Queensway Hospital Also known as Oak Tree Forest Limited

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

At our last inspection we rated this key question inadequate. The service was in breach of legal regulation in relation to good governance. The service had made improvements, but the service was in breach of regulation for good governance at the service. This meant the service management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care. At this assessment, the rating has changed to Good Requires Improvement.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Most staff we spoke with told us they felt respected, supported, and valued. All staff were positive about the new hospital manager who they felt was supportive, approachable, and visible. Staff felt they had opportunities for development and the provider promoted equality and diversity. Staff we spoke with had a passion and enthusiasm for their role, the culture of the service and the care and treatment they delivered to young people. At the time of our assessment the service was undergoing a service transformation, which staff were being involved with. Leaders had a vision for the new service provision and a training and development plan for staff moving to the new provision. However, this was impacting on some staff roles, and some staff had decided to leave because they wanted to continue to work with this service user group.

The service redevelopment included consultation and discussion with commissioners and stakeholders as part of quality improvement group meetings. The service had a comprehensive training, development, and supervision programme to ensure staff development, increase awareness of best practice and to ensure that staff understood and demonstrated the vision and values of the service.

Leaders had the skills, knowledge, and experience to perform their roles. They had a good understanding of the service, and the young people, families and staff told us they were approachable, supportive, and visible. Since the last inspection, the service had recruited a new hospital manager, and a director of transformation was supporting the service improvements and service transformation.

There was clear leadership at a local and senior level. Managers were visible during the day-to-day provision of care and treatment. Leaders were up to date with best practice and guidance and ensured that knowledge was shared across the whole team. Leaders ensured staff felt valued and supported. Young people voted weekly for ‘extra mile’ nominations for staff and gave a reason for the nomination.

Staff knew how to raise a concern and felt confident to do so. Staff said there was a positive and open culture, and they could always approach leaders if there was an issue. Managers had received whistleblowing concerns in August 2024. These were investigated thoroughly and sensitively and the outcomes shared with the staff team, commissioners, and regulators.

The hospital had a whistleblowing policy and procedure in place to ensure staff were aware of how to effectively raise a concern. It gave staff information on who they could raise concerns to senior leaders and relevant bodies including the Care Quality Commission. Staff had access to a freedom to speak up guardian and staff knew how to make contact. Staff were able to raise concerns through a variety of feedback methods. Young people and relatives had opportunities to give feedback on the service they received and were involved in decision making about changes to the service. Young people and staff could meet with the senior leadership team to give feedback.

Staff we spoke with felt managers were respectful of cultural diversity. In August 2024, concerns were raised regarding a perceived culture of racism. Leaders took appropriate action, fully investigated the concerns, and found these were unsubstantiated.

Managers supported staff through supervision and team meetings. We reviewed several meeting minutes, which included information regarding reflective practice sessions, individual support sessions and other support mechanisms available for all staff which included discussions with management, Speak Up Guardian, human resources, and a wellbeing app available for staff. Staff had the opportunity to discuss working patterns with managers. Relevant policies, procedures and training was in place for all staff.

Staff and leaders shared that they were clear about what needed to be discussed in meetings to ensure essential information was shared and discussed such as learning for incidents, complaints, and safeguarding concerns. Staff had access to the equipment and information technology they needed to do their work. We spoke with the safeguarding and patient safety lead for the provider who spoke with us about the implementation and launch of the Patient Safety Incident Response Framework (PSIRF). The implementation included a training session for staff, policies and procedures, engagement, and regular reviews of the process as it is implemented.

Our findings from other key questions demonstrated that some governance process did not always operate effectively at team level. We found some discrepancies and inconsistencies between documented procedures and processes, staff practice and a lack of oversight or monitoring of this. This included the reading of Section 132 rights for detained patients, completion of personal emergency evacuation plans (PEEPs), use and maintenance of ligature cutters. Care planned requirements for physical health monitoring did not always match with the actual completion of forms and there was some discrepancy between the medicines policy and the actual disposal of drugs no longer required. These concerns were fed back to the service after the onsite inspection and the provider was responsive to these and implemented changes to make some immediate improvements. The service did have a risk register and business continuity plans for emergencies.

Young people told us family members and external teams were involved in their care and treatment when they had consented to this. Young people were also involved in providing feedback to senior leaders and to external partners during quality reviews of the service.

Staff had good relationships with wider partners including commissioners, provider collaborative and NHS England. They had collaborative meetings with these partners enabling good practice and learning lessons.

The service was open and transparent to external stakeholders such as the provider collaborative who provided regular reviews and scrutiny to improve outcomes for young people using the service. They met with the service regularly to discuss overall performance of the service.

Processes, such as multi-disciplinary meetings ensured all relevant partners were involved in the young person’s care. The provider worked actively with local partners internally and externally.

Staff were supported to develop their skills. All staff spoke positively about their mandatory training and the opportunities to help develop their knowledge and skills and reflect on their practice.

The hospital was discussing with a previous patient about an Expert by Experience role within the service. The hospital was committed to ensuring that they met the needs of people with autism while they were receiving eating disorder treatment. The occupational therapist had completed an autistic friendly environment checklist. The service employed a member of staff as an autism champion who was working on a proposal to support other sites with this work however, we were told that this role would be no longer needed in the service after the service transformation.