Surrey and Sussex Healthcare 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.

We scored this quality statement as 2. The evidence showed some shortfalls.The trust had a clear, shared vision and strategy that reflected commitments to transparency, equity, equality and human rights, diversity and inclusion, and meaningful engagement. However, this was not reflected in the trust culture.

The trust’s vision was to pursue perfection in the delivery of safe high-quality healthcare which put the people of their community first, supported by values of safety and quality, teamwork, dignity and respect, and compassion, developed collaboratively with staff in 2012.

While the 2024 staff survey indicated these values were generally upheld, concerns remained. Staff reported a lack of compassionate culture, limited respect for individual differences, and declining perceptions of mutual respect since 2021. Questions assessing how valued staff felt by their teams, and how politely and respectfully colleagues treated one another, showed results in line with national averages; however, trust scores had been declining since 2021.

The 2024 NHS Staff Survey showed mixed results: six of nine People Promise elements met or exceeded national benchmarks, but scores for flexibility, recognition, and staff voice were lower. Appraisal rates improved but remained 10% below the national average. Overall, staff felt undervalued and under recognised, leading to declining recommendations of the trust as a good employer and reduced confidence in patient care. There had been a significant decline in staff believing the care of patients was the organisation’s top priority since 2020.

An independent review highlighted low psychological safety, inconsistent senior leadership visibility, and barriers to speaking up. In response, the trust introduced an improvement plan to strengthen their leadership culture. The implementation of the plan was in its early stages, and it was too early to evaluate the impact.

Leaders and staff recognised the need for cultural change. The organisation was transitioning from devolved management, where autonomy sometimes led to inconsistency, to a model of empowerment and ownership, where staff had the autonomy to make decisions, take initiative, and bear responsibility for outcomes.

The current five-year strategy, launched in 2023, sets out five objectives: delivering safe care, being a great place to work, acting as a valued partner, improving health outcomes, and ensuring financial sustainability. Other organisations were involved in the development of the strategy through stakeholder engagement activities. The trust’s annual priorities and breakthrough objectives were communicated across the organisation, with divisional and personal objectives aligned to these goals and monitored through regular reviews. Staff knew and understood the provider’s vision and values and how they were applied in the work of their team. Divisions and services linked their own local objectives to those of the trust, and these were clearly displayed in all areas.

The clinical strategy, published in 2024/25, aligned with the trust’s overarching strategy and was developed collaboratively with clinical teams to provide clear service-level priorities. It also supported joint working across the two Integrated Care Systems, enabling effective resource allocation and coordinated delivery of services for local communities.

The previous operating plan contained too many priorities, reducing its overall impact. The current plan streamlined objectives, aligning them with national requirements and local needs. Planning cycles now triangulated data from multiple sources, including complaints, ward dashboards, patient feedback (FFT), and clinical strategies. Data to monitor the trust priorities were embedded within the integrated performance and quality report and were, supported by red, amber, green (RAG) status, trend charts, and statistical process control analysis and reviewed monthly. Interface meetings between the executive team and the divisional leadership, had replaced traditional performance meetings to strengthen collaborative problem-solving and improved divisional accountability.

We scored this quality statement as 2. The evidence showed some shortfalls. Not all leaders understood the context in which the service delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively, or they did not always do so with integrity, openness and honesty.

Staff reported widespread burnout, driven by staffing pressures, a toxic culture, and micromanagement. Leadership support for wellbeing was perceived as limited, leaving many staff feeling undervalued and excluded from improvement initiatives. Raising concerns about harassment or mismanagement through formal channels was described by staff as difficult, with little evidence of responsive action.

There was a perception among staff of excessive scrutiny by leadership, low morale, and that a lack of recognition for systemic challenges contributed to sickness rates and potential risks to patient care.

Feedback from stakeholders highlighted a history of a rigid hierarchy and limited executive presence at key meetings, which sometimes delayed decisions affecting patient safety. However, during site visits they found strong divisional leadership through a triumvirate model.

The current Chief Executive Officer’s (CEO) clinically led approach and structural changes, including additional deputy roles for the Chief Medical Officer (CMO), were welcomed by staff. Leaders and stakeholders reported early signs of cultural improvement which included greater openness to feedback and more consistent application of learning.

