Fir Trees Independent 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

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

We have not awarded this service a score for Well-led.

Find out about when we will not publish a key question score and what we look at when we assess Well-led.

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. They had an equality, diversity and inclusion (ED&I) strategy which set out their commitment to promoting ED&I among their workforce at all levels.

The provider’s senior leadership team had successfully communicated the provider’s vision and values to the frontline staff in this service.

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

Staff could explain how they were working to deliver high quality care within the budgets available.

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.

Managers had the skills, knowledge and experience to perform their roles. They provided leadership training for staff.

Managers had a good understanding of the services they managed. They could explain clearly how the teams were working to provide high quality care.

Managers were visible in the service and approachable for patients and staff. The managers had an open-door policy, and some middle managers had been enrolled on a course in coaches for leadership.

Leadership development opportunities were available, including opportunities for staff to gain apprenticeships.

They made reasonable adjustments for staff to support staff in continuing their employment. All staff had received an induction and completed their support essentials before commencing on shift and included shadowing of staff.

They had values awards for staff, where staff could go online and nominate staff who they felt had completed some amazing work and to recognise their achievements. We saw feedback from a student that was positive and complementary to all the staff and patients at the hospital.

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. Patients and carers had different opportunities to give feedback on the service, including community meetings, surveys and feedback forms. Managers and staff had access to the feedback from patients, carers and staff and used it to make improvements.

Patients and carers were involved in decision-making about changes to the service. This was achieved through their commitment to co-production involving patients and carers in all aspects, working in equal partnership with people they supported for patients, families and carers across all aspects of their services to design, deliver, and improve their services.

Patients and staff could meet with members of the provider’s senior leadership team and governors to give feedback. The Alternative Futures Group (AFG) had been officially recognised as a great place to work by the Great Place to Work Scheme. This took place every year in October and was collated through employee engagement surveys.

The service had an established whistleblowing policy and associated Whistleblowing Audit Tool. These provided routes for staff to raise concerns and support organisational oversight of how concerns were managed. Alongside this, the provider was strengthening its broader Freedom to Speak Up (FTSU) arrangements to ensure clearer alignment with ‘just culture’ principles and the national patient safety framework.

Staff were able to raise concerns through existing management routes, whistleblowing processes, human resources, incident reporting systems, and governance structures. Staff could also use supervision and clinical supervision and performance reviews to raise concerns.

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.

There were equality and diversity champions within the service and an equality, diversity and inclusion hub where staff could access support and events and resources.

Staff could apply to work flexibly, for example, flexible working agreements to account for personal circumstances such as caring responsibilities and health issues.

Managers put reasonable adjustments in place for staff members to help them carry out their role.

The provider undertook equality monitoring of staff within the service to ensure it was diverse in its make-up and representative of the patient group.

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.

There was a clear framework of what must be discussed at ward level in team meetings to ensure that essential information, such as learning from incidents and complaints, was shared and discussed.

Staff had implemented recommendations from 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. Following audits in relation to medication errors there were a few gaps that had not been actioned immediately. This was brought to the attention of the manager and was rectified immediately. There was no impact on patients care and treatment.

Staff took part in clinical audits, benchmarking and quality improvement initiatives. There were regular audits of care records, infection control, medicines, Mental Health Act (MHA) paperwork and physical health assessments.

All audits were discussed at managers meetings, and we saw that managers used results from audits to make improvements. We saw that managers used these audits to inform discussion in team meetings and the outcome of those discussions resulted in changes to practice.

Staff understood the arrangements for working with other teams, both within the provider and external, to meet the needs of the patients.

Management of risk, issues and performance were monitored and shared with staff and leaders.

Staff maintained and had access to the risk register at ward level. Staff at ward level could escalate concerns when required. Managers received investigation training and only investigated incidents at one of their other units within the provider organisation.

The service had plans for emergencies such as adverse weather or a flu outbreak.

The service used systems to collect data from wards that were not over-burdensome for frontline staff.

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.

Information governance systems included confidentiality of patient records. The finance and human resources teams met regularly with the management and any concerns were discussed and a monthly report was produced. The head of operations and quality leads met monthly, and any policy and procedure updates were discussed.

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. Information was in an accessible format, and was timely, accurate and identified areas for improvement.

The provider quality team visited the service unannounced to complete spot checks on the unit and spoke with patients and staff. Any learning from the feedback was discussed with the manager and disseminated to staff. The Integrated Care Board (ICB) for the area visited and completed quality visits, reporting on progress. The purpose of the visit was to review the recovery focused work being delivered at Fir Trees.

There was a board of trustees who were the governing body of the provider. They monitored the management and best interests of the organisation. The board was made up of independently appointed individuals with a broad range of experience, and a diverse level of expertise and oversight. The executive team oversaw the day-to-day management, key decision-making and future strategic direction of the provider and its services.

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, Integrated Care Boards, local authorities, housing, NHS Trusts and drug and alcohol services. Weekly meetings were held with partners when patients were ready for discharge.

They also worked with other organisations in their local council to address any issues around health and wellbeing. Some patients had joined these meetings to seek support around weight management and healthy eating.

Patients and staff could meet with members of the provider’s senior leadership team and commissioners to give feedback.

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 contribute to safe, effective practice and research.

Staff were given the time and support to take opportunities for improvements and innovation and this led to changes. Staff were supported and encouraged to complete any training necessary for their role. An example of this was that all staff completed dialectical behaviour therapy.

Staff used quality improvement methods and knew how to apply them.

Staff participated in national audits relevant to the service and learned from them.

The unit was working towards the Royal College of Psychiatrists accreditation for inpatient mental health services.