Coventry and Warwickshire Partnership NHS Trust

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

In line with ‘Right Care, Right Support, Right Culture’ guidance the trust understood the inherent risk associated with closed cultures. They put measures in place to prevent these developing. Staff and leaders demonstrated a positive, compassionate, listening culture that promoted trust and understanding between them and people using the service and was focused on learning and improvement. Leaders were knowledgeable about issues and priorities for the quality of services and could access appropriate support and development in their role. Staff and leaders actively promoted staff empowerment to drive improvement. They encouraged staff to raise concerns and promoted the value of doing so. Leaders took action to continually review and improve the culture of the organisation in the context of equality, diversity and inclusion. The service had strong external relationships that supported improvement and innovation. Staff and leaders engaged with external work, including research, and embedded evidence-based practice in the organisation.

This service scored 79 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider told us the Trust board agreed six strategic workstreams to be progressed in 2024/25, aligned to the Trust strategy ‘People at our Heart’. One of these workstreams was for Brooklands to be a learning disability and autism centre of excellence. The manager for Janet Shaw Clinic talked about how they brought staff together to work as a team. They did this by spending time with staff, listening to them and ensuring they felt valued and involved. The manager of Eden ward told us that senior leaders were listening now and would make changes when they could.

We reviewed the six month Quality Improvement Plan for Brooklands following the inadequate rated inspection in March 2023. This was comprehensive and broken down into achievable steps with realistic timeframes and outcomes monitored.

The provider advised the Chief Nurse and Director of Nursing regularly visited the Brooklands site to base themselves there. These visits occurred every 2 -4 weeks and allowed them to interact with staff and visit the wards. The chief executive of the Trust facilitated collaborative conversations with staff across the trust, including at Brooklands. These will be followed up with further group and drop in sessions and working groups for staff to get involved in. Members of the Trust board visited the secure wards at Brooklands in October 2023. Staff could access daily ‘in briefs’ from a member of the executive team. Senior leaders told us they looked at the establishment and skill mix of staff and explored a variety of roles beyond the standard nurse and unqualified roles. There were no progression opportunities for nurses, so leaders introduced the band 7 clinical lead role and expanded the clinical deputy role. Senior leaders pushed to introduce the clinical lead role to work alongside the ward manager and said this made a real difference to the quality and safety of the wards. The Trust promoted development of staff, this included examples of unqualified staff training to be Advanced Clinical Practitioner and Learning Disability nurses. Ward managers and clinical leads completed the ‘Leadership in Care Programme’. Staff told us they were supported and involved in making improvements following previous CQC inspections. The Trust reported they provided closed and toxic culture training to raise awareness of what it is, how it develops, what the service aims were and what staff could do if they were worried about practices. Ward managers told us that senior leaders and Trust executives visited the service and were supportive. However, some frontline staff told us senior leaders were not visible.

Leaders developed quality improvement processes and developed an overarching quality improvement plan. Each ward implemented their own quality improvement initiatives. The provider shared results from the NHS 2023 staff satisfaction survey. The average score for staff in the Learning Disability and autism directorate (which included Brooklands secure wards) was 6.88 out of 10 which was slightly higher than across the whole trust which scored 6.67 out of 10.

The Trust advised they have increased the hours provided by the Freedom to Speak up Guardians from 30 to 60 hours per week across all services. Senior leaders told us they pushed the speaking up agenda with staff which resulted in a reduction of anonymous concerns being raised to CQC. Senior leaders have been more approachable, and staff are more confident that something will be done. Managers explored reasons that may stop staff speaking up and assured staff they would not be ‘punished’ for voicing concerns.

We reviewed the ‘Freedom to Speak Up’ report for April 2023- July 2024. The report highlighted “a reduction of CQC contacts particularly within our learning disability inpatient service, and anecdotally it appears more people are speaking up to their managers and leads.” Brooklands local induction included a specific session run by the Trust’s freedom to speak up guardian and the head of safeguarding focused on organisational abuse and speak up cultures. This was attended by anyone starting with the service regardless of their role.

Senior leaders told us that they took a flexible approach to the workforce to ensure equality, diversity and inclusion. This included reasonable adjustments for staff with specific needs. The provider recruited staff internationally and were sponsoring 2 nurses with plans to sponsor unqualified staff. Managers have provided newly qualified nurses with additional support when needed during their preceptorship. The provider reported a good mix of staff from different backgrounds and cultures across roles. However, one staff member told us that the trust expects everyone to be 100% at all aspects of role, rather than playing to staff strengths and taking a more flexible approach.

