Nightingale 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

Staff knew and understood the provider’s vision and values and how they applied to the work of their team. Leaders were visible at the service, and ensured there was a shared vision and strategy that staff understood and supported. The service had a risk register, and staff and leaders ensured any risks to delivering the strategy, were understood, and had an action plan to address them. Staff and patients spoke highly of the ward manager who was clear about the wards’ strengths and areas for development. Staff were positive about the leadership provided by the hospital director and senior leadership team and said that they were visible and approachable at the service. Staff described good workforce morale at the time of the inspection and felt that the culture was inclusive and supportive. At the previous inspection in June 2022, we found that improvements were needed in governance systems and processes in place to assess, monitor and drive improvements in the quality and safety of services provided. At the current inspection we found that there were clear and effective governance, management, and accountability arrangements. Managers acted on information about risk, performance, and outcomes, and shared this with the staff team to bring about improvements. The service had a schedule of audits for each year including audits for different departments. Audits were completed by a charge nurse and discussed in team meetings to identify improvements neededed. There was a daily meeting held at the hospital during which each ward lead met to check occupancy, staffing, and safety roles. There was a quality improvement plan for the hospital, and regular quality walk arounds by senior management to monitor the quality and compliance around all hospital units and out of hour visits. The ward had been successful in gaining accreditation with the Quality Network for Eating Disorders.

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.

Staff knew and understood the provider’s vision and values and how they applied to the work of their team. The vision and strategy were focused on providing high quality care to all patients in a safe and nurturing environment. Provider values included compassion, respect, commitment, recognition, and one team. We saw evidence of the values being applied, for example, staff treating people with dignity and respect and compassion, and working together as a team. Staff and patients had access to the minutes of staff and patient representatives’ meetings, about the running of the hospital. Staff told us that they felt respected, supported and valued and they could raise any concerns without fear. They reported a positive culture and valued the diversity of the senior leadership team. When concerns were raised, they were taken seriously and where possible addressed. They indicated an improvement in support from senior management since a difficult period on the ward during the winter of 2023/2024. Staff and leaders demonstrated a positive, compassionate culture focused on learning and improvement. They had a clear understanding of equality, diversity and human rights and felt that they received equal opportunities for development. Staff described strong teamwork, and regular staff supervision and support.

The provider had policies and procedures, indicating a clear vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity, and inclusion. Leaders were visible at the service, and ensured there was a shared vision and strategy that staff understood and supported. Staff appraisals included conversations about career development and how it could be supported. Senior leadership had introduced long service awards for staff. There were opportunities for overtime at the time of the inspection, but management ensured that staff had sufficient days off. Senior staff dealt with poor staff performance when needed. The service had a risk register, and staff and leaders ensured any risks to delivering the strategy, were understood, and had an action plan to address them. They monitored and reviewed progress against delivery of the strategy.

Staff said that managers acted by the culture and values of the service, and had the skills, knowledge, experience, and credibility to lead effectively. They described managers as having integrity and being open to engage with them. Leaders we spoke with demonstrated that they had the experience, capability and understanding to deliver the service’s vision, and manage risks. They were knowledgeable about issues of concern and priorities for the service and said that they could access appropriate support and development in their role. Staff and patients spoke very highly of the ward manager who had the skills, knowledge and experience to perform her role. The ward manager was clear about the wards’ strengths and areas for development. She gave examples of improvements that had been made including to the environment, team training, and staff culture on the ward. The ward manager said that development opportunities available for staff were discussed in supervision. One staff member told us they had decided to commence training as a registered nurse with the support of management at the hospital. Staff were able to attend external training that they requested. Sickness and absence rates were monitored, and managers offered support to staff who returned to work after a period of absence. Staff spoke positively about the leadership provided by the hospital director and senior leadership team, and said that they were visible and approachable at the service. Staff noted improvements in the support they received, systems in place, training, and environment of the ward since the new senior management team had been in place.

The service had inclusive leaders who understood the context in which they delivered care, treatment, and support. They demonstrated the culture and values of their workforce and organisation. Leaders were visible within the service and had the experience, capacity, capability, and integrity to ensure that the organisational vision could be delivered, and risks were well managed. High-quality leadership was sustained through safe, effective, and inclusive recruitment and succession planning, and professional development opportunities for staff. Observation of a staff shift handover meeting indicated that staff discussed all relevant issues to ensure safe care and treatment including allocation of patient observations, and current physical and mental health needs of patients. The management team had forged good links with local universities, enabling links with research, and nursing students to have placements on the ward.

Staff we spoke with were very positive about working at the service. They spoke highly of the support provided by management and investment in the service. They indicated that they felt heard, with actions put in place to address areas of concern they raised. Staff and leaders spoke with openness, and transparency. They were aware of the whistleblowing policy for the provider organisation, but said they felt confident in speaking up to managers at the service. Staff we spoke with were confident that their voices were heard.

Leaders fostered a positive culture where people felt that they could speak up and that their voice would be heard. They promoted staff empowerment to drive improvement. There was a whistleblowing policy in place for the hospital, with options for staff to make disclosures within or outside of the provider organisation. Two whistleblowing disclosures had been received for the hospital in the last six months to April 2024 relating to staff concerns about discrimination and working conditions, and the issues raised had been addressed.

