Becton Centre for Children and Young People

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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 last assessment we rated this key question requires improvement. At this assessment the rating has changed to good.

Leaders had the skills, knowledge and experience to perform their roles. Staff knew and understood the provider’s vision and values and how they applied to the work of their team. Staff felt respected, supported and valued. Governance processes operated effectively. Performance and risk were managed well. Teams had access to the information they needed to provide safe and effective care. Staff collected analysed data about outcomes and performance. They used this to identify improvements.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We scored the service as 3. The evidence showed a good standard. 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 people and their communities.

Staff we spoke with knew and understood the Trust’s vision and values and how they applied to their work. All staff had opportunities to contribute to discussions and the strategy for the service in regular meetings.

The service had previously had culture issues on one of the lodges, this had been addressed by senior leaders with the change in management team, medics and through supervision. Staff we spoke to believed that the culture was improving on the lodge since the changes.

We scored the service as 3. The evidence showed a good standard. The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Since our last assessment the service had made changes to the management structure. A deputy chief nurse had been recruited and had been in post for a year. They had made multiple changes to the service to try and improve the safety and culture of the lodges. They had introduced a site manager for evenings and weekends, due to staffing issues in those times and centralised recruitment for the service. They had introduced a uniform for staff to encourage professional boundaries.

The deputy chief nurse was visible on the site; they undertook clinical shifts on each lodge and knew each patient on the lodges. They were supported by the clinical director for the service.

The service had provided development opportunities for staff. Many staff at the service had leadership development opportunities, with deputy ward managers being promoted to ward managers with recent staffing changes.

With the changes that had recently been made to the service, all staff, including senior leaders, told us that patients were at the centre of their care.

We scored the service as 2. The evidence showed some shortfalls. People did not always feel they could speak up and that their voice would be heard.

Patients and carers had multiple opportunities to give feedback on the service in a manner that reflected their individual needs. All staff had access to this feedback and were able to make improvements following this feedback.

Patients and carers were able to meet with senior leaders of the site and give feedback directly.

However, some staff we spoke with felt that the freedom to speak up process was not effective. There had been cultural issues with some members of staff, that staff did not feel was addressed though they were raised through the speak up process.

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

The service had equality and diversity networks which included a race equality network, a disability equality network and a LGBT+ network.

Reasonable adjustments were available for staff along with flexible working arrangements. Staff told us that the choice was promoted by the management team.

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 act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

The service had a schedule of audits which staff partook, outcomes from the audits were shared with staff in team meetings.

Staff had access to equipment and information technology needed to do their work. The lodges had started to use digital monitoring, this meant that observations were logged straight onto mobile devices. Staff could also use these devices to access patient care plans, patient risk assessments, ward risk assessments and policies and procedures.

Handovers, risk meetings and multidisciplinary meetings had clear structures to ensure essential information was shared and discussed.

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 share information and learning with partners and collaborate for improvement.

The service engaged with external stakeholders, staff informed us that they work with any organisation that are involved in the patient’s care. This included care co-coordinators, schools and commissioners.

We scored the service as 3. The evidence showed a good standard. The service focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

The service was making improvements since our last assessment, ligature risk assessment policy, environmental risk assessment process, search policy and clinical supervision policy had been reviewed.

The service had implemented non-violent resistance; this method was rolled out via training with all staff and was central to care and treatment for the patients. The service was also presenting this method at national conferences. Staff had quality improvement training.