Board development had not commenced but was scheduled for January 2026, alongside growing awareness of financial challenges and the need for stronger external partnerships. Board development is the ongoing process of strengthening the board’s skills, knowledge, and overall effectiveness to ensure it can govern the organisation well. However, focused discussion had taken place at board seminars, with some linked to development such as strategy development, and equality diversity and inclusion (EDI) and values.

Leaders generally had the skills, knowledge and experience to perform their roles. There was an executive team of 9, two of whom were non board members. There had been some recent changes in the executive team, and the Chief Finance Officer (CFO) was an interim appointment, and the Deputy Chief Nurse was acting into the role of Chief Nursing Officer (CNO). The CMO, Chief of Strategy and Chief Operating Officer (COO), and Chief of People and Culture positions were described as stable. The Chief Digital Officer role was working well while the Chief of Kaizen Officer (an executive responsible for driving continuous improvement and operational transformation) supported the ongoing development of SASH+ (the continuous quality improvement management system used by the trust), including its transition into a broader transformation and digital improvement approach. This was alongside executive-level support to corporate governance and internal improvement capability. Learning was also shared with external partners.

With recent changes, consideration was being given to areas of accountabilities and the teams strengths and weaknesses. Some areas of accountability were described as being “looked after” while further review was completed. Trust leaders acknowledged equality diversity and inclusion leadership was an area which required strengthening and a greater focus on estates and governance would be beneficial.

For the divisions and at service delivery level the trust had adopted a triumvirate leadership model. There was a team of at least three senior leaders with shared authority and responsibility for managing the department, or function.

To build high‑performing teams, the executive triumvirate — COO, CMO, CNO introduced a leadership programme to support divisional leaders in defining their purpose, values, and behaviours.

Priorities for 2025/26 included emotionally intelligent leadership, governance, system complexity, strategic responses to the NHS operating model, coaching skills, and planning for 2026/27.

Significant work had been undertaken to strengthen leadership capability, focusing on compassionate leadership and psychological safety. Development programmes had been extended to middle management, with targeted support for newly promoted leaders who lacked experience. Through a partnership with the Florence Nightingale Foundation, 40 matrons completed a leadership programme, which was being cascaded to ward managers. Additional coaching support had been provided to divisional chief nurses and Band 7 staff in the emergency department.

The Trust offered a range of leadership development opportunities, including:

• SASH Line Managers Induction: A two-day programme for new and existing line managers.
• SASH+ Leadership Programme: Incorporates Lean methodology.
• Florence Nightingale Programme: Strengthens multi-sector relationships.
• Rosalind Franklin Programme: Designed for medicines teams.
• Connect Health and NHS Elect: External leadership training options.

While these programmes were valued, staff reported challenges such as limited study leave, requiring significant personal time to complete coursework. Smaller teams faced additional barriers, as releasing staff for training risked service continuity. Despite these constraints, leadership development for nurses and AHPs continued, with efforts to cascade learning from senior leaders to frontline managers.

A newly introduced structured programme of ward and department visits was in place for non-executive directors (NEDs), supported by a formal feedback process. NEDs valued these visits as a key aspect of their role in gaining insight into the trust’s operations.

The trust employed three systematic approaches to enhance executive visibility. A 15-minute daily huddle at the visibility board in the trust HQ, attended by triumvirate members, to review key actions and site presence. Planned visits across sites and services described as, scheduled ‘Gemba walks’, diarised to ensure consistent engagement. (A Gemba walk is a Japanese lean management practice where leaders physically go to the "real place" (the Gemba) where work happens to observe processes, talk to employees, and identify waste or opportunities for improvement first hand, rather than relying on reports). As part of the ‘Lean for Leaders’ coaching programme, managers were paired with an executive coach who then conducted six annual Gemba visits to review SASH+ innovation initiatives. Insights and success stories from these visits were reported at ‘trust guiding team’ meetings.

To promote open staff engagement in September, the trust introduced the ‘your one team update’ staff forum, led by the executive team. The monthly sessions were hosted on an electronic platform to ensure easy access for all staff and recorded for on-demand viewing. Employees submitted questions in advance or participated using live chat during the forum.