Staff described good workforce morale at the time of the inspection and felt that the culture was inclusive and supportive. Managers had a plan to have staff rotate so that they worked across different wards in the hospital, to limit the danger of having a closed culture on the ward. The management team had conducted a survey of staff satisfaction in 2023, with actions in place to address issues raised. This indicated lower scores for staff salary and benefits, and personal growth, and higher scores for individual line managers, communication and the environment. Plans for improvement included staffing levels, internal progression opportunities, employee benefits, flexible working and communication with senior management.

The provider’s policies indicated that they valued diversity in the workforce and worked towards improving equality for staff. Leaders took action to continually review and improve the culture of the service in the context of equality, diversity and inclusion. Leaders reviewed policies and procedures to tackle structural and institutional discrimination and bias to achieve a fair culture for all. Where possible they made reasonable adjustments to support staff to carry out their roles well.

Staff understood their role and responsibilities. Managers had a good understanding of the actions, behaviours, and performance of staff. There were regular audits undertaken including of record keeping and physical health monitoring, medicines administration and staffing, with results discussed with staff. Staff spoke positively about the new senior leadership team, and changes that they had brought about to the hospital environment, staff training (including in dietetics, communication and mealtime support), and implementing new and more effective ways of working. The senior management team had provided support during a period of high acuity on the ward, implemented electronic prescribing which was working well, and conducted regular quality walk arounds. Staff described them as being more responsive and flexible and listening to staff and patient feedback. There were plans to provide air conditioning in all bedrooms, following feedback about poor temperature control in the rooms. Staff told us they had access to the equipment and information technology needed to do their work. The ward manager had access to information to support them in their role such as supervision records, training data, staffing, complaints, incidents and accidents. Information governance systems protected the confidentiality of patient records. Data and notifications were consistently submitted to external organisations. At the time of the inspection the hospital had moved to a new electronic patient record system which was still being embedded. The use of both paper and electronic patient records resulted in some unnecessary duplication, which impacted on the time staff had to spend with patients. The management team were working to decrease duplication in recording. We met with the hospital director, deputy hospital director, and quality and compliance manager. Staff at the service, described clearer procedures and increased quality assurance under the current senior management.

At the previous inspection in June 2022, we found improvements were needed in governance systems and processes to drive improvements in the quality and safety of services provided. At the current inspection we found that there were clear and effective governance, management, and accountability arrangements. Managers acted on information about risk, performance, and outcomes, and shared this with the staff team to bring about improvements. The service had a schedule of audits for each year with ward audits completed by the charge nurse and discussed in team meetings where improvements needed were discussed. There was a daily meeting held at the hospital during which each ward lead met to check occupancy, staffing numbers, including additional staff available to assist across the hospital, and safety roles. Staff at the hospital completed quality performance information on a weekly basis. Audit feedback was discussed in regular staff meetings, business meetings, clinical governance meetings, and clinical improvement meeting (previously known as the clinical steering group). We reviewed a sample of meeting minutes from all these meetings, and found that they regularly discussed performance, incidents, audits, clinical outcomes, patient engagement, and complaints. Every month senior clinical staff and hospital managers met at a clinical improvement meeting to discuss emerging trends on the ward, staff training requirements and feedback from carers and patients. The risk register and quality improvement plan for the hospital, had mitigations in place including regular quality walk arounds by senior management. All management staff had received 2 days of management training. Patients’ forum meetings were held bi-monthly.

Patients and relatives/carers we spoke with were satisfied with the hospitals communication with other relevant services.

Staff understood their duty to collaborate and work in partnership with other services, including local physical health services. They shared information and learning with partners and collaborated for improvement, for example in working towards discharge with patients and their carers, addressing their specific needs and preferences. Learning from incidents and new ways of working were shared across the provider organisation, and staff learned from national patient safety alerts.

The advocate told us that staff and leaders worked well in addressing concerns raised by patients through them. They described the staff team as responsive and supportive but maintained the independence of their position as an independent advocate. An area for improvement identified included variability in some agency/bank staff interactions with patients. They were assured that management were taking these concerns seriously and working to improve training for all staff I this area.

Staff and managers at the service understood their duty to collaborate and work in partnership. They shared appropriate information and learning with partners and collaborated for improvement. Staff on the eating disorder ward were involved in contributing to a research project being undertaken alongside another healthcare provider and local university. Staff and managers engaged with people, and partners to share learning with each other that resulted in improvements to the service. They used these networks to identify new ideas that could lead to better outcomes for people. Patients and carers had opportunities to give feedback on the service they received. Carers were able to feedback directly to the ward manager and there were patient satisfaction surveys for the hospital. Although, these were not broken down by service type. There is also an annual staff survey for the hospital.

Staff and managers confirmed that there were clear processes in place to ensure that learning happened when things went wrong, as well as from examples of good practice. Reflective practice sessions were held with staff, and debrief sessions were held when needed. Learning was shared with the staff team at regular handover and other multidisciplinary team meetings. Managers encouraged staff to reflect on what could be changed, and collective problem-solving. Leaders encouraged staff to speak up with ideas for improvement and innovation. Staff told us there was a sense of trust between leadership and staff.

The provider was not using quality improvement methods within the hospital. The ward had been successful in gaining accreditation with the Quality Network for Eating Disorders who worked with inpatient and community services to assure and improve the quality of services treating people with eating disorders. The provider was also working in partnership with another eating disorders healthcare provider and a local university on research about measures of mentalising in patients with eating disorders and oral microbiome analysis.