Castle Medical Group

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 the service’s leadership, management and governance assured high-quality, person-centred care and promoted an open and fair culture. At our last assessment, we rated this key question as good. At this assessment, the rating has changed to requires improvement because governance and clinical oversight systems had not been effective in identifying and addressing risks relating to medicines monitoring, patient reviews, follow-up arrangements and staff training compliance.

This service scored 62 (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, human rights, diversity, inclusion and engagement. Staff and leaders understood the challenges and the needs of people and their communities.
Leaders had a clear vision and strategy for the service and considered the needs of people using the service and the wider community. Leaders used feedback from staff and patients to help shape and improve services.
Staff and leaders described a positive and supportive culture that encouraged learning, development and continuous improvement. Staff had opportunities to share feedback and raise concerns through a range of mechanisms, including staff surveys, return-to-work meetings and the service's freedom to speak up processes. Leaders told us they reviewed feedback and made changes where appropriate to support staff wellbeing and service delivery.
The service actively promoted equality, diversity and inclusion. Staff had access to relevant training and leaders demonstrated an awareness of the importance of providing care that was fair, inclusive and responsive to people's individual needs.
Staff described a positive and compassionate listening culture. Leaders encouraged openness and discussion following complaints, incidents and patient feedback. The service had mechanisms in place to support learning and improvement, although the assessment identified areas where further improvements were required to ensure risks were consistently identified and addressed.
 

We did not look at Capable, compassionate and inclusive leaders during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Freedom to speak up during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The service did not always operate effective governance, management and accountability arrangements.
Findings from our assessment demonstrated significant weaknesses in the effectiveness of governance and clinical oversight arrangements. Concerns identified through clinical searches affected multiple areas of care and treatment, including medicines monitoring, medication reviews, management of patient safety requirements and follow-up arrangements. These concerns had not been identified, escalated or addressed effectively through the service's existing governance systems.
The concerns identified were recurring across multiple clinical searches and demonstrated a lack of effective oversight of clinical risk. Patients continued to receive treatment despite overdue monitoring requirements and missed reviews, and follow-up actions were not always completed when concerns had been identified. Systems intended to monitor patient safety, medicines management and clinical performance were not operating effectively to identify these risks and ensure timely action was taken.
In addition, governance systems had not ensured all training requirements remained up to date. This further demonstrated that leaders did not always have effective oversight of key areas required to support the safe delivery of care and treatment.
Although leaders recognised many of the concerns when they were identified during the assessment and had begun implementing improvements, the findings demonstrated that governance arrangements had not been effective in identifying risks, monitoring performance or driving improvement. As a result, leaders could not be assured that patients were consistently receiving safe and effective care and treatment.
Staff understood the importance of confidentiality and information security, and information was shared with external organisations and stakeholders where required.
 

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Learning, improvement and innovation during this assessment. The score for this quality statement is based on the previous rating for Well-led.