Hampshire and Isle of Wight Healthcare 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

At our last assessment we rated well-led as good. At this assessment the rating has remained good. Leaders had the skills, knowledge and experience to perform their roles. Staff knew and understood the provider’s vision and values and how they applied to the work of their team. Staff felt respected, supported and valued. Governance processes operated effectively. Performance and risk were managed well. Teams had access to the information they needed to provide safe and effective care. Staff collected analysed data about outcomes and performance. They used this to identify improvement.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

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

Staff said they felt respected, valued, and safe. Staff we spoke with reported that they felt sexually safe at work and that they would be confident to raise sexual safety concerns using the reporting routes provided by leaders. Staff worked well together and supported each other as a team. Staff knew about the NHS sexual safety charter and that the trust had signed up to it.

Staff spoke about the importance of team working to provide the best outcomes for the patients. Staff had the opportunity to contribute to discussions about the strategy for the service.

We scored the service as 3. The evidence showed a good standard. The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support 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 service had inclusive leaders who understood the care and treatment needs of people in secure settings. Leaders embodied the culture and values of the staff and trust. Staff knew who the most senior managers in the organisation were and said they were approachable and visible.

Local leaders said they had an open-door policy, Staff praised the director of specialist services and felt able to raise concerns with them. Patients knew who the senior staff were and could approach them.

Ward managers were available to cover shifts at outside of Monday to Friday 9-5 at and at weekends, so they had the potential to have oversight of weekends and could speak to the staff that worked weekends.

We scored the service as 3. The evidence showed a good standard. The service fostered a positive culture where people felt they could speak up and their voice would be heard.

The newly formed trust fostered a positive culture where people felt that they could speak up and that their voice would be heard. Staff felt confident to speak up if something wasn’t right. Staff said they had access to a hotline they could ring to share concerns confidentially.

The services had dedicated Freedom to Speak Up Guardians (FTSUG) that staff could talk to if they wanted to raise concerns and speak up. The local FTSUG co-produced things with staff to support them to speak up. This included a dedicated telephone line for people to report any concerns like sexual safety.

Staff said they felt confident in raising concerns about poor professional practice or inappropriate conduct towards patients.

We scored the service as 3. The evidence showed a good standard. The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

As part of the mandatory training, staff received equality, diversity and human rights training. There was an equality and diversity sub-group who supported staff, for example, with experiences of racism from patients. The services had set up support networks for staff. These included a multicultural network and a network for lesbian, gay, bi-sexual and transgender staff. Internationally educated nurses on the wards reported a mixed experience. Some described good support, induction and cultural inclusion. However, some staff felt isolated and undervalued in their roles with limited career progression opportunities.

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

Some internationally educated nursesfaced 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 ensured senior police officers reviewed incidents, improving investigations and supporting staff victims.Staff told us they had undertaken this process and felt it had been beneficial to them, and they had been supported by their managers throughout.

Staff were able to apply to work flexibly. For example, staff could request 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. For example, there were staff who had shift timings changed to enable them to meet their caring responsibilities.

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 appropriate.

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

The senior leadership team and the ward managers met regularly in clinical effectiveness meetings to review incidents, complaints and concerns and identify themes. Lessons learned were cascaded to staff via staff meetings and team bulletins. There was evidence of consistent governance relating to ligature, fire and security risks.

Staff said that the electronic record keeping system supported them in their role and that there were systems in place to manage fire safety and ligature risks on the wards. Ligature information was easily accessed by ward staff. When we discussed ligature risk with staff, they were aware of the high-risk areas of the ward and had undertaken training in understanding how to manage the risk.

Ward managers and the pharmacist we spoke with outlined the systems in place on their wards to ensure effective governance in relation to medicines management.

Senior leaders said that there were processes in place to ensure oversight of incidents, complaints and concerns. Staff were engaged in the roll out of the Patient Safety Incident response framework management framework. This is a framework that 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.

Ward managers showed us the system they had for monitoring mandatory training updates. We could see the Key performance indicator framework the service used which generated a Quality Dashboard for every ward which supported the ward managers to see immediately what areas their ward was excelling in and which areas needed additional input.

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.

The services worked well with other agencies including commissioning bed managers, health and social care professionals and the local authority safeguarding team. For example, the ward managers all understood the key priority areas for local safeguarding referrals. Staff engaged with their professional bodies and undertook specific roles within these organisations.

Senior leaders regularly engaged with external stakeholders, such as commissioners and Healthwatch.

The advocates attended the ward and were invited to patient meetings and the senior leadership team meetings. Advocacy information was widely available on the wards and advocates were provided with confidential spaces to meet with people.

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.

Ward managers and staff described effective systems for reporting and investigating incidents to ensure debriefs were offered to staff, feedback was shared and safety improvements were made in response to lessons learned.

Bluebird House was part of a national QI programme to improve equity of experience for groups experiencing significant inequalities under the Mental Health Act. The team developed an “All about me” booklet. This booklet was designed as a tool for talking with young people aiming to support ward staff to better understand culture and background, and what was important to them, what helps young people build relationships, what helps young people communicate and the young people’s values.

There was evidence of staff engagement with quality improvement projects on the wards, they knew how to apply quality improvement methodologies, and the aim was to embed learning culture on the wards.

Ward managers received safety alerts with information about lessons learned from incidents elsewhere in the trust.

Improvement initiatives were co-produced with input from clinical staff, ward staff, and patients, embedding a ward-to-board governance structure. Evidence of a learning culture was seen through initiatives like the lessons learned workshop.