We scored this quality statement as 1. The evidence showed significant shortfalls. People did not feel they could speak up and that their voice would be heard.

The trust had expressed a renewed commitment to Freedom to Speak Up (FTSU) and acknowledged its importance. However, a prolonged absence of a FTSU Guardian raised concerns about accessibility and independence, and limited integration of FTSU processes. Staff feedback highlighted poor awareness and low trust levels in the speak up processes, and the trust had identified this as an operational risk. The 2024 NHS Staff Survey reported a significant decline in the perception that “We each have a voice that counts,” alongside reduced confidence in raising concerns and influencing improvements, with scores below the national average.

After a temporary part-time guardian role (from November 2024), the trust outsourced FTSU services to a third-party provider in July, offering 24/7 access. Within three months, 50 contacts were recorded. Despite this, historical reporting of cases had been inconsistent, and staff continued to report a fear of speaking up, a lack of psychological safety, and a reluctance to challenge others for fear of reprisal. Themes from FTSU cases frequently involved bullying and limited senior leadership support, with executive engagement described as minimal. While staff viewed the new FTSU process positively, its effectiveness and impact on staff remained unproven.

The Chief of People and Culture Officer served as the executive lead for FTSU, supported by a designated non-executive director. Plans were underway for listening events to address psychological safety concerns. However, whistleblowing channels were widely viewed as difficult to access, and trust in leadership’s responsiveness remained low. Some staff reported that concerns raised through internal mechanisms were not resolved in a timely way.

We spoke with some staff about their experiences. When significant concerns were raised with the CEO, arrangements were made to meet with dissatisfied staff.

We scored this quality statement as 1. The evidence showed significant shortfalls. The service did not value diversity in their workforce. They did not work towards an inclusive and fair culture by improving equality and equity for people who work for them.

The trust lacked a structured, outcome-focused equality and diversity and inclusion (EDI) approach. While there was an EDI vision, the framework had only been launched recently. There was no dedicated EDI lead or budget with statutory reporting sitting within the Chief of People and Culture Officer’s portfolio. There was a reliance on motivated individuals rather than organisational systems to address the shortfalls. Equality Impact Assessment (EQIA) processes met NHS England requirements, but scrutiny was limited, often relying on a single perspective. The trust recognised that the breadth of review needed strengthening, and work was underway to formalise panels and broaden involvement.

Workforce Race Equality Standard (WRES) and Workforce Disability Equality Standard (WDES) data, along with findings from internal surveys, showed higher-than-average levels of harassment and discrimination. Significant disparities persisted for ethnic minority staff and for staff with long-term conditions, particularly in relation to bullying, limited career progression, and pressure to work while unwell. Staff with long-term conditions consistently reported poorer experiences across all seven WDES metrics. Each division had an HR business partner, however, reports of bullying and harassment continued, including with examples of unfair treatment of staff with disabilities.

WRES data highlighted key gaps:

• Bullying/harassment: 22.8% of BME staff vs. 20.6% of white staff.
• Appointment likelihood: White staff were 1.56 times more likely to be appointed.
• Board representation: 12.5% ethnic minority vs. 46.5% workforce representation.

While the trust had maintained or improved overall workforce diversity and implemented policies reducing disciplinary disparities, the trust continued to face persistent challenges in the equitable progression of ethnically diverse staff, representation in senior and board roles, and in addressing discrimination and harassment. The trust was actively working to diversify the board representation through current recruitment processes.

While ethnically diverse representation had grown to 45.9% (2024), board diversity remained disproportionately low (-25.9%). Disability representation was 3.3%, well below regional (6.1%) and national (5.7%) averages. Recruitment and progression gaps for disabled staff had worsened.

Staff survey results showed declining perceptions of respect, compassion, and flexibility since 2021. Many staff did not feel safe sharing their identity and speaking up. Managers were perceived as being approachable and open to discussing flexible working. However, there were mixed views among staff about the application of the trust policy and the available opportunities for flexible working patterns and adaptions. Some staff praised the approach taken by the trust to support them to continue to work and live close to family members through a flexible approach, while others felt their requests had not been heard and their needs considered. Following the introduction of a reasonable adjustment policy some managers remained hesitant to implement changes. There was an inconsistent application of the reasonable adjustment policy and poor coordination with occupational health department.

