28 and 29 November 2017
During a routine inspection
We carried out an announced inspection of Terrence Higgins Trust South West as part of our programme of comprehensive inspections of independent health services between 28 and 29 November 2016. The service was registered with the Care Quality Commission to provide the following regulated activities: diagnostic and screening services, family planning and the treatment of disease, disorder or illness. There are no ratings for this inspection as we do not currently rate community based independent sexual health services.
Terrence Higgins Trust South West is part of a national organisation for people over the age of 18. The trust campaigns on various issues related to human immunodeficiency virus ( HIV). In particular the charity aims to reduce the spread of HIV and promote good sexual health (including safe sex). They provide services on a national and local level to people with, affected by, or at risk of contracting HIV and campaign for greater public understanding of the impact of HIV and acquired immune deficiency syndrome(AIDS). The Bristol branch provides services to people living in Bristol and the wider areas. The service was provided in line with the terms of the contract agreed with the local commissioners. The service was innovative in ways in which they reached high risk client groups and vulnerable service users.
The service was contracted to provide a weekly ‘fastest’ clinic for up to 10 people. A ‘fastest’ is where people are screened for HIV and receive the result of the test during the clinic visit. The test used by the service provided a result within 20 minutes. People were also provided with the opportunity to be tested for other sexually transmitted infections at this clinic.
Routine outreach and pop up clinics offering the ‘fastest’ were also provided to reach high risk groups within the local community. Support was also provided by a registered nurse to prisoners, prison staff and GPs at three local prisons. We did not visit any of these as part of our inspection.
The service also provided an education service to both statutory and non-statutory organisations regarding HIV and related issues. A counselling service was provided from Terence Higgins South West together with support groups for people living with HIV. These aspects of care and treatment are not part of the Care Quality Commission (CQC) registration.
We found people were provided with a safe, effective, caring, responsive, and well led service. Our key findings were as follows:
Staff were encouraged to report incidents and action was taken as a result. The organisation and staff were aware of the importance of Duty of Candour legislation and when to apply this.
Staff were provided with guidance and training regarding the safeguarding of vulnerable adults. Clinical staff were also made aware of their responsibilities for any children attending the clinic with an adult. Staff had access to additional role specific training to ensure they were competent to deliver the service.
The areas of the building that service users accessed were clean, hygienic in appearance and free from clutter. Staff had access to and consistently used protective personal equipment to promote the control of infection.
The service used technology appropriately in order to deliver an effective service. The service liaised and worked with other organisations in the local and wider areas to assist services users to access appropriate care and treatment. For people who required additional emotional help and support, pathways were in place to refer service users to appropriate professionals.
People who used the service consistently made positive comments about the service, the staff and the manner in which they were treated. Staff showed empathy, kindness and understanding to service users.
Risk assessments were carried out to identify and reduce any identified risks to service users and staff.
The culture of the service was one of openness and transparency. The local leadership shaped the culture through effective engagement with staff and service users. Staff felt respected and valued by their colleagues and their managers.
However, there were also areas of practice where the service needs to make improvements.
Importantly, the organisation should:
- review the arrangements for storing clinical waste prior to its collection.
- ensure combustible materials stored on landings and corridors that increase the fire risk within the building are removed.
- ensure peoples' medical records are completed fully and that the records are clear and understandable to the reader, particularly where acronyms are used.
- make sure staff are fully aware of the action to take should there be a need for a staff member to use their panic alarm. The organisation should ensure staff using the counselling rooms have a means to call for help in an emergency.
- systems for identifying, monitoring and mitigating against risks should be strengthened.
- review the facilities in place for hand washing in clinical rooms.
Professor Sir Mike Richards
Chief Inspector of Hospitals
Overall summary