East Lancashire Hospitals NHS 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

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.

At our last assessment we rated this key question good. At this assessment the rating has remained good.

This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, 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.

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 patients and their communities.

The trust’s senior leadership team had successfully communicated the provider’s vision and values to the frontline staff in this service. The staff we spoke with were aware of the trust’s organisational values, and appraisal documents showed that performance reviews included a review of examples of the staff member displaying the values in their work in the preceding 12 months.

Staff could explain how they were working to deliver high quality care within the budgets available. The staff we spoke with demonstrated motivation to deliver a good standard of care to their patients. We observed staff working in a dedicated and caring way on the wards, at times in challenging circumstances.

Staff had the opportunity to contribute to discussions about the strategy for their service, especially where the service was changing. The ‘Share to Care’ team meetings held on each ward included an overview of ward processes as a standard agenda item, where staff could share concerns and improvement suggestions about their ways of working.

The trust had organisational development and inclusion teams which worked to support ward teams to develop positive and open cultures. The managers and staff we spoke with told us that they believed their ward had an open culture and said they personally felt safe to raise concerns and to question how things were done if needed.

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.

Leaders had the skills, knowledge and experience to perform their roles. Leadership training was available to staff and there was a good rate of uptake of this - ward managers and senior leaders across the community inpatient service completed 171 leadership training courses in the 12 months preceding our inspection. The annual staff appraisals included a review of the individual’s career development aspirations, and the staff we spoke with told us that they felt well supported in this respect.

Leaders had a good understanding of the services they managed. They could explain clearly how the teams were working to provide high quality care. Ward managers and Matrons across the service met each morning (Monday to Friday) to review staffing and any quality and safety issues across the service. Matrons also carried out yearly and monthly Nursing Accreditation and Performance Framework (NAPF) assessments on the wards, which involved a thorough review of the systems and processes, quality checks in relation to the care environment and feedback from staff and patients. Leaders were visible in the service and approachable for patients and staff. The staff we spoke with told us that their ward managers and Matrons were supportive and approachable.

The service fostered a positive culture where people felt they could speak up and their voice would be heard.

The trust had 2 Freedom to Speak Up guardians, 22 Freedom to Speak Up ambassadors and an established process for staff to confidentially raise concerns if they had any concerns about the care being delivered to patients. All the staff we spoke with about this topic told us that they were aware of how to use the trust’s Freedom to Speak Up process and said they would feel comfortable raising concerns either through this process or by speaking with their manager.

Freedom to Speak Up reports were submitted to the trust board twice a year. The report from January 2025 (which covered the period April – September 2024) stated that 101 concerns were raised through the process in this period. The data was analysed in the report to identify any trends of concern and also over time to assess whether the number of concerns raised was changing. All staff working on the community inpatients wards received Freedom To Speak Up training as an ‘essential to job role’ module and, as at the date of our inspection, over 90% of staff had completed level 1 and 2 for this module on all wards with the exception of Albion Mill staff for level 2 (77%). The trust also monitored the timescales for investigation of and response to FTSU concerns and took action to improve response times on an ongoing basis.

The service valued diversity in their workforce. Staff worked towards an inclusive and fair culture by improving equality and equity for people who work for them.

The staff we spoke with, including international workers and staff from minoritised ethnic backgrounds, told us that they had not experienced any discrimination or unequal treatment at work. All staff received equality, diversity and human rights training as a mandatory module and, at the time we inspected, 95% of staff or more on each of the community inpatient wards were up to date with this training requirement.

The trust annually reviewed a workplace inclusion performance report at the People and Culture Committee, a sub-committee of the trust board. This included a review of the trust’s compliance with the national NHS Workforce Race Equality Standard (WRES) and Workforce Disability Equality Standard (WDES) and the work done to reduce the gender pay gap in the preceding 12 months. The most recent report (July 2024) included an action plan setting out the ongoing work to improve equity in relation to recruitment, remuneration and career development and to reduce the incidence of staff experiencing discrimination or harassment on the grounds of protected characteristics. Divisional inclusion and belonging reports were also presented to the committee, which included an analysis of NHS staff survey results from staff within various protected characteristic groups.

The trust had a range of staff networks including race equality, disability equality, gender equality and LGBTQ+ and these networks were integrated within the trust’s governance framework in relation to inclusion.

