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Provider: Lincolnshire Community Health Services NHS Trust Good

Inspection Summary


Overall summary & rating

Good

Updated 10 December 2014

When aggregating ratings, our inspection teams follow a set of principles to ensure consistent decisions. The principles will normally apply but will be balanced by inspection teams using their discretion and professional judgement in the light of all of the available evidence.

Overall we judged the trust to be good. We identified some concerns regarding how safe services were, in particular concerns regarding staffing levels especially in community services; and a concern regarding the prescription of a controlled drug in the operating theatre at John Coupland Hospital that was contrary to trust policy.

The majority of staff utilised evidence based guidance and received suitable training and support to carry out their roles effectively. Improvements were requiredregarding supervision arrangements for some staff.

Feedback from patients and their carers was positive with the majority complementary about the caring nature and positive attitudes of staff andinvolvement in their care.

The majority of services were responsive to the needs of patients, and the majority of targets were being met or performance was improving. However, there were some gaps in children’s and family services, and some specialist adult services.

The majority of services were well led at a local level as well as corporately across the trust. There were some areas of improvement in children's and family services.

Inspection areas

Safe

Requires improvement

Updated 10 December 2014

We identified a number of concerns regarding the safety of services, and judged this to require improvement.

Whilst staff were supported to report incidents and knew what the systems were to do so, learning that took place tended to remain local. Whist the majority of staff undertook good infection prevention measures, and premises were clean, a few staff did not follow good practice.

The majority of medicines management practices were good; however we identified concerns regarding the prescription of a controlled drug in the operating theatre at John Coupland Hospital that was contrary to trust policy.

Safeguarding was good, staff were aware of their responsibilities and training was high. Lone working practices were for the majority good, with some exceptions in the children’s and families directorate.

Record keeping was of an acceptable standard, though the electronic system and wireless connectivity issues were causing frustration amongst staff and added to the length of their working day.

There were numerous concerns regarding staffing levels and the correct deployment of staff across all service areas. The trust had for the most part plans in place to recruit, but in the interim staff were working long hours and this was compounded by the concerns regarding the patient record system.

Effective

Good

Updated 10 December 2014

The majority of staff utilised evidence based guidance, and care was delivered using national quality frameworks. We judged the effectiveness of services to be good.

Pain relief was provided as appropriate for patients using end of life services, and appropriate assessments of patient need regarding nutrition and hydration were undertaken.

Most staff received mandatory training, had access to supervision and received an appraisal. However this was not universally the case and further improvement is needed particularly for supervision for some staff. A range of audits had been undertaken across the trust and quality targets met, but this was not the case for some community services for adults with long term conditions.

A range of audits had taken place across the trust, though some services had limited audit activity in relation to the outcome and impact of the services they provided.

Multidisciplinary team working took place across the organisation with good links across other primary medical and secondary acute providers.

Caring

Good

Updated 10 December 2014

Overwhelmingly from patient feedback, and from observations carried out during the inspection, staff provided caring and compassionate care. We judged caring as good.

Staff maintained the privacy and dignity of patients, and involved patients as much as possible in decisions about their care, providing written information when required. Patient survey information demonstrated a high level of satisfaction with care received.

A range of emotional support was provided, and patients were encouraged to self-care where appropriate.

Responsive

Good

Updated 10 December 2014

Overall services were responsive to the needs of patients. Services were planned to meet the needs of patients, though there were some gaps in children’s and family services, and some specialist adult services. Discharge and transition arrangements were in place, and complaints were managed appropriately.

The majority of access targets were being met, and delivery in adult community services was improving, though some gaps remained.

Well-led

Good

Updated 10 December 2014

The trust had a vision and values in place and whilst many staff were aware, this was not the case for all staff. There were appropriate governance, risk management and quality systems in place that were replicated across the various business units.

Leadership locally and strategically was good, staff felt well supported and believed that the culture was open and encouraged learning and improvement. There were examples of patient, public and staff engagement, though the staff survey results had shown deterioration in the 2013 survey.

There were some examples of innovation across the different services of the organisation.