Patient data revealed persistent inequities in access and outcomes, with people living in areas of higher deprivation facing longer than average waits and higher did not attend rates. Although the trust had demonstrated strong demographic insight through data analysis and population health engagement, enabling identification of health inequalities. The trust held executive-level discussions and decision-making in relation to patient inequalities, alongside programme examples such as the Crawley work, which demonstrated data was being used not only to describe inequality but also to shape service response and improvement activity.

For example, a surgical waiting list review highlighted delays for patients with learning disabilities and autism, prompting corrective action. However, ‘learning from lives and deaths’ (LeDeR) reviews and feedback through other bodies indicated inconsistent application of the accessible information standard (AIS) and reasonable adjustments for patients. Technical challenges with the trust electronic patient record system were impeding full rollout and staff training for AIS compliance. This affected the trust’s ability to consistently identify and support patients with communication needs.

The cultural inclusion network, formerly the Black and minority ethnic network, was the trust’s first staff network and remained its oldest. The men’s network was the newest, having been recently established and the LGBT+ network had recently begun meeting. Attendance at network meetings was inconsistent, and senior leadership support for ethnic minority staff had historically been limited. There was no dedicated budget for equality, diversity, and inclusion initiatives, and network leaders were allocated only two hours per month for related activities.

Prior to the COVID-19 pandemic, the cultural inclusion network was perceived as ‘tokenistic’. A subsequent diversity risk assessment led to improvements, creating a safe space for ethnic minority staff, though participation has recently declined. The CEO had agreed to sponsor the group.

Awareness of the people and culture committee was low, and board engagement had been limited. While executive sponsors for the LGBT+ and women’s networks were active, support for the disability network had been weaker. There was limited senior expertise to lead on EDI, and staff reported that board‑level activity in this area lacked depth. Overall, staff morale had declined, though recent cultural improvements had sparked cautious optimism.

Data quality remained a barrier. The equality delivery system 2 (EDS2) is a framework used by the NHS to help organisations review and improve their services and environments for staff and patients, ensuring fairness for people with protected characteristics under the Equality Act 2010, focusing on 18 key outcomes and involving local community input to tackle discrimination and promote inclusivity. The EDS2 framework was being applied to improve workforce and patient data, enabling a more systematic approach to inclusion. This was viewed as essential for shaping meaningful strategies and safeguarding vulnerable groups.

The introduction of accessible parking bays near main buildings, was considered good practice and co-produced with staff.

The trust board received statutory reports on equality, diversity, and inclusion and monitored key metrics regularly. Although board papers showed some maturing of practice between 2022 and 2025, discussions continued to focus largely on processes and reporting, with limited exploration of the underlaying barriers for the slow progress in this important area.

We scored this quality statement as 1. The evidence showed significant shortfalls. The trust did not have clear responsibilities, roles, systems of accountability and good governance. Leaders did not act on the best information about risk, performance and outcomes. While staff reported an improved understanding of risk and the principles of risk assessment and management, this was not consistently applied in practice. There were significant gaps between reported understanding and actual implementation.

While the board maintained comprehensive structures and regular reporting to oversee culture, leadership, and workforce equality, significant gaps remained between formal governance assurances and the lived realities of staff. This was supported by the ongoing challenges with fully embedding Freedom to Speak Up, and the limited qualitative board engagement on shared culture. The Trust had commissioned an external governance review and had begun implementing the recommendations arising from this work. This included the establishment of a board-level people and culture committee and wider strengthening of governance arrangements.

An electronic risk register linked to the trust’s strategic objectives and board assurance framework. This demonstrated an intention to align risk management with strategic priorities. However, the effectiveness of this system was limited by the quality and accuracy of the information recorded. Any staff member could add a risk to the risk register, without leadership oversight or going through an approval process. This created the potential for a large, cluttered register, where critical risks were missed with issues overpowering true risks.

