Transcare Secure Services - Birmingham

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 reviewed shared direction and culture; capable, compassionate and inclusive leaders; freedom to speak up; workforce equality, diversity and inclusion; governance, management and sustainability and learning; partnership and communities and improvement and innovation as part of the well-led key question. We found well-led stayed the same and was rated as requires improvement. Governance processes remained ineffective within the service, with serious concerns identified in how assurance was gained about staff working within the service and policies and processes in place for staff to work in line with. However, staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service had improved how they engaged with patients and stakeholders, although further improvements were due to be made with how stakeholders were engaged with. All staff were committed to improving services continually.

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.

Staff told us the service had a vision and strategy which stated that the service wants to be "the leading provider of safe and secure transportation for individuals in the mental health sector. And to "prioritise a supportive approach rooted in trust and therapeutic rapport, striving to minimise the use of restrictive measures wherever possible." Staff told us that managers were supportive and there is a good culture and they worked well as a team. All staff felt the 4 core values of the service were truly embedded and demonstrated by all. Whilst speaking to the registered manager he had a good understanding of what the strengths and weakness were within the service, and how the service was working to improve these.

The service had a vision and strategy in place which was based on providing a high standard of safe and secure transportation for patients within the mental health sector. There were 4 core values which underpinned the vision of the service. These were Safety, Teamwork, Authentic and Respect.

Staff spoke positively about the management team and told us they were supportive, and approachable. Staff felt they could escalate any concerns and felt listened to. Staff told us the registered manager led by example and would support on transfers with staff and worked as part of a team. If he did not go on the transfer, he ensured that he was available to support staff on their return.

The service had a policy in place which detailed all the roles and responsibilities of the leaders within the service. There was a fit and proper person (directors) policy in place which ensured those in these positions were capable and fit to be in the positions they were.

At the time of the assessment, staff told us there were ongoing discussions around the Freedom to Speak Up Guardian and their role. The current guardian was currently away and therefore a new guardian was required. Despite there being no guardian currently within the service, there were no concerns about the lack of someone in this role. Staff told us that there was agood culture, and staff morale within the service and manager and leads were supportive.

The service had a process in place to support staff who wanted to raise concerns without fear of any retribution. The Freedom to Speak Up policy underpinned the open and honest transparent culture where staff were encouraged to raise their concerns.

Managers and staff told us that they looked at patients on an individual basis and provide the care and treatment and support to ensure the patient's transfer is a positive journey. The registered manager stated that the service is currently looking at recruitment, to have a more diverse staff team. Staff ensured when completing the transfer request form that this identified if male or female staff were required to support the transfer, the service ensured the staff mix matched the request of the person requesting this transfer.

The service had an equality and diversity policy in place; however, this was aimed at how staff treated patients they were transferring and not in relation to the equality and diversity working within the service. During the inspection in August 2022, it was identified the service did not promote equality and diversity enough and staff had not completed any training. Since this inspection, equality and diversity training had been introduced and at the time of the assessment 97.3% of staff had completed this.

Staff told us they believed the service had improved since the last inspection in relation to monitoring and recording incidents, and de-briefing staff after an incident had taken place. Staff at all levels were clear about their roles and accountabilities. Staff told us they held monthly governance meetings discussed, training, incidents, policies, staffing, compliments, complaints and safeguarding. Staff told us audits were completed and action plans completed for areas requiring improvement. However, the registered manager was not aware of areas of concern in relation to Disclosure Barring Service (DBS) checks. Staff were also completing work within the service without references having been received and no risk assessment in place for allowing them to work with vulnerable patients with no references in place. We also found concerns around what staff told us they did in relation to the safe management and administration of medicines and what the policy stated. Staff also told us they had not completed any training or review of competency since joining the service.

The service had a governance policy in place which underpinned all the processes in place within the service. Despite having this policy in place, we found their governance processes were not always effective. The service had a policy in place in relation to Disclosure Barring Service (DBS) checks, this had been an improvement identified on the last inspection in September 2022. However, during this assessment we found there were no supporting processes in place to ensure the correct checks had been undertaken. We found staff who had no evidence of a DBS check or a DBS renewal being completed despite them working with vulnerable adults and children. There was a process in place to monitor the outcomes of the service using audit. However, it was noted within the information shared after the onsite assessment, there was no audit schedule in place which meant audits were ad-hoc with no evidence of regular review of the improvements made. In addition to this, we found there was no process in place to monitor or audit the safe transfer of medicines document. As a result of this, the service had not identified staff were failing to complete these during the transfers they had completed. Leaders of the service identified the number of transfers they had completed, which was impacting on the productivity of the service. Despite the concerns over the risk to the service, this was not recorded as a risk on the risk register. The service had policies in place which did not meet the needs of the service and the governance processes in place had not identified this. This was specifically identified within the medicines and infection prevention and control policy. The service had a risk register in place which had 3 risk recorded on this. These were the health and safety of the premises, the ratings given by CQC at the last inspection and completing Oliver McGowen training.

We were unable to speak with patients directly about their experiences with partnerships and communities. However, the feedback we had reviewed during the assessment from those using the service was largely positive in relation to all aspects of the service.

Staff told us they had formed positive relationships with the stakeholders they were engaged with. However, the service only currently worked with a limited number of stakeholders. Staff told us they intended to try and improve this and work with more stakeholders in the future. Staff told us they believed their current rating had impacted on their work and as a result of this, only worked with a limited number of external stakeholders.

Stakeholders were able to give us examples of where patients were not ready to transfer to a new location and where the service gave the patient time and waited until they were ready, and the patient transferred to their new location successfully. The feedback about the service was largely positive.

The service had processes in place to engage with external partners and receive feedback in relation to the service provided. However, the minutes from the governance meetings identified the need for improvements within this area. This was part of the overall governance policy to ensure there was involvement with external stakeholders, however there was no supporting information or action plan to identify specific engagement details with them. Following the inspection in September 2022, this was identified as an area which required further improvements. Although the information shared appears to evidence some improvements with this, the service identified there was still room for improvement.

Staff told us they completed several audits which had identified learning. As a result, action plans were completed to address the concerns/issues and instigate an improvement in practices where needed. Staff were able to discuss areas of improvement since the previous inspection which included the improvement in stakeholder engagement and innovative practice where patients were able to take charge of the environment during their transfer to ensure they remained calm and relaxed. Staff were given time to complete their own learning and training to develop their skills. Staff had plans on how to further improve and grow the service, which included a 5 year plan.

The service provided details around what innovations and improvements had been made to the service to enable them to continue to provide a high standard of care and treatment whilst providing secure transfer for patients. This included improving the way staff communicated with patients whose first language was not English and also ensuring patients were able to choose the music they listened to during their transfer. The process of identifying where improvements were required was mainly from audits which were completed.