Arrowe Park 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

Well-led – 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. We assessed all quality statements from this key question. At this assessment we rated the service as requires improvement. We identified a breach of regulation in relation to the management of risks, incidents, staffing and staff training.

This service scored 54 (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’s mission statement set out a commitment to providing high-quality, responsive care that met patients’ needs. Leaders actively evaluated and developed the quality of the service, working in partnership with relevant stakeholders to monitor progress and deliver strategic priorities. They evidenced an understanding of the challenges and needs within the local community and collaborated with partner agencies to provide appropriate support. However, the governance of incidents and complaints did not always demonstrate openness and transparency or a safe learning culture.

Evidence provided by the trust, along with feedback from staff and leaders, indicated that the culture within the service was not always transparent, inclusive, or fully engaging. Staff described strong teamwork and a shared commitment to delivering the best possible patient experience. Despite this, many reported that their concerns were not always listened to or acted upon, particularly regarding the impact on patient safety of low staffing levels, inconsistent communication, a lack of standard operating procedures, and limited time for training.

Leaders understood the context in which they delivered care, treatment, and support. They presented with the skills, knowledge, and experience to lead effectively. However, this was not always evident in practice. Staff feedback indicated that senior managers were not consistently contactable throughout the full operational period and were not always available or supportive when needed.

Some staff described managers as visible and approachable, with open-door policies in place for support. However, this was not a consistent experience across the service. Staff raised concerns with senior managers through the incident management system and during daily safety huddles where staffing levels were discussed. Despite these processes, and the inclusion of staffing on the organisational risk register, the impact on patient care and staff persisted, and the situation had continued to deteriorate over the previous 12 months.

The provider had established clear escalation plans to manage periods of high demand and operational pressure. However, the supporting documentation for these plans was only introduced during the month of the assessment. Staff reported that they had not yet had the opportunity to review the document or assess its effectiveness.

Leaders told us they aimed to foster a positive culture where staff felt able to speak up and confident that their voices would be heard. Policies and procedures were in place to support this, including access to a Freedom to Speak Up Guardian.

Leaders reported that they encouraged staff to raise concerns and promoted the importance of doing so. However, while the service reported a high number of incidents, we found a prevailing “no harm” culture and limited evidence that all incidents were fully investigated or that learning and feedback were consistently shared with staff.

Staff expressed mixed views about how well they were supported when raising concerns, the way investigations were managed, and whether they would be treated with sensitivity and confidentiality.

The provider valued diversity within its workforce and actively worked to build an inclusive and fair culture by promoting equality and equity across the service. Leaders took steps to remove bias from organisational practices and ensure equality of opportunity and experience for all staff. They had a dedicated Inclusion Team to steer the organisation’s inclusion agenda supported by champions for patients and staff.

Despite these measures, staff reported challenges in maintaining equal opportunities, particularly around flexible working arrangements. High sickness levels and low staffing numbers made it difficult to accommodate annual leave requests.

Leaders described proactive approaches to engage and involve staff. However, feedback indicated that many did not feel empowered or confident that their concerns and ideas led to meaningful change.

The provider had arrangements for governance, management, and accountability. A defined management structure was in place, with designated leads for both clinical and non-clinical areas. Staff understood their roles, responsibilities, and lines of accountability. There was clear disconnect between how the service was managed and governed at provider level and at location level exacerbated by the way in which communication was shared with frontline staff.

Leaders monitored information on risk, performance, and outcomes, and discussed and implemented changes in response to feedback from patients, staff, and stakeholders. Each division and department maintained a risk register, which senior leadership teams reviewed regularly. Contract monitoring meetings with local commissioners took place to review activity, productivity, KPI compliance and performance.

The provider used quality and operational data to drive improvement. Performance was monitored across key indicators, including waiting times, patients leaving without being seen, demand, and attendance. Where targets were not met, leaders reviewed performance regularly and implemented action plans. An audit management and tracking tool with a quality dashboard enabled the management team to monitor compliance, track progress, and act where improvement was needed. However, standard operating procedures were not consistently in place or introduced quickly enough when learning was identified, for example around chest pain, managing patients with mental health problems, and service pressure escalation.

The service routinely completed specific audits through the trust-wide audit system, such as antimicrobial stewardship, prescribing, and medicines management. Performance data, risk information, productivity, and response times were reviewed at team, divisional, and board level to support continuous improvement. A major incident and business continuity plan was in place.

Staff received annual appraisals and support to meet professional revalidation requirements. However, not all staff had completed the training required for working in an urgent care setting. Leaders acknowledged that achieving full training compliance was challenging due to workload pressures and limited time away from patient care.

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 service shared information and learning with partners and collaborated for improvement.

The service demonstrated how they continually collaborated with other services operated by the provider and with external services to make improvements. For example, they had established a programme to identify and support individuals aged 18 and over who attended the ED or UTC more frequently than expected. They also aspired to further support people with a learning disability and autistic people and ADHD by creating sensory spaces within the one front door environment.

The provider worked closely with the ICB to monitor performance and for the development of the service and responded to and implemented national and public health initiatives.

The provider did not consistently demonstrate learning, improvement, or innovation, and there was limited evidence of a culture of continuous development and reflection across the organisation or at the service. Performance data was not always adequately assessed, and feedback from service users and staff was not consistently used to drive meaningful changes. Training programmes did not consistently support staff to reflect on practice, and learning was not always shared across the team.

Processes to ensure that learning from incidents was communicated and acted upon were not consistently followed, and action to prevent reoccurrence was sometimes lacking, including in collaboration with external partners and services.

Escalation plans to mitigate the risks to patient safety from low staffing, insufficient qualified staff per shift, and staff burnout were not embedded or tested. These concerns, which had been identified for more than two years, had not resulted in any meaningful improvement.