St Helens Urgent Treatment Centre

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that staff involved people in decisions about their care and treatment and provided them advice and support. Staff regularly reviewed people’s care and worked with other services to achieve this.

This is the first inspection for this service since its registration with CQC. This key question has been rated as Good.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Effective tools and systems for the management of arrival, triage, prioritisation and assessment of patients were in place. People who used the service were assessed on arrival by a triage nurse. This was to identify their presenting concern and complete observations and prioritise their treatment using the Manchester Triage System (clinical risk management tool). Patients were categorised for risk using a RAG (red, amber, green) stratification and staff across the service could therefore readily identify those patients who were assessed as requiring more urgent attention.

The provider had identified risks in relation to the assessment of people who used the service and these were included in the risk register. One of the risks identified was in relation to adult trained nurses assessing and prescribing for children and newborn babies. The provider had carried out a risk assessment for this with actions to mitigate the risk. Another identified area of risk related to there being no GP cover at weekends reducing capacity to assess and prescribe for patients with more complex needs. The provider had taken action to mitigate this risk.

During times of increased pressure when demand exceeded staffing capacity or when waiting times exceeded opening times the service stepped down to a triage only service. The triage service ensured that staff reviewed the patient’s condition, took their vital observations, assessed their clinical complaint and provided some initial treatment if required. Patients who were assessed as acutely unwell or vulnerable continued to be prioritised for a comprehensive assessment following triage. If further assessment was not required at the time of the visit, the patient would be provided with relevant patient information leaflets, red flag information and told when they needed to seek further help and what to do if their condition deteriorated. The service used a nationally recognised scoring system NEWS2 (National Early Warning Score 2) to facilitate early identification of sepsis and these patients were managed accordingly.

Staff reported all incidents when the service stepped down to triage. Staff also completed daily situation reports through the (SitRep) reporting system which indicates where there are pressures on the NHS.

The clinical team did not have access to people’s in-hours GP notes as most of the practices in the locality used a different clinical system to the one used at the service. (They did have access to the patient summary care record (SCR) which is a digital summary of key patient information held by the patient's GP, if the patient had consented to the SCR being shared).The provider told us that this had been reviewed and a decision had been made not to change systems. They told us that they would consider enabling clinical staff to have access to a view only access to people’s GP records under the EMIS patient record system.

The UTC had established a collaborative working relationship with the local hospital as this was part of the same NHS Trust.

Support was available to help assess people with additional needs or communication needs. For example, people who required the services of an interpreter and people who have a learning disability.

Where people’s needs could not be met by the service, staff redirected them to the appropriate service for their needs. Safety netting advice was provided when patients were at risk of deterioration.

Systems were in place to ensure staff were up to date with national guidance, evidence-based good practice and required standards. Clinical staff had access to guidelines from the National Institute for Health and Care Excellence (NICE) and used this information to ensure that people’s needs were appropriately met.

Staff attended regular training and educational sessions and underwent regular appraisal. A clear trust wide process was in place for annual review of each nurse prescriber.

Leaders had a clear understanding of service performance against key performance indicators, they regularly discussed performance at senior management and board level.

Leaders and staff worked closely with colleagues and relevant stakeholders to meet urgent need and support the wider system.

People who were the most clinically vulnerable were prioritised and the service worked with other healthcare professionals to deliver care and treatment when required.

The service worked with other services to ensure continuity of care and shared records and information where relevant. An electronic record of all consultations was sent to the patients’ own GP. Staff communicated promptly with registered GPs so that they were aware of the need for further action and continuity of care for their patients.

Staff had access to some of the information needed to plan and deliver care and treatment as they had access to summary care records. The provider was looking to increase this enabling staff to access more comprehensive records via the EMIS patient record system for view only purposes.

The UTC had formalised systems with the NHS 111 service with specific referral protocols for patients referred to the service.

The UTC had developed referral and treatment pathways through integration with the Trust. They had also developed effective links with the local accident and emergency department, paediatrics, orthopaedics, frailty and virtual wards to streamline pathways between the service and these specialist areas. The service could also refer patients directly into other services.

The service supported people to live healthier lives and manage their health and wellbeing. People who used the service were referred or signposted to relevant services and local support services for care and treatment, information, education, advice and support linked to their needs.

Members of the clinical team provided patients with information and support to manage their health, care and wellbeing where possible. People were provided with information to support them to make healthier choices, to promote and maintain their health and wellbeing and prevent deterioration.

The service identified patients who may be in need of extra support. Where patients’ needs could not be met by the service, staff redirected them to the appropriate service to meet their needs.

Leaders demonstrated that monitoring and improving outcomes for patients was important to them and they used information and data to drive improvement.

Leaders used information relating to incidents, complaints, patient feedback and other healthcare professional feedback to inform performance, safety and effectiveness and to identify and drive improvements.

The service supported local care and treatment pathways including the accident and emergency department and worked closely with commissioners.

Data was collected and used to identify achievement against performance indicators and drive improvement were required. Performance reports showed that a range of data was monitored, this included: the acuity of patients, the average daily, weekly and monthly number of attenders, peak times and the average length of waiting times.

A new process had been introduced to improve the supervision of non-medical prescribers in relation to the assessment of patients, the prescribing of medicines and associated outcomes for people who used the service.

Clinical audit had a positive impact on quality of care and outcomes for patients. There was clear evidence of action taken to change and improve patient care following audits. A number of audits had been carried out following complaints or incidents. The provider should also consider a planned programme of clinical audit.

The provider reviewed protocols and standard operation procedures in order to improve outcomes for people who used the service where they had recognised a need to improve. A recent example being for the management of patients with a potential fracture. Similar reviews and protocols had been introduced following complaints or incidents, demonstrating clear evidence that the service learned from incidents and events and took action to improve patient experience and outcomes.

Staff understood the importance of ensuring that people knew what they were consenting to and the importance of obtaining consent before they delivered care or treatment.

Staff completed training in the Mental Capacity Act. Staff understood the requirements of legislation and guidance when considering consent and decision making in line with their roles and responsibilities.