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Monitoring questions for community health services (NHS and independent)

Categories:
  • Organisations we regulate,
  • Community health services

During the monitoring call our inspector will focus on these specific key lines of enquiry. You can open the questions to see the type of detail they will be interested in.

Safe

S1: How do systems, processes and practices keep people safe and safeguarded from abuse?
  • Are infection risks to people using the service being thoroughly assessed and managed?
  • Have you changed the layout/environment of clinical and non-clinical areas to continue to provide services safely in this period? For example, clean sites, vehicle layout, separate entrances and waiting areas for known/suspected COVID patients, additional signage, spaces between stations, isolation facilities, ensuring compliance with best practice guidance when visiting people in their own homes etc.
  • Do you have the resources to obtain, and reliable access to, all the supplies, personal protective equipment and COVID-19 testing needed, for both staff and, where appropriate, people who use the service?
  • Are working arrangements and procedures clear and accessible to staff, people who use the service, their supporters and, where appropriate, visitors to the service?
  • Are people using the service being protected from abuse, neglect, discrimination and loss of their human rights?
  • Where applicable, have you identified when they may be depriving a person of their liberty, and followed the correct and lawful procedures, for example, DoLS application, Court of Protection?
  • Are your safeguarding and other policies and practice, together with local systems, properly managing any concerns about abuse and protecting people’s human rights?

S1. Additional prompts

All community health services, excluding CHS inpatients

  • How do you manage infection, prevention and control (IPC) issues in patients’ homes? For example, prevention of cross-contamination between homes, sanitisation of removed equipment.
  • Can you access adequate supplies of equipment to support care and rehabilitation at home, for example mattresses, syringe drivers, oxygen therapy, wheelchairs?
  • What assurances are there that equipment that has been out of use is safe?

Children and young people

  • How have you maintained robust safeguarding arrangements during the COVID-19 pandemic?
  • How have you followed up on vulnerable/at risk children, young people or family members?
  • What arrangements are in place to manage and identify appropriate safeguarding referrals of children and young people and how is this monitored and quality assured?
  • Are there any additional challenges to the process which could place children and young people at additional risk?
  • How are you dealing with risks if there a reduction in practitioners involved in safeguarding children?
  • What processes are in place to follow up on missed consultations for vulnerable children and young people, including those that have been missed or cancelled as a result of the COVID-19 pandemic?
  • Do you have appropriately sized PPE available for children and young people when needed?
S2: How are risks to people assessed, and their safety monitored and managed, so they are supported to stay safe?
  • Are risks to the health and wellbeing of people using the service being properly assessed, monitored and managed?
  • Are there enough suitable staff to provide safe care and treatment in a dignified and respectful way? Are escalation plans in place in response to surges in demand for example, second wave, seasonal pressures?
  • How are you identifying and managing risks for patients including any restrictive practices or issues affecting their legal or human rights?

S2. Additional prompts

Adults services

  • How does the service ensure caseloads are manageable in the community, such as support for people with long term conditions, pressure ulcers etc.
  • How are you identifying and managing risks to patients where there is pressure from other services to restrict access to care and treatment during the COVID-19 pandemic?

End of life care

  • How are you identifying COVID/non-COVID patients and providing appropriate support, advice and guidance?
S3: Do staff have all the information they need to deliver safe care and treatment to people?
  • Do you have access to and are following guidelines around Treatment Escalation Plans (TEPs), anticipatory care planning, Do Not Attempt CPR (DNACPR) orders and individualised care plans? Are plans in place for rapid transfer to preferred places of care – relationships and planning with primary, district nursing etc.
  • Can you effectively manage referrals and, where relevant, discharges and ensure safe transfers of care?
  • Where relevant, what testing arrangements are in place, and how do you handle transfers of known/suspected COVID patients safely?
  • How are you working with other partners?

S3. Additional prompts

All community health services

  • What steps have you taken to review care records and ensure that people do not have inappropriate DNACPR forms which were issued during the COVID-19 pandemic?
  • How do you ensure that people (for example older or disabled people) are not prevented from accessing active care and treatment through the inappropriate use of DNACPRs?

All community health services excluding inpatients

  • How do you ensure staff have access to electronic patient records?
  • How do you ensure staff have connectivity to recording systems regardless of location?

