Peterborough City Hospital

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

We rated well-led as good. We assessed 5 quality statements. Leaders had the skills and knowledge, experience and credibility to lead well. They demonstrated that progress had been made to improve the service, but further work was still required. There was a system of governance and risk management based around delivering safe and good quality care and treatment. However, timely review and monitoring of risks was not always in place. There was a commitment to learning and to make this more widely available for staff groups.

This service scored 64 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Leaders told us that forming the U&EC division rather than being with the medical division had allowed them to focus on their priorities, direction and culture over the preceding 2 years. Steady progress had been made on improving the quality of services provided. Some of this progress had been achieved by investing in staff and listening to their ideas and suggestions.

Staff told us that morale had improved. Staffing had improved and the new system of assessing patients on arrival was a good development. However, results from the U&EC services staff survey for 2023 showed that morale, being compassionate and inclusive (including diversity and inclusion) and staff engagement scored the lowest in the trust. The only measure that was above the average in the service was “We are always learning”.

The service had peoples promise champions in place to try and improve the working experience and engagement with the service’s senior team. Also, a newsletter was circulated, and staff engagement boards were in place.

Prior to our inspection some concerns had been expressed by whistleblowers if a concern was raised.

The trust had an overarching strategy and vision with 5 strategic goals. These were to deliver outstanding care and experience which included aspects of urgent and emergency care. Also, recruiting, developing and retaining the workforce, being an anchor to the communities, working together with health and social care providers and delivering long term sustainability. However, there was no formalised local strategy for U&EC services to turn the service’s vision into action.

A U&EC improvement plan was produced on a regular basis to monitor progress against several milestones to improve performance but did not directly link with the trust wide services vision and strategy.

Staff we spoke with told us they felt supported by managers and had opportunities for development. Managers were visible and approachable. Leaders of the service were knowledgeable about the issues and priorities of the service and worked for change and improvement when needed. They recognised where the service needed to be improved and were working to make improvements as part of the “Back on track” transformation programme. They focused on staff wellbeing and ensured a culture promoting good practice, good quality and aspired to give safe care and treatment.

The annual staff survey indicated that U&EC staff (across the trust) reported worse experiences than other staff working at the trust, with a particularly noticeable gap in the “We are safe and healthy” theme. This theme raises questions on burnout, time pressures and physical violence suggesting U&EC staff may be having worse experiences than other staff at the trust in these areas.

The divisional leadership structure within the U&EC service consisted of a divisional director (an emergency medicine consultant), a divisional operations director, and a divisional nursing director. The divisional triumvirate had clear roles and responsibilities. They were supported by divisional senior clinical leads, matrons and senior support staff.

Staff that we spoke with knew how to raise concerns and knew of the Freedom to Speak Up Guardian (FTSUG). The U&EC leadership team encouraged staff to talk to them if they had any concerns or raise any concerns with the FTSUG. The hospital chaplain was also visible in the U&EC department, and a priority was to support the welfare of staff as well as patients.

The hospital had a Freedom to Speak Up Guardian. The service had systems in place to engage with staff and guidance was provided on how to do this in the service policy.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Monthly quality governance review reports were reviewed by the U&EC board and covered areas such as clinical incidents and progress on the annual clinical audit programme. There was a monthly U&EC governance meeting between the two NHS hospitals U&EC services. Minutes of the last three meetings were reviewed and noted that discussion areas included incidents, complaints and patient experience.

The leadership team had time and resources to undertake effective governance and manage risk. There was a range of data and information available to understand performance and some quality improvement projects were in place.

Leaders monitored key safety and performance metrics. They identified and escalated relevant risks and issues and identified actions to reduce their impact. A clinical audit programme was in place to provide assurance of the quality and safety of the service. Clinical Governance was used to learn, improve and innovate.

The U&EC service had a clearly defined governance structure that supported the flow of information from frontline staff to senior managers and the trust executive team. The committees and groups included the U&EC divisional board, performance and improvement committee, people and culture committee, finance and improvement committee and clinical governance meetings. There were systems in place to manage current and future performance and risks to the quality of the service. The service had a risk register which reflected current risks within the service. All the risks had designated owners, risk and effect, risk ratings from red to green and actions. There was evidence of recent review of some of the risks, but some risks had not been updated for some time. For example. the U&EC service highest risk was overcrowding in the U&EC department and the inability to off-load patients and had been reviewed in June 2024, but the next joint highest risk was the impact of patients journey time within U&EC department of greater than 12 hours effecting patient safety and experience and had not been updated since January 2024 on the risk register.

There was a monthly people and culture committee which discussed issues such as mandatory training, sickness and vacancy/recruitment rates. There was some evidence of discussions regarding recruitment and workforce planning. For example, recruitment of band 6 nurses and providing development opportunities and the successful healthcare assistant recruitment day initiative. There were arrangements in place for the availability of, integrity and confidentiality of, data, records and data management systems.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Staff and leaders told us they had an understanding of how to make improvements happen. Leaders and staff were committed to continual learning, development and improving services. The leaders held a monthly U&EC performance and improvement committee to have oversight of the division’s performance and projects. This provided leadership and assurance of policies and procedures to ensure service improvement. There were imminent plans to improve the processes at reception in the U&EC service by introducing automated observation machines. Staff had provided feedback about the revised process for the initial assessment of patients at the front door reception to leaders.

A performance and improvement committee oversees a programme of service improvement. There was limited evidence of quality improvement methods in place although the U&EC department was involved in the early stages of a trial of an interpreter on wheels. This involved having a sign live app (on demand British Sign Language) and insight app (language interpreting) available to improve patient experience of services. The trust had also identified that it had a higher prevalence of hospital acquired pressure ulcers compared with the national average and the U&EC service was a location of concern. A quality improvement project had commenced looking at the prevention of patients developing pressure ulcers in the U&EC department. After an initial prevalence audit had been completed in February 2024 to establish the level of concern a training and education programme was planned to be rolled out on pressure ulcer prevention for U&EC staff. Staff would receive continuing professional development accreditation on completion of training and supervision. At the time of the inspection this had not yet commenced.