Forest Dialysis Unit

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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 4 quality statements on leadership, freedom to speak up, culture and governance. Leaders understood and embodied the culture and values of the workforce and the organisation. They had the skills and knowledge, experience and credibility to lead well. They demonstrated their integrity and honesty which was recognised by their staff. There was a clear system of governance and risk management based around delivering safe and good quality care and treatment. The department was prepared for emergencies and major incidents and worked with others as part of a multi-agency response.

This service scored 43 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Leaders ensured there was a shared vision and strategy and that staff in all areas knew, understood and supported the vision, values and strategic goals and how their role helped in achieving them. However, the vision had been developed prior to the unit changing provider so current staff had not been involved in their development. Staff and leaders demonstrated a positive, compassionate, listening culture that promoted trust and understanding between them and people using the service. Staff at all levels had an understanding of equality, diversity and human rights. Staff and leaders ensured any risks to delivering the strategy, including relevant local factors, were understood and had an action plan to address them which was monitored and reviewed.

The service had a clear strategy and vision which most staff were aware of. The values helped form the basis for annual career conversation and appraisals, although this was only just starting at the time of our inspection.

Staff felt supported and guided by their leadership team. The leaders were available when they were needed and led by example. 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 leaders were clear, and they understood their responsibilities and accountabilities. Staff were given a clear onboarding programme, however, some staff at other levels were sometimes unclear about their own accountabilities and competencies. We saw the service had comprehensive competency and training framework, but not all staff were aware of this. All staff had opportunities to develop including for future leadership roles, but some staff were unclear on how to access these opportunities. There was inclusive recruitment and succession planning. The service had effective recruitment processes and ongoing checks to ensure all staff met the legal requirements to work in the service.

Staff were aware of the freedom to speak up process and could access help, support and guidance. Staff received feedback when they raised concerns through this process and felt supported throughout.

There were clear processes for the escalation of freedom to speak up concerns which had recently been reviewed and updated to better reflect local needs. Concerns raised within the UK based clinics were now being dealt with by UK based staff whereas before this had been done in another country. Staff explained it had felt disconnected when receiving responses to concerns from staff in other countries.

We did not look at Workforce equality, diversity and inclusion during this assessment. There is no previous rating for the Well-led key question so we cannot yet publish a score for this area.

Staff had time and resources to undertake effective governance and manage risk. The service had a range of accurate and timely data and information available to understand performance and quality and improvements were made as needed. This compromised of a comprehensive series of key performance metrics linked to the overall contract. Governance was used to learn, improve and innovate. Information held about patients was secure and protected. Staff were part of the emergency preparedness network, and they had the strategies and guidance to respond to major incidents including disruptions to water supplies and inclement weather.

There were regular and effective meetings led by senior leaders who were leads for safety, audit, quality and governance. These discussed and addressed key areas of performance, risk, audit, culture and workforce. Minutes showed areas of concern were identified and actions were taken to learn and improve. Changes had been made when needed to improve the service. Good practice was recognised and celebrated. There was effective workforce planning including for managing major incidents or emergencies.

We did not look at Partnerships and communities during this assessment. There is no previous rating for the Well-led key question so we cannot yet publish a score for this area.

We did not look at Learning, improvement and innovation during this assessment. There is no previous rating for the Well-led key question so we cannot yet publish a score for this area.