Urgent Care Centre

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 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 Good. At this assessment, the rating has changed to Requires Improvement.
 

This service scored 50 (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 did not have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not always understand the challenges and the needs of people.
The service had a set of values it aimed to work towards; these were Oomph, Awesome, Fun, Humble, Go-getting, and Brave.
Staff told us that they felt clinically unsafe and that metrics for understanding unsafe staffing were driven more by business intelligence data than a culture of listening to clinicians. The told us they felt they were perceived as being individually problematic when they tried to escalate safety concerns.
Feedback from staff described a disconnect between the provider at operational head office versus the reality on the ground. They described feeling supported by local managers but that leadership at provider level was less visible. Staff told us there was an inability to review services internally in an objective and pragmatic manner. They described a culture of not listening to staff which inhibited service improvements and changes from occurring. Some systems that we looked at supported this evidence, for example, a systemic lack of wider shared learning when things went wrong. The provider acknowledged that listening to staff was an area for improvement.
The provider had a ‘being open and duty of candour’ policy which described the importance of building a caring and safe culture to build insightful, inclusive, and engaging leadership. However, we saw that the provider had not followed its own policy, regarding the requirement to make notifications of incidents to CQC.
 

Not all leaders understood the context in which the service delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively, or they did not always do so with integrity, openness and honesty. Staff told us that locally based managers were supportive and extremely busy. They told us that they only saw managers from the provider company when they came to ‘fact find’.

People did not always feel they could speak up and that their voice would be heard.
The practice had Freedom to Speak up arrangements. The Freedom to Speak Up Guardian was the Chief Operating Officer of the provider company. Not all staff were aware of how to raise concerns or who the guardian was, and of those who knew the arrangements for speaking up, some felt that they could not do so, due to the seniority of the guardian.
 

The service valued diversity in their workforce. They worked 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. Adjustments had been made to ensure all staff were valued. We saw that equality impact assessments had been considered in all policies and procedures.
 

The service did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate. Statutory notifications had not been made to CQC when they ought to have been. Extracts from the provider’s significant events log and other information regarding CQC registration matters indicated occasions where this should have been addressed. Not all staff we spoke with were clear on their individual roles and responsibilities. This was in part due to a lack of supporting systems of governance, such as standard operating procedures. Appraisals and performance reviews were undertaken but these did not cover the full scope of the clinical workforce, and there was little oversight or peer review of work undertaken by HCAs. The provider had established governance processes, but these were not always followed at local level, and not all staff were familiar with those processes. Staff could access all required policies and procedures via the provider’s intranet site. Managers held an annual meeting with staff, during which they discussed concerns and emerging risks. Staff took patient confidentiality and information security seriously. There was a system for oversight of risk, but staff did not have confidence that when they raised concerns that these would be acted on effectively or that systems would improve for the better.

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

The service did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did actively engage in wider partnership with others to promote self-care and health promotion and improvement for patients within the local area. However, they did not always actively contribute to safe, effective practice and research within the urgent treatment centre setting.