A new risk and compliance group had been established, chaired by the Chief Medical Officer. The group had only met twice, and there was insufficient evidence to assess its impact or effectiveness. Discussions with other sub-group chairs highlighted a lack of clarity about how sub-groups related to each other, where interdependencies existed, and how these would be managed. There were examples of reports being requested by the risk and compliance group from other parallel groups, despite it not being a parent group. Staff indicated confusion about governance arrangements and expectations. Staff feedback suggested that these issues were influenced by perceived hierarchies within the senior leadership team rather than by the stated purpose or terms of reference of the groups.

On reviewing the risk register, there were risks which had been open for more than 15 years. These ranged from low harm to major harm. Leaders explained that some older risks remained open due to changes in the local risk management system and challenges in implementing the new system, which had been introduced within the last two years. However, this did not account for the length of time these risks had remained on the risk register. Some risks were still relevant and related to wider system issues, such as the inability to isolate patients in the emergency department because rooms were occupied by patients with severe mental illness. Other longstanding risks lacked progress updates, appropriate mitigation or justification for remaining open.

Having unmanaged or outdated risks on the register meant the trust was reporting a higher level of risk than was accurate, and as a result, there was a risk of false assurance. This also reduced the reliability of governance processes by limiting the trust’s ability to identify, prioritise, and mitigate emerging or deteriorating risks.

Staff shared with us, that some risks were intentionally kept open to maintain visibility, and there was a fear that closing a risk could result in issues if a related incident occurred later. Conversely, there were examples where risks had not been considered appropriately, such as limited executive engagement in legislative processes that could lead to breaches of law.

We found it was too early in the implementation of the new risk management process to see clear evidence of improvement. The culture of reporting, assessing, and managing risk from frontline staff upwards was not yet embedded.

Divisions had been operating largely independently, with key processes such as complaints handling, governance oversight, and learning inconsistent with a lack of central oversight and coordination.

The effectiveness of the governance processes had impacted on the trust’s ability to maintain clear and effective oversight and effective management of risk. For example, there was a misalignment between the nursing structure and the staffing budget resulting in an overspend. A discrepancy was identified between the data from the roster and the data from the finance team. Budget setting processes had not considered the demand budget setting. In some areas, actions intended to support patients and staff for short periods at times of increased demand, such additional capacity beds have become normal practice. The governance around the use of these beds was not robust with a loss of critical oversight of their impact on patients and staff wellbeing and safety.

An external governance review led to considerable changes, with recognition the previous gaps in governance required significant remedial work and the governance structure was still maturing. There was now a clear three-tiered governance system with well-defined committees. Tier 1 committees being board and sub committees which included audit, assurance and risk; safety and quality; performance, infrastructure, and resource; people and culture; remuneration committee, and charitable funds. Executive committees provided assurance to the board and its committees. There was a rolling 4 week focus for these meetings covering digital, risk and partnerships, workforce, quality and finance infrastructure and performance. Tier 2 and 3 committees fed into these meetings. There were interface meetings between the executives and the divisions. A review of divisional leadership board meetings demonstrated discussions largely aligned with these themes, although the quality and depth of information varied between divisions.

The key issues report, also referred to as triple A reporting, was introduced to streamline reporting and improve oversight. This change was positively received, and staff spoke positively about the reporting format. The new format was reported to have enhanced efficiency and tightened governance. The board reported they now had improved assurance from board sub committees. While there was a consensus there was more to do to manage the size of committee papers, agendas were reported to be good and there was a general view of growing efficiency with the key issues reporting really helping. A mini review supported the view improvements were being made. To improve transparency and scrutiny board meetings were mostly public. However, the mechanisms for evaluating the board performance beyond review of the terms of reference were limited.

The CEO oversaw governance. The Chief of Kaizen and trust Board Secretary had oversight of corporate governance. There was less clarity about clinical governance oversight. Although the Chief Medical Officer and Chief Nursing Officer were clear they shared this responsibility, there was a lack of certainty amongst executives as to who was accountable for which elements and a few thought this sat with the Chief of Kaizen. There was no director of governance, and some leaders told us this was a leadership gap.

The trust’s integrated performance and quality report (IPQR), a document detailing an organisation's performance against key goals, had continued to evolve. The IPQR templates aligned to the trust’s strategy and objectives with a current focus on improving the commentary on alignment and the data quality.

