Sirona Care & Health C.I.C.

Ratings - Well-led

• Well-led Our assessments of NHS trusts now focus on leadership. We no longer rate trusts overall for their safety, effectiveness and responsiveness or how caring they are. We do still publish those ratings for the services they provide.

  Requires improvement

Our view of the service

Date of assessment: 3 February 2025 to 5 February 2025

Sirona care & health Community Interest Company (Sirona) was established in October 2011 and is the sole provider of NHS and local authority funded adult and children’s community healthcare services across Bristol, North Somerset and South Gloucestershire (BNSSG). Sirona is a not-for-profit social enterprise committed to serving its communities and funded by the NHS and local authorities. Sirona does not have shareholders and does not pay dividends; any surplus is re-invested back into the community.

Sirona’s services span across all ages from birth to end of life and range from preventative and pro-active support to keep people as well and independent as possible through to complex care and support in individuals’ own homes to prevent admission to hospital or to support people following discharge.

Sirona services are provided across several different locations in the BNSSG area as well as in individual’s homes, in over 250 care homes and in schools. They serve approximately 940,000 people in this area.

Sirona provides the following assessment service groups:

• Community mental health services for people with learning disabilities or autism.

• Community health services for adults.

• Community health inpatient services (four inpatient rehabilitation units).

• Community end of life care.

• Community health services for children, young people and families.

• Urgent care services (two minor injury units and one urgent treatment centre).

Sirona is registered for the following regulated activities:

• Accommodation for persons who require nursing or personal care.

• Diagnostic and screening procedures.

• Treatment of disease, disorder or injury.

We carried out a well led assessment of the provider which commenced with a 3-day site visit on 3, 4 and 5 February 2025. This assessment was due to concerns over the previous 12 months about the quality of care across various services including community health services for adults and community health services for children, young people and families. We also had concerns with regards to the stability of leadership of the organisation following some recent unexpected changes at board level.

Before carrying out this well led assessment, we carried out assessments of community health services for adults, community health services for children, young people and families and community mental health services for people with learning disabilities or autism to check how well the overall organisation strategy and risk management aligns with local services.

During the well led assessment, we identified breaches of the legal regulations relating to good governance.

People's experience of this service

Many staff expressed concern that their voices were not being heard by leadership, and some described aspects of the organisational culture as challenging. There was a perception that staff consultation processes lacked genuine influence, with decisions appearing to proceed regardless of feedback. Additionally, some individuals reported feeling unable to speak openly, citing concerns about possible negative consequences.

Partners and stakeholders told us the executive team were engaged at various strategic and quality improvement meetings within the integrated care system (ICS). They told us there was good representation from senior managers in all system and regional improvement groups.

However, several staff and stakeholders also told us there was an improving culture.