St Helens Urgent Treatment Centre

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked for evidence that people were protected from abuse and avoidable harm.

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.

Safety was a priority, and the service had a proactive and positive culture of safety, based on openness and transparency.

The provider had systems in place to identify hazards and risks and action was taken to mitigate these.

The provider had comprehensive systems in place for managing safety incidents and events including processes for staff to report incidents, near misses and safety events. The provider responded to concerns about safety and these were fully investigated. An incident log was maintained which detailed the incident, the action taken and the learning shared with individual staff members, with the local team and the wider team as appropriate. Any themes or trends were recognised and acted upon. Learning from incidents was shared across the team and action was taken to improve procedures and prevent a recurrence.

Staff felt there was an open culture, and that safety was a priority.

Staff told us they were supported to identify their training needs and protected learning time was provided for them to undertake training, learning and professional development. Training was provided within the service and through attendance at locality wide training and educational events.

The provider worked with people who used the service and healthcare partners to establish and maintain safe systems of care. There were systems and processes to share information with staff and other agencies to enable them to deliver safe care and treatment.

Members of the staff team were aware of local services and support networks that they could refer people to in order to support them with their needs and to prevent ill health.

Clinicians followed care and treatment pathways for treating and referring patients to other services and referrals were made promptly.

The provider had health and safety related policies, procedures and risk assessments in place. Staff had access to up to date policies on the online shared drive.

Individual care records were written and managed in a way that kept patients safe.

The service had systems for sharing information with staff and other agencies to enable them to deliver safe care and treatment. The service sent communication to the patient’s GP to inform them of the care and treatment provided. The service used a different patient record system to that of the majority of the GP services in the St Helens locality. The provider told us they had considered the introduction of an alternative system but had not implemented this to date. They told us they would consider introducing a read only view for the NHS GP patient record system.

The service worked to safeguard people from the risk of abuse and there were systems and processes to respond when it was suspected that people may be subject to abuse or neglect.

The provider had a designated safeguarding lead. We noted there was no designated safeguarding lead at this location. However, the designated safeguarding lead for both adults and children within the Trust supported the UTC including outside of standard business hours. Staff had guidance for managing safeguarding, including outside of standard business hours.

Staff had been provided with safeguarding training at a level that was appropriate to their roles and responsibilities. Staff had a clear understanding of safeguarding and were able to tell us who the responsible lead for safeguarding was. They knew the action to take if they had concerns about a patient’s safety and they told us they would feel confident to report concerns.

The provider carried out staff recruitment procedures in line with requirements to ensure staff were appropriate to work in the service.

Staff told us they informed the health visiting service if a child had left the service without being assessed. We noted there was no protocol to check if a child referred to the accident and emergency department had attended or been accompanied to attend. Following the assessment the provider confirmed that a protocol had been implemented.

The service worked with people to understand and manage risks. Staff understood their responsibilities to manage emergencies and to recognise those in need of urgent medical attention. They had been provided with training and support on how to identify and manage patients with severe infections, for example sepsis.

Patients were prioritised appropriately for care and treatment, in accordance with their clinical need. Systems were in place to manage people who experienced long waits. People who used the service were advised on risks related to their condition and actions to take if their condition deteriorated and how to seek further help.

The provider had a clear infrastructure to support and govern health and safety, estates and facilities. The provider detected and controlled potential risks in the environment. They made sure equipment, facilities and technology supported the delivery of safe care. A regular programme of audit/checks was in place to ensure the safe and effective running of the service. Contracts were in place to ensure the premises were clean and well maintained.

The service was located in a purpose built building that provided the required facilities such as safe access for people with physical disabilities.

Staff had been provided with training in health and safety related topics such as fire safety, infection control and manual handling. Staff told us that they had no concerns with the arrangements in place for ensuring health and safety.

The provider had a business continuity plan in place to provide guidance for dealing with a major disruption to the service, for example an IT failure.

The provider monitored patient demand for the service and reviewed staff capacity to meet anticipated demand. The service had an escalation policy in place so that staff could request additional support should demand exceed anticipated levels. The provider had developed a business case to employ staff in additional roles and was working with commissioners to make changes to the service to reduce staffing challenges.

Whilst arrangements were in place for planning and monitoring the number and skill mix of staff needed, staff told us that there were occasions when staffing levels could present a challenge when patient demand and acuity was high or there were staff absences. On these occasions the service moved to triage only but continued to manage and assesses patients who required a fuller assessment and treatment to ensure all patients were safety netted and had a plan of treatment. The provider told us that data analysis had highlighted that on days where there was a surge in attendances, specifically in the morning, it was more likely that demand would exceed capacity and waiting times would exceed opening times later in that day. This was consistent with breach analysis and subsequent reasons for breaches on those days. A review of staffing, particularly in the early part of the day between 7am -9.30am could be considered to support patient flow throughout the day. Following the assessment the provider confirmed that changes had been made to the operating hours and they had adjusted the staffing model to ensure consistent staffing across the day.

