Sussex Partnership 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 requires improvement. At this assessment the rating has stayed the same and is requires improvement. This meant the service management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service was in breach of regulation 17 (good governance).

This service scored 57 (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 2. The evidence showed some shortfalls. The service did not have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not always understand the challenges and the needs of people and their communities.

Staff knew and understood the vision and values of the trust and were able to describe how these were applied in their work. Staff told us they understood the purpose of the ward and the role of the multidisciplinary team in delivering care to young people.

However, staff consistently reported that there was not always effective collaboration across all disciplines within the MDT. Many staff described a perceived divide between some of the professional groups, which impacted on the team working together towards the shared purpose of the ward. For example, ward staff told us they didn’t always feel integrated effectively with the MDT. They said the MDT often made decisions that impacted the ward and how staff should support the young people but did not always communicate this to staff and this led to inconsistencies in care being delivered.

Staff did not always feel they had meaningful opportunities to contribute to discussions about the strategic direction of the service. While mechanisms existed for staff to raise concern, all staff we spoke with reported they did not feel their views were consistently heard or acted upon. Staff described raising concerns about not being able to meet the complex needs of some of the young people and reported feeling that these concerns were not always adequately acknowledged by senior leaders within the trust. Staff told us they had at times felt under pressure to accept referrals they did not believe were appropriate for the ward or whose needs could not be safely managed.

Ward staff told us that they did not feel their views and operational knowledge were sufficiently sought during the planning of the courtyard redesign. They felt earlier involvement could have identified practical risks and reduced delays and disruption. The trust told us the redevelopment formed part of a previous Care Quality Commission action and was overseen through its improvement process, with Estates leading the project and support from Chalkhill clinical team. The project was also discussed through monthly meetings, with input from operational and clinical staff, alongside regular environmental checks.

The trust acknowledged, however, that concerns raised by staff after the shed was installed about the risk of young people climbing onto the roof led to a retrospective clinical review and a decision was made to remove it. The trust identified learning and the importance of earlier and more systematic engagement with ward-based staff, particularly where their operational knowledge could help identify practical risks before changes are implemented’.

We scored the service as 2. The evidence showed some shortfalls. Not all leaders understood the context in which the service delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively, or they did not always do so with integrity, openness and honesty.

Not all leadership posts were filled. At the time of the inspection, the substantive ward manager was on planned leave for one year. The matron was on a secondment elsewhere in the trust and the two clinical nurse specialists were providing additional support in leading the ward alongside their substantive responsibilities. Staff told us this had an impact on their ability to fully undertake their specialist roles. In addition, the lead nurse for the service was due to leave the organisation. Despite these challenges, staff demonstrated a good understanding of the needs of the service and the young people but told us they felt frustrated and unsupported by the trust and could not always maintain safety on the ward or deliver the quality of care they wanted to the young people.

Leaders described how they wanted to strengthen the professional working relationships of the staff team. Staff described divisions between disciplines and felt this affected collaborative working. Concerns regarding team culture and leadership had been identified as a concern at the previous inspection in 2023, and although the trust had implemented actions in response to those concerns, staff reported changes made were not sustained and became a concern again.

Staff reported mixed support from senior leaders. All ward staff we spoke with reported feeling isolated from the wider organisation and felt that trust executives did not always understand or respond appropriately to the challenges faced by the service.

Leadership development opportunities were available within the trust.

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.

Staff knew how to raise concerns. The trust had a Freedom to Speak Up Guardian in place. Managers made sure staff knew how to speak up. An annual Freedom to Speak Up report was reviewed by the Trust Board. The trust also had a whistleblowing (protected disclosure) policy and procedure which encouraged staff to raise concerns internally and emphasised the importance of speaking up.

Young people and relatives and carers had opportunities to give feedback on the service they received in a manner that reflected their individual needs.

However, young people, carers and staff told us they had limited opportunities to engage directly with the trust’s senior leadership team. Those we spoke with said they had not been given opportunities to meet with any of the senior trust leaders to provide feedback about the service or their experiences.

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 service respected staff with protected characteristics and made efforts to make reasonable adjustments should these be needed.

The service had an ongoing inclusive recruitment programme and had good recruitment processes and ongoing checks to ensure all staff met the legal requirements to work at the service.

Staff received training in equality, diversity, inclusion and human rights.

We scored the service as 1. The evidence showed significant shortfalls. The service did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

Despite the trust being aware of most of the areas that needed to be improved at the service, limited progress had been made in addressing these issues. Several concerns remained unresolved which compromised the safety of the young people and staff on the ward.

Prior to the inspection, the service had an improvement plan in place in response to concerns raised by commissioners as well as concerns identified through the trust’s internal quality review.

The trust temporarily closed the service so the concerns identified could be completely resolved.

We found a lack of effective systems and processes to support a safe environment and the safe delivery of care for young people. For example, there was no clear framework to guide discussions during ward and multidisciplinary team handovers, for example ensuring all risk information and incidents discussed had been reported and followed up. There was no effective oversight or accountability for incidents and reviewing themes and trends to ensure effective mitigation and actions were in place. Although the trust told us that arrangements were in place to learn from incidents these were not effective. Incidents were not always learnt from which meant repeat incidents happened. For example, young people continued to be left unattended in areas of the ward, visual observations were not being completed as per trust policy, and documents such as incident forms and risk assessments were not being completed or kept up to date.

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 young people. They share information and learning with partners and collaborate for improvement.

Staff understood the processes for working collaboratively with external organisations and teams to meet the needs of the young people. Young people with autism received ‘care, education and treatment reviews’, and if a young person was cared for in long-term segregation, reviews took place to ensure their care needs were being met. Leaders engaged with external stakeholders, including the provider collaborative. The trust’s internal quality assurance team conducted quality reviews as did the provider collaborative.

Staff ensured that advocates were informed of any new admissions to the ward and the advocates contact information was displayed in communal areas for the young people to see and access.

The ward had processes including care programme approach meetings, discharge meetings and ward rounds to ensure all relevant partners were involved in young people’s care.

We scored the service as 2. The evidence showed some shortfalls. The service did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for young people. They did not always actively contribute to safe, effective practice and research.

The trust had improvement plans in place in response to concerns identified through their own trust internal quality reviews and a review by the provider collaborative. However, our inspection found that, although the trust was aware of many of the issues identified, actions taken to address them had not always been effective, and several concerns remained.

Staff participated in national audits relevant to the service. However, not all staff at all levels were clear about their roles, responsibilities and accountabilities and did not have regular opportunities to meet, discuss and learn from the performance of the service.