County Hospital

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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

We assessed 2 quality statement from this key question. We have combined the score for this area with scores based on the rating from the last inspection, which was Inadequate. Our rating for this key question was good. We found the provider had clear and effective governance processes, which supported the safe delivery of care. Staff were clear on their individual responsibilities and knew who was accountable for each aspect of the service.

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.

The service had a vision for what it wanted to achieve and a strategy to turn it into action, developed with all relevant stakeholders. The vision and strategy were focused on sustainability of services and aligned to local plans within the wider health economy. Leaders and staff understood and knew how to apply them and monitor progress.

Staff felt supported and guided by their leadership team. The leaders were available when they were needed. They were knowledgeable about the issues and priorities in the department and strived for change and improvement when needed. They focused on staff wellbeing and ensured a culture promoting good practice, good quality, and safe care and treatment.

Leaders had effective support and opportunities to develop and maintain their credibility and skills. The roles of staff and leaders were clear, and they understood their responsibilities and accountabilities. All staff had opportunities to develop including for future leadership roles. There was inclusive recruitment and succession planning for the future. The trust had effective recruitment processes and ongoing checks to ensure all staff met the legal requirements to work in the trust.

Staff knew who the freedom to speak up guardians champions were and were happy to speak with them if they needed to Staff told us they felt they could raise any concerns with the managers without fear of reprisal. The service had a whistleblowing policy in place to support this process.

There was inclusive recruitment and succession planning for the future. The trust had effective recruitment processes. Staff demonstrated their integrity and honesty which was recognised by their staff. Leaders kept staffing numbers at a safe level with a suitable skill mix increasing numbers as much if needed. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service promoted equality and diversity in daily work, and provided opportunities for career development. The service had an open culture where patients, their families and staff could raise concerns without fear.

Staff had time and resources to undertake effective governance and manage risk. There was a good range of accurate and timely data and information available to understand performance and quality and improvements were made as needed. Governance was used to learn, improve and innovate.

Leaders and managers supported staff, staff we spoke with were clear on their individual roles and responsibilities. Managers met with staff regularly to complete appraisals and performance reviews. The trust had an established governance processes . Staff could access all required policies and procedures. Managers held regular meetings with staff, during which they discussed clinical concerns and emerging risks. Managers clearly recorded any actions arising from these meetings and ensured they shared these with staff. Staff took patient confidentiality and information security seriously.

Trust worked closely with local mental health team. Staff felt the changes made since the section 29a warning notice around mental health provision had significantly improved their working relationship with local trusts and improved their service for those patients struggling with their mental health and well being.

Leaders and staff told us they had worked really hard to make improvements and that there had been a ‘culture shift’ in regards to conducting risk assessments and MCA assessments on the medical wards. Staff said they were confident in making MCA assessments and DoLS applications and did this routinely. There were processes in place to ensure there was learning from incidents and deaths, and staff understood their responsibilities to report incidents. There was a mortality review group and a serious incidents review group where incidents were discussed and learning shared. Staff described a learning culture in relation to learning from incidents and said they usually received feedback from any incidents or concerns they had raised. Learning was shared in meetings and huddles and there was a whiteboard on each ward for staff to add issues they wished to be included in future discussions. Leaders and staff told us they had made significant improvements to how they cared for patients with a mental health need on the medical wards. This included amending their care needs and risk assessment documentation to include a comprehensive assessment of patients’ mental capacity, as well as assessing their physical, medical, social and communication needs.

Staff had received training and additional support to enable them to conduct MCA assessments and DoLS applications with confidence. Leaders regularly monitored adherence to processes and quality of documentation and records. The Mental health liaison team had increased their support and staff had access to a mental health consultant from the local mental health trust for advice. Trust had trained over a 1000 staff to become mental health ambassadors on every ward and all staff had received mental health awareness training. Trust had also recruited additional staff to fill recruitment gaps and 2 additional mental health trained nurses to support staff on AMU. Leaders attend monthly information sharing meetings and monitor improvement.