Children and young people

  • What plans are in place to support young people with complex needs in their transition to adult services?
S4: How does the provider ensure the proper and safe use of medicines, where the service is responsible?
  • Are medicines being managed safely and effectively?
  • Has COVID-19 impacted your ability to manage medicines?

S4. Additional prompts

All community health services

  • How do you ensure there is effective transparency and accountability of clinicians who are responsible for prescribing medicines?
  • How do you support patients to manage their own medications?
  • How do you maintain oversight of safe medicines and prescribing?

Children and young people

  • How are you encouraging children and young people to be immunised, including ensuring that immunisation programmes that were postponed during the COVID-19 pandemic (for example, in schools) are delivered?
S5: What is the track record on safety?
  • Are there any significant trends in non-COVID-19 activity - never events, significant incidents, themes in incidents, mortality, unexpected deaths?
  • What are you doing to assess and learn, including mortality reviews of non-COVID patients?
  • Are there any significant trends where groups of patients are faring worse in terms of safety concerns?

Effective

E1: Are people's needs assessed and care and treatment delivered in line with current legislation, standards and evidence-based guidance to achieve effective outcomes?
  • How are you identifying, cascading and keeping up-to-date with changes in clinical guidance?
  • Where people are subject to the Mental Health Act (MHA) how are you ensuring compliance with the MHA?
E2: How are people’s care and treatment outcomes monitored and how do they compare with other similar services?
  • How are you collecting information about people's care treatment and outcomes?
  • Where relevant, are you continuing to submit to relevant national clinical audits?
  • How are outcomes being monitored for groups of people that may be at higher risk, such as people in different ethnic groups and older people?

E2. Additional prompts

End of life care

  • Do you monitor preferred place of death outcomes?
E3: How does the service make sure that staff have the skills, knowledge and experience to deliver effective care, support and treatment?
  • How are you ensuring that all staff, including those being flexibly re-deployed, have the skills and training to carry out their roles effectively?

E3. Additional prompts

Adult services

  • How are you supporting staff (community nurses) to deal with patients that have increasingly complex needs in the community?
E4: How well do staff, teams and services work together within and across organisations to deliver effective care and treatment?
  • How are you ensuring that the necessary staff, teams and services are involved in assessing, planning and delivering peoples care and treatment?

E4. Additional prompts

All core services

  • How is access to mental health services/learning disability services facilitated?
  • What arrangements are in place to effectively share information across different services? For example, between adult and children’s services, or with acute settings?
E6: Is consent to care and treatment always sought in line with legislation and guidance?
  • How do you ensure consent to care and treatment is always sought in line with legislation and guidance? Including, where appropriate:
    • ensuring that people are involved in decisions about not providing care and treatment, including advanced care plans and DNACPR decisions?
    • promoting supportive practice that avoids the need for physical restraint? Where physical restraint may be necessary, how does the service ensure that it is used in a safe, proportionate, and monitored way as part of a wider person-centred support plan?
    • ensuring staff apply relevant legislation where people may lack capacity to consent to particular care and treatment, including the Mental Capacity Act 2005 (including DoLS) and the Children’s Acts 1989 and 2004?

E6. Additional prompts

All core services

  • Has you had any challenges for managing informed consent? For example, Gillick competencies and Fraser guidelines? How have these risks been mitigated?

Caring

C1: How does the service ensure that people are treated with kindness, respect and compassion, and that they are given emotional support when needed?
  • How have you adapted how you support and engage with patients and their families/loved ones?
  • How do you ensure the care delivered is compassionate and upholds people's human rights?

C1. Additional prompts

Inpatients and end of life care

  • How do you support patients to have contact with their wider group of family and friends?

End of life care

  • Is there a personalised approach to End of Life Care? Are patients involved in Advanced Care Decisions, how does the trust approach this?
  • Has you introduced the ResPECT process and have staff been trained in the use of the process? Are the recommendations for personalised care inclusive of the patient, their family and the multidisciplinary team?

Children and young people

  • What arrangements are in place to manage the needs of parents/carers and the family?
C2: How does the service support people to express their views and be actively involved in making decisions about their care, support and treatment as far as possible?
  • How do you support people to express their views and be actively involved in making decisions about their care, support and treatment as far as possible?
  • Where appropriate, how are you managing the impacts of limited visiting on patient's wellbeing?
  • Where appropriate, how are you promoting and ensuring patients know how to access advocacy support in the absence of ward visits?

