Bradford District Care 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 assessment we rated this key question Requires Improvement. At this assessment the rating has improved to 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.

Managers could describe how they prioritised offering opportunities for development and learning to staff within the service and the wider trust. This included ensuring there were robust systems in place for sharing learning with acute services. This included implementing monthly learning sets whereby managers reviewed staff competencies. This had led to the identification of various specialist training for staff including additional safeguarding, human resources and equality, diversity and inclusion training.

The provider’s senior leadership team had successfully communicated the provider’s vision and values to the frontline staff in this service. Staff we spoke with knew and understood the provider’s vision and values and how they were applied in the work of their team. They were able to give examples and anecdotal evidence of how they adhered to these values and implemented them into their daily roles. Staff were committed to the service and spoke passionately about the patients they cared for.

Staff we spoke with were generally happy and motivated, and felt able to raise concerns. They described a good culture of learning and told us manager shared information, updates and good practice during team meetings and handovers.

Staff had the opportunity to contribute to discussions about the strategy for their service, which managers confirmed had taken place through drop-in sessions.

Staff could explain how they were working to deliver high quality care within the budgets available. There were monthly performance meetings in place with attendance from the business support, finance and human resources teams to review spending across the service and the wider trust. Managers described how a review meeting had led to the introduction of band 4 nursing associates and expanding the activities coordinator post to 7 days.

The service followed organisational processes to recruit managers and leaders with support from human resources. This included ensuring the relevant pre- employment checks were completed.

Managers we spoke with could clearly describe their function and the roles and accountability of others within the service.

Managers told us there was a high emphasis on developing staff to enable them to progress into management roles. Leadership development opportunities were available, including opportunities for staff. Some managers had completed recognised managers training, with one manager describing how they had completed the Rosilind Franklin training which is a 9- month leadership development programme delivered by the NHS Leadership Academy.

Staff felt listened to and supported by their managers and senior managers to undertake their roles. They told us that leaders were visible in the service and approachable for patients and staff.

Staff said that managers within the service recognised success. Staff further added that they could suggest new ideas and could raise challenges to their seniors. Staff generally described an open-door policy.

Managers monitored staff morale through daily handovers, debriefs, team meetings and during supervision sessions. Managers encouraged staff to raise their concerns or ideas for improvement and provided feedback on decisions made in response to them.

Patients and carers had opportunities to give feedback on the service they received in a manner that reflected their individual needs. Patients and carers were involved in decision-making about changes to the service. Managers sought feedback from former service users and completed ex- service user reports which patients had sight of. Former patients also sat on interview panels. Managers described how one former service user had worked with the trust’s practical training unit to ensure the physical intervention training contained a service user perspective. They described how this input helped to shape the content of the course and bring that element of service user experience to the training.

Patients and staff could meet with members of the provider’s senior leadership team and governors to give feedback. The Lynfield mount site was in the process of redevelopment and the board of directors completed ‘go see’ visits on the ward. These were informal visits to meet staff and patients, to ensure senior leadership visibility and to seek feedback.

Staff and managers felt able to raise concerns without fear of reprisals and they knew how to access the provider's whistleblowing policy. There was a nominated freedom to speak up guardian within the trust who staff could approach to support them in raising concerns. Managers promoted the freedom to speak up process within the service and reminded staff that they could contact the freedom to speak up guardian at any time.

Staff and leaders described how diversity was valued within the workforce. They described working towards an inclusive and fair culture and said the service promoted equality and equity for staff and patients. There were posters on wards providing information about each staff member and one thing that meant something to them.

There was information on display about different cultural events taking place including celebrations of various cultural holidays. This included Pride, Black History Month, and Diwali.

There were equality and diversity champions within the service. There were also various networks in place to support staff with protected characteristics. This included the Beacon network, which offered support to staff with disabilities, and Aspiring Cultures, which was open to all staff from a black, Asian or ethnic minority background. There was also a Rainbow Alliance in place to support LGBTQ staff.

Following a recent court ruling about gender recognition and its impact on mixed spaces, leaders held meetings and an event for members of the community to engage with them and share any concerns they had.

Staff confirmed they could apply to work flexibly. Managers put in place flexible working agreements for staff to account for personal circumstances such as caring responsibilities and health issues. This included making changes to shift patterns or reducing hours.

