Sirona Care & Health C.I.C.

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
• Environmental sustainability – sustainable development

We have not awarded this service a score for Well-led.

Find out about when we will not publish a key question score and what we look at when we assess Well-led.

The organisation had been through significant changes in the last year. Several members of the executive team including the chief executive officer, were in interim roles. The chair of the board of directors was also newly appointed, although had been promoted from their role as a non-executive director and Vice Chair for the organisation.

The organisation had a set of values which they described as “Taking it Personally”. There was a set of behaviours which underpinned the organisations values. The organisation’s vision related to ‘Improved Outcomes for All’ supported by its mission of ‘One You, One Sirona, One System’.

During our assessment, leaders spoke about the organisation’s strategy of improved outcomes for all. However, this strategy was not widely understood by most staff we spoke with. Staff we spoke with were not aware of the organisation’s direction and the plan to achieve this. At the time of the inspection, we asked senior leaders for an outline of their strategy and the roadmap to achieving this, however, they were unable to provide this.

There was a draft clinical strategy and equality, diversity and inclusion strategy which had been developed in collaboration with staff. Staff we spoke with were positive about both strategies.

The board recognised that it had been unstable over the last 12 months and had commissioned an external provider to undertake a review of the organisation’s governance and risks. At the time of our inspection, the organisation could not share the full report from the independent review.

It was evident from conversations with board members and others the team met during the inspection, that a lack of clarity across a number of key areas was impeding Sirona’s progress. Examples of this included:

• A lack of clarity about the organisation’s strategy and its implementation
• A lack of grip and pace from the board enabling and supporting staff to deliver
• A lack of curiosity about what was really going on at operational level, and an active interest in finding out
• A lack of a clear and value-adding development programme for board members
• A lack of robust and agreed sources of assurance across multiple areas

Board members frequently used the phrase "in progress" to explain the absence of a clear, agreed-upon path forward. This demonstrated the board was in a state of limbo, as many of its key work areas were considered "in progress" while they were waiting for a new Chief Executive, and other substantive executives and non-executives, to be appointed and join them.

The organisation’s board had an unstable senior leadership team over the 12 months prior to our inspection. At the time of our inspection, a number of executive leaders were either in interim roles or were due to leave the organisation. Some members of the non-executive directors were new to the organisation and some of the experienced ones were leaving. Individual senior leaders were experienced and were capable in their role. However, senior leaders were not working as a unitary board and needed time to form a stable team to drive the organisation through the challenges they were facing.

Staff told us there was a disconnect between leaders and front-line activities. Staff did not feel supported and felt the challenges they experienced in delivering services was not understood by senior leaders. For example, during the inspection of community health services, not all staff were sure how well senior and executive leaders took their views into account. We were told that there was a lack of traction at executive level relating to concerns raised by the community services leadership team, such as demand and capacity concerns.

Staff we spoke with told us where they had been consulted on changes within the organisation, however they felt their views and opinions had not been taken into account. They felt leaders had undertaken consultations as a process rather than a desire to hear about staff views. For example, at the time of the inspection, the organisation had recently moved their head office. Staff were required to base themselves at the head office on a number of days per week. Several members of staff raised that the new location meant they had to travel long distances to get to the office when they could be based in an office nearer to their geographical workplace. The rationale for this decision and requirement was unclear and had led to staff feeling unvalued.

We saw evidence the organisation had commissioned an external organisation in 2022 to support them with a workplace strategy which included ways of working and recommendations on their premises. The report included a recommendation to develop a ‘Way of Working Charter’ to define ways of working specific to each team and a hybrid working framework, as not one size fits all the different staff groups and types of service delivered. Staff felt however, they had no flexibility, and senior leaders did not fully understand the hybrid working policy.

The organisation sent evidence to show the changes they made to their initial proposal to move offices based on staff feedback.

The interim Chief Executive Officer held monthly virtual meetings with staff where staff could attend and ask them anything. Board members were encouraged to go out to services and meet with staff regularly. The organisation planned for this to take place quarterly, however, this had not been undertaken consistently by board members.

The organisation held a staff engagement week in September 2024 to gather feedback from staff. The purpose of this event was for the feedback to help the executive team to collectively determine and develop a programme of work and to inform a culture change for the organisation. The feedback was themed and 8 actions were recommended. Although those actions were categorised as either immediate, short term or medium term, there were not clear timescales on when these would be completed.

