

The organisation had invested in quality improvement methodologies, with nearly 4,700 staff trained to ‘bronze’ level, and over 250 to ‘silver’. Approximately 780 staff had training in human factors, the study of the interrelationship between humans, the tools and equipment they use in the workplace, and the environment in which they work.

We saw the organisation had made improvements in performance since the last trust well led inspection in 2022. They achieved an 87% reduction in patients waiting over 52 weeks over a two-year period (the second largest reduction nationally) and improved ambulance handover performance from a peak of over two hours during Winter 2023 to an average handover time of 21 minutes at the time of the inspection, moving from one of the worst-performing trusts nationally to one of the strongest performers for ambulance handover times.

Summary Hospital-level Mortality Indicator (SHMI) had fallen for 14 months in a row. SHMI is the ratio between the actual number of patients who die following hospitalisation at the trust and the number that would be expected to die based on average England figures, given the characteristics of the patients treated there. An example given was a deep dive into patients with a fractured neck of femur, where a review identified delays in the emergency department causing harm. The review led to improved patient flow, and reduced delays, resulting in improved outcomes and reduced risk of harm for patients.

The leadership team had good oversight of learning from patient safety incidents. The trust had adopted the Patient Safety Incident Response Framework (PSIRF), which sets out the NHS’s approach to developing and maintaining effective systems and processes for responding to patient safety incidents for the purpose of learning and improving patient safety. Since its introduction, the trust held 7 'quality summits' to address identified incidents or concerns. We saw this led to quality improvement initiatives and projects, leading to improved outcomes and services for patients. Learning was also shared through the trust's 'Safety Department Newsletter'. Staff had made significant progress on closing serious incident outstanding action plans. Level 1 training completion rates for PSIRF across the trust were at 96%, but Level 2 Patient Safety Incident Response Framework training was targeted to specific roles and was not a universal compliance requirement for all staff at the time of inspection.

The ophthalmic imaging team, in collaboration with partners, won a joint award for 'Most Impactful Use of Technology' at the Health Service Journal Partnership Awards for the Community Ophthalmic Link (COL) project. This digital system securely integrates all 66 optometry practices in Gloucestershire with secondary care hospitals and has led to a 16% drop in new patient hospital waiting lists, prevention of hospital referrals, and annual savings of over £225k.

The trust had also introduced an artificial intelligence (AI) initiative which predicted how long a patient might stay in hospital. This enabled staff to focus on discharge of a patient at admission stage, helping to ensure patients did not stay in hospital longer than required.

The trust declared a climate emergency in 2019 and developed a Green Plan in response outlining their vision of becoming a leader in sustainable healthcare, acting sustainably and leading by example. The organisation had a sustainability and environmental strategy, in line with national guidance, and the integrated care system they operated within with a focus on their estates and travel.

The trust proactively engaged with government schemes such as the Public Sector Decarbonisation Scheme to secure funds in reducing carbon emissions. They were focused on implementing air source heat pumps in various parts of the hospital. The Public Sector Decarbonisation Scheme provides grants for public sector bodies to fund heat decarbonisation and energy efficiency measures.

The Director of Improvement and Delivery was the Board lead for climate-related issues, providing executive leadership and ensuring Board oversight. The Trust's Climate Emergency Response Group reported to the Audit and Assurance Committee to provide assurance regarding the delivery of actions and mitigation of associated risks. The Trust also sought support from external partners to help address challenges associated with the delivery of its decarbonisation plans whilst maintaining a focus on quality.

There was a tracker on performance relating to carbon emissions reduction to track progress. Leaders told us they attended Green Group meetings with the ICB every six weeks and engaged with other partners such as the Police, and Fire Services in procuring a mobile charging vehicle to support electric vehicle charging across the community.

The group responsible for environmental and sustainability initiatives described actions they had taken to ensure the trust’s commitment to Net Zero emissions. These included connecting nitrous oxide and oxygen gases to main lines in the hospital to reduce the amount being released into the air as well as recycling gases that is breathed out. The gases are a mixture of nitrous oxide gas and oxygen widely used for fast and short-term pain relief and anxiety reduction. They also described investing in reusable tourniquet and replacing fabrics on chairs rather than discarding of them to reduce waste.

There were Green champions in various parts of the organisation and some had established sustainability groups in their departments to take action in reducing carbon emissions. The trust’s 2024/25 annual sustainability report showed a 9% decrease in anaesthetic gases.