The BAF aligned to strategic objectives and was reviewed by subcommittees, with each risk aligned to a subcommittee, this change in approach was reported to have resulted in better integration and challenge and was welcomed by the non-executive directors.

Last year the trust reviewed its processes around data quality resulting in an updated data quality policy and a new data quality and business intelligence delivery group. There was a regular agenda item to review data quality completeness, which had highlighted strong data quality within the trust’s commissioning data sets. A data quality notification process has been established to oversee data quality errors where they had been highlighted. For example, Data fields associated with the pre-assessment pathway were not captured within the electronic patient record resulting in a data gap. This process enabled the tracking issues and the action taken to rectify them.

The trust participated in regional and national clinical audits. Sometimes there are also national confidential enquiries that investigate an area of healthcare and recommend ways to improve that area of healthcare. During 2024 to 2025 annual cycle the trust participated in 98% of the national clinical audits and 100% of the national confidential enquiries, of the national clinical audits and national confidential enquiries in which it was eligible to participate.

The trust’s annual complaint volumes averaged 650. Overall, processes were described as inefficient and resources stretched with no dedicated complaints team. In acknowledgement of their challenges with managing complaints in a timely way the trust accepted external support. There were significant swings between high and low complaint months illustrating a process that was vulnerable to unpredictability, which had the capacity to strain resources and impact resolution consistency. Compliance with complaint acknowledgement had been maintained between 92%–98% in line with the Complaint Regulations (2009), which required acknowledgement within 3 working days. In June 2025, the trust adopted a 60 working day response key performance indicator, aiming to improve both timeliness and quality with data supporting an improving picture. However, this remined significantly below the trust target of 95%. Patient engagement and communication was by some described as weak. There was a sense cultural resistance had hindered efforts to strengthen patient involvement. There were concerns some divisions did not recognise the importance of effective complaints and engagement processes.

Complaint responses were variable in quality, often delayed, and not subject to consistent executive scrutiny, with limited evidence of shared learning, oversight of action plans, or standardised processes across divisions. Whilst there was some oversight there was limited evidence of effective trend analysis or monitoring, and documentation was frequently incomplete, making it difficult to track progress, ownership, or service improvements resulting from complaints.

There was limited clarity around roles, remits, and accountability within the governance structure, and siloed working across complaints, patient safety, and legal teams hindered collaboration. Staff reported gaps in training and inconsistent use of templates, with some concerns about the impact of cost‑driven decisions not being subject to adequate quality assurance. Cultural issues, including resistance to change and a perceived divide between frontline staff and leadership, continued to impede progress. Leadership engagement was variable, and without consistent senior oversight and a patient‑centred action plan aligned to regulatory requirements, improvements were unlikely to be sustained.

Training on complaint handling, conflict resolution, and response writing was not mandatory, with a risk of inconsistent and poor handling of sensitive cases. While an improvement workshop was being held, changes to date do not appear to have benefited patients or strengthened their voice in the organisation.

The trust’s people’s panel was intended to offer patient, carer, and public insight to support service improvement across the trust and with system partners. Panel members had contributed to local and national projects; however, the number of internally driven opportunities was limited. This supported the need for increased awareness across trust teams of the value and statutory requirement of patient involvement in service improvement.

Non-executive directors demonstrated strong awareness of the trust’s financial challenges. External auditors issued an unqualified opinion on the 2024/25 accounts, confirming they presented a true and fair view. While no major weaknesses were identified, the value-for-money review highlighted the need for actions to address the trust’s significant financial challenge. The Head of Internal Audit Opinion for 2024/25 confirmed an adequate and effective framework for financial risk management, governance, and internal control, with recommendations for further enhancement. The trust’s financial position remained concerning, with no clear route to deliver the 2025/26 plan. A financial recovery plan was in development. Strengthening financial reporting was seen as essential to match the scale of the challenge. An NHS England review in June 2025 identified further improvements in financial governance. The Interim Chief Finance Officer described steps being taken and was aware of the need for rapid implementation.

There was a notable disconnect between staff and the board in their understanding of the trust’s financial position, which contributed to reduced confidence in decision‑making and concerns that cost‑saving measures were not always subject to adequate quality assurance.

