Archived: South Tyneside NHS Foundation Trust

Updated 2 March 2018

Not used

Updated 2 March 2018

Our rating of the trust stayed the same. We rated it as requires improvement because:

Updated 1 December 2015

Overall rating for this core service Good l

Overall community health services for adults were good, with caring rated as outstanding. Incidents were reported across teams and learning from incidents was identified. The safeguarding policy was understood by staff and used as part of their practice. Equipment was used safely. The service had infection prevention and control policies in place. Staffing levels were sufficient in most areas to meet current demand. The service had a lone working policy in place and implemented procedures to reduce the risks to staff working alone. The service had plans in place to respond to major incidents.

The service undertook a range of audits to improve performance and ensure patient safety. Clinical governance meetings were held regularly. The service had introduced the Friends and Family Test (FFT) patient satisfaction survey in January 2015. The service was in the process of introducing integrated care an innovative multi-disciplinary practice model.

Staff understood their individual roles and responsibilities. Recognised assessment tools were used for the assessment, planning, and review of patient care and treatment. There was good multi-disciplinary working and effective handover and multi-disciplinary team meetings. Staff consistently told us they had good links, and access to, a wide range of other services. Staff felt the executive team were approachable; but the community teams were attached to different divisions. Managers and team leaders demonstrated a clear understanding of their role and position in the trust. Local team leadership was effective.

Patients and their relatives were truly respected and valued as individuals and were empowered as partners in their care. Feedback from patients and their families was consistently positive about the way staff treated them. Patients thought staff went the extra mile in providing care, treatment, and support.There was a strong person-centred culture. Staff were considerate and empathetic towards patients and their relatives. Staff respected patient confidentiality in written records and other communications. The approach staff used in the home setting demonstrated compassion and consideration for the patient.

Patients could access community health services promptly. Discharge liaison arrangements between the acute hospital and community settings were in place. Arrangements were in place for the training of clinical staff in caring for patients living with dementia. Staff were aware of complaints patients had made, and what was done to resolve complaints. Following the investigation of complaints actions were identified. This was discussed with patients and actions were monitored to completion.

The service had governance and risk processes in place. The service actively maintained a risk register and responded to identified risks; long-term staff sickness was not identified on the register. The service planned for seasonal fluctuations in demand. Managers and staff told us they felt integrated care provided a clear vision for community services. The service had a strategy of improvement and changes to service delivery.

Updated 1 December 2015

Overall, we rated community health services for children, young people and families as good.

Services were safe and people were protected from harm. The staff knew how to manage and report incidents, we saw there had been learning following a serious case review. Risks were actively monitored and acted upon. We found that there were good safeguarding processes in place. We found that there was enough staff with the right qualifications to meet families needs. In addition, we saw that the clinics and health centres we visited were clean.

Services were effective. We found good evidence that the service reviewed and implemented national good practice guidelines. The trust had also successfully implemented evidence based programmes, such as the family nurse partnership programme. We also saw that patient outcomes and performance were monitored regularly, and that all staff received regular training, supervision and an annual appraisal. There was good evidence of multidisciplinary and multi-agency working across the services.

Services were caring. Children, young people and parents told us that they received compassionate care with good emotional support.

Services were responsive. We found the service planned and delivered services to meet the need of local families. In addition parents, children and young people were able to quickly access care at home or in a location that was appropriate to them.

Services were well led. Staff we spoke with told us the patient was at the centre of what they do, they were positive and proud about working for the organisation. There was an open culture in the service, and staff were engaged in the process of service improvement. Staff reported being supported by their line managers and teams within the organisation. Staff participated in a successful flu vaccination pilot, which has been widened and commissioned for a further three years. Staff were proud of this work and the positive evaluation.

Updated 1 December 2015

Overall we rated dental services at this trust as good, with well led as outstanding. The service was very well-led with organisational, governance and risk management structures in place. These governance arrangements were proactively reviewed and reflected best practice. There was strong leadership of the service, with an emphasis on driving continuous improvement. The local management team were visible and the culture was seen as open and transparent. There was strong collaboration and support across all of the service with a strong emphasis on improving the quality of care. Staff were aware of the way forward and vision for the organisation and said that they felt well supported and could raise any concerns with their line manager. Staff at all levels were actively encouraged to raise concerns. There was high levels of staff satisfaction across all staff groups. Team meetings and staff surveys demonstrated that the service engaged all staff.

Patients’ were protected from abuse and avoidable harm. Systems for identifying, investigating and learning from patient safety incidents were in place. Infection control procedures were in place. The environment and equipment were clean and well maintained.

Dental services were effective and focussed on the needs of patients and their oral health care. We observed good examples of effective collaborative working practises within the service. The service is able to meet the needs of the patients who visited the clinics for care and treatment because of the flexible attitude of all members of the service.

The patients we spoke with, their relatives or carers, said they had positive experiences of their care. We saw good examples of care being provided with compassion and of effective interactions between staff and patients. We found staff to be hard working, caring and committed to the care and treatment they provided. Staff spoke with passion about their work and conveyed how dedicated they were in what they did.

At each of the clinics we visited the staff responded to patient’s' needs. We found the service had begun actively seeking the views of patients using a variety of means using the new Friends and Family Test. People from all communities, who fit the referral criteria, could access the service. Effective multidisciplinary team working ensured patients were provided with care that met their needs and at the right time. Through effective management of resources, delays to treatment were kept to reasonable limits.