The service’s governance systems did not always enable staff to deliver the best possible standard of care to patients. However, the service had clear responsibilities, roles and systems of accountability. Staff acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate.

Care records were not always managed safely and the trust’s record keeping system did not always enable staff to deliver high quality care to patients. Some confidential patient information was being stored in wall mounted pockets in the corridor outside their bedroom, and therefore was not secure, at multiple locations across the community inpatient service.

Staff told us it had been a challenge to get used to the electronic records system which was introduced 18 months prior to our inspection. When we visited Hartley ward in the evening we were told that the IT system was down which was putting additional pressure on the nursing staff who were carrying out observations and administering medicines. The trust confirmed after the inspection that this was caused by a temporary disruption to the WiFi network. Staff on Hartley ward told us they did not have enough computer terminals and the ongoing issues with the records system meant staff had less time to spend with patients. We were told that mobile and fixed terminals had been allocated to the wards on a 1:4 device to bed ratio, which was calculated following consideration of expected usage patterns, patient acuity and the need to balance digital access with physical space needs on the wards. The trust advised us following the inspection that no concerns had been raised about access to sufficient computer terminals in any staff meetings prior to our inspection. A visiting GP also told us they found the system challenging and not supportive of clinical best practice. We struggled to find the information we needed on the records, for example at the Rakehead Centre, a patient had a Deprivation of Liberty Safeguards (DoLS) authorisation in place and it took staff some time to find their mental capacity assessment when we asked to see this - this was eventually found in the daily progress notes.

However, 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. We saw minutes of ward level, management and trust board sub-committee meetings that showed how staff at all levels maintained oversight of a range of quality and safety indictors. Ward managers and ward-based staff gave examples of governance topics discussed at team meetings, including lessons learned from audits and incidents, patient and relative feedback and quality improvement projects.

Staff had implemented recommendations from reviews of deaths, incidents, complaints and safeguarding alerts at the service level. Minutes of governance and ward meetings and examples of alerts circulated to staff showed how lessons learned from incidents both within the trust and externally were shared with staff on an ongoing basis. The staff we spoke with confirmed that they received this information.

There were a range of ongoing quality monitoring systems in place across the community inpatient wards at the time we inspected. These included a range of audits and environmental checks and the Matrons’ monthly and annual Nursing Accreditation and Performance Framework (NAPF) reviews which involved a review of quality and safety on the wards incorporating a range of evidence including staff, patient and relative feedback, inspection of the environment and equipment and sample checks of care records.

Staff had access to the trust’s live risk register at directorate level. Examples of the types of risks relating to the community inpatient service included specific areas of staffing pressures, environmental constraints and stock shortages. The risk register was kept under regular review by the trust’s governance team. There was a draft written business continuity plan for the community inpatient service which was awaiting approval by the trust’s Emergency Preparedness, Resilience and Response committee at the time we inspected. There was also a trust-wide business continuity plan for IT failure, which was last updated in January 2025.

The service understood their duty to collaborate and work in partnership, so services worked seamlessly for patients. Staff shared information and learning with partners and collaborated for improvement.

Directorate leaders engaged with external stakeholders, for example a collaborative working project with North West Ambulance NHS Trust and the trust’s emergency care directorate was included in the community inpatients service’s 2024-2025 business plan. We saw evidence on the wards of collaborative working with other health and social care stakeholders to ensure patients had effective pathways of care.

The service at Albion Mill was delivered in partnership with Blackburn with Darwen Borough Council. The trust’s governance systems enabled effective collaboration between the organisations, with ongoing quality monitoring and senior management oversight.

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

Innovations were taking place in the service. A range of quality improvement initiatives had taken place across the service in the 12 months preceding our inspection, including an active hospitals project, aimed at reducing deconditioning during inpatient admissions, the implementation of patient diaries to improve information sharing between clinicians and patients and families and improvements to the handover process. The monthly Matrons’ governance checks on the wards included a review of progress of any ongoing quality improvement projects, as did the divisional quality meetings which took place quarterly.

Staff used quality improvement methods and knew how to apply them. The management and leadership training available for staff to complete included improvement methodology and some of the management staff within the community inpatient service had completed this training in the 12 months preceding our inspection.

Staff participated in national audits relevant to the service and learned from them. National clinical audits were led by a named clinician and progress was tracked via the trust’s governance systems.