Cornwall & The Isles of Scilly – Plymouth

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

We looked for evidence there was an inclusive and positive culture of continuous learning and improvement based on meeting the needs of patient who used services and wider communities.

This is the first assessment for this service. This key question has been rated good. This meant patient’s needs were met through good organisation and delivery.

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 patient and their communities.

The service had a vision for what it wanted to achieve and a strategy to turn it into action. Staff spoken with had awareness of how their work contributed to achieving the aims and objectives set out within the strategy. Staff were focused on the needs of patients receiving care and delivering a high quality of service.

Leaders promoted equality and diversity in daily work and provided opportunities for career development. The service had an open culture where patients, their families and carers as well as staff could raise concerns without fear.

Staff felt respected, supported and valued. Staff reported the leadership culture to be inclusive and spoke about feeling valued and respected. Relationships between staff were positive, with strong teamwork and collaboration.

Team and individual staff achievement, and success was recognised and celebrated by employee of the month award. Staff told us they were thanked for their work.

Leaders usually had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty and understood the impact their behaviours and leadership had on patient outcomes and experience. Leaders had an open-door policy and staff said they felt able to approach with any issue.

Managers had a range of experience, skills and abilities to run the service, and they understood and managed the priorities and issues the service faced. Leaders were visible and approachable. Staff felt the leaders supported them to develop their skills.

Leaders took incidents seriously and knew how to deal with concerns when raised, which promoted a positive culture in the service.

Staff were invited to team meetings and could directly access the registered manager to ask questions or make suggestions. Information was cascaded to staff through team meetings, email and posters on the noticeboard.

The service fostered a generally positive culture where patients felt they could speak up and their voice would be heard.

The service had up-to-date policies to support freedom to speak up. The service had a named freedom to speak up guardian. The freedom to speak up process was advertised to staff in newsletters and posters at the transport base.

Staff and leaders acted with openness, honesty and transparency. Staff were encouraged to raise concerns and offer ideas; the culture allowed staff to be confident their voices were heard. Senior staff were encouraged to respond to immediate concerns or complaints with a view to resolution.

There was an open-door policy to make leaders approachable. Staff told us they were able to speak to leaders at any time.

The service valued diversity in their workforce. Staff work towards an inclusive and fair culture by improving equality and equity for everyone.

Leaders acted to improve where there were any negative experiences for staff with protected equality characteristics. Leaders took steps to remove bias from practices to ensure equality of opportunity and experience for the workforce within their place of work, and throughout their employment.

The service acted to prevent and address bullying and harassment at all levels and for all staff, with a clear focus on those with protected characteristics under the Equality Act and those from excluded and marginalised groups. Staff felt everyone was treated fairly and they would be able to report behaviour or attitudes which were negative.

Staff with disabilities were offered reasonable adjustments to support them to carry out their roles well.

At the time of our assessment the service employed 20 staff members. Staff represented the local population. Staff received training in equality, diversity and inclusion. Staff understood the need to give everyone the same rights and opportunities and to value and respect people's differences. Records showed 74% of staff had completed refresher training in equality, diversity and inclusion.

The service usually had clear responsibilities, roles, systems of accountability and good governance. Staff used these to manage and deliver good quality, sustainable care, treatment and support. Staff acted on information about risk, performance and outcomes, and shared this with others when appropriate.

The service usually operated effective governance processes through various committees. There was a range of information collected, monitored but not always communicated internally at the relevant committee meetings. The appraisal rates were not discussed at quality and clinical governance group meetings and did not appear on the location risk register.

Performance data was analysed and compared within the organisation and where improvements were needed at the location level, action plans were developed to make this happen.

Staff at all levels were clear about their roles and accountabilities. Staff had job descriptions, and these set out expectations and responsibilities. Where senior staff had designated tasks related to audit and monitoring quality of services, they understood what was required of them.

Managers could find the data they needed, in easily accessible formats, to understand performance, make decisions and improvements. The information systems were integrated and secure. Data or notifications were submitted to external organisations as required. The service had not reported any data breaches and systems were secure. Patient identifiable information was handled correctly.

Leaders made sure accurate information was discussed and shared with key staff. For example, information was shared through newsletters and team meetings.

Risks were usually identified and a formal log of these was used to keep oversight and manage mitigations and/or bring to resolution.

Audit processes and the outcomes were used to ensure quality of services was maximised.

The service had plans to cope with unexpected events and had a business continuity plan, which included major incident plans.

We reviewed several service level and provider policies and found these were up to date and readily available to staff. There was leadership oversight of the accuracy and validity of each policy.

The service understood their duty to collaborate and work in partnership, so services work seamlessly for patients. Staff shared information and learning with partners and collaborate for improvement.

Staff and leaders at the service collaborated with relevant external stakeholders and agencies to improve care and treatment for patients using the service. For example, they worked closely with local NHS and private healthcare institutions, hospices, community health teams and renal units.

The registered manager met with external stakeholders and regional networks to understand the needs of the community and the provider ambitions.

The service focused on continuous learning, innovation and improvement across the organisation and local system.

We were told about some of the areas of work which the provider had focused on. This included hosting paramedic students from the local university for a 2-week placement to develop their skills and understanding of the service.