North Staffordshire Combined Healthcare NHS 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

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.

Good: This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred 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.

The majority of staff said they worked well as a team, and felt respected, supported and valued. Most staff said morale was good and there was an open and transparent culture.

In the summer of 2024, the service had undergone a significant change and merged the previously separate access and crisis team and the home treatment team. The aim of the merge was to increase efficiency, reduce duplicate and multiple assessments and ensure seamless pathways of care. This had created a lot of change and staff from both teams were now required to work together, share their knowledge and skills and work across all areas of the new team.

Not all staff were happy with the change and some felt there were not always enough staff, patient safety was compromised and there was a lack of transparency and effective leadership. Some staff had raised concerns to senior managers and to CQC. The trust had responded to concerns raised by staff and put in place the following: they had reviewed the service model, ensured staff had access to a dedicated freedom to speak up resource, enhanced the way staff escalated concerns, reviewed the data to ensure capacity met demand, provided a leadership development day and ensured senior staff were visible and worked with the team in a collaborative way.

We spoke with 17 staff. Most staff were initially unsure about the need to change however were happy with the way the team was now working and had progressed, and felt that overall, the changes had been positive and they could see improvements.

Managers we spoke with agreed that some staff had been reluctant for the change and were initially apprehensive, however when problems had been found they had been rectified and processes and procedures were still being evaluated and modified to further enhance the service.

Staff knew that a minority of the team were not happy. They described the minority as having a negative impact and how it could create a ‘different atmosphere on different shifts’, dependent on who was working.

Managers had used a quality improvement approach to manage the change and had involved staff in the initial conversations and continued to engage with them. Managers listened to staff and took their feedback to make improvements.

Staff knew and understood the trust’s vision and values and how they applied to their work and they were displayed across trust premises.

Some of the concerns staff had raised were related to the leadership team. The trust had provided a leadership away day for development and to promote cohesion. Senior managers told us one of their priorities was to work with the leadership team to strengthen their unity and consistently push the whole team in the same direction to make improvements and consolidate the progress already made.

Managers said they felt supported, although they said it was difficult to manage the unease that the minority of staff felt because their concerns had not been reported directly to them so they were unable to listen and respond.

Leaders had the skills, knowledge and experience to perform their roles. Most staff felt the leaders were approachable although some felt there was favouritism due to the relationships managers had with some staff. This had been addressed and discussed following the quality review visit. Staff said managers were visible and available when required.

Leaders had a good understanding of the services they managed. They were experienced with crisis and home treatment services. They were able to describe how the service provided good quality care and the opportunities and challenges the team faced.

Staff had leadership development opportunities and leadership training was available.

The trust had a dedicated freedom to speak up team. Staff could speak to one of the speak up champions if they wished. Due to the concerns some staff had expressed, the trust had increased the freedom to speak up provision and provided dedicated sessions for the team. Managers provided staff with well being sessions on the back of the feedback they received.

Most staff said they felt comfortable raising a concern with their manager and would feel listened to. However, a few staff were unhappy to do this although the trust did provide other ways staff could raise their concerns, such as the ‘Dear Buki’ (CEO) process. Some staff had forwarded concerns onto the trust anonymously. Managers told us they had put resources in place to deal with the concerns but it had been difficult as it had a negative impact on the rest of the team and them personally.

The trust had taken staff concerns seriously, and had undertaken an unannounced quality assurance visit which focused on staff wellbeing and support. Recommendations had been advised following the review although overall the visit had been positive and the majority of staff felt supported and valued.

Patients and carers had opportunities to give feedback on the service they received in a manner that reflected their individual needs such as verbal, written or through technology such as on-line.

The trust had a diversity and inclusion lead who monitored and highlighted workforce, diversity and inclusion across the whole trust. The trust undertook equality monitoring of staff within the service to ensure it was diverse in its make-up and representative of the patient group.

Staff were able to apply to work flexibly to account for personal circumstances such as caring responsibilities and health issues. Managers put reasonable adjustments in place for staff members to help them carry out their role.

The trust had a governance structure in place to ensure information was shared appropriately from board level to the team. Managers had efficient and comprehensive governance arrangements in place and had access to information to ensure the service was performing well. The information was in an accessible format and was timely, accurate and identified areas for improvement.

Managers attended leadership meetings led by the service manager who then reported into the acute care directorate governance meeting. The agenda was comprehensive including items such as feedback from quality visits and audits, quality indicators such as supervision, training and staffing, risk register, incidents, complaints and compliments, best practice updates and performance updates.

Staff had implemented recommendations from reviews of deaths, incidents, complaints and undertook local clinical audits which were sufficient to provide assurance. The service had a risk register which included mitigations to help reduce the risk. There was 1 risk; the service would not be able to meet the needs of the population and provide a timely response due to an increase in referrals. The service had a business continuity plan in case of emergencies or an unexpected incident.

Staff had access to the equipment and information technology needed to do their work. The information technology infrastructure, including the telephone system, worked well and helped to improve the quality of care. Information governance systems included confidentiality of patient records.

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.

Directorate leaders engaged with external stakeholders such as the local integrated care board.The trust engaged with carers through the service user and carer council, and work within the triangle of care standards for crisis care. Information was fed back to the board.

The mental health crisis team had been accredited by the Home Treatment Accreditation Scheme (HTAS) which was overseen by the Royal College of Psychiatrists and supported the quality and improvement of crisis and home treatment teams in the UK and Ireland.

Staff had used quality improvement methods for projects such as the implementation of the transformation project, improving the safety and security of the assessment area by changing the front doors and paediatric resus equipment training.

The trust encouraged and supported staff to engage with quality improvement projects. At the time of our assessment, 2 quality improvement initiatives had started; to reduce the variation of next of kin recording and to improve the communication from the leadership team to the wider team.