St Bernard's Hospital

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

At our last assessment we rated well-led as good. At this assessment the rating has remained 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 mostly 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.

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.

The trust’s 4 values were Togetherness, Responsibility, Excellence and Caring. The provider’s senior leadership team had successfully communicated the provider’s vision and values to the frontline staff in this service.

Staff knew and understood the trust’s vision and values and how they applied to the work of their team and promoted good outcomes for patients. Staff demonstrated the values in their responses to patients, carers and their approach to delivering care and treatment. Staff spoke about respecting each other, working together and caring for patients and other staff members.

Staff had the opportunity to contribute to discussions about the strategy for their service, especially where the service was changing.

Leaders and staff described a positive, respectful and open culture, where learning was embedded through regular supervision, team meetings and reflective practice. These forums supported continuous learning, development and the maintenance of high standards of care. Staff told us they felt listened to, valued and supported in their roles. The service actively promoted a culture of psychological safety, encouraging staff to speak up, share concerns and contribute to service development. Staff also described effective team working and collaborative relationships within and across wards and external partners.

Staff understood the model of the service being provided. They were clear about delivering services for patients with organic needs (like dementia) and functional needs (a diagnosed mental illness). Where services did both, they could describe how they manage the needs of both groups of patients.

Senior leaders could explain how they were working to deliver high quality care within the budgets available.

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 inspection, the older people's wards had been removed from the service line structure and integrated within the trust's borough-based community health/mental health service structures. Senior leaders had extensive experience of working with older people, including those with physical and mental health needs and cognitive impairment. Leaders demonstrated the skills, knowledge and experience required to carry out their roles effectively and provide appropriate oversight of the service.

We spoke to managers and leaders from each ward. Leaders had a good understanding of the services they managed and the needs and demands of the service. They could explain clearly how the teams were working to provide high quality care, including through leadership governance meetings, regular audits and listening to patients, carer and staff feedback. They spoke about the challenges and priorities relating to the quality of the service, for example the environmental challenges on Jubilee ward and delays in funding when patients were ready for discharge.

Leaders were visible in the service and approachable for patients and staff. Staff on all wards said leaders visited the wards regularly. Staff reported that ward managers were supportive and provided inclusive leadership.

Leadership development opportunities were available for staff at different levels. Staff had access to training and development to support their career progression. Staff spoke positively about development opportunities available for colleagues from underrepresented groups. The trust had established programmes to support professional development for staff from Black and ethnically and culturally diverse backgrounds.

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

Managers and staff had access to the feedback from patients, carers and staff and used it to make improvements.

Patients and carers had opportunities to give feedback on the service they received in a manner that reflected their individual needs. The service used a range of feedback mechanisms, including surveys, CPA meetings and individual meetings with the ward managers. Advocates were easily accessible and could be involved in these discussions.

Patients and carers were involved in decision-making about changes to the service.

The trust valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked at the trust. The trust had an equality, diversity and inclusion policy and over 96% of staff had completed the Equality, Diversity and Dignity at Work training.

Staff reported that the trust promoted equality and diversity in its day-to-day work. The trust monitored workforce equality data to understand the diversity of its staff group and to support a workforce that was reflective of the communities and patient populations it served. The trust managed its approach to diversity and inclusion through a central Equality, Diversity and Inclusion (EDI) Strategy, which aligned with the London Workforce Race Strategy.

Staff could apply to work flexibly. For example, flexible working agreements to account for personal circumstances such as caring responsibilities and health issues. Managers put reasonable adjustments in place for staff members to help them carry out their role.

Staff had access to a range of staff networks, which provided support, fostered inclusion and offered opportunities for staff to share their experiences and contribute to service development. The trust actively promoted equality, diversity and inclusion through participation in a range of national and cultural awareness events, including Pride Month, LGBTQIA+ History Month, Black History Month etc.

Overall, we found that appropriate governance and management systems were in place and these systems were effective in supporting the delivery of safe care. However, during our inspection we identified a small number of areas relating to medicines management and documentation where risks had not been fully recognised or addressed by the service. This was fed back to the provider for their attention and action.

We found other areas of good practice in relation to governance, management and sustainability. There was a clear framework of what must be discussed at a ward, team or directorate level in team meetings to ensure that essential information, such as learning from incidents and complaints, was shared and discussed. Wards held monthly team meetings to ensure essential information was shared amongst the staff.

