Ailsa House

This service is rated as Good overall. (Previous inspection September 2019 rated Requires Improvement)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

We carried out an announced focused inspection at Ailsa House on 11, 12, 13 October 2021. to follow up on breaches of regulations. We inspected the following key questions:

• Safe
• Effective
• Well Led

At our previous inspection we found:

• There was learning from significant events but it was not always disseminated fully.
• Performance data was not in line with targets.
• The provider did not stock naloxone (naloxone is used to counteract the effects of opioids on a patient’s respiratory system) and had not risk assessed this.
• Staff training records were not adequately maintained to be fully assured that all staff were compliant with training requirements.

At this inspection we found:

• The service had taken steps to address the breaches of regulations identified at our previous inspection.
• We found learning from significant events and complaints was disseminated amongst staff and we identified that improvements had been made a result.
• The specific data used to measure performance had changed since the last inspection. In addition, the provider had ceased to deliver an NHS111 call centre. Instead, an Integrated Urgent Care (IUC) Clinical Assessment Service (CAS) (remote telephone and video triage and clinical assessment) was delivered in a collaborative commissioned approach. Due to the change in contract and commissioning arrangements it was not possible to directly compare performance between the two inspections.
• Mandatory training was closely monitored and there were very high levels of compliance both amongst clinical and non-clinical staff.
• The service routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• The provider was highly innovative and we identified several areas of outstanding practice generated as a result of pioneering practice.

We saw several areas of outstanding practice:

• The Attention Deficit Hyperactivity Disorder (ADHD) service for patients on the Isle of Wight had had a significant impact for patients using the service, reducing waiting time from two years to six months. This had met a gap in the system which previously meant patients were living with a distressing condition without assessment or treatment for considerable periods of time.
• We saw a positive culture demonstrating inclusivity and a caring attitude towards staff. The provider had supported World Menopause Day 2021, by sharing information with staff about where they could find information and seek help and by supporting staff to have conversations in the workplace. There was a monthly support group available for staff who were experiencing symptoms of the menopause. The provider had held a mental health week during which staff were encouraged to go for walks on their breaks and take time for themselves.
• The provider had created an integrated solution for remote patient monitoring called YOULA. The system enabled remote monitoring in a non-invasive way, through in-home sensors and human interactions, and was being piloted for patients on the Isle of Wight. The system monitored basic movements such as how often the kettle was switched on, how often the front door was opened and how often the fridge door was opened. Artificial intelligence was used to understand each person so that when something was out of the ordinary it could be quickly identified, and help alerted automatically. The service was managed via a real time dashboard. Patients also received a daily telephone call. The impact on the integrated care system (ICS) meant a 24/7 bridge between acute and primary care, patients receiving care in their own home rather than a hospital environment, facilitated early discharge from secondary care, hospital admission/readmission avoidance all resulting in significant cost savings. Of the 150 patients who had trialled the YOULA 92% reported the service to be excellent or good.
• The paediatric (paeds) desk had been developed as a pilot which had been very successful and expected to be extended. The service had piloted the GoodSam app which enabled paediatric trained nurses to see children via a video call, staff were able to effectively assess children and provide reassurance for distressed parents. There were strict protocols around the use of the GoodSam app and a private area had been set up in the call centre. This project had had a big impact on reducing A&E admissions.
• The provider played an important role in supporting the integrated care system (ICS) by bridging gaps in the system between primary and acute care. The ability of the provider to diversify (often with little notice) supporting multiple systems provided resilience to the overall system. This meant waiting lists were able to be reduced and patients had access to care and treatment when they needed it.

The areas where the provider should make improvements are:

• Continue to review and improve key performance indicators for the contact centre.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care