Archived: Enterprise Health Care

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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

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 on 11 June 2019, we rated this key question as Good. At this assessment, the rating has changed to inadequate.The service was in breach of legal regulations due to concerns about leadership culture, structure, and strategy. There were no effective systems in place to assess or manage performance and risks, and governance and oversight arrangements were either absent or ineffective, including those required to define staff roles and ensure appropriate HR processes and checks. There was also no assurance of a proactive working culture. People’s feedback about whether their concerns would be listened to and acted upon was mixed.

This service scored 36 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There was no clear vision or strategy in place for the service. The Registered Manager and the GP clinical lead had not attended the location where patients received care and treatment for several months, and the manager was working remotely. As a result, there was no leadership presence on site and no alternative arrangements, such as regular staff meetings, to provide shared direction or support staff engagement. Essential responsibilities required to ensure a shared understanding of fundamental standards such as safeguarding, health and safety, operational expectations and escalation pathways were not effective or formalised and leadership staff lacked clarity about their roles. However, staff on duty demonstrated good customer care during the inspection.

Leadership capability was insufficient to ensure the service operated safely or effectively.

The service could not demonstrate it had inclusive leaders who understood the wider context in which they delivered care, treatment and support. Although some staff were trained in equality, diversity and human rights (EDHR), related considerations had not yet been appropriately addressed. Consideration of the needs of people with communication, sensory or cognitive impairments was limited to those with a hearing impairment.

There were no effective systems or processes for leaders to engage with the service key stakeholders, such as its patients and staff.

There were no staff meetings or alternative arrangements in place to support staff in raising concerns. Although a “being open” policy existed, leadership staff were not aware of it.

There was no Freedom to Speak Up protocol or Freedom to Speak Up Guardian, which limited opportunities for staff to raise concerns safely.

Feedback we received from stakeholders, both before and during the inspection was mixed, including regarding the provider’s approach to handling people’s complaints or concerns. We also saw that significant events reported by staff, had not been followed up. Evidence indicated that people’s concerns were not consistently recognised or acted upon, and we were not assured that people’s voices would be heard.

The service had a diverse workforce in accordance with its scale of operation.

Staff we spoke to on site during the time of our inspection told us they felt included and leaders were approachable.

The provider had not established effective or sustainable governance processes.

There were no governance meetings or processes for tracking actions or performance or reviewing risks. There were no regular staff meetings, appraisals or performance reviews of the service or people working within it, nor any clinical meetings where clinical concerns and emerging risks were discussed. The provider held a staff meeting in response to our inspection; however, the notes did not contain any clear framework to ensure actions agreement or follow up.

The provider was registered with the Information Commissioner’s Office (ICO), the UK’s independent body responsible for upholding information rights and enforcing data protection laws such as GDPR. Staff understood their responsibilities for maintaining patient confidentiality; however, there were no arrangements in place to manage or securely store people’s information in the event the service ceased trading. The clinical record keeping in the 19 patient records we reviewed was appropriate.

There were no arrangements to underpin leaders and managers supporting staff or clarify their individual roles and responsibilities. The management staff role was undefined, and they did not have access to information such as HR for which their responsibilities were also unclear. HR systems were ineffective, with gaps in induction, and training and recruitment evidence, including job descriptions to ensure clarity of roles.

Policies central to safe operation, including safeguarding, significant events and recruitment, were missing, outdated, or had not been implemented effectively. Recruitment processes did not reflect the workforce model, including the engagement of consultants working under use of practising privileges. These deficiencies meant leadership arrangements were not sufficient to ensure safe or consistent care.

There were no clear arrangements for leadership, clinical or operational oversight or day to day management in the absence of clinical and operational lead staff.

The provider implemented arrangements for monitoring safety alerts and medicine recalls in response to our feedback, as no systems were in place previously.

The provider told us that consultant led education sessions were held. There was no other evidence of information sharing, joint learning, or collaboration with partners for improvement.

There was no structured approach to learning or improvement.

Significant events and complaints did not lead to learning or to improvements in the quality or safety of the service. No clinical auditing, other auditing, or spot checks were undertaken. There was no other evidence of quality improvement activity.