C2. Additional prompts

End of life care

  • How do you ensure that people’s choices delivered in a timely way?
  • How are you ensuring that end of life care patients die in their preferred place of death?

Children and young people

  • How will you deal with calls from concerned parents of children with and without risk?
  • How have you communicated changes to the service to children, young people and their families for COVID-19 and non COVID-19 cases?
  • How have you ensured that the views of children and young people have been sought during this period?

Responsive

R1: How do people receive personalised care that is responsive to their needs?
  • How do you ensure that you meet the needs of the population served and do you enable flexibility, choice and continuity of care?
  • Where relevant, do individual patients have choices about how, when and where they are seen?

R1. Additional prompts

End of life care

  • How do you ensure that patient’s wishes about their preferred place of death are acted on quickly?
  • How are you supporting informal carers?

Children and young people

  • What is being done to identify and support babies and children and young people who have an increased risk of poor outcomes as result of service changes during the pandemic?
R2: Do services take account of the particular needs and choices of different people?
  • How are services delivered, made accessible and coordinated to take account of the needs of different people, including those with protected characteristics under the Equality Act and those in vulnerable circumstances? This may include:
    • how do you ensure that each patient has their information and communication needs identified, recorded, flagged, shared and met?
    • how do you identify and make other reasonable adjustments for disabled people?
  • Where new protocols for admission are being used, how are these being communicated to staff and how are they reviewed to ensure they are non-discriminatory?

R2. Additional prompts

All community health services

  • How do you ensure access to care and treatment for people who are digitally excluded, for example due to disability, poverty or language needs?

Inpatients

  • How are you adapting to provide care and treatment to patients recovering from COVID-19 (if applicable)?

End of life care

  • Do people at end of life and their families have access to differentiated and appropriate spiritual and pastoral and religious support? For example, Muslim, Hindu, Buddhist, Humanist, Jewish, Sikh?
R3: Can people access care and treatment in a timely way?
  • How are you managing access to the service to ensure that high-risk patients/pathways are being identified and prioritised appropriately, including reinstating services and handling backlogs of activity?
  • Is there a structured approach to patient flow that ensures all components of the system are appreciated and managed appropriately, and flow issues are escalated appropriately? How does the approach take account of the pandemic?

R3. Additional prompts

Adult services

  • What, if any, gaps are there in the provision of services to patients in the community?

Inpatients

  • What impact, if any, is there on patient pathways, where some services have not restarted post COVID-19?

End of life care

  • How are you ensuring that there is sufficient end of life care capacity in the community to meet any increase in demand? Is there any capacity to build in flex in the system?
  • How do you ensure that patient’s wishes about their preferred place of death are acted on quickly

Children and young people

  • What, if any, gaps are there in the provision of services to children, young people and families in the community? How is the impact of this being mitigated?
  • How are you ensuring that health visitors can carry out statutory baby checks?

Well-led

W1: Is there leadership capacity and capability to deliver high-quality, sustainable care?
  • Has there been any impact on leadership capacity as a result of the COVID-19 crisis? Are there plans and mitigations in place should it be affected?
  • Do leaders understand the challenges to quality and sustainability during this period, and can they identify the actions needed to address them? >
W3: Is there a culture of high-quality, sustainable care?
  • Is the service monitoring and protecting the health, safety and wellbeing of staff?
  • How are you taking action to protect the health, safety and wellbeing of staff, for example, access to emotional support, supporting staff to raise concerns, adequately risk-assessing and placing staff in appropriate environments to protect their health and safety, including staff in different ethnic groups and other staff at high risk of COVID 19? (not for NHS trusts – this is covered at trust level)
W4: Are there clear responsibilities, roles and systems of accountability to support good governance and management?
  • Can you work effectively with system partners when care and treatment is being commissioned, shared or transferred?

W4. Additional prompts

Inpatients

  • What are the arrangements for the governance of medical staffing?
W5: Are there clear and effective processes for managing risks, issues and performance?
  • Do you have effective systems and methods for monitoring the overall quality of the service and for responding to business risks and issues as they arise? How often are these reviewed?
Last updated:
26 November 2020