Staffing levels and time pressures were identified as an area of concern in the latest staff survey. Some staff reported a greater challenge at weekends when there was no GP cover. Risk assessments were in place to mitigate risks associated with staffing in terms of both numbers and skill mix. There were appropriate arrangements in place for covering staff sickness, absence and vacancies and the use of temporary staff.

A recent change to the current staffing model had been the addition of a supernumerary co-ordinator on every shift. The purpose of the role was to improve patient flow, provide oversight of clinical priorities and manage risk, reduce risk of deterioration of patient’s conditions and provide support to junior staff. The provider was able to demonstrate the positive impact of this role with improved triage times and reduced breaches to key performance indicators. In addition, the service secured funding for a lead GP to provide a clinical leadership role. The role included introducing systems for clinical oversight of the staff team, providing an interface between the service and wider NHS Trust and local services and improving care and treatment pathways. The role also included increasing the clinical GP capacity.

Leaders provided staff with the support they needed to deliver safe care. Staff had protected time for them to undertake training, learning and professional development and they had received training appropriate and relevant to their role.

Staff recruitment records showed recruitment practices were carried out in line with requirements. All new staff underwent a comprehensive induction programme and were required to undertake mandatory training within an appropriate timescale. The provider used competency frameworks to support staff to continuously learn and professionally develop. The service had adopted the competency frameworks recommended by NHS England.

Staff were supported through attending education programmes and internal learning events from the specialist teams that are part of the trust. Systems were in place to support staff with coaching, mentoring, appraisal and support for revalidation. The provider maintained up to date records of staff skills, qualifications and training and reviewed monthly reports for mandatory training to ensure compliance with training targets.

The provider ensured that staff worked within their scope of practice and had access to clinical support when required. This included the recent introduction of formal one to one supervision to include an overview of the assessment, consultation and prescribing decisions made by non-medical prescribers. A process was in place for carrying out an annual review and competency check for each nurse prescriber. We noted there was no minimum requirements for training and competencies for staff in this role.

Staff attended a daily meeting referred to as a staff ‘huddle’. This was a short meeting where important information about the service, staffing and patient information was discussed and where issues could be escalated. At the time of the assessment this was predominantly the only form of staff meeting. The provider could consider the introduction of wider staff meetings for more general discussion, communication, service development and education purposes.

There was an effective approach to assessing and managing the risk of infection, that was in line with current relevant national guidance and standards.

The premises were purpose built, clean and contained the appropriate facilities to minimise the spread of infection. Personal protective equipment was in good supply and located appropriately around the premises.

Staff roles and responsibilities around infection prevention and control were clear with a dedicated lead person and staff had undergone training appropriate to their role.

Cleaning schedules were in place and infection prevention control and cleaning audits were carried out on a regular basis. Cleaning equipment was stored securely and in line with best practice.

The provider made sure that medicines and treatments were safe and met people’s needs. The systems and arrangements for managing medicines, including medical gases, emergency medicines and equipment, and vaccines, minimised risks. Our findings showed that medicines were managed safely overall and the approach to medicines reflected current and relevant best practice and professional guidance.

Staff followed established processes to ensure that when people were prescribed medicines their GP was informed. The Trust had a non-medical prescribers lead whose role included ensuring that non-medical prescribers had appropriate qualifications and experience to undertake the role. All non-medical prescribers were required to complete an annual review and declaration to practice. The provider had introduced a new system to review a sample of the non-medical prescribers’ consultation and prescribing decisions. The provider could consider introducing a scheduled programme of audits to ensure prescribing is in line with best practice guidelines for safe prescribing.

The service kept prescription stationery securely and monitored its use. All prescriptions were printed and not sent electronically. The service was equipped to respond to medical emergencies (including suspected sepsis). Staff had access to emergency medicines and equipment including oxygen and a defibrillator and they were suitably trained in emergency procedures. Emergency medicines were regularly checked for stock availability and to ensure they were in date. The medicines were stored securely. However, the provider could consider a review the current arrangements to ensure the medicines continue to be stored safely but can be readily accessed at all times, to include a review of the location and availability of anaphylaxis kits.

The provider monitored fridge temperatures where vaccines and medicines were kept. Records indicated the maximum temperature of 8 degrees centigrade may have been breached. The provider took action to investigate this and prevent a recurrence.

The provider had effective systems to manage and respond to safety alerts and medicine recalls.