Archived: Herstmonceux Integrative Health Centre

The Community Cardiology Service started as a practice based commissioning (PBC) scheme in 2008. It was conceived by Drs Jackson, Lloyd and Blakey (Directors of Integrated Cardiology Solutions Ltd) and aligned with the Department of Health White paper 2006: Our Health, Our Care, Our Say. It was founded by the Hailsham PBC Group in collaboration with the local clinical commissioning group, NHS trust and heart network. The combined aims of this partnership are:

• patient focussed care, closer to home and avoiding unnecessary trips to hospital.

• delivering a one stop non-invasive cardiology assessment and diagnostic service with a holistic primary care focus

• integrating primary and secondary services with a seamless care pathway from the patient perspective.

• reducing cardiology outpatient waiting times to achieve 18 week targets.

Following the success of the pilot scheme in the Hailsham and Herstmonceux area, the service was rolled out to the wider Eastbourne, Hailsham and Seaford area in 2012. The expansion of the service, changes to primary care contracting and reconfiguration of primary care practices in Hailsham, required that the contract for the service move to its own business entity. Integrated Cardiology Solutions Ltd. was founded by the clinicians working in the service in 2014 for this sole purpose. It assumed the contract for the service on 1st October 2015.

There were two diagnostic tests carried out at Herstmonceux Integrative Health Centre. These were electrocardiograms (which is a test to measure cardiac rhythm and electric activity) and echocardiograms (which enable an examination of the heart using an ultrasound scanner).

This location is registered for the regulated activities of:

• Diagnostic and screening procedures

• Treatment of disease and disorder

We inspected this service using our comprehensive inspection methodology supported by the diagnostic imaging inspection service framework. We carried out an inspection on 17 December 2019 at short notice and conducted an interview with the CEO on 31 December 2019.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

Services we rate

We had not rated this service before. We rated it as Good overall.

This was because:

• Staff received and kept up-to-date with their mandatory training.

• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse, and they knew how to apply it.

• The service controlled infection risk. Staff kept equipment and the premises visibly clean.

• The design, maintenance and use of facilities, premises and equipment kept people safe. Staff were trained to use them. Staff managed clinical waste well.

• Staff knew about and dealt with any specific risk issues.

• The service had enough staff with the right qualifications, skills, training and experience to provide the right care and treatment.

• Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date, stored securely and easily available to all staff providing care.

• The service knew how to manage patient safety incidents. Staff could recognise incidents and near misses and knew how to report them appropriately.

• The service provided care and treatment based on national guidance and evidence-based practice. Managers checked to make sure staff followed guidance.

• Staff monitored the effectiveness of care and treatment. They used the findings to make improvements and achieved good outcomes for patients.

• Staff were experienced, qualified and had the right skills and knowledge to meet the needs of patients.

• Staff treated patients with compassion and kindness and respected their privacy and dignity.

• Staff gave patients and those close to them help, emotional support and advice when they needed it.

• Staff made sure patients and those close to them understood their care and treatment.

• Managers planned and organised services, so they met the changing needs of the local population.

• The service was inclusive and took account of patients’ individual needs and preferences. Staff made reasonable adjustments to help patients access services. They coordinated care with other services and providers.

• People could access the service when they needed it and received the right care promptly. scan in line with

• Staff understood the policy on complaints and knew how to handle them.

• Leaders had the skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff. They supported staff to develop their skills and take on more senior roles.

• The service had a vision for what it wanted to achieve and a strategy to turn it into action.

• Staff felt respected, supported and valued. They were focused on the needs of patients receiving care.

• Leaders operated effective governance processes throughout the service and with partner organisations. Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service.

• Leaders and teams used systems to manage performance effectively.

• The service collected reliable data and analysed it. Staff could find the data they needed, in easily accessible formats, to understand performance, make decisions and improvements. The information systems were integrated and secure.

• Leaders and staff actively and openly engaged with patients and staff.

• All staff were committed to continually learning and improving services. They had a good understanding of quality improvement methods and the skills to use them. Leaders encouraged innovation and participation in research.

However:

• Most policies did not have review dates.

• Although staff cleaned equipment, they did not disinfect it between patient use.

• Staff did not always have access to interpreter services for patients.

Nigel Acheson

Deputy Chief Inspector of Hospitals