Barnet Lane Clinic

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

Managers did not have consistent quality assurance processes in place to ensure they had sufficient oversight of medicines storage and recording. Managers had not adequately recognised gaps in their staff gender mix where some patients had delays in having their immediate needs met by female staff. The service was changing its remit to a female only service, managers needed to ensure staff gender mix was adequate to ensure patients’ immediate needs were always being met. Managers had not ensured patients requiring rehabilitation at the service had educational and vocational opportunities available to them to support their recovery in line with their rehabilitation model of care. Carers feedback demonstrated further learning and improvements were required to continue to embed good practice at the service. However, leaders were visible within the service and had the experience, capacity, capability and integrity to ensure that the organisational vision could be delivered, and risks were managed well. Leaders fostered a positive culture where people felt that they could speak up and that their voice would be heard. There were clear and effective governance, management and accountability arrangements. Managers acted on information about risk, performance and outcomes, and shared this with the staff team to bring about improvements.

This service scored 61 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff were aware of the remit and vision of the hospital as a rehabilitation service. However, managers did not provide patients with vocational and educational opportunities to enhance their recovery. Staff understood the vision, values and goals and their role in achieving them. Managers noted that they had been focused on building the culture of the service, in the first year since acquisition by the provider and were continuing to embed changes at the service. Staff said that managers consulted with them about the vision, values and strategy and they had opportunities to meet with managers to give feedback and raise any concerns. Staff and leaders demonstrated a positive, compassionate culture. They had a clear understanding of equality, diversity and human rights and felt that they received equal opportunities for development. Staff said that they were asked about what needed to change within the hospital in their morning meetings with managers. They thought that the provider cared about staff and patients, and invested in the team, describing strong teamwork, improved organisation, and regular staff supervision and support.

Managers did not ensure patients had access vocational and educational opportunities to enhance their recovery in line with their rehabilitation approach. Leaders were visible at the service, and ensured there was a shared vision and strategy that staff understood and supported. Managers ensured the service had a risk register, and staff and leaders ensured any risks to delivering the strategy, were understood, and had an action plan to address them. They monitored and reviewed progress against delivery of the strategy and relevant local plans.

Staff said that managers acted by the culture and values of the service, and had the skills, knowledge, experience, and credibility to lead effectively. They described managers as having integrity and being open to engage with them. Leaders we spoke with demonstrated that they had the experience, capability and understanding to deliver the service’s vision, and manager risks. They were knowledgeable about issues and priorities for the service and said that they could access appropriate support and development in their role. Staff told us that managers had arranged a recent staff appreciation event at the hospital, and also held a celebration to mark one year since the provider acquired this service, each of these included patients and all staff. Staff were aware of future plans for the hospital including opening an acute ward on site and moving to a hospital for female patients only. Managers gave ‘Star awards’ to staff members each month, taking into account feedback from patients about who had been particularly kind and helpful.

The service had inclusive leaders who understood the context in which they delivered care, treatment, and support. They demonstrated the culture and values of their workforce and organisation. Leaders were visible within the service and had the experience, capacity, capability, and integrity to ensure that the organisational vision could be delivered, and risks were well managed. High-quality leadership was sustained through safe, effective, and inclusive recruitment and succession planning, and professional development opportunities for all staff. Minutes of daily operations meetings indicated that staff discussed all relevant issues to ensure safe care and treatment including allocation of patient observations, and current physical and mental health needs of patients. There were action plans for the most recent staff and patient surveys from 2023, including the appointment of staff champions, incorporating carer feedback, improving communication, staff listening breakfasts, human resources drop-in sessions and learning and development road shows.

Staff we spoke with were very positive about working at the service. They spoke highly of the support provided by management and investment in the service. They indicated that they felt heard, with action plans put in place to address areas of concern they raised. Staff and leaders spoke with openness, and transparency. They were aware of the Freedom to Speak up Guardian for the provider organisation, but said they felt confident in speaking up to managers at the service. Staff we spoke with were confident that their voices were heard.

Leaders fostered a positive culture where people felt that they could speak up and that their voice would be heard. Leaders actively promoted staff empowerment to drive improvement. There was a poster at the service detailing how staff could contact the Freedom to Speak Up Guardian. No recent issues had been raised from staff at the service. However, managers had developed an action plan due to the results from last staff survey to make improvements following staff feedback.

Staff said that workforce morale was fair at the time of the inspection. Morale appeared to better for day staff than night staff. Managers had a plan to have staff rotate so that they worked both on days and on nights, although they had inherited some staff who had night only contracts. It was hoped that more rotation on nights would improve practice and morale on the shifts.

The provider’s policies indicated that they valued diversity in the workforce and worked towards improving equality for staff. Leaders took action to continually review and improve the culture of the service in the context of equality, diversity, and inclusion. Leaders take steps to review policies and procedures to tackle structural and institutional discrimination and bias to achieve a fair culture for all. Where possible they made reasonable adjustments to support staff to carry out their roles well. There was no current staff representative, but there were staff champions appointed in different areas such as safeguarding.

