South Warwickshire University NHS Foundation Trust

Updated 4 December 2019

Not used

Updated 4 December 2019

• We rated safe, effective, caring as good, and responsive and well led as outstanding. We found all four of the core services inspected as outstanding for being well led. In rating the trust, we took into account the current ratings of the eight services not inspected this time.
• We rated well-led for the trust overall as outstanding.
• Staff treated patients and their families with great compassion and kindness, respected their privacy and dignity, and took account of their individual needs. Patients and their families were truly respected and valued as individuals by an exceptional service. Staff found innovative ways to provide emotional support to patients, families and carers to minimise their distress. Staff routinely empowered patients to have a voice and ensured a person centred approach and went above and beyond to support them. Feedback about services was extremely positive.
• There was compassionate, inclusive and effective leadership at all levels. Leaders had the skills and abilities to run the service and deliver high-quality, patient centred care. Staff understood the trust’s vision and values, and their role in achieving them. Staff felt truly respected, supported and valued. They were highly motivated and committed to improving the quality and sustainability of care and people’s experiences. Staff at all levels were clear and passionate about their roles and accountabilities and had regular opportunities to meet, discuss and learn. The trust engaged well with patients, families, the local community and external partners to help improve services. All staff were highly committed to continually learning and improving services. There was a strong record of sharing work locally, nationally and internationally.
• Patients’ individual needs and preferences were central to the delivery of tailored services. Staff worked collaboratively with others in the wider system and local organisations to plan care and improve services. There was a proactive approach to understanding the needs and preferences of different groups of people and to delivering care in a way that met those needs, which was accessible and promoted equality. People could access the service when they needed it, in a way and time that suited them and received the right care at the right time. It was easy for people to give feedback and raise concerns about care received.
• The trust had enough staff to care for patients and keep them safe. Staff understood how to protect patients from abuse and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The trust managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided great care and treatment and prescribed pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.

However:

• Not all staff were up-to-date with mandatory and safeguarding training, but it was improving. Appraisal completion rates were below the trust target for allied health professional, nursing support and administrative staff groups in some areas.
• Some people could always not access the therapy service when they needed it. The service had effective plans in place to prioritise and mitigate this.
• Not all equipment in the emergency department (ED) was checked, and records kept that in line with trust policy and monitor all chemicals are stored safely.
• Consultant hours in the ED did not meet national guidance.
• Staff did not always complete or update risk assessments for each patient in medical care and did not always identify clear actions to remove or minimise risks.

Updated 4 December 2019

Updated 4 December 2019

Updated 4 December 2019

Our rating of this service improved. We rated it as outstanding because:

• Staff understood how to protect patients from abuse. The service controlled infection risk well. The premises and equipment kept people safe. Staff completed and updated risk assessments for each patient and removed or minimised risks. Staff kept detailed records of patients’ care and treatment. Medicines were safely prescribed, administered, recorded and stored. The service used monitoring results well to improve safety. The service managed patient safety incidents well.
• The service provided care and treatment based on national guidance and evidence-based practice. Staff regularly checked if patients were eating and drinking enough to stay healthy and help with their recovery. Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way. Staff monitored the effectiveness of care and treatment. All those responsible for delivering care worked together as a team to benefit patients. Staff gave patients practical support and advice to lead healthier lives. Staff supported patients to make informed decisions about their care and treatment.
• Staff treated patients with compassion and kindness. Staff provided emotional support to patients, families and carers to minimise their distress. Staff supported and involved patients, families and carers.
• The service proactively planned and provided care in a way that met the needs of local people and the communities served. The service was fully inclusive and took account of patients’ individual needs and preferences. It was easy for people to give feedback and raise concerns about care received. People could access the service when they needed it and receive the right care in a timely way. People almost all received timely access to initial assessment and treatment. The integrated single point of access service was working well, and we noted the reduction in the calls’ abandonment rates.
• Leaders had the experience, integrity, skills and abilities to run the service. The service had a clear vision for what it wanted to achieve and a realistic strategy to turn it into action. Staff felt respected, supported and valued. Leaders operated embedded and effective governance processes, throughout the service and with partner organisations. Leaders and teams used systems to manage performance effectively. The service collected reliable data and analysed it. Leaders and staff actively and openly engaged with patients, staff, equality groups, the public and local organisations to plan and manage services. All staff were committed to continually learning and improving services.

However,

• Not all staff were not up to date with mandatory training. The service did not have enough staff in all areas, but patients’ needs were being met.
• Completion rates did not meet the service target for Prevent training.
• Some people could always not access the therapy service when they needed it. The service had effective plans in place to prioritise and mitigate this.

