Mill Garth

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

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.

At our last inspection we rated well-led as good. At this inspection the rating has remained good. Leaders had the skills, knowledge and experience to perform their roles. Staff knew and understood the provider’s vision and values and how they applied to the work of their team. Staff felt respected, supported and valued. Governance processes operated effectively. Performance and risk were managed well. Teams had access to the information they needed to provide safe and effective care. Staff collected data and analysed outcomes and performance. They used this to identify improvements.

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 people and their communities.

In the 12 months prior to inspection, leaders completed several reviews of organisational culture, including an internal peer review, a lived experience review and a staff survey. These identified issues relating to staff relationships, patient and staff interactions, and some cultural and interpersonal differences within teams. The lived experience review found that some staff were reluctant to engage with patients, and incidents of patient-to-staff racism had been identified. We spoke with the registered manager about these findings which they said had been used to develop an improvement programme.

This included holding staff listening events and using real-time feedback to understand staff experiences. Feedback identified a need for greater team development, improved understanding of colleagues’ roles and increased cultural awareness. In response, the service introduced team development days, including sessions on psychological safety, communication and cultural awareness, alongside team-building activities.

At the time of the inspection, 4 teams had completed the programme, and staff feedback had been positive. Leaders planned to evaluate the impact through further staff feedback, repeat listening events and a follow-up lived experience review. Cross-department job shadowing was also being introduced to improve understanding and collaboration across teams.

Although previous reviews had identified areas for improvement in organisational culture and teamwork, we found leaders had taken appropriate action to address these. Staff we spoke with were happy and motivated, felt able to raise concerns, and described a significant improvement in the organisational culture. They were committed to the service and spoke passionately about the patients they cared for.

The organisation had a 5 year ‘Priory Plan’ in place which ran from 2026 to 2030 and set out a corporate strategy. Underpinning the plan were organisational vision and values, and 6 strategic goals, including an aspiration to embed a culture of openness, inclusion and trust where people feel they belong. Managers told us they communicated the vision and values to the frontline staff in this service which they said started at the point of induction. Staff we spoke with knew and understood the provider’s vision and values and how they were applied in the work of their team. The staff survey referred to the organisation’s vision and values, and staff nominations were made based on how staff felt others had adhered to these.

The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

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.

Managers could clearly describe their function and the roles and accountability of others within the service.

Leaders had the skills, knowledge and experience to perform their roles. The registered manager had completed a graduate-level degree in management to support their leadership, strategy, and business skills. Other managers had completed certified management courses.

Leaders were visible in the service and approachable for patients and staff. The registered manager held weekly clinics which any staff member could attend to discuss concerns or make suggestions.

There were regular meetings on the ward which allowed managers to hear and engage with staff who wished to raise issues. Managers facilitated debriefs after incidents or event and worked with staff to collaboratively put plans in place for improvement.

Staff said they could suggest new ideas and could raise challenges to managers and leaders and described an open-door policy. Staff survey results evidenced that 94% of staff felt their line manager respected them as an individual, and 91% of staff indicated that they received regular feedback on their performance to help them improve. 97% of staff felt that they were clear about what their line manager expected of them in their role.

Leadership development opportunities were available, including opportunities for staff. There were formal talent mapping and succession planning arrangements in place. Managers implemented development plans to ensure staff had clear goals to enable their progression into management roles.

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

Patients and carers had opportunities to give feedback on the service they received in a manner that reflected their individual needs through staff surveys

There was a nominated freedom to speak up lead who staff could approach at any time to support them in raising concerns. The team also held regular freedom to speak up ‘surgeries’ which gave staff designated time to meet with them to raise concerns.

The freedom to speak up lead documented any concerns raised through the speaking up process and the registered manager shared this with leaders across the organisation to identify themes or trends nationally. Managers promoted the freedom to speak up process within the service and reminded staff that they could contact the freedom to speak up lead at any time.

The whistleblowing policy was available on the provider’s intranet. Contact details for the Care Quality Commission were displayed in ward areas as another avenue for patients and staff to raise concerns.

Manager gathered staff feedback and concerns and suggestions through a ‘Have Your Say’ online forum which was reviewed and acted on by a dedicated lead.

Patients were involved in decision-making about changes to the service. Managers had appointed a lived experience partner whose role was to consult with patients, share feedback with senior leaders, and attend clinical governance meetings. The lived experience partner was involved in the ongoing review of the service’s business model.

Patients and staff could meet with members of the provider’s senior leadership team. A nominated patient representative attended patient safety meetings to feedback and consult with senior leaders about patient- related issues.

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.

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

There were equality and diversity champions within the service. The service celebrated events including Pride and Black History Month.

Managers put reasonable adjustments in place for staff members to help them carry out their role. This included work adaptations, and changes to working hours. Managers had also arranged for staff to move into non-clinical roles due to health-related issues.

