Parkway

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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.

At our last assessment we rated this key question as requires improvement. At this assessment the rating remained as requires improvement.

The service did not have clear responsibilities, roles, systems of accountability and good governance, and there were a number of vacancies in leadership roles that were being covered by staff with other responsibilities. The service did not act on the best information about risk, performance and outcomes.

However, staff could see that leaders were working to deliver high quality care amid the ongoing changes to the service.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service’s vision was ‘Professional excellence in providing safe, timely and appropriate care for patients’. The service values were stated as ‘Care with passion- high quality, safe care; Dignity & Respect towards all patients, relatives, carers & colleagues; Good Communication- Listen, be responsive to the needs of our patients’.

Staff knew and understood the provider’s vision and values and how they were applied in the work of their team.

At the time of our inspection there had recently been a change in the leadership arrangements within the service, although service clinical directors and service leads were accountable to the Director of Quality and Performance and the CEO. Some staff we spoke with said they had not always had the opportunity to contribute to discussions about the strategy of the service, especially where elements were changing.

However, staff could explain how they were working to deliver high quality care, and they saw this as a priority.

Leaders did not always have the skills, knowledge, experience and credibility to lead effectively.

The clinical lead for the minor surgery service was the medical director, who had principal external work commitments as an independent GP. Although the medical director made frequent visits to Parkway and was contactable by phone, in day-to-day practice the lead for delivery of the service was the operations manager. At the time of inspection, there had been a recent change in senior leadership arrangements, and these were not yet fully embedded. The original governance structure from before the change was displayed in the reception area. Two of the three service lead posts across different service areas had been vacant for some time and there was a lack of sufficient resource to effectively oversee the services which were being delivered.

Two consultants worked flexibly in the minor surgery service according to their availability, with one of the consultants undertaking the majority of the cases in the service. Although this consultant appeared to be the primary clinician in the service, they were not identified as such in an established role. Also, there were no formal arrangements for clinical supervision beyond occasional informal contact between the two surgeons.

Senior leaders of the overall services provided at Parkway had a broad understanding of the services they managed. They could explain how teams aspired to fulfil the service’s ambition to provide high quality care. However, we saw that two of the key personnel in the service held significant operational responsibilities for the day-to-day service delivery. In practice, the overall service delivery was largely based on the immediate knowledge and availability of these particular staff, with a lack of contingency for any unforeseen circumstances in their absence. We saw that there was a lack of leadership capacity for effective oversight and management of the services being provided.

Development opportunities were available, and we spoke with several staff who had been supported to develop into more senior roles in the service.

The service had a Freedom to Speak Up policy that provided guidance for staff around how to raise concerns. However, we saw this policy contained some outdated information referencing NHS Protect, and the procedure for staff to follow appeared limited to having conversations with line managers. Staff we spoke with said they were aware of what to do if they wished to raise any concerns about the service, but we did not hear any further examples of when they had done this. There had been no whistle blower concerns received by the Care Quality Commission relating to this part of the service during the past 12 months.

Service users and carers had opportunities to give feedback on the service that they had received in a manner that reflected their individual needs. Managers and staff had access to the feedback from service users, carers and staff and used it to make improvements.

The service had an Equal Opportunities policy, an Equality, Diversity and Inclusiveness policy and an ‘Equality, Diversity and Inclusiveness in Employment’ policy. Staff were aware of service policies and their work reflected these principles in service delivery.

Different support mechanisms were provided for staff with protected characteristics, including flexibility around working arrangements and shift patterns. We heard examples of flexible working agreements for staff to account for personal circumstances, such as caring responsibilities and health issues. However, we noted in contrast with this that the latest staff survey January 2025 indicated 9% of staff said they had experienced discrimination due to health or disability.

The service did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate. The service advised during the assessment that they were in a period of organisational restructure following the recent appointment of a new Chief Executive Officer, who subsequently resigned from the service shortly after the inspection visit.

Staff in the minor surgery service and service leaders collected different information on performance and across the service overall. However, we saw this was limited in practice and there was little evidence of how the information was being used to improve overall quality and outcomes.

Managers reviewed risk and service performance information at quarterly governance meetings. Whilst there was a process in place for reviewing the different information, there was a lack of understanding of the key risks to the service, and a failure to identify actions to remove these or mitigate the level of risk. The service’s risk register failed to identify several key risks, including those regarding medicines management which we identified during the inspection. The service’s most significant risks were related to identifying urgent histology results in gastroenterology, clinical image storage servers being out of warranty, and the risk of failing to meet corporate contractual obligations. It was not clear in the register how regularly each risk was being reviewed or when mitigating actions were due to be completed by.

The service had a Safer Recruitment policy; however, leaders failed to ensure that this was applied in the recruitment of all staff. We found that one member of staff living overseas who worked remotely in the service to complete quality audits did not appear on any current staff list. There were no records of how the service carried out criminal records checks for a member of staff living overseas in such circumstances.

Similarly, we found a lack of evidence of the required checks having been undertaken for some of the directors on the senior leadership team. The director staff files we observed included information relating to their qualifications and identification checks. However, some records did not demonstrate that additional checks had been carried out to confirm they were of good character or to confirm there were no concerns around past criminal or financial irregularities, in line with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 5 requirements for fit and proper persons; directors.

Meeting minutes we reviewed showed that there was a general framework for discussions, to include the review of core information such as learning from incidents and complaints. However, actions to assess, monitor and mitigate the risks relating to the health, safety and welfare of service users which arise from the carrying out of the regulated activities were not clearly recorded in a timely way. There was a lack of demonstrable assurance and effective oversight of risk in the governance systems the provider had in place.

However, the service had identified an emergency preparedness and business continuity plan.

Service leaders engaged with external stakeholders including NHS organisations for ongoing review of commissioning arrangements or contractual arrangements with other healthcare providers in relation to undertaking surgical procedures and other areas of service delivery.

The service had engaged with community organisations to promote educational events around health and wellbeing, including healthy eating, exercise and lifestyle.

Although there was limited evidence directly of innovation in the minor surgery service, we saw some examples of a service focus on continuous improvement across the organisation. Staff were focused on improving the experience of care for people using the service. One example was a quality improvement project aimed towards implementing electronic discharge information for service users, which was about to be implemented in the service. This would address long-standing inefficiencies in the current system, including delays in discharge letter turnaround, which had impacted care continuity and onward referrals.