Torbay and South Devon NHS Foundation Trust

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.

At our last assessment we rated this key question outstanding. At this assessment the rating has changed to good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care. The service had a positive culture and direction. Staff felt able to share concerns and had confidence in leadership. Managers reviewed service provision with the aim to make improvements. However, there was not an effective process to review performance of subcontracted services. Some processes did not identify safety issues.

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 evidence showed a good standard. 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 service operated under the trust’s vision and strategy and developed local objectives to support the delivery of care. Managers and staff told us the service was focused on the principle of right vehicles, right place, right time.

Managers and staff told us values were embedded in training and were built into appraisals. This ensured everyone knew what was expected. Each job role had clear roles and responsibilities.

The service involved staff to develop a patient transport code of practice. The code of practice set out expectations on how the service was to be delivered. This was built into job roles.

Staff told us managers actively asked for feedback on how to make improvements in the service.

The evidence showed a good standard. 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.

Leaders were experienced in patient transport, valued the workforce and understood challenges that staff faced when performing their duties.

Managers adjusted working patterns, where possible, to support staff who were experiencing personal challenges. Staff told us they could raise any concerns to managers and believed these would be taken seriously.

During the assessment staff told us they had confidence and trusted managers to do the right thing.

The evidence showed a good standard. The service fostered a positive culture where people felt they could speak up and their voice would be heard.

The service had access to the trust’s Freedom to Speak Up (FTSU) process supported by an up-to-date policy and named FTSU Guardians. The service’s policy provided information on how to raise concerns internally and externally to the service. Staff knew how to access support and raise concerns.

Staff told us they felt free to speak up and share concerns about the service. They said there were a number of ways to do this in confidence

The evidence showed a good standard. The service valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

Staff had training in equality and diversity. Staff understood the need to give everyone the same rights and opportunities and to value and respect people's differences. Recruitment practices were inclusive.

Most staff were employed on flexible contracts. Where possible leaders considered personal circumstances when planning rotas. Staff told us they were able to swap shifts with colleagues if needed.

The evidence showed some shortfalls. The service did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

The service did not always operate systems and processes to identify, monitor or manage risks to the service. There was not a process to regularly review the performance of subcontracted patient transport providers, for example complaints or incidents investigation. During the assessment leaders told us they had contacted their subcontracted providers and would consider how to monitor performance in the future.

Systems and processes were not always effective in identifying safety issues. Processes did not identify all infection prevention control risks or ensure personal protective equipment would be effective and stored in line with manufacturers’ guidance,

There was a clear management structure. Managers and staff understood their roles and responsibilities. There was a clear reporting structure, from the service to the trust’s board, with various meetings reviewing the quality and safety of the service.

Managers understood most risks and maintained a risk register that was regularly reviewed and updated. The service had a business continuity plan in case there was a major interruption to the service.

The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, they shared information and learning with partners and collaborated for improvement.

The service worked with system partners to share information and review service provision in the local area. Managers attended monthly integrated patient transport meetings with other stakeholders.

The evidence showed a good standard. The service focused on continuous learning, innovation and improvement across the organisation and local system. They actively contributed to improving safety.

Managers continuously reviewed service provision with a focus on providing better availability for people. Prior to our assessment the service had reviewed and proposed to reduce operational hours to ensure there was better availability of staff and vehicles when they were needed most.

The service worked with discharge teams within the trust to implement a process to improve hospital discharges. The service was able to transport people home from hospital without waiting for their take home medication to be ready. These medications would be transported to people’s homes as soon as they were ready. Managers told us this saved the trust money and meant people did not have to wait unnecessarily in hospital.