Garston Urgent Treatment Centre

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 service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

This is the first inspection for this service since its registration with CQC. This key question has been rated as good.

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 provider planned the service to meet the needs of the local population working in collaboration across the wider system of primary, secondary and urgent care.

Leaders were committed to evaluating and developing the quality of the service and they worked in partnership with relevant stakeholders to monitor and deliver its strategy.

A range of management and governance meetings were held regularly where performance against a range of indicators was reviewed, evaluated and action planned to make improvements as required.

There was a clear vision for the development of the service and supporting plans to achieve priorities. The strategy was in line with meeting the health and social care priorities across the locality.

Staff told us there was good teamwork and that the service promoted the best possible person-centred care for people. However, feedback indicated that some staff were not clear on the future plans for the service. Some staff expressed apprehension about the planned changes to offer more services, given that they felt that staffing levels were not always sufficient.

The service demonstrated openness, honesty and transparency in responding to incidents and complaints and lessons learned were shared across the team to prevent a recurrence.

Leaders understood the context in which they delivered care, treatment and support. Leaders had the skills, knowledge, and experience to lead effectively.

The leadership team worked in collaboration with other agencies, stakeholders and commissioners and were engaged in the development of services within the locality to support patient experience and improve outcomes for patients.

The provider had clear escalation plans that could be brought into effect during the operational period when pressures and high demands were experienced by staff. All staff knew how to trigger escalation and how to report this to the management team.

The provider monitored and acted upon data about outcomes for patients. They made improvements when required.

Staff told us that leaders were visible. The majority described leaders as supportive and inclusive in their approach to managing the service.

Leaders encouraged staff to raise concerns and promoted the value of doing so. Overall, staff told us they felt well supported and confident to raise concerns.

The service had established freedom to speak up arrangements. There was a dedicated ‘freedom to speak up’ person that staff could approach. There was also a whistleblowing policy.

The provider was aware of and had systems to ensure compliance with the requirements of the duty of candour.

The provider valued diversity in their workforce and actively promoted equality and diversity. They worked towards an inclusive and fair culture by supporting equality and diversity for people who worked for them.

Reasonable adjustments were made to support staff to carry out their roles. For example, staff with caring responsibilities were actively supported with a flexible approach to accommodate their needs.

Staff had completed training in equality, diversity, and inclusion and were aware of supporting people with protected characteristics such as age, gender, religion, or disability. The practice had an equality, diversity, and inclusion policy.

We were informed that all staff had the opportunity to discuss and raise concerns at listening events named “Your Voice Your Change”. The service also had monthly visits from senior managers to talk with staff and gather their views and opinions. We saw action plans were drawn up after these meetings to identify actions taken in response to staff issues raised. However, several staff told us they had raised concerns about low staffing levels, but felt their concerns were not addressed by management.

A staff survey was sent to all staff across the trust. Specific feedback for Garston UTC was not available as the trust’s policy was that a minimum of ten responses were needed to produce a service level analysis of this data. We therefore did not see evidence that the views of staff on the operation of the service had been sought via a process that allowed for views to be collated, analysed and responded to.

The provider had clear and effective arrangements for managing and governing the service and ensuring accountability. Garston UTC was governed by the trust infrastructure, for example for health and safety, training and development, infection control, safeguarding, patient experience and estates and facilities. 

A clear management structure was in place with designated staff members who acted as leads for clinical and non-clinical areas. Staff roles, responsibilities and lines of accountability were clear.

Management and governance meetings were held across the trust. There were clear processes to escalate risks so that leaders knew about them and could act on them. Risk registers were in place across each of the divisions and departments monitored by the trust board senior leadership teams.

There were monthly contract monitoring meetings taking place with local commissioners to monitor activity, productivity, KPI compliance, performance, incident management and quality standards.

Quality and operational information was used to improve performance. The provider monitored the performance of the service across key indicators and improvements were made to the service as required.

A regular programme of internal audit/checks were in place to ensure the safe and effective running of the service. External audits were undertaken to provide assurance that systems and processes were in place to accurately report performance against the service key performance indicators.

All staff we spoke with were clear on their individual roles and responsibilities. There was a clear structure for induction, mandatory and on-going training and to assess competence. Staff could access all required policies and procedures.

Processes were in place to support communication at the service and with the leadership team. For example, staff attended a daily meeting where important information about the service, staffing and patient information was discussed and where issues could be escalated. Monthly team meetings took place. Fortnightly meetings took place with the clinical team leaders and operational managers.

A major incident/ business continuity plan was in place. Staff had been involved in emergency planning exercises, for mass casualty incidents and for managing people who had been exposed to hazardous materials.

The provider worked collaboratively and in partnership with relevant stakeholders, commissioners and partner agencies to support joint working and provide and develop effective services.

The provider had arrangements in place to allow patients the opportunity to provide feedback on the service. There was a system to review people’s feedback and act on this when required.

Healthwatch had visited the service in December 2023 and gathered people’s views about the service. Although most of the feedback was positive, peoples experiences resulted in Healthwatch making recommendations about how improvements could be made. These related to communication and to making the service more accessible to people who were neurodivergent or had a learning disability. The provider demonstrated the action they had taken and were taking to address these recommendations.

The provider worked closely with the Integrated Care Board to monitor performance and on the development of the service. The provider responded to and implemented national and public health initiatives.

The service worked with local hospitals, NHS 111, NWAS and local primary care networks (PCNs). Standard operating procedures were in place that clearly outlined how the provider worked with others to support people.

The service demonstrated how they continually collaborated with other services operated by the provider and with external services to make improvements. For example, they were developing a Mental Health and Self-Harm Policy for Children and Young People in urgent treatment centres that supported escalation, safeguarding and referral onwards to specialist services.

There was a focus on continuous learning and improvement across the service.

The provider learnt from incidents and events and took action to improve the service in response.

There was recognition of the challenges the service faced. For example, the service had moved from being a walk-in centre to an urgent treatment centre. This brought the challenges of new services being offered, staff training and maintaining an appropriately skilled workforce. The provider shared with us strategies to combat these challenges that had been or were being implemented or considered.

Quality improvement projects were put in place to develop the service and respond to any areas where it had been identified that improvements were needed. This included a project for the management of x-rays. A project to increase the amount of patient feedback through the Family and Friends Test and a project to offer an appointment (the next day) to patients with lower clinical need who could not be reviewed on the day of attending the UTC. These projects were regularly reviewed to ensure they were meeting the goal of improved patient care.

The provider worked collaboratively and in partnership with stakeholders to improve the experience of people who used the service and those within the locality.