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Inspection Summary


Overall summary & rating

Updated 8 February 2018

We do not currently rate community sexual health services.

The Brandon Centre provides contraception and sexual health services to young people aged 12 to 24 in the London Boroughs of Camden and Islington. We carried out an announced inspection of the service on 14 and 15 November 2017.

We found the following areas of good practice:

  • The service demonstrated how learning took place from incident investigations, including from near misses and the review of individual cases.
  • Staff understood and adhered to the principles of the duty of candour.
  • We saw excellent safeguarding practices including multidisciplinary working and a rapid response for urgent safeguarding concerns.
  • Staff achieved a balance between appropriate risk management and meeting the sexual health needs of young people who presented with complex or high-risk behavioural needs.
  • Staffing was provided by an experienced and competent multidisciplinary team. Clinical staff practiced at other services and demonstrated their commitment for children and young people. The service had good systems in place to ensure continuity of care when patients were seen by different members of the team.
  • The service ensured that when something goes wrong, young people received a sincere and timely apology. We saw that young people were told about any actions taken to improve processes to prevent the same happening again.
  • Staff gave sufficient priority to the safeguarding of vulnerable adults, children and young people and focused on early identification.
  • The service monitored patient outcomes regularly to improve care including treatment for sexually transmitted infections and care plans for pregnant patients.
  • There were extensive opportunities for staff to undertake continuing multidisciplinary professional development and to progress in their clinical competencies. Each individual also had access to regular supervision and appraisal to support the effective delivery of care and treatment.
  • Multidisciplinary working was embedded in practice and staff used a range of established links with social services, safeguarding teams and genitourinary medicine providers to ensure patients received coordinated care. We saw examples of excellent proactive work from clinicians when patients were under the care of multiple doctors in different specialties.
  • The centre team invested considerable time and resources in developing health promotion interventions and strategies that met individual needs. This included highly individualised contraception, sex and sexual health advice for people based on their identity, experience and age. The service monitored outcomes from health promotion work and used this to further develop the service and identify unmet need.
  • Staff used consent and mental capacity assessments in line with legislation and guidance for patients based on their age and level of need, such as the Fraser guidelines.
  • Patient survey results and feedback from patients was consistently good and all of the patients we spoke with were passionate about the service. There was evidence of long-term care for patients and individuals frequently cited the individualised and confidential service as important factors in their decision to go there. Individuals gave examples of significant levels of support staff had provided that had improved their lives for the better.
  • Staff recognised and respected the totality of young people’s needs.The service adapted care and advice options to the changing needs of the patient population and local young people. This was an ongoing process and we saw substantial evidence the service was proactive in ensuring individual needs were understood and met.
  • Staff used rapid access pathways and partner services to ensure patients who were vulnerable received coordinated care, including in urgent circumstances such as suspected sexual exploitation.
  • Facilities and premises are appropriate for the services being delivered.
  • There was a consistent, demonstrable focus on improving the service for patients and improving work processes for staff that paid attention to detail. The service ensured a consistent focus on this through structured clinical governance and a programme of meetings that enabled all staff were involved in the running of the service.
  • The overall culture of the service was demonstrably passionate and positive and this was reflected in all elements of the operation.
  • The leadership team was highly respected and demonstrated how they engaged with staff in the running of the service, including for development and improvement.

This was a dynamic service led by a motivated team of experienced specialists and professionals keen to develop their career in sexual health. The service went above and beyond the expectations of young people and meeting the needs of its local community.

Inspection areas

Safe

Updated 8 February 2018

  • An incident reporting system was embedded in the service and staff demonstrated how this contributed to safer standards of care and practice.
  • Effective infection control audits were in place and had demonstrably led to improved practice and environmental maintenance.
  • Safeguarding was a priority for the whole team, which was evident in our review of clinical governance processes and in the practice of staff.
  • Staff achieved a balance between appropriate risk management and meeting the sexual health needs of young people who presented with complex or high-risk behavioural needs.
  • Staffing was provided by an experienced multidisciplinary team. Clinical staff practiced at other services and demonstrated their commitment for children and young people. The service had seamless systems in place to ensure continuity of care when patients were seen by different members of the team.
  • A mandatory training programme ensured staff met the needs of patients and the service manager maintained oversight of this.