Managers had not ensured patients requiring rehabilitation at the service had educational and vocational opportunities available to them to support their recovery in line with their rehabilitation model of care. Managers did not have systems and processes in place to ensure they had sufficient oversight of medicines storage and recording. Managers had not adequately recognised gaps in their staff gender mix where some patients had delays in having their immediate needs met by female staff. The service was changing its remit to a female only service, Managers needed to ensure staff gender mix was adequate to ensure patients’ immediate needs were always being met. Carers feedback demonstrated further learning and improvements were required to continue to embed good practice at the service. Managers described systems to manage the service’s performance and risks to the quality of the service. They took a proportionate approach to managing risk and had plans to encourage new and innovative ideas to be tested within the service. Managers were considering setting up a laboratory to enable faster blood test results for patients. Managers told us of action taken to address reports of some staff sleeping whilst on observations on the night shifts. Actions included repeated warnings, surprise visits, and specific training provided on how to stay alert. We met with the service director, clinical service manager and hospital director. Staff at the service, described clearer procedures and increased quality assurance under the current provider. At the time of the inspection, managers had reduced patient numbers from 32 to 28, as the service was reconfigured to include an acute admission ward, moving towards being a female only hospital, and building and refurbishment works took place.

Managers did not have consistent quality assurance systems in place to ensure safe medicine storage and recording, sufficient staff gender mix to always meet patients’ immediate needs or have vocational and educational opportunities to meet rehabilitation and transitioning needs of patients. Managers needed to embed further improvements from carer feedback. However, managers shared information about risk, performance, and outcomes with the staff team to bring about improvements. Three monthly hospital-wide meetings were used to share information and ideas between different services run by the provider. The risk registers for the service included difficulties with recruitment of registered nurses, proximity to busy roads and motorways, the need for emergency drill scenarios, delayed discharges, and recent issues with the alarm systems. There were mitigations in place to address each of these risks, including the use of radios, and raising awareness of some incorrect locations displaying on the alarm system. By the time of our last inspection visit to the service, this was no longer an issue, with the alarm system updated as appropriate. Staff understood their role and responsibilities. Systems to manage current and future performance and risks to the quality of the service took a proportionate approach to managing risk allowing new and innovative ideas to be tested within the service. There were robust arrangements for the availability, integrity and confidentiality of data, records, and data management systems. Information was used effectively to monitor and improve the quality of care. The management team had put systems in place following an IT system outage, during which staff had returned to using paper records. Staff now had portable dongles and hot spots available in the event of a reoccurrence.

Patients and carers told us they had contact with commissioners who had placed them at the hospital, and patients had regular contact with the service’s independent advocate. The advocate confirmed that some female patients had not always had their immediate needs met. Carers feedback demonstrated further learning and improvements were required to continue to embed good practice at the service.

Staff were aware of their need to provide further rehabilitation opportunities for patients to access educational and vocational opportunities in the community to support their recovery. The new occupational therapist and registered managers described plans to develop further relationships with educational and vocational providers within the local area. Managers understood their duty to collaborate and work in partnership with other services, including local physical health services. They shared information and learning with partners and collaborated for improvement, for example in working towards discharge with patients and their carers, addressing their specific needs and preferences. Learning from incidents and new ways of working were shared across the provider organisation. Staff also met with commissioners at regular independent care and treatment reviews of patients to discuss support in a collaborative approach.

Commissioners and the advocate told us that staff and leaders were open and transparent, and worked well in partnership with them. They described the staff team as responsive and supportive across the board, from the senior leadership team (including medical staff) through to administrators. Particular strengths noted included staff interactions with patients, monitoring of patients on high dose anti-psychotic medicines, information provided about medicines, and adaptability to changes. However, areas for improvement identified included patients’ risk assessment on admission and keeping the treatment room clean. They would also have liked to be kept up to date with information about changes being made to the whole unit including the move to a single-sex unit.

Managers were working towards improving patients access to opportunities in the community to enhance their rehabilitation. Staff and managers at the service understood their duty to collaborate and work in partnership. They shared appropriate information and learning with partners and collaborated for improvement. Staff and managers engaged with people, and partners to share learning with each other that resulted in continuous improvements to the service. They used these networks to identify new ideas that could lead to better outcomes for people.

Quality improvement (QI) initiatives had not yet been introduced at the service, although they were in place elsewhere in the provider’s services. The registered manager spoke of plans to introduce a quality improvement project aimed at reducing levels of prescribed anti-psychotic medications, and this would be supported by a new consultant psychiatrist who was a QI champion, and due to start at the service soon. Managers had identified other QI champions in the unit, and all staff had completed QI stage 1 training. Other planned projects included harm reduction and improving family and carer engagement. However, staff and managers confirmed that there were clear processes in place to ensure that learning happened when things went wrong, as well as from examples of good practice. Reflective practice sessions were held with staff, and debrief sessions were held when needed. Learning was shared with the staff team at regular handover and other multidisciplinary team meetings. Managers encouraged staff to reflect on what could be changed, and collective problem-solving. Leaders encouraged staff to speak up with ideas for improvement and innovation. Staff told us there was a sense of trust between leadership and staff.

The provider had a framework for introducing QI methodology focused on continuous learning, innovation, and improvement across the organisation. A year after the transition from the previous provider, the registered manager was looking to embed QI methodology and encourage creative ways of delivering equality of experience, and quality of life for patients.