Winnersh

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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

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 inspection for this service since its registration with CQC. This key question has been rated as Requires improvement.

The service was in breach of legal regulation in relation to governance.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Leaders in the service had a shared vision, strategy and culture. The service had a clear strategy which included business objectives. Their plan was to continue to expand the business which had experienced rapid growth in a short period of time. Leaders at the service told us their culture was to put the patient first; however, some staff told us they felt the focus of the service was more commercially driven rather than focused on a ‘patient first’ approach. Feedback from staff regarding the culture of the service was mixed, with some staff who told us they felt supported and confident to raise concerns. Other staff told us they did not feel supported and did not feel safe to raise concerns and if they did, they would not be listened to.

Leaders at all levels demonstrated an understanding of the context in which they delivered care and embodied the organisation’s culture and values. Leaders described their approach as being based on integrity, openness and honesty, which was supported by feedback from some staff. However, other staff described the leadership style as hierarchical and that communication was not always open, transparent or collaborative. Recent provider staff surveys highlighted that most staff were positive about working in the service.

Staff and leaders in the service told us they had a programme of meetings where information was shared. We saw minutes of meetings to support this.

The service encouraged staff to raise concerns or suggest improvements to managers and used an engagement survey as a platform for staff to share their views. Some staff described positive examples where their feedback had led to changes, such as the introduction of scheduled screen breaks and individual reasonable adjustments. However, other staff told us they did not always feel confident that their voice would be heard. Several staff members described raising similar concerns, such as the lack of protected time for administrative tasks or training, without seeing any action taken by leaders.

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.

Policies and procedures to promote diversity and equality were in place. The Recruitment policy reflected that all candidates should be reviewed and selected fairly, on merit and without bias. All staff were required to complete training in equality and diversity.

The service did not always have clearly defined responsibilities, roles, systems of accountability, or effective governance arrangements. Leaders did not consistently act on the best available information regarding risk, performance, and outcomes.

We found that systems and processes were not always operating as intended. There were notable gaps in governance, including the absence of a fire risk assessment following internal building works that created a compartmentalised workspace. During our site visit, we observed a locked fire door that obstructed a signed escape route, posing a safety risk in the event of a fire. Leaders were unable to provide a satisfactory explanation for why the fire door was locked.

Training and induction compliance was not being monitored effectively. For example, a doctor on the specialist register had begun clinical work without their training being confirmed by the service. Some newly recruited staff expressed concern that their induction focused more on the commercial development of the service than on the patient journey.

Leaders and managers told us they supported staff, and most staff reported feeling supported. However, some staff disagreed and provided examples to illustrate this. While individuals were generally clear on their own roles and responsibilities, shared responsibilities were not always well defined. For instance, the safeguarding messaging group allowed staff, including clinicians, to request support, but there was no rota in place to ensure safeguarding coverage during evenings and weekends when appointments were taking place. Leaders in the service told us that the safeguarding support was available at all times that patient appointments were being provided. At the time of our assessment there was no rota in place to cover weekends but leaders in the service told us that these were monitored in real time by senior leadership. Following our assessment, the service informed us that they were taking action to address this and were developing a rota system.

The service understood their duty to collaborate and work in partnership, so services worked seamlessly for people. There were systems in place to communicate with the patient’s own GP when treatment was initiated and when individual prescribers felt it was clinically appropriate to do so. Leaders in the service told us they would not routinely contact any other services that were providing care to their patients but would do so if necessary.

We were told that the service’s representatives attended round table discussions with the Department of Health and Social Care (DHSC). The service also had some engagement with Police Forces, providing letters to support patients who had interactions with police officers who had requested evidence of their treatment.

Leaders in the service told us they were focused on continuous learning, innovation and improvement across the organisation and local system. We saw some evidence of how feedback from audits, investigations and clinical outcomes were used to strengthen governance and improve processes. They wanted to encourage creative ways of delivering equality of experience, outcome and quality of life for people. Leaders in the service described future plans for service developments that they believed would improve clinical safety and the patient experience. Given the concerns we identified at this assessment which had not been identified by the service’s own quality assurance processes, there was further work required to ensure the above aims could be met.