Broomhill

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

We identified some areas of concern under the well led key question which will require an action plan under the governance, management and sustainability quality statement. While the provider had put in place actions to address issues CQC identified during the last inspection, many of these actions had taken a long time to be implemented. There had not been sufficient time to evaluate how well actions had been implemented or embedded in practice. Some issues we identified as having took time to address include areas of concern around catering and provision of food; introduction of the audio welcome leaflet; working with risk and care planning workshops, plans to commence the patient run café and the implementation of a recovery model of care. Patient and carer forums were relatively new (introduced in December 2023). Working in collaboration with patients needed further work. We acknowledge that at the time of our assessment, occupancy was below 50% and only 5 wards were open. While staff and patients said there were enough staff to meet patients’ immediate needs, they also acknowledged that this had not been consistent in the past when patient numbers were higher. Staff need to plan further admissions with care to ensure needs can be met. There was still a sense of disconnect between the board and the wards. However, we are aware that governance arrangements had recently been reviewed and strengthened. There had been numerous changes in hospital managers and ward managers since our last inspection. Staff told us they would benefit from a stable management team at ward level. Senior leaders acknowledged in the past they had not valued staff as they should have. Work has been ongoing to improve this. Minutes of meetings we viewed did not appear compassionate towards staff. However, leaders had continued to work and collaborate with the Integrated Care Board and other stakeholders with regards to their quality improvement plan.

This service scored 46 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff could not articulate the vision of the hospital and appeared to have a lack of direction. Some staff thought that the hospital might close. Staff told us that some colleagues had left due to the uncertainty. The senior leadership team had a shared vision and strategy, but sadly this had not filtered down to ward staff we spoke with. Leaders acknowledged in the past there had been some elements of a blame culture among the staff and they had been working to change this to a more open culture committed to learning. Leaders had made an effort to acknowledge and appreciate the staff team. This had included an increase in pay and introducing additional benefits for staff. Senior leaders had been working with partner organisations on their quality improvement plan. Some improvements to the service had been made although it was clear some further work needed to be completed to ensure all staff had a clear direction and were supported with appropriate tools and knowledge to offer the best care possible.

Leaders had made an effort to acknowledge and appreciate the staff team. This had included an increase in pay and introducing additional benefits for staff. Senior leaders had been working with partners on their quality improvement plan. Some improvements to the service had been made although it was clear some further work needed to be completed to ensure all staff had a clear direction and were supported with appropriate tools and knowledge to offer the best care possible.

Since our last inspection in June 2023, there had been three changes of registered manager at Broomhill and several changes of ward managers. However, many of the other senior leaders, including the CEO, Deputy Director of Nursing and Associate Medical Officer had remained constant. Feedback from staff surveys and staff meetings had been discussed during local governance meetings. Staff who had been undertaking enhanced observations (2:1) at the local general hospital with a patient had asked if the 12-hour shift could be split. Meeting minutes concluded that this was not realistic, breaks were available and just needed co-ordinating. Staff being on enhanced observations for such a length of time is not in line with the providers policy nor best practice. We did not feel this was a reasonable response.

Due to the changes in management at the service, the staff and patient action plan from the bi-annual surveys had not been fully completed. The results had been published in January 2024. On this survey, staff had reflected negative views on how they were supported and felt unable to speak up. The new hospital manager was following this up and had recently completed an action plan. However, the next survey would be due for circulation this summer. Due to the time lapse we did not think managers saw this work to have been a priority. We viewed some local governance meeting minutes and some discussions recorded did not feel compassionate towards staff. There had been a discussion around supervision compliance not being high enough, and a suggestion was that staff should be pulled into the service even if it is their day off to ensure they received supervision. There were discussions around the level of sickness being too high, but no possible solutions such as ensuring return to work interviews were completed to get an understanding of why individual staff members had been off.

Staff we spoke with told us they knew how to speak up if they had concerns and would do this if it would benefit patient care. Staff knew who the freedom to speak up guardian was and knew how to contact them. Staff could make contact via telephone or via email. The freedom to speak up guardian sits on the senior leadership team but did not view this as a barrier to staff speaking up. Staff initially had some concerns about the freedom to speak up guardian making appointments with staff at the service. This was acted upon, with staff then being given the opportunity to meet in a more discreet area, or outside of the service. Some staff were concerned that this would not be anonymous due to having CCTV and audio recording.

The provider had an identified freedom to speak up guardian (FTSUG). Staff we spoke with told us they knew how to contact the FTSUG and would speak up if they thought this would benefit patient care. Staff could make contact via telephone or email. While the FTSUG sits on the senior leadership team staff did not view this as a barrier to speaking up. However, the FTSUG reports into the CEO of the hospital, and this was seen as a barrier. Staff initially had some concerns about the FTSUG making appointments in the hospital, they were concerned that this could not be anonymous due to having CCTV and audio recording. In response to this concern staff were given the opportunity to meet in more discreet areas, or outside of the service. In recent months the provider had actively promoted use of the FTSUG at the service. A survey was completed to identify potential barriers to raising concerns. In addition to the FTSUG there were 2 FTSUG champions who visited the hospital weekly. Between 2023 and 2024 staff had raised 8 concerns through this process. Themes were collated by senior staff and appropriate actions taken. One example of actions taken was around staff saying they were not sufficiently trained to deal with some complex behaviours and incidents. The provider recognised that a lack of management presence had not helped. They then ensured a clinical manager was allocated to each unit. The provider also made sure staff were offered de-briefs and could also access external support if required.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Senior leaders acknowledged that their governance systems needed strengthening and so this was reviewed early in 2024. However, staff still felt there was some disconnect between the board and staff on the wards. This had not been helped by the changes in hospital managers and ward managers. We also found that practice and procedures were different across wards such as the checking and labelling of emergency grab bags. Staff were aware improvements needed to be made following the last CQC inspection and knew lots of work was going on. However, staff did not feel that communication had been effective, with some changes seemingly happening overnight, such as changes to paperwork.

The provider had put in place actions to address issues CQC identified during the last inspection. However, many of these actions had taken a long time to be implemented, meaning that evaluation of how effective these plans were had not yet been completed. Neither was it possible to gauge how effective plans required following our previous inspection were implemented and embedded in practice. Some issues we identified as having took time to address include areas of concern around catering and provision of food; introduction of the audio welcome leaflet needing patient voice; working with risk and care planning workshops, plans to commence the patient run café and implementation of a recovery model of care. Patient and carer forums were relatively new (introduced in December 2023) .This assessment has identified further concerns with the provider not having robust oversight of a number of issues, to include medicines management, assessing patients needs and educating staff about active rehabilitation and purpose of the service, There continues to be a lack of active involvement between patients and staff when planning and reviewing care.

Some external partners expressed some concerns about the service being able to successfully sustain improvements on a long-term basis. The service has been found to have significant shortfalls during previous CQC inspections for which action plans have been produced, submitted and worked through. Some of these improvements and actions have not been sustained or embedded into practice. Positively, the providers have been willing to share information and work collaboratively with the Integrated Care Board as well as other partners. Staff on the wards we spoke with expressed concerns about the patient numbers increasing, as with lower numbers they felt they could meet their needs. Staff were concerned about how busy the hospital will become as and when occupancy rises.

At the time of this assessment senior staff were collaborating and accepting guidance and advice from stakeholders and other partners. Despite this, there were still lots of improvement work needing to be completed and monitored. However, we did see that learning was now shared across the St Matthews Healthcare group and managers and leaders were committed to improve the experience of people who use the service.

We did not look at Learning, improvement and innovation during this assessment. The score for this quality statement is based on the previous rating for Well-led.