The provider had a people management team that monitored workforce equality data and recruitment to help ensure the workforce reflected the diverse needs of the people using the service. Leaders told us they had a diverse workforce and had processes in place to support all new staff, including internationally recruited colleagues, to develop the skills and confidence needed for their roles. This included assessing communication skills and role-specific competencies during recruitment and providing tailored induction and support where required.

Where managers identified that staff required additional support, they provided this through one-to-one meetings, coaching, safety huddles, multidisciplinary discussions and monthly case reviews. These arrangements helped staff build confidence, develop therapeutic skills and deliver personalised care to people with complex mental health needs.

The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver high-quality care, treatment and support. Staff understood the arrangements for working with internal and external teams and organisations, to meet the needs of the patients.

Staff participated in audits to identify areas for improvement. Audits included documentation audits, care records audits, medicines management, clinic room checks, ligatures audits, quality walk arounds, and care plan and risk inspection audits. Whilst these arrangements enabled managers to act on improvements, we found that the standardised process for checking fridges and food items did not prompt staff to check use by dates which led to some out-of-date tinned, food items in the patient fridge.

Managers had access to all information needed to support them with their role. This included information on the performance of the service, staffing and patient care.

Staff received information governance training and maintained patient confidentiality. Governance meetings 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.

There were clear agendas for the various meetings that took place to ensure that staff and managers discussed all information relevant to the service. Standard meetings included clinical and regional governance meetings, safeguarding meetings, health and safety meetings, and regular staff meetings.

Staff adhered to legislation and knew how to deal with complaints, reported incidents and safeguarding concerns. Managers shared lessons learned from investigating complaints, incidents and safeguarding issues.
Managers maintained and had access to the risk register which they reviewed monthly. Staff at ward level could escalate concerns when required. Current risks included a vacancy for a substantive psychologist, low occupancy and financial viability, and patients missing meals or not ordering food from menu.

Staff had access to the equipment and information technology needed to do their work. Managers acknowledged occasional issues with the internet connection and had installed internet boosters to strengthen the quality and speed of the internet. Staff did not raise this as a concern, and we did not identify issues with internet during the inspection.

Staff submitted data and notifications to external bodies when needed. These included safeguarding referrals to the local authority and statutory notifications to the Care Quality Commission.

The service clearly understood and carried out their duty to collaborate and work in partnership, and services worked seamlessly for people. They always share information and learning with partners and collaborate for improvement.

Managers described good working relationships with a range of external stakeholders. These included the integrated care board, police, and local authority. Some staff had been temporarily seconded to adult social care services within the local area.

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

Staff invited family members and external professionals to meetings so they could discuss any issues and receive any updates about their patient's / family member's care and treatment.

The service provided evidence to show how it had strengthened the care pathway for patients admitted through out-of-area placements from an NHS trust in the South of England. Managers told us they recognised that patients admitted far from their home communities faced additional challenges, including separation from family support networks, and delays in accessing local services.

In response they implemented a more structured approach to care delivery which focussed on reducing unnecessary delays and supporting timely repatriation to services closer to home. This involved collaborative working with the NHS trust and Integrated Care Board within the local area. Some of the actions taken included developing a structured out of area admission triage process, implementing earlier multidisciplinary reviews and taking steps to strengthen collaborative working with community mental health teams, care coordinators, and discharge planning teams within the trust. Managers described how this initiative had enhanced patient flow, improved collaborative working and strengthened patient experience. This initiative had led to the service being nominated for an award, which is a national project prize given by the provider’s incident reporting software for improving patient safety.

The service focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

Leaders had systems in place to monitor quality and drive improvement. Staff told us managers supported improvements and innovations. Staff survey results evidenced that 86% of staff felt that within their team they were always looking for ways to improve what they did and deliver a better level of service.

The senior leadership team completed regular quality walkarounds and out-of-hours night visits to oversee standards of care and identify opportunities for improvement. The quality improvement lead also carried out bi-monthly reviews, which included compliance with policies and procedures, incident management, safeguarding, clinical governance and identifying areas for nursing development.

The service had established a quality improvement programme and was developing its approach to quality improvement by identifying quality improvement champions and providing training to support staff involvement in improvement projects.

The service was exploring opportunities to participate in a ‘Listening Beyond Words’ project, which uses voice analysis technology to support the identification of depression. At the time of inspection, the hospital manager was attending introductory events to understand how this could be implemented within the service.

Managers had also undertaken quality improvement work to enhance the patient experience and strengthen staff working relationships. Following an independent review of a patient in one of the bespoke therapeutic placements, managers had developed a Rehabilitation and Recovery Practice Development Programme. The programme covered core therapeutic practice, practical skills and informed practice. Managers were in the process of developing visual practice guides, structured training sessions and supervision to embed learning. Managers told us the programme would be rolled out across another hospital within the Priory Group to promote consistent practice.