Updated 4 December 2019

• Staff treated patients and their families with great compassion and kindness, respected their privacy and dignity, and took account of their individual needs. Patients and their families were truly respected and valued as individuals by an exceptional service. Staff found innovative ways to provide emotional support to patients, families and carers to minimise their distress. Staff routinely empowered children and young people to have a voice and ensured a family centered approach and went above and beyond to support them. Feedback about the service was extremely positive.
• There was compassionate, inclusive and effective leadership at all levels. Leaders had the skills and abilities to run the service and deliver high-quality, child and family centered care. Staff understood the service’s vision and values, and their role in achieving them. Staff felt truly respected, supported and valued. They were highly motivated and committed to improving the quality and sustainability of care and people’s experiences. Staff at all levels were clear and passionate about their roles and accountabilities and had regular opportunities to meet, discuss and learn. The service engaged very well with patients, families, the local community and external partners to help improve services. All staff were highly committed to continually learning and improving services. There was a strong record of sharing work locally, nationally and internationally.
• Children, young people and families individual needs and preferences were central to the delivery of tailored services. Staff worked collaboratively with others in the wider system and local organisations to plan care and improve services. There was a proactive approach to understanding the needs and preferences of different groups of people and to delivering care in a way that met those needs, which was accessible and promoted equality. People could access the service when they needed it, in a way and time that suited them and received the right care at the right time. It was easy for people to give feedback and raise concerns about care received.
• The service had enough staff to care for patients and keep them safe. Staff understood how to protect patients from abuse and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment and prescribed pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.

However:

• Not all staff were up-to-date with mandatory and safeguarding training. Completion rates for some courses did not meet the trust target.
• Appraisal completion rates were below the trust target for allied health professional, nursing support and administrative staff groups.

Updated 19 August 2016

We rated community in patient services as good because:

• We saw that community inpatient services were safe, effective, caring, responsive and well-led. All care provided revolved around patient rehabilitation and reablement. Feedback from patients and relatives was very positive and we observed staff were caring and compassionate in their approach.

• Admissions and discharges were well managed. Delayed transfers of care were mainly due to family choice, lack of nursing home places and waiting for packages of care.

• Staff were aware of specific needs individual patients had and were able to put in place appropriate arrangements, where possible. Staff were knowledgeable about the complaints process and what action they would take.

• Risks and issues described by staff corresponded to those reported and were understood by leaders.

• There was a clear vision and strategy for the future of the service. Leaders were clear of their roles and accountabilities. There was a strong focus on continuous learning and improvement at all staff levels. Staff shared innovations and improvement work that they were involved with.

• Staff on the Central England Rehabilitation Unit (CERU) had developed an assessment tool called Sensory Tool to Assess Responsiveness (STAR). STAR is a tool aimed at providing an accurate diagnosis of prolonged disordered consciousness and establishing any means of communication in the patient.

Updated 8 March 2018

Our rating of this service improved. We rated it as good because:

Updated 19 August 2016

Overall, we rated the community end of life care service as requires improvement.

We rated safety and caring as good, effectiveness and responsiveness as requiring improvement and well-led as inadequate.

• There was not a strategy for community end of life care services. Staff were unsure of the trust wide direction for the future of the end of life services.
• The trust did not have a non-executive director who provided representation of end of life care at board level.
• There were no formal processes in place to gather feedback from patients or relatives.
• The individual plan of care for the dying person, which was a replacement for the Liverpool Care Pathway, was designed to be used for patients in hospital and community settings. However, this was found to be not used by the community teams.
• The trust did not monitor the number of end of life patients who were rapidly discharged from hospital to die. Following our inspection the trust held a ‘rapid home to die workshop’ in June 2016 to assess and identify difficulties with the capacity of the community based services and coordination of the services, including third sector providers, involved in delivering end of life care.
• For the period January 2015 to January 2016 there were 906 deaths, of which less than half 434, (48%) of patients died in their preferred place of care.
• The community specialist palliative care team (SPCT) did not have a local audit programme in place, which meant they were unable to measure the effectiveness and outcomes of the service.
• Advance care plans (a plan that documents patients’ views, preferences and wishes about their future care) were not always in place for patients receiving end of life care and those we found, had not been consistently completed.
• We did not see evidence of how the service planned and delivered care to people in vulnerable circumstances,
• The SPCT did not carry personal protective clothing. This meant that staff and patients could be at risk of infection.
• Nutritional risk assessments were not always found in place. This meant there was a risk that patients would not receive the appropriate nutritional support and advice.
• The community SPCT were below the trust target for completion of mandatory training in eight of the 10 training requirements, including safeguarding children level one and two training. This meant that staff were not keeping their skills up-to-date and the service could not be assured that staff had the necessary knowledge in these areas.

However we also found:

• Patients were very positive about the service they received.
• Staff were committed to providing compassionate end of life care.
• Medicines were appropriately prescribed, administered and checked thoroughly and there was guidance available for staff on prescribing and the use of anticipatory medicines at the end of life.
• Staff working across end of life care community services used the same syringe driver; this ensured continuity of care and reduced the risk of medicine errors.
• Patients had access to equipment or aids they required. Community staff were able to arrange delivery of the equipment for patients who were returning home for their end of life care, on the same or the following day.
• The community specialist palliative care team (SPCT) provided services seven days a week. There was an on call consultant in palliative medicine available to provide telephone advice, to patients and professionals in community and acute settings, across Coventry and Warwickshire 24-hours a day.
• Do not attempt cardiopulmonary resuscitation (DNACPR) forms, indicated staff had involved the patient, or (if appropriate) relatives, in the decision.