13 September 2022
During a routine inspection
We have not previously rated this service. We rated it as outstanding because:
- The service provided mandatory training in key skills and worked with other partners and stakeholders to promote training compliance and opportunities for development.
- Staff understood how to protect patients, had training on how to recognise and report abuse, and they knew how to apply it. Staff and managers worked together with external stakeholders to safeguard patients.
- The service-controlled infection risk well and used equipment and control measures to protect patients, themselves and others from infection including the safe management of clinical waste. Staff were trained to use equipment and ensure that the services vehicles and premises were visibly clean using audit and maintenance schedules.
- The service used strong comprehensive safety systems, with a focus on openness, transparency and learning to protect people. Staff took a proactive approach to anticipating and managing risks to people and safety was recognised as being everyone’s responsibility. Staff identified and quickly acted upon patients at risk of deterioration. External organisations were actively engaged in assessing and managing anticipated future risks and the service had comprehensive business continuity and emergency plans.
- The service had enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed and adjusted staffing levels and skill mix and gave staff a full induction.
- Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date, and stored securely.
- The service used strong comprehensive systems and processes to safely prescribe, administer, record and store medicines. The service took a proactive approach to improving their medication safety.
- There was a truly holistic approach to assessing, planning and delivering care and treatment to people who used the service. There was a safe use of innovative and pioneering approaches to care in urgent and emergency care settings and staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way.
- There was a genuinely open, and “Just” culture in which all safety concerns raised by staff and people who use the service were highly valued as integral to learning and improvement. All staff were open and transparent, fully committed to reporting incidents and near misses. The level and quality of incident reporting showed the levels of harm and near misses, which ensured a robust picture of quality. There was ongoing, consistent progress towards safety goals reflected and learning was based on a thorough analysis and investigation of things that went wrong.
- All staff were actively engaged in activities to monitor and improve service quality and patient outcomes. Opportunities to participate in benchmarking, peer review and research were proactively pursued.
- The continuing development of staff skills, competence and knowledge was recognised as integral to ensuring high quality care. Staff were proactively supported to acquire new skills and share best practice and leaders used innovative approaches to implementing new roles and career development opportunities.
- Staff, teams and services were committed to working collaboratively and had found innovative and efficient ways to deliver more joined-up care to people who use services. External stakeholders were consistently positive when describing multidisciplinary working and told us the service was focused on working together to save lives, limit the impact of life changing events and improve urgent and emergency care across the region.
- Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent. They knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health.
- People were truly respected and valued as individuals. Feedback from people who use the service and those who were close to them was continually positive about the way staff treat people. People thought that staff went the extra mile and the care they received exceeded their expectations. Staff were highly motivated and inspired to offer care that was kind and promoted people’s dignity.
- The involvement of other organisations and the local community was integral to how services were planned and ensured services met the needs of local people and the communities served. People could access the service when they needed it and received the right care in a timely way and the service had developed innovative ways to improve access to the service.
- It was easy for people to give feedback and raise concerns about care received. There were active reviews of complaints and how they were managed and responded to, and the service improvements were made as a result across the service.
- Leaders had an inspiring shared purpose, strove to deliver and motivate staff to succeed. Leaders had the skills and abilities to run the service, they understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff.
- The service had a mission for what it wanted to achieve and a strategy to turn it into action, developed with all relevant stakeholders. The strategy and supporting objectives were stretching, challenging and innovative while remaining achievable. These were aligned to local plans within the wider health economy. Leaders and staff understood and knew how to apply them and monitor progress.
- There was a strong culture that was centred on the needs of patients. Leaders at all levels across the service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values to deliver high quality person-centred care. The service provided opportunities for career development and staff could raise concerns without fear. Staff were proud of the organisation as a place to work and spoke highly of the culture.
- Leaders operated effective governance processes, throughout the service and with partner organisations. Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service.
- Leaders and teams used systems to manage performance effectively. They identified and escalated relevant risks and issues and took actions to reduce their impact. They had plans to cope with unexpected events.
- The service collected a wide range of reliable data and analysed it. Staff could find the data they needed, in easily accessible formats, to understand performance, make decisions and improvements. The information systems were integrated and secure. Data or notifications were consistently submitted to external organisations as required.
- Leaders and staff used gathered feedback from people who used services and the public. This was then used to plan and manage services. They collaborated with local, national, international partner organisations to help improve services for patients.
- All staff were committed to continually learning and improving services. The leadership drove continuous improvement and staff were accountable for delivering change. Safe innovation was celebrated. There was a clear proactive approach to seeking out and embedding new and more sustainable models of care. Leaders encouraged innovation and participation in research.