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Inspection carried out on 5 & 6 November 2019

During a routine inspection

We carried out this announced inspection on 5 & 6 November 2019 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection to check whether the registered provider was meeting the legal requirements in the Health and Social Care Act 2008 and associated regulations. The inspection was led by a CQC health & justice inspector who was supported by a second health & justice inspector, and a specialist professional advisor.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?

• Is it effective?

• Is it caring?

• Is it responsive to people’s needs?

• Is it well-led?

These questions form the framework for the areas we look at during the inspection.

Background

The Bridge SARC is in Bristol and provides services to children, young people and adults. NHS England commission University Hospitals Bristol NHS Foundation Trust (UHB NHSFT) to deliver the paediatric pathway supporting children and young people up to the age of 18 years. A different provider was commissioned to deliver forensic medical examinations to over 18s. This inspection was of the paediatric pathway only delivered by UHB NHSFT.

The Bridge SARC provides services for children and young adults up to the age of 18 across a large geographical area. The SARC accepts referrals for children and young adults requiring a medical examination from the counties of Wiltshire, Gloucestershire, Avon & Somerset and Swindon.

The SARC is situated within the Central Health Clinic in the centre of Bristol with sexual health services delivered on the ground floor, and the SARC on the second floor. Access to the SARC is via a lift with secure entry to both the building and SARC on the second floor. The SARC offices are open between 9am and 6pm Monday to Friday, and between 10am and 4pm at weekends. Paediatric examinations may be carried out within these hours during the week, and between 12 noon and 4pm at weekends. A 24 hour telephone advice line is available for professionals 365 days a year.

The SARC facilities include two forensic medical examination suites with pre-examination, examination and bathroom facilities adjoining each other, and separate aftercare rooms. One suite is set up for adult patients and the second for children and young people. The provider has access to a loft space where forensic samples are stored, as well as a staff kitchen, staff shower and bathroom facilities and a disabled toilet. Staff work within a small office area and have access to a large meeting room which can be booked as required. Plans were in development to utilise a disused room on the same floor of the building as a shared staff comfort area.

The SARC team is led by a service manager and the paediatric pathway overseen and delivered by a consultant paediatrician. Three bank clinical sexual offence examiners are utilised to cover the rota with two substantive paediatricians due to join the team in January 2020. The provider’s staffing structure includes five full time equivalent crisis worker posts, of which one is currently vacant. Recruitment has taken place and the role is due to be offered imminently. 10 crisis workers from the trust bank cover out of hours provision on zero hour contracts.

During the inspection we spoke with three managers and four crisis workers. Throughout this report we have used the term children and young people to describe people who use the service to reflect our inspection of the paediatric patient service.

We looked at policies and procedures and other records about how the service is managed, and sampled care records for 15 children and young people.

Our key findings were:

  • The provider had systems to help them manage risk.
  • The staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
  • Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
  • The clinical staff provided children and young people’s care and treatment in line with current guidelines.
  • Staff treated children and young people with dignity and respect and took care to protect their privacy and personal information.
  • The appointment/referral system met children and young people’s needs.
  • The service had effective leadership and a culture of continuous improvement.
  • Staff felt involved and supported and worked well as a team.
  • The provider asked staff and children/young people for feedback about the services they provided.
  • Staff followed appropriate information governance procedures.
  • The provider maintained a clean and welcoming environment for children, young people and visitors.
  • Infection control procedures reflected published guidance.

There were areas where the provider could make improvements. They should:

  • Implement a formal audit programme to align with the trust audit calendar and support the service’s culture of learning and development.

Inspection carried out on 10 September 2014

During a routine inspection

We carried out an inspection of the Central Health Clinic on 10 September 2014. This was part of a planned inspection of the University Hospitals Bristol NHS Foundation Trust. The Central Health Clinic operates a number of smaller clinics located within the community. These clinics operate in the same way as the Central Health Clinic and are staffed by a core team, therefore we did not inspect the smaller satellite clinics.

We found the service provided a good quality of care to people who used it.

Our key findings were as follows:

  • Safeguarding procedures were in place and staff were knowledgeable regarding their responsibilities for safeguarding children and adults.
  • The department was clean and tidy and infection control policies and procedures were in place and followed to ensure the safety of people who visited the department and staff who worked there.
  • Care and treatment were provided in line with regional and national guidelines.
  • Feedback from people who used the service was sought and the outcomes audited. Action had been taken in response to suggestions made by people who used the service.
  • People’s privacy, dignity and confidentiality were respected at all times.
  • People who attended the service were positive in their comments about their care and treatment and all said that they would recommend the service to their friends.
  • Services were available to people over six days each week and clinics were led by trained and competent staff.
  • The department had a clear vision and strategy and staff were positive and proud regarding their work.
  • Staff worked as part of an integrated multidisciplinary team, which had positive outcomes for patients.
  • Risk management systems were in operation and identified risks were escalated appropriately within the trust.

We saw several areas of outstanding practice, including the following:

  • The staff worked well as a multidisciplinary team, both internally (within the department) and with external partners and organisations, for example with Barnardo’s on a project working to combat child sex exploitation and with the police in the sexual referral centre.
  • The Bristol Central Health Clinic provided an integrated sexual health service that ensured easy access to services where the majority of sexual health and contraceptive needs could be met in one clinic, by health professionals who worked together collaboratively.
  • The service had responded to the needs of people in the local communities for accessible clinics by providing extended opening times, a variety of locations, walk-in clinics and a facility for people to book appointments by texting from their mobile telephones.

However, there were also areas of practice where the trust needs to make improvements. The provider should:

  • Ensure that patients’ electronic records are consistently completed appropriately to provide full and detailed information regarding the person’s care and treatment.
  • Ensure that regular formal supervision and clinical supervision for staff take place in a planned way.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection carried out on 4 October 2012

During an inspection looking at part of the service

We visited the service on 4 October 2012. The purpose of this inspection was to check that improvements had been made to achieve compliance with outcome 21. During our visit 20 March 2012 we found that there was a lack of proper information about people in so far as certificates of opinion (HSA1 forms ), required as part of the management of the regulated activity of termination of pregnancy, were not properly maintained.

We received an action plan from the trust on 9July 2012 about the improvements in place to ensure that proper information about people in so far as certificates of opinion (HSA1 forms), required as part of the management of the regulated activity of termination of pregnancy, were being properly maintained.

We were told that an audit to test compliance was also being carried out by the trust on 30 September 2012.

During this visit we did not involve people who used the service, but we spoke with registered nurses, a nurse manager and a doctor who worked in the clinic. They told us about the new systems in place to ensure that the procedure for two doctors to provide their certified opinion, formed �in good faith�, that at least one and the same ground for a termination of pregnancy was met.

Staff told us that there were no presigned certificates of opinion (HSA1 forms) used in the clinic. We also asked to see a sample of patients medical records. We looked at these records and we found no presigned certificates of opinion (HSA1 forms.

Inspection carried out on 20 March 2012

During a themed inspection looking at Termination of Pregnancy Services

We did not speak to people who used this service as part of this review. We looked at a sample of medical forms. This was to check that current practice ensured that treatment for the termination of pregnancy was not commenced unless two certificated opinions from doctors had been obtained.