- Independent mental health service
Moorlands Neurological Centre
Report from 25 November 2024 assessment
Contents
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
Well-led
Leaders had the skills, knowledge and experience to perform their roles. They had a good understanding of the services they managed and were visible in the service and approachable for patients and staff. Managers continued to work towards ensuring all staff worked in line with the transdisciplinary team model, and they consistently shared the vision and values for the service which encompassed all aspects of this way of working. The provider worked well with external partners also involved in the patients care. The service were pro-active in promoting and developing a positive culture. Staff felt respected and valued and said that leaders were open and honest, so they were able to raise concerns without fear. Opportunities were available for staff to raise concerns and give feedback about the staff through staff engagement forums and Freedom to Speak up representatives. The service had effective governance systems in place which identified, managed and monitored risk well. Managers implemented action plans, strategies and processes which had worked well and improved the overall governance of the service. Where required lessons had been learned and communicated from incidents, which were used to drive improvement.
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 continued to work towards ensuring all staff worked in line with the transdisciplinary team (TDT) model, and they consistently shared the vision and values for the service which encompassed all aspects of this way of working. The model was new to the majority of staff. Managers were aware that not all staff had fully embraced the new ways of working and nursing and therapy staff needed to work closer together. Some staff were not comfortable with the 'role blurring' which meant that their professional roles took second place to firstly being a behavioural therapist. However, staff had embraced the new service and had worked hard to learn and adapt to care for patients with acquired brain injury, and managers were confident that given time, the service would be thriving. Managers ensured that they recruited people with the same vision and values who could support with the development of the service and the transdisciplinary model. Staff said the service transition had been managed well. Staff were committed and compassionate about the service although still required support and reassurance about working with people with acquired brain injury.
The provider used staff engagement surveys to gather feedback from staff and subsequently implemented action plans clearly showing areas they were going to prioritise as an organisation. Following a staff survey, managers developed a monthly staff engagement forum to ensure that visions and values of the service were consistently shared and allowed staff to give feedback and raise concerns.
Capable, compassionate and inclusive leaders
Staff told us that leaders were supportive, visible and approachable. Leaders had actively tried to engage staff and they felt more valued. One staff member said they would like more recognition for the good work that staff do. Staff told us that they had been given opportunities to develop and progress in their career.
Managers described ways in which the culture had improved since our previous inspection. Managers were more visible and provided drop in sessions for staff. All staff completed closed culture training on induction and managers completed closed culture audits. Staff teams had naturally changed over the last 18 months, due to staff leaving and new staff had been recruited to the service. Before the service had opened, senior managers with experience of working within acquired brain injury rehabilitation services helped set up the service and continued to work alongside managers and leaders providing advice and support to staff and patients. Managers who were very experienced in this specialism, role modelled ways of working when the service changed. They were very passionate about the service and the impact they can make on patients lives. The lead nurse for the service provided increased input onto the wards whilst they recruited into the ward manager post, to ensure consistency and oversight and to support staff and patients.
Freedom to speak up
Staff knew how to raise a concern and felt confident to do so. Staff felt that there was a positive and open culture. Managers had not received any whistleblowing concerns for a number of months although said they would investigate them thoroughly and sensitively.
The provider had a whistleblowing policy and procedure in place. The policy guided staff on how raise concerns and encouraged staff to feel confident in raising concerns and to question and act upon concerns about practice. It gave staff information on who they could raise concerns to including senior leaders and relevant bodies including the Care Quality Commission. Staff had access to a freedom to speak up guardian to whom they could raise concerns to and posters were displayed throughout the service directing staff on how to make contact. Staff were also able to raise concerns within the monthly staff engagement forum.
Workforce equality, diversity and inclusion
Staff said they felt valued and respected. They felt managers were respectful of diversity.
Managers supported staff through supervision and engagement forums. Staff had the opportunity to discuss working patterns with managers. Relevant policies, procedures and training were in place for all staff.
Governance, management and sustainability
Managers had efficient and comprehensive governance arrangements in place, and had relevant information at hand to ensure the service was performing well. Managers attended regular clinical governance meetings and had sufficient oversight from senior leaders within the organisation. Patient representatives attended governance meetings and cascaded information from the community meetings.
We reviewed monthly governance meeting minutes. These were attended by a range of staff and a patient representative was invited to part of the meeting. Key performance indicators and monthly audit processes were in place to help give oversight of the service. Managers had clear expectations of what care and support the service aimed to provide. Robust processes were in place to safely manage sensitive data which allowed them to maintain people’s privacy, dignity and confidentiality. The provider had a risk register in place which clearly stated what the risk was, when and how it was raised and what mitigation had been put in place to help reduce the risk. These risks were discussed within governance meetings alongside other issues including patient complaints, stakeholder feedback, incidents, staffing and safeguarding. Each area was discussed in detail and when required appropriate actions were put in place, and reviewed at the next meeting.
Partnerships and communities
Patients told us family members and external teams were involved in their care and treatment when they had consented to this.
The provider was open and transparent to external stakeholders such as the integrated care board who provided regular reviews and scrutiny. Commissioners told us they met with the provider monthly to discuss overall performance of the service . They were positive about the provider and told us that safeguarding and restraints were low. They said that staff at the service were open to feedback and always worked with the best interests of the patient's at heart. However, they did say that discharge decisions could be slow and the transdisciplinary model was not yet fully embedded.
The provider had processes including the care programme approach meetings, discharge meetings and ward rounds to ensure all relevant partners were involved in patient care.
Learning, improvement and innovation
Staff said that they were supported to develop their skills. Examples were given of links with local providers to share knowledge, management and leadership training and access to support and coaching from managers and senior leaders.
The provider was focused on embedding the transdisciplinary team model and expanding the service, and a new ward was due to open in Summer 2024. The provider had started to develop quality improvement projects although these were in the early stages of progress. There were processes in place to enable learning and continual improvements. The provider was committed to improvement and we saw evidence of an action improvement tracker to ensure that quality standards were met throughout the care journey . Outside agencies and partners visited the provider, their advice and findings were appreciated and addressed. For example, commissioners told us they met with the provider monthly to discuss overall performance of the service.