Blackpool 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 requires improvement. At this assessment the rating has changed to good.

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. Governance processes mostly operated effectively; however not all young people had a risk assessment and care plan. 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. Some staff did not always feel respected, supported and valued, and had not always received sufficient training to support them in carrying out their roles.

This service scored 68 (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 vision and values and how they were applied in the work of their team.

The provider’s senior leadership team had successfully communicated the provider’s vision and values to the frontline staff in this service. The provider’s values and strategy were shared with staff in their welcome pack and during their induction. It was also covered during appraisals and during training.

Staff had the opportunity to contribute to discussions about the strategy for their service, especially where the service was changing. Issues raised by staff in the staff survey were taken forward in action plans to improve the service.

Staff could explain how they were working to deliver high quality care within the budgets available. Staff worked creatively to provide care for young people despite staffing challenges due to reducing budgets within the service.

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 mostly had the skills, knowledge, experience and credibility to lead effectively, and they did so with integrity, openness and honesty.

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

Most leaders had a good understanding of the services they managed. They could explain clearly how the teams were working to provide high quality care. However, teams felt disconnected from senior managers in the Trust and felt there was insufficient understanding and representation of mental health services within the Trust.

Most leaders were visible in the service and approachable for young people and staff. However, not all teams felt supported by their managers, and some staff gave examples where managers had not been available and had not provided support following incidents.

Leadership development opportunities were available, however leadership opportunities for staff were limited due to budget constraints.

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.

Young people and carers had opportunities to give feedback on the service they received in a manner that reflected their individual needs. For example, carers had completed a friends and family survey which provided mostly positive feedback. Young people and carers felt able to give feedback and felt this would be taken seriously. The service had QR codes which people could use to give feedback on the service.

Managers and staff had access to the feedback from young people, carers and staff and used it to make improvements.

Young people were involved in decision-making about changes to the service. The service had a young people’s participation group called Entwined Minds. The group were involved in shaping and improving the service, for example they had created a new mural for the waiting room and had been involved in staff interviews.

The Trust has a freedom to speak up guardian and there were processes in place to support staff to speak up where they had concerns.

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.

There were equality and diversity champions within the service. The service had champions in individual teams, for example there was a cultural awareness lead, and the service had awareness months to support staff to improve their understanding of diversity.

Staff were able to apply to work flexibly e.g. flexible working agreements 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 provider undertook equality monitoring of staff within the service to ensure it was diverse in its make-up and representative of the patient group.

We scored the service as 2. The evidence showed some shortfalls. The service did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes, however they shared information securely with others when appropriate.

There was not always a clear framework of what must be discussed at a team or directorate level in team meetings to ensure that essential information, such as learning from incidents and complaints, was shared and discussed. All team meeting agendas were different; some teams had a clear agenda which included items such as learning from incidents and training whilst others were more basic. There was limited focus on this service within wider governance meetings for the trust. However, the trust had monthly clinical governance meetings and risk meetings attended by senior staff in the service and there was a monthly compliance report for the service which included an review of incidents.

The trust had a range of policies and procedures, however, these did not always take into account the needs of the community CAMHS service. For example, the discharge policy related to children on a paediatric unit and did not apply to young people being discharged from the community service. However, local procedures ensured this was done effectively.

Staff had implemented recommendations from reviews, complaints and safeguarding alerts at the service level; however reviews were not always carried out following incidents.

Staff undertook local clinical audits. The audits were sufficient to provide assurance and action plans were in place to address record keeping concerns.

Staff understood the arrangements for working with other teams, both within the provider and external, to meet the needs of the young people. Teams worked well together to support young people and stakeholders told us that communication was effective.

Staff maintained and had access to the risk register. Staff could escalate concerns when required. Staff concerns mostly matched those on the risk register. Most items on the risk register related to staffing and recruitment challenges. However, most items on the risk register did not contain clear management strategies or mitigations for the risks that were raised.

The service had plans for emergencies such as fire, floods and IT emergencies.

Where cost improvements were taking place, these were impacting on care. For example, staff told us that clinics were sometimes cancelled and there was no psychologist for the service.

The service used systems to collect data from wards and directorates that were not over-burdensome for frontline staff. 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.

Information governance systems included confidentiality of 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 care. Information was in an accessible format, and was timely, accurate and identified areas for improvement.

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 worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

Directorate leaders engaged with external stakeholders – such as commissioners and Healthwatch. Commissioners provided positive feedback about the service. They felt the service was responsive and worked collaboratively in planning and delivering services. The service communicated effectively with stakeholders and had worked together to improve the service including waiting times, numbers accessing the service and enabling self- referral through the single point of access.

The service worked collaboratively with other services in the area including schools, social care and local community services in order to provide support for young people and their families and carers.

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 contributed to safe, effective practice and research.

Staff were given the time and support to use opportunities for improvements and innovation and this led to changes. Staff completed case studies and carried out reflective practice.

Staff had opportunities to participate in research. For example, the education mental health practitioners had participated in research about whole school and college approaches to mental health and wellbeing.

Staff sought creative solutions for challenges in the service and innovations were taking place. For example, staff had carried out a piece of work to improve access to the ADHD service and staff collaborated with the acute paediatric service to improve the experience of young people attending hospital in crisis. Staff also worked together to embrace the thrive model which provided young people with a more cohesive and responsive service.

The service participated in accreditation schemes relevant to the service and learned from them.