Bradford Teaching Hospitals NHS Foundation Trust

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• 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

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.

At our last assessment we rated this key question good. At this assessment the rating has remained as good.

This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care. Leaders had the skills, knowledge and experience to perform their roles. Staff knew and understood the provider’s vision and values and how they applied to the work of their team. Staff felt respected, supported and valued. Governance processes operated effectively. Performance and risk were managed well. Teams had access to the information they needed to provide safe and effective care.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We scored the service as 3. 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.

Staff knew and understood the provider’s visions and values, and how they were applied in their work. At Westwood Park the values were displayed within the ward and staff referred to them and how they were incorporated into the daily care of patients.

Managers had a good understanding of the service that they managed, they understood the needs of the patients and understood the current risks of the service. Managers told us they had good support from senior managers in the Trust.

Staff were able to contribute to changes within the organisation and were involved in making suggestions to change and improve the organisation.

We scored the service as 3. 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 had a good understanding of the services they managed. They could explain clearly how the teams were working to provide high quality care. They worked across the two units to share areas of learning and improvement and there were regular meetings to share with each other and the wider community health inpatients service. By working together, they aimed to provide a high level of care.

Staff told us that they felt the leaders in each unit were approachable and would provide support and encouragement to staff.

Leaders had appropriate skills and were knowledgeable about the patient community that they supported. Staff could also access leadership development opportunities when available, and staff were given the time to access learning and development opportunities.

We scored the service as 3. 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.

In the 12-month period prior to the inspection, there were no reported cases of bullying and harassment in the service. The Trust fostered a positive culture where people felt they could speak up, and managers understood the importance of creating a culture where staff felt safe to raise concerns. On both units there was freedom to speak up information for staff to access, and staff felt confident to raise concerns if required, and they had access to freedom to speak up guardians.

Patients and carers could give feedback on the service and would receive a response that would reflect their individual needs. There had been no formal complaints raised in the previous 12 months. Patient satisfaction survey data on discharge showed, over a 12-month period, the average satisfaction rating for Westwood Park was 94% and Westbourne Green was 99%. The surveys looked at elements of patient experience such as environment, communication and overall ward experience.

We scored the service as 3. The evidence showed a good standard. The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

The Trust had an Equality, Diversity and Inclusion strategy in place for 2023-2025, and there were three staff networks in place, Enable Staff Network, Race Equality Staff Inclusion Network and LGBT Staff Equality Network who fed in to the Trust’s Equality and Diversity Council and the Trust’s Executive Management Team.

Where possible managers enabled staff to work flexibly, to support people’s personal circumstances, however, as the units were both small and standalone managers had to balance this with safe staffing of the ward.

Following feedback from the National Staff Survey, the Trust put in place an action plan across the organisation, which worked to address concerns raised for staff. The actions developed were shared with all services and managers were responsible for implementing them, the actions also aligned with the Trust’s strategic priorities.

We scored the service as 3. The evidence showed a good standard. The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

Staff undertook or participated in local clinical audits. The audits were sufficient to provide assurance and staff acted on the results when needed. The Trust used an electronic data platform to gather data monthly. The data was then reviewed by matrons for comprehensive oversight and was shared at the Trust’s Quality and Safety meetings There was a high level of compliance within the service. Team managers had access to information to support them with their management role. This included information on the performance of the service, staffing and patient care.

Managers were aware of the risk their unit’s faced, and these were present on the departmental risk register. The main concern for the service when a patient transferred from intermediate care to the emergency department they had to be discharged and admitted to the ED, which meant the electronic drugs chart was cancelled and medications had to be manually re-prescribed. All potential issues and risks had been captured through the risk register and actions had been put in place to mitigate the risks.

There was a clear framework of what must be discussed at a ward, team or directorate level in team meetings to ensure that essential information, such as learning from incidents and complaints, was shared and discussed.

Staff had access to the equipment and information technology needed to do their work. The information technology infrastructure worked well and helped to improve the quality of care. Patient records were all electronic and staff ensured that computers with patient records were locked when they walked away to ensure patient confidentiality.

However, information was not always in an accessible format, when staff reviewed care plans with the inspection team they struggled to navigate the records. They could not always identify if referrals had been completed and what action had been taken in a timely manner. This was raised as part of the feedback to the Trust, and refresher training for the electronic patient record system was discussed.

At Westwood Park, the patient voice was not always evident in the care plans we reviewed. The care plans were not always written in a way that ensured that patients would be able to understand them, and risk assessments were not created in partnership with the patient. Also, when care audits were completed, it was not recorded which care plans had been reviewed as part of the audit.

We scored the service as 3. The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

Directorate leaders engaged with external stakeholders such as commissioners, local authorities and health care partnerships. One example of this is the collaborative work between the Trust, Bradford District and Craven Health and Care Partnership and City of Bradford Metropolitan District Council to develop Home First Assessment Support Team (HFAST) to support timely discharges. Through the integrated health and social care model, HFAST supported the discharge of people on pathway 1 within 24 hours of them no longer meeting the criteria to reside in hospital.

We scored the service as 3. The evidence showed a good standard. The service focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

The service had developed the Rehabilitation Support Worker (RSW) role, which provided health care assistants (HCA) with a structured development programme in collaboration with Allied Health Professionals. Under the supervision of physiotherapists and occupational therapists, RSWs were trained to implement and reinforce rehabilitation plans tailored to individual patients. This had led to improved continuity of care, enhanced patient engagement and increased the integration of therapy into nursing and support care

The service was also involved in local and national audits in order to gain assurance and identify areas of learning. This included the Patient Led Assessment of the Care Environment audit, which is an annual appraisal of the non-clinical aspects of healthcare settings, undertaken by teams made up of staff and local people (known as patient assessors). The completed assessment were shared with NHS digital for comparison and benchmarking.

Both units had done targeted work on falls prevention and pressure ulcer reduction, the effectiveness of this work had been highlighted by senior leaders and tissue viability nurses. However, staff were not currently involved in any ongoing research or quality improvement initiatives.