Brainkind Neurological Centre York

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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. This is the first assessment of this service. This key question has been rated 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. They had a good understanding of the services they managed. Most staff felt respected and said managers were visible. However, some staff did not feel valued and fed back that managers were not always responsive to their concerns. Staff survey results showed that staff did not feel confident in managers and leaders. This included concerns about their communication, decision-making and understanding of staff and the people they supported. The service worked well with external partners also involved in people’s care. There were effective governance systems in place which identified, managed and monitored risk. Managers implemented action plans, strategies and processes which had worked well and improved the overall governance of the service. There was evidence of learning and continuous improvement, and managers were in the process of reviewing systems and processes following the organisational rebranding and moving to the new site.

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.

Managers continued to work towards ensuring all staff worked in line with their model of care. The organisation was in the process of developing new values following re-branding. Managers described positive changes towards sustainability and the use of technology. They were aware that not all staff had fully embraced some of the changes since moving to the new site, particularly around the reduction in staffing numbers.

Managers ensured that they recruited people with the same vision and values who could support with the development of the service. Staff were committed to the service and spoke passionately about the people they cared for.

The service followed organisational processes to recruit managers and leaders with support from human resources. This included ensuring the relevant pre- employment checks were completed. There were interviews taking place on the day of inspection for a vacant managerial position.

Managers were very passionate about the service and the impact they could make on people’s lives. They described a range of courses available to them which they said supported them in carrying out their roles. This included various management and leadership development courses and workshops.

Managers we spoke with could clearly describe their function and the roles and accountability of others within the service. They could also provide examples of succession planning and told us they tried to provide staff with opportunities for development wherever possible.

The provider used staff engagement surveys to gather feedback from staff and subsequently implemented plans clearly showing areas they were going to prioritise for action. Whilst some areas of the survey had high positive scores, other areas scored between 30% and 50% positive responses. These included questions about immediate managers, regional managers and the senior leadership team, including their communication, visibility and understanding of the service and patient group. For example, only 39% of staff reported positive experiences with regional managers. Only 39% of staff felt regional managers led by example, and 35% felt managers of the service or department managed change effectively. Furthermore, only 32% of staff felt regional managers understood their views or opinions.

Following the publication of the survey, managers held several listening events. One of the findings from the events was that many staff were not familiar with the senior leadership team. In response, the service developed an action plan which included service structure charts and manager profiles, which they circulated to staff.

Nevertheless, we observed positive interactions between managers and staff during our inspection. Whilst some staff fed back that managers were not always approachable or available, others spoke positively about the support they received, telling us they could contact a manager at any time who was responsive to any issues they raised.

Staff knew how to raise concerns. Managers provided examples that they felt showed staff at all levels contacted them directly and they described an open-door policy for raising concerns.

There was a whistleblowing line which was managed centrally by the organisation. Managers told us they did not have any concerns about the speaking up culture.

All staff said they felt managers were respectful of diversity. They completed occupational health reviews and made reasonable adjustments for staff where appropriate.

The organisation had an equality, diversity and inclusivity group forum. This was advertised centrally for staff from the service who wanted to join the group. The group held regular events to celebrate different groups and shared updates with staff.

Staff had the opportunity to discuss working patterns with managers. Relevant policies, procedures and training were in place for all staff.

Managers had governance arrangements in place and had relevant information at hand to ensure the service was performing well. Managers attended regular governance and leadership meetings and quality, performance and risk meetings. These had oversight from senior leaders within the organisation.

We reviewed a sample of governance meeting minutes. These were attended by a range of staff and leaders. Key performance indicators and monthly audit processes were in place to help give oversight of the service. Managers had clear expectations of what care and support the service aimed to provide. Robust processes were in place to safely manage sensitive data which allowed them to maintain people’s privacy, dignity and confidentiality.

The provider had a risk register in place which clearly stated each risk and mitigation in place to help reduce the risk. These risks were discussed within governance meetings alongside other issues including complaints, incidents, patient experience, compliance and standards, and research. Each area was discussed in detail and appropriate actions were put in place when required and reviewed in subsequent meetings.

There was a business continuity plan in place. The plan covered potential risks related to staffing, local emergencies, and building or maintenance issues affecting service delivery. Managers understood and had access to the annual budget. They monitored monthly expenditure reports, which enabled them to track and plan the annual budget.

People told us family members and external teams were involved in their care and treatment when they had consented to this. Carers spoke very positively about how staff involved them in all stages of people’s pathways and described excellent communication.

Managers arranged for funders to attend review meetings and meet with people prior to admission. The provider was open and transparent to external stakeholders including commissioners and provided them with regular updates. Managers supported commissioners to visit the service and to complete audits and quality visits for the people they funded. There were good links with the local council and clear safeguarding processes in place.

The provider had processes including care programme approach meetings, discharge meetings and ward rounds to ensure all relevant partners were involved in people’s care.

We saw evidence of processes and initiatives in place to enable learning and continuous improvement. The service was completing a quality review to assess service performance and effectiveness since rebranding and moving to the new site. This included reviewing all job descriptions, roles and responsibilities, current meetings, and making changes to improve the induction timetable.

The service was in the process of completing a project in response to the introduction of CQC’s single assessment framework. The project aimed to better capture and analyse data from people, families and stakeholders, and to be able to publish the findings in a more accessible way.

Managers had developed an action plan which aimed to improve the ward round process. This included reviewing how staff created people’s goals and ensuring care plans were individualised and person centred.

There was a quality improvement plan in place that contained a range of recommendations and actions to improve areas, including learning and development, compliance, safeguarding, and incidents. There were also actions in place to improve clinical practice.