Hampshire and Isle of Wight Healthcare NHS Foundation Trust

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• 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

Good. This meant the service management and leadership was consistent. This means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture This is the first assessment for this service. This key question has been rated as Good. The culture they created supported person - centred care.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Description: We have a shared vision, strategy and culture that is based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding and meeting the needs of people and our communities.

Quality Statement Score: 3

We scored the service as 3 The service had a clear clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did understand the challenges and the needs of people and their communities.

However the provider’s senior leadership team had not always successfully communicated the provider’s vision and values to the frontline staff in this service. Some staff from the newly acquired trusts said they did not feel part of the bigger picture with the new trust and it’s values.

Staff had the opportunity to contribute to discussions about the strategy for their service, especially where the service was changing. However, some staff felt they were not always listened to by senior leaders.

Senior leaders explained the impact of CIP to the wards and staffing levels for activities and these were found to not impact on patient care delivery.

Description: We have inclusive leaders at all levels who understand the context in which we deliver care, treatment and support and embody the culture and values of their workforce and organisation. They have the skills, knowledge, experience and credibility to lead effectively and do so with integrity, openness and honesty.

Quality Statement Score: 2

2. We scored the service 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.

Leaders did not always have the skills, knowledge and experience to perform their roles.

Leaders did not always have a good understanding of the services they managed. They could not always explain clearly how the teams were working to provide high quality care.

Staff felt following the coming together of 3 existing trusts into the current trust in October 2024 that senior leaders had lost touch with staff and patients and the large scope of the trust now meant everything felt impersonal. This meant some staff did not feel represented or valued as individuals.

Leaders were not always visible or approachable for patients and staff. Staff said senior leaders were remote and did not feel approachable by frontline staff.

Senior Leaders were aware of these concerns and gave assurances that the transformation process was being monitored and embedded across the trust. Leaders acknowledged that some staff had found the process easier than others.

Leaders at Cherry ward at Parklands were inconsistent and had no clear oversight or management. This led to the ward environment feeling chaotic. We reviewed incidents and observed care on the ward during our visit. Leaders were aware of the concerns we raised on Cherry ward. We had also previously had other staff whistleblowing and further evidence after reviewing incidents on the ward. These incidents included self-harm by patients who were on enhanced levels of observation. Leaders said new staff were in place and the ward was being closely monitored and supported. The ward had voluntarily closed to new admissions at the time of inspection.

Leadership development opportunities were available, including opportunities for staff. We saw evidence of staff career progression and leadership programmes.

Some services had introduced clinical team leader roles at ward level and staff found these more approachable and responsive to their needs. Staff said having dedicated clinical expertise at ward level had helped improve patient care.

We saw the trust was developing and implementing changes in it's leadership pathways but these were not always embedded at ward level at time of inspection.

Description: We create a positive culture where people feel that they can speak up and that their voice will be heard.

Quality Statement Score:3

We scored the service as 3 The evidence showed staff and patients felt empowered to speak up.

However some patients and carers did not always have opportunities to give feedback on the service they received in a manner that reflected their individual needs. For example, some patients felt that their concerns over restrictive actions by some staff were not taken seriously.

Managers and staff had access to feedback from patients, carers and staff and used it to make improvements, such as changes to ward menus.

Patients and staff could meet with members of the provider’s senior leadership team and governors to give feedback.

Description: We value diversity in our workforce. We work towards an inclusive and fair culture by improving equality and equity for people who work for us.

Quality Statement Score: 3

2. We scored the service as 3. The service did value diversity in their workforce. However they did not always work towards an inclusive and fair culture by improving equality and equity for people who worked for them.

There were equality and diversity champions within the wards and members of equality networks.

Some staff were able to apply to for a flexible working agreements to account for personal circumstances such as caring responsibilities and health issues.

Managers put reasonable adjustments in place for staff members to help them carry out their role. However, staff said this could be inconsistent across the trust.

The provider had undertaken equality monitoring of staff within the service to ensure it was diverse in its make-up and representative of the patient group.

Some international nurses working on the wards had a mixed experience. Some described good support, induction and cultural inclusion. However, some staff felt isolated and under valued in their roles with limited career progression opportunities.

Some international staff faced racist discrimination from patients and the trust encouraged them to report this to the police as part of Operation Cavell. Operation Cavell is a partnership between local NHS and Hampshire Constabulary to tackle violence and abuse against staff. It ensures senior police officers review incidents, improving investigations and supporting staff victims. The trust supported staff to access operation cavell and it was well used by staff.

Senior leaders were aware of these concerns and explained a series of actions were in place to support affected staff and encourage staff to speak out.

Description: We have clear responsibilities, roles, systems of accountability and good governance to manage and deliver good quality, sustainable care, treatment and support. We act on the best information about risk, performance and outcomes, and we share this securely with others when appropriate.

Quality Statement Score:3

3. We scored the service as 3. The evidence showed a good standard. The service had clear responsibilities, roles, systems of accountability, and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They act on the best information about risk, performance, and outcomes, and share this securely with others when needed.

There was a clear framework of what must be discussed at a ward, team or directorate level in team meetings to ensure that essential information, such as learning from incidents and complaints, was shared and discussed.

Staff had implemented recommendations from reviews of deaths, incidents, complaints, and safeguarding alerts.

Staff undertook or participated in local clinical audits. The audits were sufficient to provide assurance and staff acted on the results when needed.

Staff understood the arrangements for working with other teams, both within the provider and external, to meet the needs of the patients.

Staff maintained and had access to the risk register at ward or directorate level. Staff at ward level could escalate concerns when required.

Staff concerns matched those on the risk register.

The service had plans for emergencies such as adverse weather or a flu outbreak.

Where cost improvements were taking place these did not compromise patient care.

The service used systems to collect data from wards and directorates that were not over-burdensome for frontline staff.

Staff had access to the equipment and information technology needed to do their work. The information technology infrastructure, including the telephone system, worked well and helped to improve the quality of care.

Information governance systems included confidentiality of patient records.

Team managers had access to information to support them with their management role. This included information on the performance of the service, staffing and patient care.

Information was in an accessible format, and was timely, accurate and identified areas for improvement.

Description: We understand our duty to collaborate and work in partnership, so our services work seamlessly for people. We share information and learning with partners and collaborate for improvement.

Quality Statement Score: 3

3. We scored the service 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.

Directorate leaders engaged with external stakeholders such as commissioners and Healthwatch. The Chief Executive of the trust attended Healthwatch meetings locally.

Patients and staff could meet with members of the provider’s senior leadership team and commissioners to give feedback.

Description: We focus on continuous learning, innovation and improvement across our organisation and the local system. We encourage creative ways of delivering equality of experience, outcome and quality of life for people. We actively contribute to safe, effective practice and research.

Quality Statement Score:3

3. We scored the service as 3. The evidence showed a good standard. The service 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.

Staff were given the time and support to make opportunities for improvements and innovation and this led to changes.

Staff had opportunities to participate in research.

Staff used quality improvement methods and knew how to apply them. For example, identifying patients by date of birth before giving medicines at Melbury Lodge

Staff participated in national audits relevant to the service and learned from them.

Wards participated in accreditation schemes relevant to the service and learned from them.