PSS Birmingham

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 – 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 inspection we rated this key question good. At this assessment, the rating remained good. This meant the service management and leadership was consistent. Leaders and the culture mostly supported the delivery of high-quality, person-centred care.

This service scored 68 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff and people were disengaged and lacked trust in leaders. The culture did not always support understanding and learning. A lot of the staff we spoke to did not feel supported or valued. We spoke to staff on the day of assessment and sent out 30 questionnaires to randomly selected staff following the assessment to gather their feedback. Most staff enjoyed working at the service. However, some staff told us since the new management had started in late 2023 and there had been significant changes, they felt undervalued, not listened to and not respected. Staff told us the culture was poor and there was a lack of transparency and communication. They said important information was not shared equally and some had access to information before others which led to a sense of exclusion. One staff told us, “The culture has changed in the last 12 months and our mental health is no longer considered, staff morale is on the floor and management have offered little to no support.” Whilst this is not what all staff told us, this reflected the views of a lot of the staff we spoke to. We raised this with the managers, and they acknowledged the feedback. They had a number of actions in place to improve how staff were feeling and were keen to build on this. We could see they had started to improve communication channels and there were actions in place to improve this within 2025. A few staff we spoke to felt the change in management structure was positive. They felt there was more support with the increased management structure and additional resources introduced. They felt the new managers were more professional and had made it a safer service. Managers were aware that staff felt like this as they had recently completed a wellbeing survey and had noticed a big decline in morale in the last 6 months. They told us they were working to improve the culture with several actions but there was a lot of work needed for the staff to feel valued and supported.

The managers had a vision “to become the largest clinically-led mental health provider in the UK, recognised for delivering exceptional care that improves patient and customer outcomes”. Leaders told us they wanted to develop and improve by involving the staff to create new vision and values. There were several strategic priorities for 2023 to 2024 which included workforce, technology, quality improvement and growth. Most of these had been completed as part of their transformation project and they were working on the growth of the company. There was a quality improvement plan to advance the service for staff and for patients. This included recruitment, staff experience and engagement, moving to paperless documentation, more customer feedback and becoming digitally advanced.

Leaders had the experience, capabilities, and skills to run the service and ensure risks were well managed. However, their leadership style did not always ensure staff felt valued and listened to to gain the best out of their workforce. There had been a recent restructure which had brought in new leaders within the last 12 months. Some staff told us managers were not approachable or they did not know who they were. One staff told us they felt “undervalued and unheard” and “clearer roles, better communication, and more engagement from senior management would make a significant difference.” Some staff told us they did not feel informed about changes which were happening. For example, cameras were installed in all the ambulances. Staff were not consulted or informed about the purpose of these cameras, which created “anxiety and uncertainty.” The managers we spoke to told us they were aware there were issues and a disconnect between the staff and managers and wanted to improve this, but not enough action was being taken. Following the assessment, we received further information from staff and fed this back to the managers. They were accepting of the feedback and information we reviewed showed they provided the staff with a lot of information and communications. They showed us that most of their communications had been read by 85% to 95% of staff. Staff also told us managers had made positive changes which had improved the safety of the service. One staff member told us the support was getting better and they had received a welfare check from their manager following a difficult shift. Most of the managers we spoke to were passionate and understood the issues the service was facing but needed to do more to engage and support the staff.

The managers told us they wanted the staff to develop and had introduced a new structure. They had created leadership roles for the ambulance staff including clinical team leaders and clinical support workers. The managing director had created a new leadership structure and brought in a head of nursing and education, head of quality and governance and an operations director.

The managers told us they had an open-door policy and wanted the staff to feel they could speak up. Some staff felt the managers were approachable and were encouraged to raise concerns, but most we spoke to did not. They felt the managers did not listen and felt they could not raise concerns for fear of retribution. We spoke to the managers about this, and they told us they used protective measures for the staff whilst investigations were ongoing which included suspension and there were not retributions. The service had a Freedom to Speak Up Guardian (FTSUG), however no staff had spoken to the Guardian. We saw that 90% of staff had read the communication sent to them by managers making them aware of who the FTSUG was. We saw in December 2024 newsletter, the policy and guardians were highlighted to the staff. Managers told us during the assessment that morale was low and the staff felt unsupported and this was mainly due to the changes made following the transformation project. They told us they planned to have events to engage with the staff following the completion of the consultation period in November 2024 and to create a staff council to hear more of the staff voice.

There was a ‘speaking up at Prometheus’ policy which outlined different ways to speak up and how staff would be supported. The service had completed a staff survey following the transformation project which launched end of 2023. The results showed all results had declined since May 2024. For example, ‘Do you feel you get the support you need at work?’ decreased from 48% in May 2024 to 27% in October 2024. Only 22% of staff felt appreciated at work. The managers had completed a “you said, we are doing” presentation to show what they were doing to make improvements. They were creating mental health first aiders, ensuring staff had quarterly support supervisions, creating a staff counsel and prioritising focus areas and setting specific goals to make improvements.

