Kneesworth House

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• 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

This means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question good. At this assessment the rating has remained good.

This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

Leaders had the skills, knowledge and experience to perform their roles. Staff knew and understood the provider’s vision and values and how they applied to the work of their team. Staff felt respected, supported and valued. Governance processes operated effectively. Performance and risk were managed well. Teams had access to the information they needed to provide safe and effective care. Staff collected analysed data about outcomes and performance. They used this to identify improvements.

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.

We scored the service as 3. The evidence showed a good standard. The service had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

Staff knew and understood the provider’s vision and values and how they were applied in the work of their team. The staff received a welcome pack which included the staff values.

The provider’s senior leadership team had successfully communicated the provider’s vision and values to the frontline staff in this service. There was a monthly staff forum where the hospital director shared future plans with the staff.

Staff had the opportunity to contribute to discussions about the strategy for their service, especially where the service was changing.

The hospital held award ceremonies for recognition for staff including night staff and managers, and staff told us there was an open-door policy for managers and leaders.

We scored the service as 3. The evidence showed a good standard. The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Leaders had the skills, knowledge and experience to perform their roles. Leaders had a good understanding of the services they managed. They could explain clearly how the teams were working to provide high quality care. Leaders were visible in the service and approachable for patients and staff. Staff told us that leaders regularly walked around the wards and were approachable.

Leadership development opportunities were available, including opportunities for staff. The hospital welcomed apprenticeships, managers encouraged staff to progress in their careers as well as students and graduates to join the staff team.

We scored the service as 3. The evidence showed a good standard. The service fostered a positive culture where people felt they could speak up and their voice would be heard.

Patients and carers had opportunities to give feedback on the service they received in a manner that reflected their individual needs. Managers and staff had access to the feedback from patients, carers and staff and used it to make improvements. Patient engagement was evident on the wards with opportunities for senior leader engagement. However, carers and staff told us there was room for more communication and engagement with carers which the hospital had plans to improve.

There was a freedom to speak up process that staff described, and the hospital had 4 freedom to speak up guardians.

Patients were involved in decision-making about changes to the service. The hospital held regular staff forum and patient forum meetings for staff and patients to be able to give feedback directly to senior leaders.

We scored the service as 3. The evidence showed a good standard. The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

The provider had a range of equity, diversity and inclusion networks that staff could access.

Managers put reasonable adjustments in place for staff to help them carry out their roles. Staff told us managers were flexible with their annual leave and working hours for personal, family, student studies and religious practices.

Managers told us that if any member of staff received abuse due to their protected characteristics the police will be called to investigate, and the member of staff supported. Staff did not raise concerns about discrimination.

We scored the service as 3. The evidence showed a good standard. The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

The service held monthly senior manager team meetings which followed a clear agenda including risk management and learning from incidents and complaints, these were shared and discussed and there was a clear action planning process.

Governance meetings demonstrated how lessons learnt were escalated at a regional level. Staff had implemented recommendations from reviews of deaths, incidents, complaints and safeguarding alerts at the service level.

Staff undertook or participated in local clinical audits. The audits were sufficient to provide assurance and staff acted on the results when needed. We observed there were good record keeping and audits in place on the wards. Managers told us the audits they completed and which audit committees they participated in. Pharmacists carried out weekly audits of all medicines to ensure they were within British National Formulary (BNF) levels.

Wortham ward environment was on the risk register for a programme of maintenance works.

The service had a recently updated their major incident contingency plan which included loss of essential services, fire and severe weather. Information governance systems included confidentiality of patient records.

Staff had access to the equipment and information technology needed to do their work. The information technology infrastructure, including the telephone system, worked well and helped to improve the quality of care. However, staff did tell us the Wi-Fi was slow, and leaders told us this was under review.

Team managers had access to information to support them with their management role. This included information on the performance of the service, staffing and patient care. Managers used dash boards to monitor their completion of staff mandatory training.

We scored the service as 3. The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

Directorate leaders engaged with external stakeholders such as commissioners and Healthwatch. Managers told us they had good links with local commissioning groups and NHS England. The service received referrals from local and national commissioners. Doctors told us they had excellent GP links with local practices and hospitals. Local GP practices carried out annual health checks and ECGs for Care Programme Approach (CPA) for patients in the bungalows. The service had monthly meetings with the police to review any ongoing cases.

Patients and staff met with members of the provider’s senior leadership team and commissioners to give feedback. Regular patient and staff forums took place with senior leaders.

We scored the service as 3. The evidence showed a good standard. The service focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively

Staff told us they had opportunities to participate in research. Innovations took place in the service. Occupational therapists had apprenticeship links with Hertfordshire university. Quality Improvements (QI) took place across the hospital. Staff told us about a recent QI project to increase carers involvement, they used QR codes to encourage carers to give feedback.

The hospital had an awards system to reward wards and staff who had worked hard to resolve a difficulty on their ward. Staff received a reward who had worked with new patients who had been initially challenging for staff, but staff had worked with these patients to overcome these challenges.

Clinical staff told us about regular medical advisory meetings that took place, inviting external speakers including an ex-deputy medical director from Birmingham and Solihull mental health trust. Clinical staff told us how doctors take it in turns to provide internal teaching to the staff.

The bungalows recovery cluster team were awarded the Priory Award 2023 for their work with the patients in the bungalows for their commitment and the Integrated Care Boards (ICB) acknowledge the progress those patients made.