Durham Dales Health Federation

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 previous inspection we rated this key question as Requires Improvement. At this assessment we saw improvements had been made and the rating has changed to Good. This meant the service was consistently managed and well-led.

We looked for evidence that the service had followed their action plan following our previous inspection. We saw that leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. Leaders and the culture they created promoted high-quality, person-centred care. 

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.

We saw the service had a business plan which included their shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

Staff told us from the staff surveys we sent out, that they all thought there was a clear vision for the future. Feedback was mixed as to whether staff were involved in the planning of this. Some staff said they were not involved. Others told us they had helped to devise the vision, and they had supported the development of new services. They had been encouraged to put forward ideas, had regular sit down and reflection meetings on the new service delivery to help them move forward.

The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and they embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Staff consistently reported that the management team at the service were approachable, supportive and made them feel valuable. Staff were encouraged to develop and encouraged to attend training. The various teams in the service were supported to grow and improve. There was a weekly newsletter produced for staff.

We saw the leadership team worked with GP practices in the primary care network and were engaged in the development of primary care services within the local area.

At our previous inspection in 2022 some staff told us they were unsure or unaware of who the Freedom to Speak Up Guardian was for the service. Some staff said that general issues raised with management had not been addressed.

At this assessment we saw that the service fostered a positive culture where people felt they could speak up and their voice would be heard. The service had Freedom to Speak Up and whistleblowing policy and arrangements in place for staff to raise concerns. Staff told us from questionnaires they completed, that they were aware of how to raise concerns.

Staff told us they were well supported; they had regular meetings with managers. Changes were made to processes at the service with a positive effect, following staff feedback. We were told leaders gave thanks to staff for their feedback.

The service valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who work for them. The management team valued diversity and ensured they followed best practice guidance.

At our previous inspection we found that some assurance processes did not operate effectively. For example, there were gaps in training for staff, a lack of assurance of the safety of premises and gaps in infection control arrangements.

At this assessment we saw that improvements had been made. We saw that the issues we raised at the previous inspection had been addressed.

The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They acted on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

Leaders and managers supported staff, and staff we received feedback from were clear on their individual roles and responsibilities. Managers met with staff regularly to complete appraisals and performance reviews. The provider had established governance processes that were appropriate for their service. Staff could access all required policies and procedures. Managers held regular staff meetings, during which they discussed clinical concerns and emerging risks. Managers clearly recorded any actions arising from these meetings and ensured they shared these with staff. Staff took patient confidentiality and information security seriously.

The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They shared information and learning with partners and collaborated with them for improvement.

The service assisted member practices with offering extended access and an overflow service. They had linked in with their patient forums to gain community patient feedback. They had developed teams to assist the community and offered services such as a community wellness team, care navigation, clinical pharmacists, healthcare coordinators, social prescribing link workers, an integrated diabetes service and practice aligned mental health services.

The service focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to safe, effective practice and research.

The service’s business plan was in place and set out how they were going to drive forward improvements. Staff were encouraged to put forward and test out new ways of working.

The service had a link worker who was funded by the local Integrated Care Board (ICB) who worked with the veteran’s community and local veterans’ charity. A hospital trust had adopted the ideas from this service model.