We reviewed the provider’s ‘Work Force Race Equality Standard (WRES) 2023-24’ report. The actions within the report indicated that the Trust was effectively monitoring WRES indicators to improve the working environment for Black and minority ethnic staff. The trust increased the number of Black and minority ethnic staff employed and there was a decrease in the ratio of Black and minority ethnic staff subjected to disciplinary processes; However, Black and minority ethnic staff reported an increase in bullying and harassment from other colleagues since the last report in 2022. Black and minority ethnic staff did not believe they had access to equal opportunities for progression.

We discussed the escalation process for staff to raise concerns about the ward environment with senior leaders. We expressed concerns that staff had not escalated the issues with repairing the damaged doorframe at Janet Shaw Clinic. Senior leaders advised there were escalation processes in place for staff to follow and they do not know why this did not happen. Senior leaders told us they implemented meeting structures at the service. Ward managers and clinical leads met monthly and then split into separate meetings to look at operation and clinical issues. Senior leaders attended regularly to feedback on specific issues, for example, if there had been high use of bank and agency staff. Ward managers and clinical leads provided support to each other through sharing experiences and discussing scenarios.

We reviewed risk registers for the secure wards at Brooklands. Risks on the register included the risk of unfilled vacancies; medics not completing seclusion reviews in line with policy; the risk of not cordoning off the back of the building from the front with additional fencing. We reviewed ward governance meetings held between September 2023 and October 2024 for each ward. Eden ward held 11 meetings during this time, Janet Shaw Clinic held 10, Malvern 11 and Onyx 11. The agendas for these meetings included, reducing violence and aggression; improving patient flow; reducing health inequalities; patient meetings and involvement; staffing and human resources; medication errors and medicines management; budget position; estates update; safety and quality feedback; action plans; feedback from investigations/learning from incidents; complaints/compliments.

We observed people on all wards accessing leave in the community. People told us about their visit to community facilities, such as shops and takeaways and walks to the airport to watch the planes taking off. One person told us about their volunteering role in a community gardening project.

Staff described how they supported people to access the community. This included support for people to meet up with family and friends. The safeguarding lead told us how they ensured people in the service were seen as part of the community by the local authority safeguarding board.

The local authority safeguarding board reported that staff in the service worked collaboratively with them to improve safeguarding experiences for people at the service. The provider collaborative involved people at the service in their processes to ensure their voice was heard.

The trust implemented processes to enable staff and leaders to engage with people, communities and partners and share learning and improve outcomes for people. One example was staff using learning from deaths of people with learning disabilities in the community to improve the health of people in the service.

Senior leaders told us that the trust had a research programme focused upon understanding outcomes from hospital admission. This was looking at the national and local picture. The trust was awarded funding to evaluate care and treatment reviews for adults with learning disabilities and autism with the aim to understand outcomes and publish a good practice guide. The trust was working with a local university looking at national datasets to evaluate outcomes from hospital admission and were preparing two papers for publication. Other research projects included trials for ‘Sertraline for Anxiety in adults with a diagnosis of Autism’; guided self-help versus treatment as usual for depression for autistic adults; Trauma-Aid: Eye movement desensitisation and reprocessing for symptoms of post-traumatic stress disorder in adults with intellectual disabilities; Antipsychotic Prescribing for Adults across Specialist Intellectual Disability Services. Managers told us about specific quality improvement initiatives introduced on their wards. These included, ‘Improving the Documentation of Handover at Brooklands’; Improving patient safety by increasing the number of referrals to the Dysphagia Service to prevent / reduce choking incidents; ‘Identification of Risk Factors in Learning Disability and Autism Patients’; Improvements in diet and physical activity in line with national guidance/recommendations; Improving the wound pathways; Culture of Care Programme; Improving patient engagement in contributing to their care records; Implementing a one-page profile to improve engagement and communication between staff and patients; Improving access to activities. Senior leaders told us staff records for seclusion and observation improved after this was set as a quality goal. The service held a monthly secure services steering group that drove forward service development ideas.

The provider shared published research reports completed by clinical professionals working within the Brooklands service, for example ‘A systematic review of in-patient psychiatric care for people with intellectual disabilities and/or autism: effectiveness, patient safety and experience’. We reviewed ward governance meeting minutes for Eden ward which stated that Eden ward was part of the trauma aid trial with 3 people participating and was involved in the Eye Movement Desensitisation and Reprocessing (EDMR) research project.