Managers put reasonable adjustments in place for staff members to help them carry out their role. Examples included providing loop ear plugs for staff with sensory needs to help prevent over stimulation, and screen overlays and Dragon speak for staff with dyslexia. They had also arranged for anti-glare screens for staff with vision issues and provided electric desk and standing desks for staff with physical health needs.

The service completed equality monitoring of staff by collecting data through staff diversity profiles. Ward managers attended a values and behaviours meeting to review this data, together with staff survey results and the workforce race equality standard (WRES), the workforce disability equality standard (WDES), and NHS LGBTQ Metrics to try and ensure that workforce was diverse and reflective of the patient group.

There were clear systems of governance in place. There was a monthly quality and safety meeting which covered all relevant areas of clinical governance. Meeting minutes showed that managers escalated any issues arising from these meetings to the Inpatients Quality and Operations (QUOPs) meeting chaired by the Service Manager.

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. Team meetings took place on all wards and were chaired by ward managers or a senior nurse.Meeting incorporated the sharing of information from quality and safety meetings, including learning from incidents, and any other relevant safety issues or alerts.They also provided a forum for staff to share any concerns,improvementsand good practice.

Staff had implemented recommendations from reviews of deaths, incidents, complaints and safeguarding alerts at the service level. Managers described how after-action reviews helped improve partnership working and increased staff awareness.

Staff undertook or participated in local clinical audits. The audits were sufficient to provide assurance and staff acted on the results when needed. These included relevant medicines managementaudits carried out quarterly by the pharmacy team, with findings and actions shared with the Medicines Management and Safety Group and escalated to the Clinical Board and Quality and Safety Committee where necessary to ensure oversight by the executive team and senior leaders.

Managers recorded all audit actions on a centralised spreadsheet and arranged for follow-up audits where appropriate.

Staff and managers understood the arrangements for working with other teams, both within the trust and external, to meet the needs of the patients.

Staff maintained and had access to the risk register at ward or directorate level. Staff at ward level could escalate concerns when required. The risk register identified a lack of CCTV coverage within the communal areas of the low secure wards which was not in parity with low secure environments. Work was underway to install CCTV.

The service had plans for emergencies – for example, adverse weather or a flu outbreak. There was a business continuity plan in place for the service in addition to a shared plan in place for the local group of services within the provider collaborative.

Managers described good working relationships with a range of external stakeholders. These included other independent mental health providers and NHS trusts within the provider collaborative and the local authority.

Staff invited family members and external professionals to meetings so they could discuss any issues and receive any updates about their patient's/family member's care and treatment.

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

Staff had access to regular team meetings on the wards. They offered a forum for staff to propose, exchange and discuss ideas in terms of good practice.

Staff could attend reflective practice sessions facilitated by the psychology department.

The service participated in the culture of care programme. This is an NHS national programme and set of standards designed to improve inpatient mental health, learning disability, and autism services. As part of the programme, staff were assigned quality improvement coaches whom they could seek advice and guidance from regarding different aspects of care delivery.

Mangers described how they met with two staff from the culture of care programme to co-create actions for improvement for the ward including work around how they could ensure staff were able to best utilise all their skills and attributes in their role, and improvements to the activities provision. They had implemented several changes including introducing health care support workers shadowing nurses, allocating health care support workers to each patient, implementing cross ward reflective practice and introducing staff away days to support team building.

Managers had Implemented a skills sharing programme so staff and patients could share skills. They told us patients had delivered cooking sessions to other patients and staff. Other shared skills included IT sessions, and support with banking and finance.

The service had completed joint work with the acute service within the trust which aimed to create uniformity in systems and processes, and in the care and treatment patients received. Managers described how this joint work was an additional forum for sharing good practice.

Other innovations included a review and update of the security induction standard operating procedure and associated documentation which managers said was designed to be user friendly for staff.

Managers were reviewing the current safety huddle process. This included a move to these being recorded digitally which managers said would make it easier to monitor that these had taken place. Planning was also in place to digitalise clinical manager huddles and introduce a digital RAG rating system for assessing clinical acuity on each ward.

Funding had been agreed for the implementation of ‘virtual wards’ in partnership with a local college. This was a training package of immersive learning for all new starters. Managers told us they were in the process of agreeing the content of this training and spoke passionately about how it would benefit staff during their induction.

The service had implemented a ‘rapid improvement week’ which is a tool used within the trust’s quality improvement methodology called ‘care trust way’. One improvement was the review the admission process to streamline the process and remove duplication.

Managers created action plans in response to recommendations from provider collaborative quality visits.