Leaders acted to review and improve the culture of the organisation in the context of equality and diversity. The service had recently changed their appraisal paperwork to include equality and diversity to ensure it was a conversation with each member of staff. Staff did not always find that there was equality. One staff told us ,“Jobs are not always allocated fairly, and some people always get allocated easy jobs and others are always on harder jobs.”

Equality, diversity and human rights training was part of staff’s mandatory training programme; 100% of staff had completed this. There were policies and processes in place to ensure the service was inclusive and valued diversity in their workforce. The service had created newsletters for October and November 2024. They included activities relating to black history month, highlighted national and religious holidays and celebrations. Managers started a group for neurodivergent individuals. It was an informal session to provide a safe and supportive space for neurodivergent individuals to connect, share experience and offer tools and strategies.

Leaders had a governance process for the service, which was mostly effective. We saw evidence of information being discussed by managers at monthly governance meetings, but the information did not always filter down to the staff. Most staff we spoke to were not aware of changes, incidents and audit results. There was a clear governance structure which was overseen by the newly appointed head of quality and governance. Leaders monitored quality and operational processes and had systems to identify where action should be taken. The service held monthly CQGB meetings. We looked at minutes and saw they discussed recent complaints, outstanding actions from previous meetings, audits and incidents. There was an operations leadership team meeting monthly. We saw minutes from September 2024 which showed actions were acted upon and key updates were provided.

Audits were completed in line with their schedule and were discussed in CGQB meetings. There was a monthly governance report which had been commenced in October 2024. Managers told us audits results and learning from incidents was shared at team meetings. We saw there was a lessons learned bulletin was attached to clinical supervision documentation to ensure it was discussed in these meetings. We were told it was shared via their online application “connect teams” and in team meetings. However, some staff we spoke to told us they did not receive any feedback from incidents or complaints and did not feel there was learning. There was a risk register which was discussed at CGQB meetings. It contained 8 current risks. Their highest risk was staff satisfaction following the recent consultation which had resulted in job losses and resignations due to the restructure. This risk was monitored monthly. All risks were regularly reviewed and updated to show controls and actions planned to reduce the risks.

All staff had a good understanding of their role and accountability. Some staff received appraisals and clinical supervision. Managers decided to defer appraisals until the transformation programme had finished. They overhauled the appraisal process, created appraisal training and had a new senior management team in post. Supervision rates for between June and September 2024 were 49%. The service had an action plan to improve this and would review at the end of December 2024. The service were taking steps to becoming more sustainable and a paperless office. They were aiming to reduce their paper usage by 25% over the next 12 months. They had a carbon reduction plan in place which included several initiatives they were doing to reduce their carbon footprint.

We did not observe any patient journeys during this assessment and were unable to speak to patients.

Staff told us they worked well with the services who booked their transport. They worked in partnership with organisations to support effective transportation of mental health patients safely and were open and transparent with them.

Stakeholders told us their relationship was highly professional and beneficial. They told us the booking process was effective and safe for both staff and patients and they worked together to convey the patients safely.

The service had agreements with the local NHS trusts and independent hospitals and were their first responders and choice of mental health transport.

We saw there was some effort to ensure there was learning in the service through different avenues such as meetings, “connect teams” application, newsletters and on noticeboards but there was still disconnect between this and the staff. Most staff we spoke to did not feel there was any learning in the service and most told us they did not receive feedback after incidents or complaints. One staff told us, “I have never had any positive or negative feedback after completing an incident form. It appears to be only a tick box exercise.” One staff member told us they had raised incidents about safety and rather than investigate the incident, they have just been put on a different job. Managers showed us evidence of communications sent to staff and they held data which showed the proportion of staff who had read it. This ranged from low percentages to over 70%. Managers told us all incidents were investigated and only communicated to staff where incidents were scored above a 3. Whilst managers were trying to ensure learning, there was a still a disconnect from the staff and this was not embedded.

There were processes in place for staff to learn from incidents such as feedback in meetings, information on the application and the lessons learned bulletin. However, staff told us they did not receive feedback and did not feel empowered to raise concerns due to the lack of support. This meant they did not feel there was learning and therefore there was not a positive learning culture. The managers told us about an innovation project they had worked on. The service completed a pilot where they reduced the pressure on the blue light services in Cheshire and Merseyside by working alongside the police and ambulance services. They were conveyed when there was a patient in mental health crisis to reduce unnecessary delays in conveyance and allowed emergency services to return to their duties. The pilot ran from February 2022 to August 2023 and saved 7746 police hours and supported 491 patients detained.