Royal Stoke University 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 at all levels were clear about their roles and understood their responsibilities and who they were accountable for. The service had suitable arrangements for identifying, recording and mitigating risks. The main risks within ED was flow, capacity, visibility of patients in certain areas and corridor care. Managers monitored action plans to ensure they mitigated risks in a timely way.

This service scored 68 (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 vision for what it wanted to achieve and a strategy to turn it into action, developed with all relevant stakeholders. The vision and strategy were focused on sustainability of services and aligned to local plans within the wider health economy. Leaders and staff understood and knew how to apply them and monitor progress. Staff had a good awareness of the trust values and felt these was embedded in their practice. They demonstrated how they worked together (as a team), showed compassion for their patients, always aimed to provide safe care and treatment and wanted to ensure they were able to provide a safe environment for their patients and all had a desire to continually demonstrate ideas and ways of improving. The department had a vision which was in line with the trusts vision. The vision remained to provide an emergency care service which met the needs of the community. However, in order to do this, the department had to work with the wider health economy and ensure patients received the right care, at the right place, at the right time. The strategy focused on three streams of work, the community services which built on existing clinical networks, secondary care which will look at improving patient outcomes by becoming more efficient and effective and tertiary and specialised services which concentrates on the major trauma side of the department. Staff felt their well-being mattered to their local managers. Managers were aware of the impact the pressures on the system had on staff and that staff in some areas were close to burn out.

We saw evidence of work being carried out around patient and staff engagement to shape and improve the service around cumulative time spent within the Emergency Department (ED), and the key indication of capacity and flow within the wider organisation, such as the aggregated patient delay (AGPD) above the 4 hour standard, AGPD is a measure of overall delay for all patients, and used as a marker of congestion known to impact on patient experience and mortality. Patients awaiting admission constitutes a large proportion of the total AGPD but overcrowding from patients who may not occupy a trolley and could, with timely input avoid admission is also important. The trust has recently seen a deterioration in performance against the access standards for emergency care impacting on patient care. We reviewed the trust standard of process for referral and admission, the aim of this document was to outline the way in which the trust behave while caring for patients. This was in response to the introduction of the new urgent and emergency care standards and replace all previous versions of Internal professional standards (IPS) at the trust. This document described the professional courtesy and respect that all person should expect from each other. Trust friends and family test (FFT) response rate for ED in February was reported as 9%. NHS England (NHSE) target was 30%.

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.

We did not look at Freedom to speak up during this assessment. The score for this quality statement is based on the previous rating for Well-led.

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 understood their role and responsibilities, what they were accountable for, and to whom. Leaders mostly operated effective governance processes, 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. However, we had concerns around the challenges for the department leads and staff around the increased pressures and the impact this may have on patients. Leaders and teams used systems to manage performance as effectively as possible. They mostly identified and escalated relevant risks and issues and identified actions to reduce their impact Staff told us there was an ‘open door’ approach to all managers and leaders in the department. If there were any concerns, staff felt they were able to raise them without fear of reprisal. Some staff told us they were actively encouraged to speak up if they had concerns.

Staff from the department attended monthly emergency medicine directorate clinical governance meetings. These meetings were chaired by the clinical director for the department and had multidisciplinary team attendance. These meetings discussed key governance issues including (but not limited to) incidents, complaints, risks and clinical effectiveness and audits. These meetings covered both the adult and paediatric departments and demonstrated where aspects from both departments had been raised for escalation to the board. This was the main governance meeting where members of the department were required to attend. Staff attended other internal governance meetings including the non-elective improvement group and mortality and morbidity meetings. Any learning or actions would be escalated and discussed at the department’s main governance meeting

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.