Effective

Updated 8 February 2018

  • People’s care and treatment was evidence-based against national guidance from appropriate organisations including the British Association of Sexual Health and HIV, the British HIV Association and the Faculty of Reproductive and Sexual Health.
  • Staff had established working links with a range of multidisciplinary professionals that enabled them to refer patients to other specialties. We saw examples that these relationships resulted in better patient outcomes, including through the use of internal referral pathways to the counselling and psychotherapy service.
  • The service monitored patient outcomes including treatment for sexually transmitted infections and care plans for pregnant patients’. This information was used to improve and develop services.
  • The service had a track record of 100% success in initiating partner notifications for patients who received a positive test result for a sexually transmitted infection. The completion rate consistently met national standards. This meant the risk of onward infection from each person’s sexual network was decreased.
  • Staff provided sexual health promotion information to patients to help them also look after the health of their partner(s). This included providing young men with information on female sexual health and vice versa.
  • Significant focus was placed on developing staff competencies and professional practice and each individual underwent regular supervision and appraisal. Learning opportunities were multidisciplinary and the service manager facilitated an annual away day for staff to access the professional expertise of other clinicians.
  • Health promotion formed a significant element of the service and staff delivered this in line with the latest national guidance and tailored to each individual. Outcomes were monitored for further service development.

Caring

Updated 8 February 2018

  • The service promoted open and honest feedback from people who used the service and used this to identify areas of good practice and for improvement.
  • In the patient survey carried out between April 2016 and June 2017, 100% of respondents described their care as very good. They also rated dignity and respect highly.
  • Feedback from patients was unwaveringly positive. Frequent comments about the service cited individual service, a non-judgemental attitude from staff and accessibility.
  • Patients gave examples of how staff involved them in their care and provided emotional support when needed. This had led to word-of-mouth recommendations amongst the young people in the local area.

Responsive

Updated 8 February 2018

  • The organisation demonstrated adaptability to meet the increasingly complex needs of local young people. This included through service reconfiguration, the implementation of more streamlined teams and significant partnership working.
  • Staff had developed communication techniques to help them more effectively and efficiently understand the needs of individuals.
  • Staff delivered services with recognition of the principles of equality and diversity and patients said they felt they were never judged.
  • Young people had contributed significantly to service development to ensure it continued to meet their needs, particularly through a period of challenge when a substantive local service closed.
  • Systems were in place to ensure patients who were vulnerable received appropriate care that were coordinated by local teams such as safeguarding and mental health. Staff used rapid access care pathways where they suspected domestic violence or sexual exploitation.
  • Patients could access the service on a pre-booked or walk-in basis and the senior team had reconfigured the service to meet the demands of increasingly complex needs and the overall 11% increase in young people in 2017.
  • In 2017, the service cancelled 15 clinics due to late-notice of non-availability of staff. In each instance a member of staff contacted the affected young person to find out if a service could be provided without clinical input, such as free condoms. All young person were offered another appointment and signposted to the next most appropriate service in the case of urgent need.

Well-led

Updated 8 February 2018

  • The service manager had improved clinical governance systems in 2017 and we saw a positive track record of performance and quality review and improvement.
  • The leadership structure was stable and coherent and all of the staff we spoke with were positive about this.
  • The service had developed a service charter with young people to establish expectations and minimum standards.
  • The senior team with their counterparts in the psychotherapy service met regularly to ensure decision-making was completed with all service users in mind.
  • The senior team placed value on the work-life balance of staff and ensured support was in place for any circumstances that added pressure to the team.
  • Engagement with young people who used the service and the local community was embedded in practice and the entire team demonstrated how this contributed to development and improvement. This was also evident in the decoration of the environment, staff approach to communication and the types of appointments offered.
Checks on specific services

Sexual health services

Updated 8 February 2018

The Brandon Centre provides contraception and sexual health services to young people aged 12 to 24 in Camden and Islington.