25 Harley Street

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 there was an inclusive and positive culture of continuous learning and improvement that was based on meeting the needs of patient who used services and wider communities. We checked that leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred and sustainable, and to reduce inequalities.

At our last assessment this key question was rated requires improvement. At this inspection we rated it good. This meant patient’s needs were met through good organisation and delivery.

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 patients and their communities. Staff within the service were aware of the organisation’s direction and understood its core values.

The provider had recently rebranded to align all their services to the same direction and values. We reviewed the team presentation which showed staff why these changes were being made and how the rebrand was a commitment to living the mission, vision and values every day. Values ambassadors were created and located at all sites. The service had an ambassador who helped colleagues connect values to everyday actions. The provider had plans for senior leaders to visit each of their locations with a roadshow to engage with staff over the new mission and values.

Senior staff demonstrated these values in their approach to leadership, showing respect for individuals and promoting a culture of kindness and compassion. Staff told us they felt valued and respected within the organisation. We observed that staff at all levels reflected these values in their interactions with patients.

The service fostered a caring and inclusive culture, staff told us they felt respected, supported, and valued. They remained focused on meeting patients’ needs and worked effectively to achieve positive outcomes for people they cared for. Staff were positive and expressed pride in working for the service.

The service had leaders who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders usually had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty and understood the impact their behaviours and leadership had on patient outcomes and experience.

Senior leaders demonstrated an understanding of the context in which care, treatment and support were delivered and promoted the organisation’s culture and values. They had the skills, knowledge and experience to carry out their roles effectively and led with openness and integrity. Staff told us leaders were visible and approachable and there was a positive and open culture.

The service had local leadership who reported to the director of clinical services (DCS). The DCS reported directly to the hospital manager. A new role was being recruited to at the time of the inspection for an outpatient manager to provider an additional level of support. There was a clear leadership structure and reporting line.

Leaders we spoke with were passionate about the services they led. They understood the pressures of the service and worked with staff to make improvements.

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

Staff and leaders acted with openness, honesty and transparency. Staff were encouraged to raise concerns and offer ideas; the culture allowed staff to be confident their voices would be heard.

The provider had designated Freedom to Speak Up lead who staff could contact for advice and support. The Freedom to Speak Up guardian also provided an independent route for staff to raise concerns safely and confidentially. Staff told us they were aware of these roles, understood their purpose and felt confident they could approach them if needed. We observed posters displayed with contact details for the lead.

The provider had a freedom to speak up policy and public interest disclosure (whistleblowing) policy to support staff and provide guidance should they wish to raise a concern. At the time of the inspection, there were no ongoing concerns.

Staff told us they had been supported when they had raised concerns. One staff member gave an example of a number of leaders coming to speak with them following an incident and they had appreciated the support.

Patients were provided with information to explain how they could raise a concern and how this would be investigated. Staff were encouraged to respond to immediate concerns or complaints with a view to resolution. There were policies to support the complaints process and staff knew how to access these.

The service valued diversity in their workforce. Staff work towards an inclusive and fair culture by improving equality and equity for everyone.

The service promoted equality, diversity and inclusion through policies and mandatory training which set expectations for respectful and fair treatment in the workplace. Staff we spoke with told us they felt comfortable being themselves at work and described a culture where colleagues treated each other with respect.

Staff and leaders described how flexible working arrangements were used across the organisation to support both service needs and staff wellbeing. For example, staff could take time off in lieu during quieter periods and repay hours by working additional shifts at times that suited the service. Staff we spoke with told us these arrangements worked well for them and helped support a positive work–life balance.

Leaders took steps to remove bias from practices to ensure equality of opportunity and experience for the workforce within their place of work, and throughout their employment. All policies carried out an equity impact assessment prior to them being ratified in order to ensure the policy did not discriminate against any protected group. This included the recruitment policy.

Mandatory training supported staff to understand and address bullying and harassment and equality, diversity and inclusion with training compliance over the 85% target.

Staff we spoke with were able to explain how individual patient needs would be supported within the service. For example, translation services were available for patients who required them, and there was disabled access to clinical areas.

The service had clear responsibilities, roles, systems of accountability and good governance. Staff used these to manage and deliver good quality, sustainable care, treatment and support. Staff acted on information about risk, performance and outcomes, and shared this with others when appropriate.

The service had clear governance, management and accountability arrangements in place. Staff demonstrated a good understanding of their roles and responsibilities, and governance systems supported the delivery of safe and effective care. The service operated within an integrated governance framework that included the Medical Advisory Committee, Clinical Learning and Improvement Plan (CLIP) meetings and corporate governance forums. We reviewed the meeting minutes from the weekly CLIP meeting where incidents, complaints, audit findings and activity data were reviewed. Discussions were constructive and focused on identifying learning and improvement opportunities, including sharing feedback with partners where appropriate. Information from these meetings was escalated to executive management meetings, where leaders reviewed performance, risks and compliance with key organisational requirements such as training targets.

Leaders used information about risk, performance and outcomes to support decision-making. A performance dashboard monitored key indicators and enabled leaders to track progress against targets, with some data available in real time. Executive meetings also reviewed safety alerts, complaints, compliance with practising privileges requirements and other governance information. At a local level, daily safety huddles and staffing review meetings enabled teams to discuss staffing levels, patient activity and emerging risks. Learning from incidents and other important information was shared with staff through these meetings, helping to maintain situational awareness and support safe service delivery.

The service had a local risk log for the radiology department, and a location risk register for the outpatient centre. The risks on the local log reflected what staff and leaders had told us about. For example, the use of bank staff was on the risk log. The risk log included the mitigation in place and an action owner. The locations risk register included one risk relevant to the service, there was mitigation in place, and each risk was given a score to indicate the risk level.

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

The service worked collaboratively with external healthcare providers to support the delivery of care. They worked closely with the teleradiology provider who reported on the images taken. It was reported by leaders that there was a good working relationship and open communication.

The service worked well with equipment suppliers. Leaders told us they were responsive and supported the introduction of new procedures through training and the provision of equipment where required.

Leaders and staff actively and openly engaged with patients and staff to plan and manage services. The patient and staff forums had a voice and senior leaders told us these groups fed back important information to help them improve the service.

The service focused on continuous learning and improvement across the organisation. Staff encouraged creative ways of delivering equality of experience, outcome and quality of life for patients. Staff actively contribute to safe, effective practice.

The service demonstrated a commitment to learning and improvement. Leaders encouraged staff to contribute ideas that could help improve services and the patient experience. Staff told us they felt supported to share suggestions and were encouraged to take part in initiatives aimed at improving efficiency and patient care. For example, one member of staff described proposing the introduction of an artificial intelligence system to support aspects of the imaging service. They told us that senior leaders listened to their suggestion and took the proposal seriously, demonstrating that staff ideas were valued.

The service had introduced a consultant newsletter to improve the communication with medical staff, many of whom worked under practising privileges. This was created in order for consultants to easily see what updates were relevant to them and included information about recent national guidance. We reviewed the last 3 newsletters and found information about new national patient safety initiatives, patient feedback and updates on the government’s health bill.