Pennine Care 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 Good

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

At our last assessment we rated well-led as good. At this assessment the rating has remained good. 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. Staff collected analysed data about outcomes and performance. They used this to identify improvements.

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.

Staff knew and understood the provider’s vision and values and how they were applied in the work of their team. The trust values were kindness, fairness, ingenuity and determination.

The provider’s senior leadership team had successfully communicated the provider’s vision and values to the frontline staff in this service. We saw these displayed on posters throughout the wards.

Staff had the opportunity to contribute to discussions about the strategy for their service, especially where the service was changing. There were regular staff meetings and the strategy reflected targets of creating the best conditions for staff and investing in their wellbeing and development to support the delivery of outstanding care.

Staff could explain how they were working to deliver high quality care within the budgets available. This included working in teams with increased multidisciplinary working, reduced reliance on bank and agency staff and improving person centred care.

Leaders had the skills, knowledge and experience to perform their roles.

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 supported ward staff and we saw examples of this during the assessment. The psychology team ran reflective practice sessions across units monthly; themes from these are shared with leaders and actions taken where appropriate. Modern matrons provided support to ward staff and carried out a programme of audits to improve patient care.

Leaders were visible in the service and approachable for patients and staff. Staff and patients knew who their leaders were and said that they regularly visited the ward.

Leadership development opportunities were available, including opportunities for staff. There was a dedicated section for management and leadership training on the trust’s learning and development system. In addition to this there was a range of apprenticeship courses including coaching, project management and operations management.

Patients and carers had opportunities to give feedback on the service they received in a manner that reflected their individual needs. Managers and staff had access to the feedback from patients, carers and staff and themes were identified for quality improvement.

Patients and carers were involved in decision-making about changes to the service. This included service development, such as reviewing clinical team meeting (CTM) processes and some patients attended at CTM launch event and participated in developing the action plan. Another patient was involved in the development of a ‘CTM Prep Sheet’ that was used for patients to complete prior to CTM meetings to ensure that patients views and wishes were communicated. Patients were also directly involved in the recruitment process, reflecting a commitment to co-production and shared decision-making

Patients and staff could meet with members of the provider’s senior leadership team and governors to give feedback. There were regular listening events that both patients and staff attended and there were patient representatives on the patient’s council. The service completed quarterly staff pulse surveys and the results were monitored by the workforce team and shared by network business partners.

The Trust had a dedicated Freedom to Speak Up Guardian; Trust wide, there were 38 Freedom to Speak Up Ambassadors, with12 situated within the specialist services network, where the LSU (low secure unit) wards sit.

There was a range of staff networks in place across the organisation, including Men’s Wellbeing, Women’s, Race equality, LGBTQ+, Neurodiverse, Positive ability, Carers and Faith and beliefs.

Staff could apply to work flexibly to account for personal circumstances such as caring responsibilities and health issues. There was a flexible working policy and Tatton Unit and Prospect Place had several staff that had a flexible working pattern in place. These were reviewed regularly to determine if the staff member still required the flexible working pattern and that it met the needs of the service.

The provider undertook equality monitoring of staff within the service to ensure it is diverse in its make-up and representative of the patient group. Equality monitoring reports were routinely completed for both units.

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 implemented recommendations from reviews of deaths, incidents, complaints and safeguarding alerts at the service level.

Staff undertook or participated in local clinical audits. The audits were sufficient to provide assurance and staff acted on the results when needed. The new implementation of the Quality matron monthly assurance visits had strengthened the audit process.

Staff understood the arrangements for working with other teams, both within the provider and external, to meet the needs of the patients. We saw examples of the low secure service working well with other areas of the trust and in partnership with external stakeholders.

There were robust systems and processes in place to monitor risk at all levels of the service. Managers had oversight of all areas of risk and were able to escalate concerns where necessary. There were KPI’s in place which enabled leaders to ensure that teams were carrying out their roles effectively and outcomes were monitored.

Staff maintained and had access to the risk register at ward or directorate level and could escalate concerns when required.

We reviewed the risk register and saw that staff concerns matched those on the risk register.

The service had plans for emergencies for example, adverse weather conditions which could impact on staffing levels or a flu outbreak.

Where cost improvements were taking place, they did not compromise patient care.

The service used systems to collect data from wards and directorates that were not over-burdensome for frontline staff. We saw that managers had easy access to dashboards and they used these to monitor outcomes and compile information across the service. However, some essential mandatory training was low and below compliance rates and supervision was low at the Tatton Unit.

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.

Information was in an accessible format, and was timely, accurate and identified areas for improvement.

Directorate leaders engaged with external stakeholders such as commissioners, safeguarding boards, police and Healthwatch.

Patients and staff could meet with members of the provider’s senior leadership team and commissioners to give feedback. There were scheduled and unscheduled visits to all low secure units and these occurred at CEO, executive deputy, network leadership team and care hub leadership team level. Some of the visits were informal, part of scheduled listening events or planned quality and safety visits. They took place both within and out of hours and routinely involved patients and staff. For example, the Specialist Network Psychological Therapies lead attended the MDT meeting on Prospect Place, Network Director of quality attended morning handovers, Associate Director of Operations and the Head of Quality routinely worked from both units. The CEO also led a listening event for all staff on a rolling programme.

Staff were given the time and support to discuss opportunities for improvements and innovation and this led to changes. Recently there had been the introduction of the daily “board rounds” to ensure that each patient was discussed by the MDT.

Staff had opportunities to participate in research. In the 12 months prior to the assessment, the service had been involved in the following studies: Understanding anger and aggression, physical activity, CAFI, which focussed on looking at a family intervention technique adapted for people from a sub-Sahara African or Caribbean background in conjunction with a local university.

Innovations were taking place in the service, including a new Low Secure Unit induction training package and a co-produced and facilitated psychology wellbeing group.

Staff used quality improvement methods and knew how to apply them. Quality matron audits had been introduced throughout the service. Examples of improvements as result of these audits included care planning personalisation, IPC compliance, workforce metrics and medicine management.

Staff participated in national audits relevant to the service and learned from them. The service had been part of a national audit on the use of clozapine, which is used to treat treatment resistant schizophrenia.

Wards participated in accreditation schemes relevant to the service and learned from them. Tatton Unit and Prospect Place were accredited through the Forensic Quality Network for Forensic Mental Health Services. This is a peer review process in which a face to face inspection takes place against key standards. A report is produced outlining the services strengths and weaknesses and provides recommendations