Ariel Healthcare

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 in December 2017, we rated this key question as good. At this assessment, the rating remains the same.

The provider was in breach of the legal regulation in relation to good governance.

This service scored 71 (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 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.

Staff had contributed to the development of the service’s vision and strategy, which was kept under review. Staff described the service as supportive and friendly with an open culture and a focus on people’s care.

The service experienced an increase in patient population size following the merging of two services in October 2023 and taking over 6,000 patients from a closed GP service in February 2024. The service worked collaboratively with the local integrated care board (ICB – an NHS organisation responsible for planning and funding of services for their local population) to overcome the challenges. These included forming a harm review team to assess and provide appropriate care for the inherited patients and carrying out quality improvement projects to strengthen the safeguarding process and opioid prescribing (medicines with risk of dependence).

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.

Staff told us leaders in the service were visible and approachable and responded to any concerns raised. Staff from different roles gave examples of how they were supported by their leaders at work, and work adjustments were made for personal or family circumstances. Leaders were aware of the challenges of delivering good quality care and were striving for improvements.We received different examples of how the service implemented changes in response to staff feedback. For example, the administrative staff which were previously based across 2 sites were now working at a single site together to promote communication and effective working.

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

Staff felt confident to raise concerns with their managers and leaders. The service had a whistleblowing policy within the staff handbook which clearly laid out the process of raising concerns. Most staff were aware of the freedom to speak up guardian (FTSUG - a person who supports workers to speak upwhen they feel that they are unable to do so by other routes) role and how to access their support. The current FTSUG was external to the service and one of the staff in the service was training to become the FTSUG.

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.

There were policies and procedures to promote equality and diversity. All staff were up to date with their equality and diversity training.

The service made reasonable adjustments to ensure all staff were valued. For example, we saw workstation adjustments to support disabled staff.

The service had some established governance processes that were appropriate for their service. However, systems of accountability and good governance were not always effective. They did not always act on the best information about risk, performance and outcomes.

There was a lack of management oversight to ensure complaints were handled effectively and a lack of risk assessment and action plan to handle summarising backlog prior to our assessment.

The service did not always take actions on issues identified from health and safety and fire risk assessments to control risks in the care environment.

There were gaps in reference checking during recruitment process, lack of formal documentation of clinical supervision and non-medical prescriber (NMP) audits was only carried out after our assessment.

Leaders and managers supported staff, and all staff we spoke with were clear on their individual roles and responsibilities. Managers met with staff regularly to complete appraisals and performance reviews, with learning and development identified.

The service held regular leadership and staff meetings to ensure all staff members were aware of changes to service delivery and the latest guidance. Meeting minutes were taken and shared with staff who could not attend. Staff had access to all required policies and procedures.

There was a system to monitor the completion of mandatory training and evidence showed that staff training was up to date.

The remote clinical searches evidenced an established process for monitoring clinical care which was effective.

Following our site visit, the service developed an action plan in response to our findings.

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

The service met regularly with the district nurses to discuss people’s needs. For example, the service reviewed whether people could be switched from home vitamin B12 injections to oral replacement. This was not just more convenient and comfortable for the people but also helped to free up district nurse resources for other clinical needs.

The service worked jointly with the complex care team from their primary care network (PCN) to optimise care for the frail people requiring complex care. (A PCN is a group of general practices that work together to provide a wider range of services to the local population.)

Feedback from the care homes that the service worked with was positive, and they considered that people’s needs were being met by the service.

The service had an active patient participation group (PPG) representing people using the service. The feedback from PPG members was mixed. Some felt they were listened to with improvements made as a result. However, some members felt they were not valued by the service and wished for better communication with the service.

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 and effective practice.

Staff were encouraged to develop their skill set to enable them to take on new roles, responsibilities and further their career. For example, the service supported their pharmacists to train up for prescribing qualification so that they could prescribe medicines within their competence.

The service was a training practice for doctors training to become GPs and for student nurses. To enable the service to be a training practice they must meet specific criteria including having adequate facilities and a supportive learning environment.

The service adopted a pilot project from the local integrated care board (ICB) to have a paediatric practitioner in the service which now became an established role in the service. The staff completed the master’s degree training to become an advanced paediatric nurse practitioner, supported by the service with protected time and funding. In addition to promoting continuity of care for children and young people, the role also helped to reduce the prescribing of anti-microbials as a result of her experience in assessing and managing these patient groups.

The service conducted various prescribing and clinical audits to drive improvement in people’s outcome.

All staff were encouraged to put forward and test out new ways of working. For example, staff told us various examples of how the workforce was adjusted and appointment allocation was rearranged to promote efficiency.