Lancashire & South Cumbria 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

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 inspection we rated this key question as requires improvement. At this inspection 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.

Since the last inspection, managers had developed governance procedures to ensure improvements within the service identified as required at the last inspection were in place.

As well as an internal accreditation award, managers had introduced a new national standard; Culture of Care. We saw this was beginning to change the way care was delivered, such as with staff sharing lunch with patients, but at the time of inspection was only implemented on a small number of wards. Senior leaders were reviewing this and planning to implement this more widely across the trust.

There were effective governance systems and processes in place to ensure that the provider had appropriate oversight and monitoring of the care and treatment being provided. The systems and processes in place did assist staff in assessing, monitoring, and improving the quality and safety of the services provided. There were performance management and audit systems and processes in place which ensured managers had up to date information on the performance of the service.

Risks identified within action plans were reviewed or actioned.

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.

Staff knew and understood the provider’s vision and values and how they were applied to the work of their team. The visions and values of the service were displayed around the ward. Staff we spoke to could tell us the visions and values and explain how they were followed to ensure all staff were working together.

Some staff had the opportunity to contribute to discussions about the strategy for their service, especially where the service was changing. Staff that had transferred over to the trust from another provider felt that good practice they had in place had been acknowledged and used by the rest of the service. Conversely, they had seen working practices change to accommodate good practice elsewhere.

Staff felt respected, supported and valued. They said the trust promoted equality and diversity in daily work and provided opportunities for development and career progression. They could raise any concerns without fear.

All staff we spoke with said they felt supported and valued at the service, with both management and staff saying they felt the staff team were happy. Staff told us the role could be stressful, but that they were managed and supported by colleagues and senior staff.

There were no reports of bullying or harassment at the service, and all staff we spoke with knew how to use the whistleblowing process. All staff told us that they felt they could raise concerns to management about the service without fear of retribution.

We saw no evidence of a closed culture at the service. Managers we spoke with had identified the risk of closed cultures and had put operating procedures in place. Rotas were prepared to prevent this. Most staff, other than those with relevant personal requirements, did not work more than one month a year on nights and staff were mixed to prevent the same staff always working together. Managers also completed unannounced night visits.

Within the staff survey, staff gave the service a 7.49 out of 10 believing the service to be compassionate and inclusive.

Staff felt there was a positive culture on the wards and none of the staff we spoke with raised concerns about racial discrimination or bullying.

We saw evidence that there were regular team meetings for staff to discuss any issues. All the staff we spoke with told us that they were confident they could speak up if they had any concerns about the way they or the patients were treated.

All staff we spoke with knew how to use the whistleblowing process. All staff told us that they felt they could raise concerns to management about the service without fear of retribution. They all knew about the freedom to speak up champions and how to contact them if they had concerns.

Managers confirmed they attended staff meetings. They examined staff surveys and incidents for any intelligence of trends which would identify inappropriate behaviour.

Staff, patients and carers had access to up-to-date information about the work of the provider and the services they used, for example, through the intranet, bulletins and newsletters. Managers and staff had access to the feedback from patients, carers and staff and used it to make improvements. Staff reported that the provider promoted equality and diversity in its day-to-day work and in providing opportunities for career progression, for example, staff knew about career opportunities to progress from their current role towards a more senior role.

Managers supported staff through supervision and team meetings. We reviewed several meeting minutes, which included information regarding staff welfare. There was a 24-hour contact number which offered support should a staff member report stress or physical health problems. The trust had also launched a new Occupational Health dashboard.

Governance policies were in date and provided comprehensive guidance for staff. There was a clear framework of what must be discussed at a ward level in team meetings to ensure that essential information, such as learning from incidents, was shared and discussed. The provider had policies to guide staff in the day-to-day operation of the service. There was a standard agenda to ensure consistency and items included lessons learnt, governance, staffing and safeguarding. There were a range of meetings in place to support the running of the wards including safety huddles, board rounds and patient flow meetings. Managers made necessary changes and ensured learning was disseminated. Governance and performance processes reflected best practice. They were effective and strong, they identified and addressed issues and were used to make improvements. Managers monitored staff fill rates for each ward, on a clinical and non-clinical staff level and broke down the figures into day and night shifts. The trust risk register reflected that all wards were under staffing pressures. Staff undertook or participated in regular clinical audits to ensure quality, such as care plans, risk management plans and medicines audits. The audits provided assurance and staff acted on these results when needed. Audit findings were dealt with in a timely manner. However, staffing reports showed that there were high numbers of bank and agency staff, and that these staff did not always have the required training or supervision. Managers did not always ensure that these staff were inducted prior to working on the ward. There was a risk register in place for the Trust, this was ward focused with all wards having its own risk register. It identified that the trust had completed actions related to identified risks such as the fitting of nurse alarm call buttons in patient bedrooms. Other identified risks were ignition devices and patients bringing restricted items onto the ward.

There were processes in place to ensure patients had regular access to community healthcare such as opticians or dentists and these were recorded within the patients’ records, and we could see they attended local services when and if required.

We found that within the service communication with other services who would have responsibility for the patients following discharge differed from location to location. In some locations members of those teams attended multi-disciplinary meetings whilst in other locations they held discharge meetings separately and staff were tasked with communicating with those services outside that meeting and reporting back.

Managers had worked closely with local authority safeguarding boards to improve the discharge process, and we saw at the Chorley site that new safeguarding and discharge procedures had been introduced to ensure there was more effective communication between all partners.

The trust had developed its own accreditation process based on eight core standards of Staff Experience, Patient Experience, Safety, Care Planning, Therapies/Activities, Environment, Communication and Leadership. Wards were assessed internally. Wards were rewarded with a gold, silver or bronze rating.

Out of the 21 ward we visited all were rated gold or silver apart from Duxbury, Lathom, Stevenson and Churchill. Bronze wards were reassessed in six months.

The trust had developed this further by introducing the NHSE Culture of Care Standards for Mental Health Inpatient Services. Including those for people with a learning disability and autistic people.

The standards are aligned to 3 key approaches 1. Trauma-informed, 2. Autism-informed and 3. Culturally competent care; in order to support the ambition for equality focused inpatient care.

On the wards following this process we saw changes to service such as staff and patients eating lunch together. This was in its’ infancy and was yet to be rolled out on the majority of wards.

There were generic quality improvement projects across all wards such as self-harm reduction and rapid tranquilisation as well as some wards having individualised programs such as a reduction of violence and aggression on Orwell ward or looking to ensure appropriate admission orientation on Orchard and Kentmere wards.