St Martins Hospital

HCRG Care Services Ltd provide services within the Bath and North East Somerset (BaNES) area. Services are provided in the local community which includes impatient services and community adults and children’s services. Headquarters for the services were based at St Martin’s hospital in Bath.

St Martin’s hospital was previously registered under a previous entity. This was the first inspection for this service under this provider.

We undertook this inspection as part of our inspection programme and inspected the following three community core services.

Community Hospital - Inpatient Ward

There are two community hospitals serving the population of Bath and North East Somerset. Sulis Inpatient ward is located at St Martin Hospital and can admit up to 29 patients into bays or individual side rooms.

The aim of the inpatient service is to enable people to regain health and wellbeing through rehabilitation and recovery.

The community hospital inpatient service is part of an onward pathway of care for patients following a period of acute hospital care:

• active rehabilitation for individuals who have suffered a trauma or illness, to facilitate their ongoing independence and return to their normal place of residence as quickly as possible
• intensive and specialist rehabilitation for individuals following a stroke and are unable to return home directly from the Acute Stroke Unit
• palliative and end of life care for individuals who chose not to die at home.

Patients praised regular staff but commented that staffing levels were low, which limited the amount of time spent with them. They said the staff had encouraged patients to be independent but there was little time from staff to support them with regaining lost skills. Other patients were understanding of staff’s commitment to deliver good care but were concerned about their skills to meet their individual needs.

Patients feedback on their experiences of care related to the lack of staff on the ward, lack of activities and reablement. They were not aware of having a care plan or the arrangements for their discharge. Some patients commented on the poor frequency of physiotherapy and occupational therapy programmes to facilitate their discharge.

Generally, patients said the meals were of a good standard.

We rated it as requires improvement because:

• The target for mandatory training in key skills such as Basic Life Support, Moving and Handling and Fire awareness was not met.
• Checks of the equipment held in resuscitation trolley were not robust
• Staff assessed risks to patients, but assessments lacked evidence of escalation where high risks were identified.
• Care plans did not detail patients’ preferences on how their needs were to be met. Their care plans were not developed on all areas of need or on their discharges. Action plans did not provide guidance to staff on how assessment needs were to be met or reviewed where assessments had identified further monitoring where potential deterioration was identified.
• Medicine systems were not fully safe. There were gaps in the recording of medicines administered. Staff did not always record the reasons for not administering medicines.
• Whiteboards with patient’s details were in full view of patients and visitors to the ward.
• Although steps were taken to recruit and retain staff high levels of agency staff were used to maintain basic staffing levels.
• Staff did not feel valued by the organisation due to the lack of resources and staff shortages.
• Patients gave feedback about staff’s lack of willingness to assist them.

However:

• Staff were committed to delivering good standards of care and their feedback related to the shortfalls with staff vacancies and meeting the needs of patients.
• Staff treated patients with compassion and kindness and took account of their individual needs and helped them understand their conditions.
• Patients and relatives felt confident to approach staff and managers with concerns.
• Managers investigated concerns and made recommendations on how to improve the service for patients.

Community Health Services - Adults

St Martin’s Hospital is within the Bath and North East Somerset (BaNES) area and provides community health and care services for adults. The adult community services delivered in a person’s home or in a nearby local care setting.

We rated this service as outstanding because:

• Services were tailored to meet the needs of individuals and were delivered in a way to ensure flexibility, choice and continuity of care. Individual needs and preferences were central to the planning and delivery of tailored services. Patients could access services in a way and at a time that suited them.
• The involvement of other organizations’ and the local community was integral to how services were planned and ensured that services met people’s needs. There was good interaction between the local GPs and the services provided.
• The leadership, governance and culture were used to drive and improve the delivery of high-quality person-centred care. Comprehensive strategies in place ensured the delivery and development of the desired culture. Leaders had a shared purpose, strove to deliver and motivate staff to succeed.
• While the service had staff vacancies, they used regular bank and agency staff to maintain care for patients that kept them safe.
• Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service-controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records.
• The service used systems and processes to administer and record medicines safely. The service recorded safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Team leaders monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.
• There was a proactive approach to understanding the needs of different groups of people and to deliver care in a way that met these needs and promoted equality. This included patients with complex needs.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service provided care to meet the needs of local people, took account of patients’ individual needs, and ensured people were able to give feedback. People could access the service when they needed it and received the right care in a timely way. It worked with external agencies and organisations to plan care.
• Leaders were knowledgeable about quality issues and had the experience and capability to ensure that the strategy could be delivered. Leaders encouraged cooperative, supportive relationships among staff so that they felt respected, valued and supported.
• Governance and performance management arrangements were proactively reviewed and reflected best practice. There was an effective and comprehensive process in place to identify, understand, monitor and address current and future risks.
• Leaders actively reviewed complaints and how they were managed and responded to, and improvements were made as a result across the service.

Community Children and Young Person

St Martins hospital is a registered location for HCRG Care Group, providing community health services for children and young people across Bath and North East Somerset.

We rated the service as good because:

• Staff understood how to protect children, young people and their families from abuse and the service worked well. The service-controlled infection risk well. Staff assessed risks to children and young people, acted on them and kept good care records. The service managed safety incidents well and learned lessons from them.
• Staff provided good care and treatment. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of children and young people, advised them and their families on how to lead healthier lives, supported them to make decisions about their care and had access to good information.
• The service responded to health matters affecting children and young people in society. They worked with partner agencies to educate and equip families to provide and maintain healthier lifestyles for children and young people.
• The service provided interventions aimed at the prevention of risky behaviours and promotion of healthy relationships. The service worked alongside partner agencies to promote positive outcomes for children, young people. Routine perinatal screening and additional listening visits undertaken in partnership with external organisations and midwives promoted better outcomes for families and newly born children. Referral to appropriate specialist services as part of this intervention ensured mothers were better equipped to provide warm and nurturing care to their children and young people.
• Staff treated children and young people with compassion and kindness, respected their privacy and dignity and took account of their individual needs. They provided emotional support to children and young people, families and carers.
• The service planned and provided care in a way that met the needs of local people and the communities it served. It also worked with others in the wider system and local organisations to plan care. Staff made reasonable adjustments to help children, young people and their families access services. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff.
• Leaders had the skills and abilities to run the service. They understood and managed the priorities and issues the service faced. The vision and strategy were focused on sustainability of services and aligned to local plans within the wider health economy. Leaders operated effective governance processes, throughout the service and with partner organisations.

However:

• In some services children and young people had to wait for treatment longer than the provider’s target timeframe. For example, some people had to wait longer than the target treatment time of 18 weeks for the community paediatrics.