Updated 1 December 2015

Overall rating for this core service GOOD l

Overall, we rated community end of life care services as good, with caring rated as outstanding. Incident reporting was effective and embedded across the service. Staff were aware of their reporting responsibilities and there was evidence of learning from incidents. When things went wrong incidents were investigated, and lessons learned were shared. Risks to patients were assessed and managed to ensure safe delivery of care. Staff responded appropriately to safeguarding concerns. There were systems and processes for the monitoring of medication and infection control and they were regularly reviewed and improvements made. Staffing levels were monitored and reviewed to keep patients safe and meet their needs at all times of the day and night. Documentation and care records were completed appropriately. Do not attempt cardio-pulmonary resuscitation (DNACPR) forms were completed consistently. Equipment was available for patients and appropriate safety checks were in place.

Care and treatment followed evidence based guidance and legislation. Patient care was based on the best available evidence. Patients needs were assessed appropriately and care and treatment was planned and delivered in line with current legislation. Staff were appropriately qualified and competent to carry out their roles. There was a multi-disciplinary collaborative approach to care and treatment. Staff worked effectively in partnership with the mental health trust to promote the best outcomes for patients who were subject to the Mental Health Act.

Patients and their families were respected and valued and were empowered as partners in their care. Feedback from patients and their families was continually positive about the way staff treated them. There was a strong person centred culture. Staff always took patients personal, cultural, social and religious needs into account when delivering care. Patients emotional and social needs were valued by staff and was an important part of their care and treatment. Any complaints were dealt with appropriately and any lessons learnt were cascaded to staff.

Patients needs and preferences were important in the planning and delivery of services. The involvement of other organisations and the local community was important to how services were planned to ensure patients needs were met. Patients could access services in a way that suited them.

The leadership, governance and culture were used to drive and improve the delivery of high quality patient centred care. Staff were actively involved in the development of the service. Staff worked in collaboration with other services to provide high quality care. There were systems in place to monitor and audit the quality of care. Patients and their families were approached for their views and feedback was shared and acted upon.

Updated 2 March 2018

This was the first time the service had been rated. We rated it as good because:

• There were sufficient skilled and competent staff to meet the needs of patients. Staff managed caseloads effectively. Staff completed mandatory training and received regular supervision and appraisals. Staff sickness rates were very low and there were no vacancies within the service.
• Staff carried out effective patient assessments, including risk assessments. Physical health needs were assessed and any issues addressed. Patients had individualised intervention plans which were reflective of their needs and risks. Patients and family members were involved in decisions about treatment and care.
• Staff demonstrated a good understanding of safeguarding procedures and made referrals when appropriate. Staff had a thorough knowledge of the Mental Capacity Act and carried out capacity assessments when required.
• Staff knew how to report and record incidents, although there were low rates of incidents within the service. There were good processes in place to share learning from incidents across the trust.
• The staff team was made up of professionals from a range of disciplines, meaning patients had direct access to speech and language therapy, occupational therapy, physiotherapy and nursing interventions. Patients also had access to psychiatry and psychology interventions when needed.
• Staff knew patients well and were kind, caring and compassionate when delivering treatment and care. Feedback from patients and family members was positive.
• Staff were passionate about the service and morale was high. Managers within the service were highly regarded by staff.

However:

• There was no electronic patient case management system in place. Patient information and assessments were stored electronically but these could be changed without appropriate audit processes in place. Processes to flag risk were not robust. The trust planned to implement an electronic case management system into the service in February 2018.
• There was a lack of patient information leaflets within the service, although staff printed these off upon request.

Updated 2 March 2018

We have not rated this service before. We rated it as good because:

• There were sufficient skilled and competent staff to meet the needs of patients during the day. Staff completed mandatory training and received regular supervision. Staff were supported to attend additional training to meet the needs of patients. Staff sickness and vacancy rates were low. Bank staff were experienced learning disability staff who knew the service and patients well.
• Staff knew patients and their families well and had a thorough understanding of patient needs and risks. Comprehensive assessments including assessment of risk were regularly reviewed and updated, including at each admission for respite. Family members were very involved in assessment processes.
• Patients had individualised care plans which were reflective of their needs and risks. These included the views of patients and families. Patients with specific dietary needs had speech and language therapy assessments and care plans which reflected these.
• Staff were kind, caring and compassionate with a good understanding of the needs of patients. Family members knew staff well and felt listened to by staff.
• Staff had a good understanding of how to report incidents, even though there were low numbers of incidents. There were effective processes in place to learn from incidents when these did occur.
• Staff were passionate about the service and morale was high. Managers within the service were highly regarded by staff.

However:

• There was no female only lounge available in the unit, although staff used rooms on the ward appropriately to meet individual patient needs. Patients’ privacy and dignity was maintained as all bedrooms were en-suite and patients were supported to use the adapted bathroom.
• Doors were locked on the unit (for example bedroom doors and kitchen door). Staff said these would be unlocked based on individual patient assessment.
• No ligature assessment of the environment had been carried out, although staff were aware of these. Patients were individually risk assessed and none had been identified to be at risk of ligature due to their complex health needs.
• There were only two members of staff at night. We were concerned if both staff were attending to one patient, there would be no other staff to support other patients at that time.
• Staff did not carry personal alarms, despite them being available. We were concerned about how staff on night shift would raise alarms for assistance if required, when only two members of staff would be on duty.
• There was no electronic patient case management system in place. Patient information and assessments were stored electronically but these could be changed without appropriate audit processes in place. The trust planned to implement an electronic case management system into the service in February 2018.