Good Hope 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 reviewed capable, compassionate and inclusive leaders and governance, management and sustainability for the well-led key question. We found well-led had gone down to requires improvement.

There was a lack of effective governance processes which provided senior leadership teams with the essential oversight of the service. However, there had been a change in the structure of leadership at the hospital which staff believed would in time improve the management of the service.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

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

We received mixed feedback about leaders at various different levels. Some staff said leaders were visible, approachable and accessible. Others did not feel valued or respected. We heard reports of a ‘blame culture’ where staff may be made an example of when incidents happened. We were given an example of staff being asked for the name of who they should blame. They felt this culture may possibly still exist to a degree as some of the same management remained. There was a culture review process ongoing at the time of the assessment, which would generate a report from staff feedback sessions.

The trust underwent a change in the structure of the leadership for the hospitals in October 2023. This process saw hospital leadership teams being put in place for each of the main hospital locations, including Good Hope Hospital. Under each hospital leadership team was a clinical delivery group which had a clear structure for leadership within the service. The reorganisation saw the roles and responsibilities of each leader redefined to ensure they had the experience, capacity and capability and integrity for leading the service.

Action was taken by leaders following the staff survey to improve the culture within the service. The new operating model had refreshed the communications and engagement approach within the service. This had seen some improvements within the culture and feedback from staff. However, there was acknowledgement that further work on the culture within the whole trust, and the service more specifically was required.

We received mixed feedback about freedom to speak up. Some staff said leaders listened to them and they could ask questions and raise concerns without fear. Others said they could not always raise concerns, as some leaders were supportive and responsive with this, but others were not. We heard leaders did not always listen and did not always follow through on concerns raised.

Theatres had a staff suggestions box for feedback and polls. However we heard staff could be reluctant to reveal their identity when giving feedback and would only do so if they believed they could not be identified, and it was completely anonymous.

There had been 2 freedom to speak up cases in the last 12 months. Both related to alleged discrimination, with one also alleging harassment, bullying, poor induction and ineffective support.

The trust had a Freedom to Speak Up Guardian which the service was engaged with and promoted. Information provided showed there were 2 contacts with the service from the surgical staff. Both cases were related to bullying and discrimination.

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.

Staff told us there was a relatively new organisational structure where previously centralised management and governance had recently moved to local sites. This meant there was an evolving picture of where risks may now sit. Leaders and managers felt better supported by a local site team, and some felt the restructuring had helped improve compliances with certain aspects of care. However, the management and governance of clinical groups (CDGs) was cross site. This meant not all services at Good Hope Hospital were managed there. For example, gynaecology, orthopaedics and anaesthetics were managed from Birmingham Heartlands Hospital. Therefore, some doctors and processes at Good Hope had remote management, and governance was managed through the governance site rather than the actual site. We heard concerns that governance was weak and the risks inherent in systems had not yet been evaluated and were not well understood.

Staff told us there were concerns around the electronic system, which was used at the trust, as this was used as an assurance system. Staff raised concerns that this was not fit for purpose as an assurance system. The system required staff to be logged in to receive alerts and there were concerns around the alerts function and who was accepting these or the issue around staff ignoring alerts. Despite the concerns raised by staff, this was not on the risk register.

Staff also raised concerns around the speed in which concerns and risks were addressed. Staff shared examples at the time of the assessment where there had been delays in addressing concerns and risks.

The service had governance processes. However, these were not always effective. The service had dashboards which provided oversight of aspects of care including missed medication and falls assessment completion. However, the number of operations, cancellations, failed discharges and readmissions, complications amongst other key data was not in a single place to support the service’s oversight. In addition to this, information shared after the assessment indicated some key information was not readily available for oversight but would require specific manual audit.

The service had 4 separate risk registers (general surgery, gynaecology, orthopaedics and theatre risk registers) which did not have all relevant details on them including dates they were identified and registered as risks as well as no identified owner of the risk. Information provided after the onsite assessment did not provide assurance all risks were recorded. An updated general surgery risk register was provided which showed an additional risk had been added after queries were made by the assessment team.

The information systems used by the service did not enable staff to easily and readily access data to enable leaders to be fully informed about the performance of the service and where risks existed.

The service had evidence where audits had been completed; however, there was no action taken as a result of the findings. The service also demonstrated a delayed response to investigating some serious incidents which resulted in delayed learning and action.

Governance meetings were held regularly and followed a standardised format. In addition to the regular meetings, each speciality were required to produce a “four box report” which provided details of positive work, area of concern, outcomes and learning and improvements.

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.

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