Royal United Hospital Bath

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

For the well-led domain, we looked at the quality statement, ‘shared direction and culture’, ‘freedom to speak up’, ‘learning improvement and innovation’ and ‘governance and assurance’. We rated this good.

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.

The service had a clear strategy, vision and goals which was developed in collaboration with staff, patients and interested community members. Linked to the strategy were the priorities for the surgical division for a 3 -year period. The service had focused on improving its organisational culture over the last 2 years and was implementing a cultural transformation programme. One of the objectives for 2023 / 2024 was to reduce the percentage of staff reporting they had personally experienced discrimination at work from their manager, team leader or other colleagues. In the March 2024 board papers stated, “the number of people reporting discrimination continues to be of concern, it has increased since efforts have been made to encourage people to report discrimination”. It is clear the trust and the division are focused on improving the organisational culture of the trust and whilst there is still work to be completed, we were assured the senior managers were aware of the issues and taking actions to encourage improvement. For example, we were told the associate director for people: culture change was working closely with staff in theatres and the matrons were working to set expectations with some of the senior sister and charge nurse staff who were new to leadership roles. Staff, during the site visit, said they enjoyed working for the trust and felt valued and supported. We were told they could raise concerns without fear of retribution.

The service had processes in place to support its vision, strategy and goals. These included the cultural transformation, improving together and the leadership development programme. The service has systems to support safety, patient flow and hospital discharge. We were told that there had been a recent bed reconfiguration of the surgical service and the management team felt satisfied that this would help to improve safe care with patients being cared for in the right places. There was a clear induction process which included a code of expectations for employees.

We did not look at Capable, compassionate and inclusive leaders during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The trust had a cultural improvement programme which was actively encouraging staff to speak up about any concerns. There was a network of freedom to speak up guardians. Staff we spoke to said they felt able to bring any issues to the attention of their direct line manager and were aware of the freedom to speak up guardians.

Processes around encouraging staff to speak up about concerns were actively encouraged. We saw evidence of this in board papers and management minutes.

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 we spoke to were aware of governance structures.

Governance processes were in place throughout the service and with partner organisations. Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service. The service had now established a local risk register detailing risks to and from the service and these were escalated accordingly onto the trust risk register. The surgical divisional boards met monthly and held surgical division Clinical Governance Meeting every 2 months. Items on the risk register were discussed at specialty governance meetings to ensure risks were being managed. Governance meetings also fed into the trust Quality and Safety group. Roles, responsibilities and accountability for cyber security and data protection and security are clear. The deputy chief executive is the senior information risk officer (SIRO) for the trust. We saw evidence of how information breaches were handled and that they followed the correct processes. We reviewed the trust’s Information Systems Security Policy which had not been reviewed within the given timeframe; however this was expected to be ratified imminently. There were 31 information governance breaches last year for the trust as a whole. 17% of these information governance breaches occurred within the surgery core service.

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 were committed to continually learning and improving services. They had a good understanding of quality improvement methods and the skills to use them. The surgical division had 5 trained professional nurse advocates who worked with specific regard to restorative clinical supervision. Restorative clinical supervision is a way of addressing the emotional needs of staff, supporting the development of resilience by reducing stress. It creates a thinking place for discussion, reflective conversations, supportive challenge and open and honest feedback. The trust planned to increase the number of professional nurse advocates in the next year. The trust was committed to improving its surgical services to improve the patient experience. The trust had acquired another surgical location in 2021. This was an independent hospital that provided care for both private and NHS patients. This was an innovative move from the trust in response to COVID 19 and the delays in elective care. In May 2023 the modular theatre at Sulis went fully operational which should help address the backlog in orthopaedic elective surgery. The service was also looking at ways to use outpatient facilities rather than theatre facilities in order to create more availability to treat patients in theatres. The surgical department was open to improvement ideas. For example, the service used approximately 100,000 disposable surgical caps every year and was in the process of moving to reusable surgical caps. These would have the staff names and roles printed on which would help to improve the patient experience as they would know the name and the role of the person they were communicating with. Safety alerts and standard judgement reviews on recent deaths were discussed at governance meetings.

The service had processes to encourage quality improvement work.