The service managers and clinical leads attended regular clinical governance meetings. Managers fed information from these meetings back to their teams. Staff discussed recommendations from reviews of deaths, incidents, complaints and safeguarding alerts at these meetings. Following a death at The Limes the service revised its policy on ward transfers, information sharing and risk assessments. We saw incidents and learning being discussed in meeting minutes.

Staff undertook or participated in local clinical audits. The audits were sufficient to provide assurance and staff acted on the results when needed. Leaders monitored services where performance was below what was expected and took actions to address this. Jubilee ward had been put on a support and intervention plan that was reviewed fortnightly and progress on actions reviewed.

Staff understood the arrangements for working with other teams, both within the provider and external, to meet the needs of the patients.

Staff maintained and had access to the risk register at team and directorate level. Staff at team level could escalate concerns when required. Staff concerns matched those on the risk registers for each of the wards. Risk registers were reviewed monthly at senior leadership meetings and discussed at each ward clinical improvement meeting, ensuring risks were effectively monitored, managed, and escalated where necessary.

The service had plans for emergencies such as adverse weather or a flu outbreak.

Where cost improvements were taking place, they did not compromise patient care.

The service used systems to collect data from teams that were not over-burdensome for frontline staff. Managers and leaders had access to information to support their roles, including data on service performance, staffing and patient care. They could review key performance information through the various trust dashboards.

Staff had access to the equipment and information technology needed to do their work. The information technology infrastructure, including the telephone system, mostly worked well and helped to improve the quality of care.

Information governance systems included confidentiality of patient records. Information was in an accessible format, and was timely, accurate and identified areas for improvement.

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 had strong and effective partnerships with acute hospitals and a wide range of external stakeholders, including commissioners, voluntary services, primary care providers, social care services, the Integrated Care Board (ICB), Healthwatch, and third-sector organisations. These partnerships strengthened governance and oversight, supported continuous improvement, and aimed to deliver seamless, well-coordinated care throughout a care pathway.

Teams worked closely with social services and primary care to jointly manage risks, support complex discharges and ensure continuity of care for people with ongoing needs. The service had regular interface meetings with the Community Teams-Specialist Older Adults Mental Health Services (SOAMHS), Cognitive Impairment and Dementia Services (CIDS) and the Care Home In-reach Liaison Service (CHILS) to support continuity ofcare for patients moving on from the wards.

Patients and staff could meet with members of the provider’s senior leadership team to give feedback.

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.

Staff were given the time and support needed to make improvements. For example, senior leaders had placed Jubilee ward within a Level 2 Support and Intervention Plan following a period of concerns relating to quality, safety, workforce, and leadership indicators. We saw evidence that improvements were being made, although progress was gradual. The leadership team demonstrated a clear understanding of the ward's challenges and had identified the areas requiring improvement, with actions in place to address these concerns. Areas identified included environmental risk management, patient supervision, staff support, workforce morale and leadership development.

Concerns relating to environmental risks, including ligature risks, blind spots and patient supervision, had led to the commissioning of a comprehensive safety and environmental review. Key recommendations were being implemented under the oversight of the Executive leadership team, including strengthened risk management processes and enhanced oversight of patient care. A clearer and more auditable clinical pathway had also been introduced on Jubilee ward to support the consistent delivery of evidence-based care. We saw that treatment pathways were being reviewed and monitored to ensure compliance and clinical effectiveness. Concerns had also been identified regarding staff support, induction arrangements and supervision. Staff on Jubilee Ward told us they were now receiving regular monthly supervision and attending team meetings. The team was also receiving dedicated workforce and human resources support to improve staff wellbeing, engagement and morale.

Staff used quality improvement methods and knew how to apply them. Meridian ward was taking part in the national Culture of Care programme, delivered in partnership with the Royal College of Psychiatrists. Through co-production with staff, patients and carers the ward had embedded three improvement initiatives, such as the sensory garden, one-to-one activities and dining with dignity.

All 3 wards were piloting Uber Health for patient related journeys for time-critical tasks which​ could delay patient care or discharge. For example, reducing the length of time patients wait for hospital transport to attend external appointments.

The service was committed to reducing restrictive practices. The Reducing Restrictive Practice Team within the service had devised a Use of Force Guide that was Specific to Older Adults​ and provided bespoke seclusion of older people’s training.