We scored this quality statement as 3. The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

The trust had strengthened its partnerships and system-wide engagement over the past year, demonstrating a clear commitment to collaborative working. Leaders were increasingly visible across the system, actively participating in forums such as the system quality group, quality and performance assurance committee, and Integrated Care Board meetings. They maintained regular dialogue with community partners and had adopted a system-wide approach to addressing shared challenges.

System partners told us the trust had become more inclusive in their ambition to function as one team with partners. Partners described the leadership team as highly responsive and shared the trust had recently adopted a system wide partnership approach to reviewing some of their key trust challenges. The trust engaged routinely with local system partners discuss shared opportunities and address shared challenges.

The trust was fully engaged in national initiatives such as CORE20PLUS5, a national NHS England approach to inform action to reduce healthcare inequalities at both national and system level. The trust played an active role in the provider collaboratives. A provider collaborate is a partnership in which two or more NHS trusts work together at scale within an integrated care system to improve quality, reduce variation and use resources more effectively. Strategic collaboration included joint development of mental health strategies and collective efforts to improve efficiency, resource management, and patient outcomes. Recent improvement events with partner organisations had focused on sustainable models of care, enhanced communication, and shared decision-making.

Examples of successful collaboration include:

• Frailty Model and MDTs: Reducing admissions and emergency attendances.
• Geriatrician Integration: Embedding specialists within neighbourhood teams.
• Acute network/provider collaborative working

In Autumn 2025, the trust worked alongside other providers in an 'improvement event' to identify opportunities to strengthen their ways of working together. A focus of this work was to develop and evaluate new ways of working to be sustained long-term, with a focus on structured daily meetings, enhanced communication and collaborative decision-making. The work involved exploring shared challenges including issues such as length of stay and care pathways and identifying common areas for action. The trust investment of time and resource reflected their clear commitment to system working.

The trust's commitment to partnership working on behalf of the local communities collectively served was illustrated by the development of a specific mental health strategy. This demonstrated a holistic approach to healthcare where individual NHS provider organisations recognised the need to work collaboratively within an integrated system.

The trust also led the digital transformation within the provider collaborative and presented the collaborative digital operating model to the committee in common which was well received and evidenced a stronger focus on collaborative working. Working closely with its Integrated Care System (ICS) partners in Sussex and Surrey the trust had developed a local strategy, in line with the national community diagnostic centre (CDC) programme, to respond to the rising demand for diagnostic testing in its local communities. The trust was advancing diagnostic capacity through the CDC programme. This included expanding services at Crawley CDC and opening a new spoke site in Redhill, significantly improving local access to tests and reducing patient travel.

Stakeholders told us the trust had shifted from an insular approach to one characterised by openness, responsiveness, and co-production, fostering strong relationships that benefited patients and communities.

We scored this quality statement 3. The evidence showed a good standard. The trust focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

The trust was one of 5 NHS trusts partnered with an educational organisation to establish quality improvement methodology. This led to the introduction of the SASH+ improvement system to embed a culture of continuous improvement. This lean-based programme empowered staff-led change, aligned with the trust’s strategic objectives. Lean based structured improvement is an approach that supports services to maximise value for patients by systematically identifying and removing inefficiencies from care processes. Leaders received practical tools through ‘lean for leaders’ training, with improvement efforts supported by a central team, executive sponsorship, and structured value streams.

Approximately 10% of staff had completed the SASH+ programme, which included education for staff working at all levels and a dedicated leadership track. Progress was monitored through monthly meetings, attended by executive leaders. The approach focused on coaching, empowerment, and systematic problem-solving to improve patient care and operational efficiency. On the acute medical unit, staff focused on efficiency working and productively, while ensuring the patient was at the centre. This led to the introduction of a patient care pack meaning patients did not have to wait as long when they needed assistance with cleaning up as staff took less time to locate and collect the equipment they required.

During its first five years, SASH+ it delivered strong outcomes aligned to strategic objectives and organisational risk. However, the COVID-19 pandemic disrupted this progress, leading to a shift towards a command-and-control model and slowing the return to staff empowerment. The trust quality improvement focus has now shifted addressing complex, long-standing issues that have proven resistant to resolution. There was a desire to employ their most experienced improvement resources to tackle systemic challenges, ensuring clear alignment with organisational strategy and national priorities.

