Black Country Healthcare NHS Foundation Trust

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

We looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement.

This meant people did not always feel well-supported, cared for or treated with dignity and respect.

Staff did not always treat patients with compassion and kindness, and patients' needs were not always met in a timely manner. Some staff did not feel listened to or well supported by managers. However, staff understood patients' individual needs and supported them to understand and manage their care, treatment and condition. Staff also encouraged patients to be involved in decisions about their care wherever possible.

This service scored 60 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The evidence showed some shortfalls. Although most staff treated people with kindness, empathy and respect, compassionate and therapeutic engagement was not consistently demonstrated across all services.

Most interactions observed between staff and patients were positive. Staff generally demonstrated kindness, respect and compassion when supporting patients.

Most patients and family members spoke positively about staff, describing them as friendly, respectful and helpful. However, one patient at Bushey Fields Hospital reported requesting support when experiencing difficulties with their mental wellbeing and felt their request was not responded to appropriately. The patient said a staff member declined to provide support, stating they were busy.

At Penn Hospital, we observed a staff member speaking about a patient in an unprofessional and derogatory manner. We raised this concern during the inspection, and leaders provided assurances that appropriate action would be taken.

At the MacArthur Centre, we observed limited therapeutic engagement between staff and patients. Patients were frequently seen sitting alone or appearing disengaged, while staff interactions were largely task focused. The ward environment was often noisy, with staff calling across the ward to colleagues. We also observed staff spending prolonged periods in the nursing office while patients remained outside, creating a noticeable separation between staff and patients.

These findings suggested that, although many staff treated patients with kindness and respect, compassionate and therapeutic engagement was not consistently demonstrated across all services.

The evidence showed a good standard. The service generally recognised and responded to people’s individual needs, preferences, cultural backgrounds and protected characteristics. Staff took steps to support personalised care and ensure people could access services in a way that met their needs.

Staff described examples of personalised care planning. For example, a multidisciplinary assessment identified that 1 patient required hoist access due to their physical health and mobility needs. This enabled admission to the most suitable ward and access to ongoing support from both physical and mental health professionals.

Staff had access to interpreter services and told us these were readily available when required. Staff described using interpreters to help patients understand their rights, participate in decisions about their care and treatment, and access information in a way that met their communication needs.

Patients had access to information about treatments, local services and how to raise concerns. Several patients told us their cultural, religious, dietary and individual needs were recognised and respected. Although many patients expressed dissatisfaction with the quality and choice of food, staff generally accommodated dietary, religious, cultural and medical requirements, including halal, vegetarian, vegan and allergen-specific diets.

We found evidence that the service considered equality, diversity and inclusion when delivering care. Staff were able to identify and respond to individual needs and had access to resources and support to help people receive care that reflected their personal circumstances and preferences.

However, feedback from one patient on Abbey Ward highlighted difficulties accessing spiritual and religious support. The patient told us contact with the Spiritual Care Team was limited and that requests for support were not always responded to promptly. They also told us access to the spiritual room within the Resource Centre could be restricted due to escort requirements. While this reflected an area where the patient experience could be improved, it was not representative of the wider evidence reviewed, which demonstrated that the service generally met people’s individual, cultural and religious needs.

The evidence showed a good standard. The service promoted people’s independence, so people had choice and control over their own care, treatment and wellbeing.

Staff told us that patients were encouraged to be actively involved in the development and review of their care plans, primarily through regular one-to-one discussions with their named nurse.

Care plans were routinely printed and shared with patients, who were encouraged to read them, provide feedback, and identify any changes or additions they wished to make. Staff described using these discussions as an opportunity to ensure care plans reflected patients' views, preferences and goals.

Staff referred and signposted patients to advocacy services when required. Information about available advocacy support was displayed within patient areas, helping to ensure patients were aware of how to access these services.

The evidence showed some shortfalls. Staffing pressures meant people did not always receive support and assistance as promptly as they needed.

Several staff and patients told us that, although staff tried to meet patients' needs, staffing levels and staff availability frequently delayed the provision of the support patients required, meaning people's needs were not always met in a timely manner.

We observed examples of staff providing effective support to patients experiencing anxiety or distress. Staff responded appropriately to patients' emotional needs, helping to de-escalate situations and provide reassurance, while also ensuring the safety and wellbeing of other patients within the ward environment.

The evidence showed some shortfalls. The service did not always ensure staff were consistently supported to maintain their wellbeing and deliver person-centred care.

Most staff spoke positively about their roles and demonstrated a strong commitment to providing compassionate care. However, they also described ongoing pressures, including staffing shortages, high workloads and the impact these had on their wellbeing. Despite these challenges, staff remained committed to supporting patients and achieving positive outcomes. Although trust data indicated low vacancy rates, staff consistently told us that staffing levels did not always reflect patient acuity, enhanced observation requirements and operational demands, which affected therapeutic engagement and aspects of care delivery.

Most staff told us they felt well supported by their colleagues and ward-level managers. They described positive team working and said their immediate managers were generally approachable, responsive to concerns and supportive following incidents. Staff also told us they were encouraged to undertake training and professional development. However, this experience was not consistent, and some staff did not feel adequately supported by their ward managers. Staff were generally less positive about leaders above ward level, with several commenting that senior managers were not always sufficiently visible or responsive to concerns. Staff cited examples of ongoing staffing shortages not being addressed and limited consultation regarding changes to working arrangements, including breaks and leave arrangements.

Leaders told us staff had access to a wide range of health and wellbeing support services. These included occupational health, physiotherapy, psychological therapies, counselling, employee assistance programmes, mental health first aiders, restorative supervision, wellbeing resources and flexible working arrangements. Staff could also access health checks and targeted support relating to areas such as stress management, menopause, caring responsibilities and wellbeing at work. Many staff spoke positively about the wellbeing offer, highlighting regular wellbeing events, dedicated wellbeing leads, mindfulness groups and access to specialist support services.

The trust also recognised staff achievements through initiatives such as its annual CARE in Action Awards, which celebrated individuals and teams who demonstrated the trust's values. Peer-to-peer recognition was encouraged through a dedicated 'thank you' section in the weekly staff newsletter, and long-service awards recognised staff commitment to the organisation.

Staff could access structured support following incidents through a trust-wide network of trained debriefers, coordinated by the staff wellbeing team and supported by psychology services. However, feedback about debriefs was mixed. While some staff found them valuable, others told us debriefs did not always take place or were rushed due to staffing pressures. This reduced assurance that all staff received consistent support following distressing incidents.

Staff on Abbey Ward expressed particular dissatisfaction with changes to break arrangements. They told us breaks had been divided into two shorter periods, which they felt did not provide sufficient time away from the ward. Staff described feeling rushed when trying to balance breaks with clinical responsibilities and raised concerns about the lack of suitable staff facilities, including limited access to microwaves and the absence of a dedicated staff room. Although staff said these concerns had been raised, they felt insufficient action had been taken to address them.

Some staff also reported limited flexibility to support caring responsibilities or unexpected personal emergencies. They told us requests for carers' leave, emergency leave or other flexible arrangements had sometimes been declined. As a result, some staff said they felt they had no alternative but to report sickness absence when they were unable to attend work due to unforeseen circumstances.