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Provider: Birmingham Community Healthcare NHS Foundation Trust Good

On 30 September 2014, we published our inspection reports for Birmingham Community Healthcare NHS Trust.

Read the full service reports below.

We are carrying out checks on locations registered by this provider using our new way of inspecting services. We will publish the reports when our checks are complete.

Inspection Summary


Overall summary & rating

Good

Updated 30 September 2014

We found that the provider was performing at a level which led to a judgement of Good. Services were safe, staff reported incidents and near misses and learning took place. The majority of services had sufficient staff though there were a number of vacancies across most teams, especially administrative staff, which were impacting on the delivery of services. Staff received suitable training and supervision.

Services were delivered using evidence based practice, and were delivered through multidisciplinary teams utilising care pathways. The majority of premises were fit for purpose and equipment was available for staff to access in the community.

Staff were caring and compassionate, and we saw some excellent examples of care especially in end of life services. The majority of services were responsive to the needs of patients, and there were innovative examples of care delivery. However there were some services, particularly in dental and children and family services where services were not as responsive as they should be.

The trust is well led, with an accessible and visible executive team, especially the chief executive and executive nurse. Governance systems and processes are in place and there is performance and quality management information available. Quality is high on the trusts agenda.        

Inspection areas

Safe

Good

Updated 30 September 2014

We judged services to be safe at the time of our inspection. Systems and processes were in place to report incidents, accidents and near misses, and there was evidence of learning though this varied across different services. Infection prevention measures were effective; staff actively washed their hands and were bare below their elbows in clinical areas. Some concerns were identified in dental services, related to decontamination processes, but the trust were aware of these and were taking action.

The majority of facilities were in a good state of repair, though there were one of two concerns regarding the timeliness of action by the estates department. There were some trip hazards and unlocked facilities that could have posed a risk in the intermediate care units. Medicines were managed effectively, safeguarding policies and training were effective and records were well maintained. Record keeping was good, though some concerns were identified with the quality of records on some inpatient wards.

There were some concerns regarding staffing levels, clinical staff from a range of services indicated that there were not enough administrative staff which required them to cover these duties. Data from the trust indicated they were within safe staffing levels. Vacancies existed in many community teams; some had been filled with temporary staff, some of whom had been in a temporary position for many months.

Major incident plans were in place though staff from adult and children’s services and inpatient units indicated that they had not received any training.

Effective

Good

Updated 30 September 2014

Over all the effectiveness of services was good. The majority of staff used national guidelines to provide care, and in some cases this was being recognised nationally. The use of national guidelines was more limited across inpatient units with some concerns regarding the provision of guidelines for stroke care. Pain relief medication was provided as required, with anticipatory prescribing in end of life care.

Patients nutritional and hydration care was appropriately managed, and there were a range of patient outcome measures identified across teams, the majority being positive; though inpatient services would benefit from further development in this area.

Staff took part in audit activity, and there was a comprehensive array of performance and quality information available, though not all clinical teams had access at present. Staff were competent to deliver services, and the majority had access to performance assessments, supervision and mandatory and professional training, though some gaps did exist.

Overall access to equipment was good, and the majority of premises were of good quality.

Multi-disciplinary team working took place across teams both within Birmingham Community Healthcare NHS Trust and with staff from other organisations. Pathways were utilised though there were concerns from staff in children and family services about the effectiveness of transitional arrangements between children’s and adults services.

Caring

Good

Updated 30 September 2014

Staff were caring and compassionate towards their patients and families, and sought to respect their dignity at all times. We observed and found some excellent care in end of life services, including nursing staff verifying expected deaths, and seeking to meet all the needs of their patients, including understanding and taking into account difference in cultural need.

The majority of patients were involved in decisions about their care, and staff sought to take the time to explain to patients about their care to ensure patients could fully consent to their treatments.

Staff provided emotional support for patients, and we discussed a range of support that staff in end of life services had provided to patients and their families including their approach to involving parents individually depending on their emotional state, open visiting on the Sheldon Unit and writing to employers to support parents care effectively for their children.

Responsive

Good

Updated 30 September 2014

The majority of services were responsive to the needs of patients, though there were concerns regarding some services for children, young people and their families. A range of services were provided to meet the needs of people and staff endeavoured to provide flexible services as close to people’s homes as possible.

The single point of access service provided a range of interventions that prevented around 200 people a week requiring hospital admission. Although most services provided care within the agreed time frames, some children’s services, and in particular speech and language services had had long waiting times, and whilst they were reducing still exceeded the expected timeframe. Other delays were also noted with some dental services.

The trust handled complaints appropriately, and sought a variety of ways in which to gain feedback and handle complaints.

Well-led

Good

Updated 30 September 2014

Overall the provider was a well led organisation, with an open and supportive culture. The executive team, and chief executive and executive nurse in particular were well known amongst staff, and made time to visit with staff to hear their views of the organisation. The chief executive took the opportunity to communicate with staff in a variety of ways including video blogs, and there was a dedicated email address for the chief executive for staff to provide feedback.

There was a trust vision and values in place, the values had been developed in conjunction with staff, though at the time of the inspection knowledge varied across the staff groups that we interviewed.

There were appropriate governance and performance management structures in place that extended corporately down into the divisions. Performance and safety information is available to staff and is shared in a variety of ways. Continuous improvement of these systems takes place for example the development of Gel Solutions that will provide all staff with ‘live’ information on performance and quality indicators. The trust had also developed its own essential care indicators as quality measures. There was some concern regarding the visibility of other senior directorate managers, and some staff were more familiar with the executive staff than their own directorate leadership.

Patients, staff and members of the public were engaged by the trust, and there was evidence of improving patient satisfaction from surveys and the Family and Friends test.