Staff were aware of the Freedom to Speak Up process (FTSU) and knew who the FTSU champions and leads were. However, they also told us there was a lack of transparency relating to issues and the turnover at leadership level. They expressed concerns about the leadership culture and staff did not feel they could speak up without fear of retribution.

At the time of the inspection, the organisation had 1 person performing the role of FTSU guardian in addition to their role as learning and development lead. While protected time was allocated for this member of staff to fulfil the role of FTSU guardian, the organisation identified this was not sufficient. As of April 2025, we were told there would be 1 FTSU guardian responsible for the role full time and they would be reporting to the CEO, chair of the board and deputy director of people. The provider confirmed following the inspection that this role was now in place.

There were FTSU champions across the organisation and they had used a variety of ways to advertise the roles including their intranet, posters and lanyards. The guardian attended corporate inductions to make themselves known to new staff.

FTSU champions we spoke with were passionate about their role. They understood their role and there was a positive culture among the group.

FTSU mid year report was discussed at board meeting in September 2024. The report highlighted month on month increase in cases being reported. The main themes from cases reported were line management, attitude and behaviours and work pressures.

We saw FTSU was discussed at the people committee. The November 2024 papers for the committee highlighted that a baseline data capture had been gathered between the period of 1 July 2022 and 1 July 2024 for concerns raised in relation to racism. This showed there were 25 incidents recorded ranging from no injuries to minor physical harm.

Although there was clear enthusiasm for the FTSU function, it was a recent development by the organisation having been identified as a medium-term action following the staff engagement week in September 2024. This contributed to the disparity in how front-line staff and senior leadership perceive openness and transparency.

The organisation had a sponsor for equality, diversity and inclusion (EDI) at board level. It had EDI leads across the organisation, and had established an equality, diversity and inclusion steering group. We saw since January 2024, equality, diversity and inclusion agenda had been driven by the EDI group and lead.

There was recognition that neither the workforce nor board members reflected the diversity of the local population. We observed non-executive directors raising the need for the board to be more diverse and inclusive when recruiting new board members. At the time of the inspection, the board had 6 substantive NEDs in place 50% of whom had a protected characteristic. Of the substantive Executives, 20% (1 out of 5) had a protected characteristic.

The Workforce Race Equality Standard (WRES) report 2024 showed Sirona needed to improve data collection around workforce demographics, as they only held data on 81% of staff. The provider sent additional information following the inspection to show this had improved to 86% by February 2025. There was an overrepresentation of staff from ethnic minority groups in lower pay grades and underrepresentation in higher graded roles. The data also showed that if you were white and applied for a role at Sirona, you were four times more likely to be appointed than if you were from ethnic minority groups.

Staff from ethnic minority groups were also more likely to enter the disciplinary process and have lower access to non-mandatory training and continuing professional development.

Over four times as many staff from ethnic minorities than white staff experienced discrimination from colleagues, and across all indicators, staff from ethnic minority groups expressed their experience of working in Sirona was more negative than their white colleagues.

The Workforce Race Disability Standard (WDES) report published in 2024 for data collected in 2023, showed the organisation needed to improve data collection around workforce demographics for Disabled people. Disability data based on the staff survey in 2023 showed that 80% of staff declared if they had a disability or not; and of those, 6% of staff declared they had a disability.

The data also showed the relative likelihood of non-disabled candidates being appointed from shortlisting compared to disabled candidates was 1.57 which indicated that non-disabled candidates were more likely to be appointed disabled staff. More disabled staff entered formal capability processes.

A slightly higher proportion of disabled staff experienced bullying, harassment, and abuse from the public than non-disabled staff.

A higher proportion of disabled staff experienced bullying, harassment, and abuse from managers and colleagues within Sirona than non- disabled staff.

The organisation had created an Equality, Diversity, and Inclusion Strategy Action Plan 2023/24 which identified 8 objectives,12 ambitions with a range of actions. However, none of the identified actions had a deadline. Of the 12 ambitions, only 3 had progress updates. We also reviewed the EDI Taskforce monthly highlight report. However, this did not link back to the strategy action plan, and also did not include progress updates. We were told the EDI taskforce had analysed data sets to formulate a plan to reduce the disparity identified in the 2024 report.

