CQC rates leadership at The Princess Alexandra Hospital NHS Trust as requires improvement

The Care Quality Commission (CQC) has rated leadership at The Princess Alexandra Hospital NHS Trust as requires improvement following an inspection carried out in January.

The trust provides general acute, outpatient and diagnostic services across The Princess Alexandra Hospital, Herts and Essex Hospital and St Margaret’s Hospital. It employs around 4,000 staff and serves a local population of approximately 350,000 people, extending to around 500,000 across Harlow, Epping, Bishops Stortford, Hoddesdon, Cheshunt and Broxbourne.

The inspection assessed how well-led the trust is and followed themes identified during recent inspections of its medical care, surgery and urgent and emergency services. CQC now gives NHS trusts a single trust-level rating focused on leadership and culture.

Inspectors found that leaders had clear ambitions for the organisation and a well-defined strategy, but these had not yet been fully embedded across the trust. CQC identified concerns around staff experience, organisational culture and the way concerns raised by employees were handled.

Staff told inspectors that confidence in the trust’s response to concerns remained low. More than a third of staff who had spoken up reported having a negative experience as a result, while some employees on visas were reluctant to raise concerns because they were worried about their immigration status.

CQC also found that organisational changes had been implemented at a pace and in a way that negatively affected staff morale. Some employees felt they had not been given a clear explanation for decisions made during the trust’s recent restructure.

Inspectors said further work was needed to create a more inclusive workplace, with staff networks for different groups still underdeveloped. The board’s arrangements for managing risks and responding to concerns raised by staff also required further development to provide consistent and effective oversight.

However, CQC highlighted improvements in the trust’s senior leadership. The board has been significantly strengthened since 2021, with a new Chair, Chief Executive, Chief Nurse, Medical Director and Chief Operating Officer. Stakeholders described the leadership team as open, honest and transparent, while partners said the trust was constructive and willing to collaborate.

The trust’s patient panel was also highlighted as a particular strength and has received national recognition, including the Queen’s Award for Voluntary Service. Inspectors additionally noted progress on environmental sustainability through a refreshed green plan and successful bids for external funding to improve energy efficiency.

Operational performance has also improved. The trust has cleared its entire 78-week waiting list and reduced the number of people waiting 65 weeks from 583 to 17.

Sarah Ivory-Donnelly, CQC deputy director of hospitals in the east of England, said the trust had made improvements since its previous inspection but needed to do more to ensure staff felt safe and confident raising concerns.

CQC has told the trust where further improvements are required and said it will continue to monitor its progress.

Stay informed with the stories shaping health and social care.