The trust was supporting other trusts to develop their own local versions of the SASH+ programme. During an improvement week the trust collaborated with system partners to enhance patient outcomes and staff experience, develop sustainable ways of working, and foster a culture of cross-organisational collaboration.

The trust also hosted an improvement week at East Surrey Hospital, working with system partners on learning, improvement and innovation. The focus of this work was to improve the experience and outcomes for patients with mental health needs; Enhance the experience and working environment for staff delivering care; Develop and scale new ways of working that can sustainably improve the system; Build a culture of collaboration across teams and organisations. This demonstrated leadership with a clear focus on system-wide improvement.

The trust was exploring speech-to-text solutions to improve clinical documentation. Previous attempts were discontinued due to governance issues. There had been discussions with suppliers and plans developed to trial a new dictation solution. Early clinical safety testing was planned. Noise levels in some areas presented a challenge, which was being considered. The approach reflected the trusts commitment to safe, practical innovation that enhanced clinical workflows.

Weekly care counts meetings served as a dynamic forum for learning and improvement. Initially designed for ward managers, these meetings had evolved to include consultants and therapists, fostering multidisciplinary collaboration. Staff shared innovations and practical solutions, creating a culture of shared ownership for safety improvements.

The CEO published monthly public updates on the trust website, taking an open approach to sharing key messages and information.

We scored this quality statement 3. The evidence showed a good standard. The trust understood any negative impact of their activities on the environment. They strived to make a positive contribution to reducing this and supported people to do the same.

Leaders were engaged with the trust’s green plan and had clear goals and a vision for their journey to net zero. The trust had a board approved green plan in line with NHS requirements, outlining their commitment to the net zero NHS trajectory and with an associated action plan to deliver against it. Their approach was embedded within the organisational strategy, as part of ‘improving health outcomes’ strategic objectives: reduce our environmental impact to improve the health of our local population.

There was appropriate governance in place to ensure performance against targets for net zero. A bimonthly report was provided to the board. In addition, the board was provided with an update on progress annually through the trust annual report.

There was a board lead for sustainability and net zero, who was responsible for delivery of the green plan programme. Environmental sustainability was a core part of the director of estates and facilities portfolio. Planning and sustainability impact was considered for all projects, supported by an external specialist team, which provided expert advice, facilitated programmes, and oversaw delivery. An annual work plan with associated costs was agreed, and progress was reported to the board quarterly.

The trust’s approach to reducing environmental impact prioritised risk-based capital projects, assessing site, cost, and environmental factors. Current initiatives included replacing hired boilers with medium-temperature hot water systems and reducing energy consumption and carbon footprint under the green plan. The updated green plan was due for sign-off by the board by year-end, with 80% of targets expected to be met. Transport for staff, patients and visitors remained a challenge, with plans to promote alternatives such as cycling. A solar array project, externally funded and approved through governance, was scheduled to go live by February 2026.

Key priorities for the trust included energy efficiency and reducing medical gas emissions, particularly nitrous oxide. The green plan was aligned with NHS guidance with annual review to reflect evolving priorities, including supply chain impact and service resilience. Waste reduction had achieved a 26% decrease in the past year, supported by improved segregation, food waste diversion to anaerobic digestion, and expanded recycling initiatives. Future plans focused on reducing single-use items and promoting reuse across the system. Work had begun on a reforested area that could be used by patients and the public.

Staff engagement with the green agenda remained challenging but was supported through campaigns, sustainability weeks, induction sessions, and surveys. A system-wide impact assessment tool was being developed to integrate sustainability into decision-making. Additional actions included appointing a clinical sustainability lead at executive level, embedding sustainability objectives into personal development reviews, and considering a champions programme.

The biggest challenge to achieving net zero was retrofitting existing infrastructure, which was costly and complex. Integration of sustainability into clinical practice was essential, as 80% of emissions originate outside estates. Despite resource constraints, significant progress has been made, including enhanced waste management and data-driven prioritisation. The refreshed green plan ensured continued focus on high-impact areas.