In the last 12 months the organisation had held focus groups and events and was aiming to have EDI representatives from the staff networks across the organisation to speak up for staff. We saw from the September 2024 board report there was a focus for board members to complete anti-racism training in October 2024 and January 2025, and for senior leadership team to complete the same training in November 2024. There was also a focus on recruitment and retention. The board report also highlighted that 10 members of staff completed the “train the trainer programme” on anti-racism with a view that those staff members would attend team meetings to provide support.

Staff told us that there was a drive from staff to create diversity across the organisation, but that the recent challenges in the executive team and confusion around governance had led to a loss of focus on EDI. This had led to a disconnect between the board and EDI staff. EDI representatives also reported a lack of dedicated protected time to support colleagues and progress actions, and often worked on EDI support in their own time.

Staff were not always clear on the governance processes and reporting structures. The organisation recognised their governance systems needed reviewing and had taken action by commissioning an external organisation to carry out an independent review of their governance systems and make recommendations for improvement. This recently took place and at the time of our inspection, the organisation could not share the full report from the independent review as it was not available to them.

The organisation shared the process they had gone through with the external organisation in reviewing the governance systems. There was good participation from board members. However, a number of board members were either due to leave the organisation or were in interim roles.

Leaders told us they had good relationships with each other and could challenge decisions. For example, the Chief Nursing Allied Health Professional Officer, Chief Medical Officer and Chief Finance Officer worked together to ensure quality of care was not compromised by financial constraints.

The executive team told us the board assurance framework (BAF) had recently been refreshed however, non-executive board members told us they had not been involved in the development of the new board assurance framework. There was a risk the BAF would not support the senior leadership team to work as a unitary board. There was a lack of curiosity or engagement by the board with the creation and management of the BAF as a dynamic risk management tool.

Staff indicated a disconnect between operations and leadership which was exacerbated by the reduced frequency of Board and its Sub Committee meetings to quarterly and the of absence of integrated performance reports. This was demonstrated by non-executive directors being unable to track performance and there not being a clear account of how downgraded risks were signed off. Leaders from the organisation told us they were working on developing an integrated performance report and were making good progress with this. While most board members could articulate the organisation’s top risks, we saw a number of these had been downgraded in the BAF within the previous quarter and no clear details on progress on the risk’s reduction actions identified. For example, senior leaders described the top risk as being demand and capacity. Our inspection of services for community adults in January 2025 prior to this well led assessment highlighted significant concerns in relation to delivery of community services for adults which were linked to capacity and demand. However, the BAF showed the risks scores had been downgraded from severe in Quarter 1 and 2 for 2024/2025 to moderate in Quarter 3. There were 13 actions identified most of which were due for completion in March 2025. However, these did not provide assurance or details on how they were having the desired impact to justify the reduction in the risks level. Following the inspection, the provider sent us further information on how the risks scores had been downgraded. Some of the non-executive directors, despite having been able to identify the top strategic risks appeared to be unaware that these had been downgraded. This suggests a lack of ownership of the BAF by the unitary board.

Staff described a level of uncertainty over the management of operational risks. There was no formal check and challenge of decisions to reduce or increase risk scores by risk owners which may lead to inconsistencies in how these are prioritised and addressed.

Board members told us they recognised the importance of having integrated performance reports and the absence of this had made it challenging to track performance and trajectory. However, we were told by the executive team that this was currently being developed as a priority.

The organisation was in enhanced contractual surveillance with the local integrated care board (ICB). Leaders from the organisation engaged well in integrated care system quality groups and provided timely quality assurance information to commissioners and regulators when required.

External partners told us the organisation was operationally challenged and while they engaged well with system quality improvement groups, there was not always clear actions to sustain improvements. They also told us the organisation had delivered on the National Emergency Preparedness, Resilience, and Response (EPRR) standards. National EPRR standards are the minimum requirements all NHS-funded organisations must meet to demonstrate their ability to respond to emergencies while maintaining critical services.

We saw the organisation had taken some learning from previous events where board members did not have means to raise concerns through a senior independent director. The organisation had appointed to this role which serves as an intermediary for executive and non-executive directors to raise concerns that had not been resolved through other channels.

Staff working for the organisation were hardworking, dedicated and knowledgeable. The safeguarding lead was knowledgeable and there were some good operational leaders.

Leaders were clear of their roles and responsibilities to collaborate with system partners and work in partnership to improve community health provision.

