Heartbeat Alliance

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 in May 2022, we rated the provider as inadequate for providing a well-led service as systems and processes to demonstrate effective oversight and good governance were not in place. At the inspection in May 2023, we found improvement in some but not all areas. At this assessment in May 2024, we rated Heartbeat Alliance as good for providing a well-led service. We found the concerns identified in our previous inspections had been addressed.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Leaders understood the challenges and needs of people and their communities, and their delivery approaches reflected this accordingly. They demonstrated a commitment to developing a supportive and open culture for staff which was supported by the positive feedback received from staff about the atmosphere and culture of the service. Staff reported that they had enough equipment, and resources to perform their duties to a high standard. They told us that their competencies to carry out their role were checked and that health and safety was prioritised. Staff at all levels felt confident to report concerns at the service. Guidance, written procedures, policies, and patient safety alerts were effective and accessible to all staff.

Staff at all levels had a well-developed understanding of equality, diversity, and human rights, and they prioritised safe, high-quality, compassionate care. Equality and diversity were actively promoted, and the causes of any workforce inequality were identified, and action was taken to address these.

Staff and leaders spoke positively about the capability of the leadership team to operate the service effectively and inclusively. They told us that Heartbeat Alliance was excellent at caring for staff and patients, listening to concerns, determining where improvements could be made, and acting on them immediately. They also told us that the management team was easy to contact and that they listened to their staff, whatever the size of the problem. Concerns previously identified relating to the leadership arrangements had been addressed.

There were now policies, processes, and systems to support the governance and management of the service. There were regular meetings during which issues significant to the delivery of clinical care were discussed and reviewed. There was an up-to-date business continuity plan in preparation for major incidents. The service had good oversight of governance arrangements. Examples of this included an improved clinical governance policy, increased scrutiny at the Board level, and a protocol of regular clinical meetings. The provider had been responsive to our findings and demonstrated it could prioritise actions needed to improve the service.

Staff knew how to raise concerns about the service, and they felt comfortable and empowered to do so. However, not all staff were aware of the Freedom to Speak Up Guardian.

The provider had in place a process for regularly seeking and responding to staff feedback. The findings were now shared with the Board at agreed times throughout the year. Heartbeat Alliance had a reciprocal agreement with a neighbouring federation which facilitated a Freedom to Speak up Guardian. The process for staff to access this was set out within its Duty of Candour Policy.

Leaders told us the new Board and leadership structure had been implemented to create a more diverse view of the service. Systems and processes for equality and diversity were in place. This included policies and procedures, mandatory training, and a process for staff to raise concerns and these to be responded to. Arrangements were now in place to enable proactive engagement with staff. For example, monthly online meetings, providing minutes from clinical governance meetings, and a staff newsletter. The nature of the enhanced access service meant most staff were ‘bank’ staff. This meant they could opt to work the desired hours and locations to suit their needs. For those staff who were not ‘bank’ staff they were able to work flexibly when needed.

Leaders described how governance had improved and was now embedded in all levels of the organisation. They had arranged what they had referred to as “Triangles of Accountability” aimed at ensuring diversity of perspective and experience to influence and inform decision-making. They described how they had established new or closer working relationships with external partners.

A refined organisational and clinical governance structure was in place with clear and effective governance, management, and accountability arrangements. There was defined leadership with renewed engagement at the Board level. The clinical lead now focussed solely on the enhanced access contract. An annual review of board skills and effectiveness was planned for 2025. Staff now clearly understood their role and responsibilities. The systems to manage current and future performance and risks to the quality of the service took a proportionate approach to managing risk that allowed new and innovative ideas to be tested within the service. These continued to be tested, developed, and embedded. Information was now used effectively to monitor and improve the quality of care. Leaders implemented or were working towards implementing relevant or mandatory quality frameworks, recognised standards, best practices, or equivalents to improve equity in experience and outcomes for people using services and tackle known inequalities. For example, engaging with the local Integrated Care Board regularly to contribute to the strategy and address local critical issues. There were robust arrangements for the availability, integrity, and confidentiality of data, records, and data management systems.

CQC had not received any feedback from members of the public regarding this service. The evidence we reviewed did not show any concerns about people’s experience regarding partnerships and communities. The provider had arrangements in place to allow patients the opportunity to provide feedback on the service received. The way they managed feedback showed the views of people were listened to and considered.

Leaders described and evidenced how they collaborated with a range of relevant stakeholders and agencies. For example, regular engagement with the GP practices who used the service, the Integrated Care Board, the Primary Care Network, and the Local Medical Council. We found staff and leaders were open and transparent.

Partners told us the leadership team was visible and demonstrated a commitment to develop and maintain relationships. They supported providers, particularly those to whom they sub-contracted work. They consulted widely with partners on changes to pathways, ensuring that a multitude of views were considered.

Systems were in place to allow two-way engagement with the provider and people, communities, and partners. Leaders have begun to develop an improved structure of engagement with people, communities, and partners to share learning and continuous improvement. Some of these improved arrangements were in their infancy. They were using these networks to identify new or innovative ideas that could lead to better outcomes for people. For example, reviewing the way some of their clinics were operated. An improved scheduled programme of meetings at the Board and leadership level contributed to the understanding, reviewing, and improving the quality of care to better serve the practice population and improve relationships with external agencies. For example, the local NHS Trust.

Leaders demonstrated, how over the last 12 months they had improved. New personnel, refining the organisation structure, implementing new ways of working, and embedded governance arrangements supported the ability to do this. Leaders described that whilst embedding processes they now reviewed the effectiveness of what had been implemented and explored ideas for further improvement. They described this as a continual evolving process. Leaders demonstrated a comprehensive understanding of how to improve. There was now a keen sense of trust and accountability between the Board and the leadership team. The provider demonstrated they had established and were continuing to establish strong external relationships that supported improvement and innovation. Some staff we spoke to commented that significant improvements had been made at the service since our last inspection. Processes were in place to ensure that learning happened when things went wrong and from examples of good practice. Governance arrangements now supported the ability to do this. Systems were in place for staff to provide feedback and to encourage staff to provide feedback and to contribute to improvement initiatives.