Arbury Court

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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

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 previous inspection we rated this key question requires improvement. At this assessment the rating has changed to good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

Managers were compassionate and inclusive, and senior leaders stressed the importance of freedom to speak up within the service. Governance processes operated effectively and performance and risk were managed well. The service worked in partnership with external services effectively.

However, many staff were not aware of the service’s direction, and staff morale had been poorly affected by the service’s reorganisation. Staff highlighted that senior leaders did not feel visible or approachable. There was also limited quality improvement in the service.

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.

We scored the service as 2. The evidence showed some shortfalls. 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 and their communities.

Most staff were not aware of the service’s provider’s visions and values, or hospital’s strategy. The hospital had recently been through a large-scale re-organisation which meant there had been a change in senior leaders, managers and nursing staff, as well as staff changing wards and shift patterns. The aim of this reorganisation was to address concerns regarding the hospital’s culture, as well as low ward occupancy. Leaders could give examples of how patient safety was central to considerations of the reorganisation and improving the culture of the wider hospital.

When we inspected the service, most of these changes had only recently been implemented. Staff felt that these changes had impacted on their wellbeing, as changes were communicated at short notice, with no opportunity for feedback or explanation as to why they were happening. At the time of our visit staff were still experiencing these changes and staff told us their morale was low.

We scored the service as 2. The evidence showed some shortfalls. 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.

At the time of inspection, the hospital was going through large-scale re-organisation. Staff we spoke with told us that the senior leaders were not always visible and approachable, particularly during the restructuring of the hospital. Communication regarding the re-organisation was not always clear and staff did not always understand why changes were taking place, and some changes happened suddenly, leaving staff feeling anxious and unsettled about potential future changes.

However, local managers were described as supportive, approachable and accessible. Managers had the necessary skills, knowledge, and experience to effectively lead and manage their team. They had a good understanding of the service they provided and were able to explain how the team worked together to provide care for their patients. Senior leaders had clear aims to improve the culture and care provided at the service.

We scored the service as 3. The evidence showed a good standard. The service fostered a positive culture where people felt they could speak up and their voice would be heard.

Staff we spoke with understood the term ‘freedom to speak up’ and said they would feel comfortable raising concerns about patient safety if necessary and that if they did so, they felt confident these would be listened to and acted upon.

The provider had a Freedom to Speak Up (FTSU) and whistleblowing policy. Staff could contact the Freedom to Speak Up Guardian and they visited the ward every month.

Patients felt confident to give feedback and raise concerns and did so regularly. The ward had regular community meetings for patients to raise their concerns, and this feedback was used by staff and managers to make improvements on the ward were possible.

We scored the service as 3. The evidence showed a good standard. The service valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

Elysium healthcare had a variety of staff networks to support diversity, equality and inclusion, such as Race and Ethnicity, LGBTQIA+, and family and carers. Leaders were mindful of potential discrimination, and when concerns of racism had been raised to leaders, they arranged a session on a session on open discussions and setting clear expectations with senior nurses. This was to be shared with teams.

The service employed a diverse team of staff from varied backgrounds. Employment practices promoted equality of opportunity. Staff could apply for flexible working arrangements, within the scope of working in an inpatient service, and managers put reasonable adjustments in place for staff, where possible.

We scored the service as 3. The evidence showed a good standard. 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 acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate.

The provider had recently reorganised the service, with changes to the number of wards, shift patterns and changes to the senior leadership team. The senior leadership team was reduced and better reflected other locations within the Elysium Healthcare, this ensured that senior leaders had clearer roles and responsibilities for oversight. For example, plans were in place to give ward managers greater responsibility over incidents that required use of the Patient Safety Incident Response Framework (PSIRF), and additional training was in place for managers to complete these.

The effect on the acute wards and psychiatric intensive care unit meant the service was reduced from an acute ward and PICU to just a PICU and had moved locations. The ward moved locations in December 2025, and changes to staffing rotas came into effect in January 2025 for nurses and February 2025 for health care assistants. This meant that staff felt they were still establishing their roles in teams and at the time of our inspection still felt unsettled during the reorganisation.

There was a clear agenda of what must be discussed at a ward, team or directorate level in team meetings to ensure that essential information, such as learning from incidents and complaints, was shared and discussed.

Team managers had access to information to support them with their management role. This included information on the performance of the service, staffing and patient care, supervision and appraisals, and mandatory training. Staff also implemented recommendations from reviews of deaths, incidents, complaints and safeguarding alerts at a service level.

Managers and nurses undertook and participated in regular clinical audits; medicine audits were also completed by the external pharmacy provider. Actions were identified during audits and raised with staff to address and learn from. Staff also completed regular environmental checks; however, we found the overall ligature risk assessment for the ward was poor, lacking in specific risks and actions to mitigate those risks.

We observed staff working well with external teams to ensure patient continuity, and ward staff regularly engaged with teams from other hospitals to holistically support patients care and treatment. Care records were clear and detailed and identified patients’ risks, mitigation actions and processes that had been put in place. There was clear evidence of discharge planning as part of the assessments.

The service had clear plans in place for emergencies and had a generic risk assessment, which included adverse weather conditions, and fire safety.

We scored the service as 3. The evidence showed a good standard. 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.

Leaders had recently completed a closed culture review of the service, and following this created an action plan owned by the senior leadership team. The action plan was progressing within expected timelines, and included improving communication between staff and leaders, targeted training and access to freedom to speak up guardians.

Employment practices promoted equality of opportunity. Managers said the service did not discriminate against staff from minority groups. Staff did not raise any concerns about discrimination or bullying within the team.

The commissioners had oversight of and met regularly with the provider. This included representatives from commissioners of patients’ care packages and the local authority safeguarding team.

We scored the service as 2. The evidence showed some shortfalls. The service did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research.

Staff we spoke with told us there was limited opportunity for additional training. There was limited quality improvement activity within the service, although there were plans to establish quality improvement projects in the future. The ward was completing a benchmarking exercise to identify where improvements needed to be made.

However, the ward manager engaged with networks within Elysium, such as the national psychiatric intensive care unit network, where they were able to share learning and improvements. There were plans to visit other PICUs within the network to review how their MDTs worked, and look at working collaboratively to develop good practice.