External partners told us leaders in the organisation have often led on improvement initiatives across the system. For example, on discharge to assess initiatives. They also told us leaders in the organisation actively engaged in the local integrated care system quality improvement groups which we had also observed.

Leaders understood their demographic and integrated care system pressures. For example, in the December 2024 board report, it was highlighted the organisation was already seeing an increased demand for community services ahead of winter, and teams were responding to support hospital discharges to help with capacity at the local acute hospitals. However, the capacity within community teams to attend to patients who were already receiving services remained challenged with a number of patients being deferred as highlighted in our latest report for community services for adults.

Leaders told us capacity and demand was one of the biggest risks and while they understood community care was vital to avoid hospital admission, there was a lack of strategy and sufficient actions had not been taken in a timely manner to improve the quality of services to the communities they served.

Representatives of service users told us there was a lack of engagement from the organisation on co-production of strategies to address shortfalls within certain services. For example, to address long waiting lists for autism and attention deficit hyperactivity disorder (ADHD). They felt there were missed opportunities for the organisation to engage with patient groups and drive improvements to address inequalities within some communities.

In the absence of a clear strategy, the organisation had missed an opportunity to position themselves as the only main community health provider in the Bristol, North Somerset and South Gloucestershire area and proactively plan services to support their position, and unique contribution they bring to the whole integrated care system.

The organisation had developed a board development plan with the aim for the board to work effectively together which included governance and leadership, key areas they needed to focus on, and learning and reducing risks across the organisation. There were key objectives set out between January and December 2025. At the time of our inspection, it was too early to assess the progress of the board against the development plan due to the high turnover of board members and the number of interim appointments.

Key learning points from the staff engagement week held in September 2024 had been identified and reported in the November 2024 people committee papers.

However, there was no evidence the board had oversight of learning from incidents and complaints and that actions implemented were effective and sustainable. Patient stories were shared at board meetings, and we saw from the September 2024 minutes of the board, learning from an incident was shared. However, the report also identified that disseminating learning to the wider organisation was work in progress. During our community health services for adults assessment, we identified a lack of oversight of incident reporting and implementing actions that were effective. We found some incidents were still happening with similar themes still occurring. In some areas, we found actions had been identified however, there was no action plan with clear timescales and accountability.

There was evidence of the organisation supporting quality improvement projects and research. Quality improvement methodology was aligned with NHS IMPACT (NHS IMPACT (Improving Patient Care Together) had been launched to support all NHS organisations, systems and providers to have the skills and techniques to deliver continuous improvement.). They demonstrated the use of technology and artificial intelligence to improve outcomes for patients.

The organisation secured a grant from the Clinical Research Network which was used to form a team to promote research and embed findings. At the time of our inspection, there were 5 active projects and 9 being set up.

The organisation had a sustainability and environmental strategy, in line with national guidance, and the integrated care system they operated within with a focus on their estates and travel. The strategy set out 3 objectives which aimed to create an organisation wide approach to sustainability, reducing environmental impact from their activities and reducing environmental impact on the communities they serve.

We saw the organisation had commissioned a baseline audit from an external organisation so they could identify the areas which generated the most carbon emissions. The audit identified areas of carbon emissions and actions the organisation had already started to implement to reduce these. This included working with the Bristol Clean Air Zone to provide charging points for electric vehicles, salary sacrifice scheme to support staff with purchase of electric vehicles and improvement to estates to reduce energy consumption.

The organisation had developed a decarbonisation plan which detailed priorities, actions and initiatives between the year 2025 and 2030. The plan highlighted the estates department within the finance directorate had responsibility for environmental initiatives. This plan included detailed areas of focus to achieving Net Zero emission. There were 14 areas highlighted and included appointing an executive lead to oversee progress.

While the decarbonisation plan outlined high-level actions for year 1 and year 2, there was no detailed action plan which highlighted areas of responsibilities and how progress will be monitored. However, we noted the plan was recently implemented.

External partners told us the organisation engaged in discussion with regards to Net Zero initiatives and were actively seeking solutions to reduce carbon footprint of staff travel to deliver services.

Staff we spoke with were not confident the organisation had considered the impact of carbon footprint when moving to their new head office and implementing the hybrid working policy.

Within some areas, such as estates, there was a clear understanding of where reduction in emissions could be achieved. However, the organisation recognised there was further work to be done in ensuring the principles of net zero were embedded into all areas of the planning and delivery of patient care.