Liverpool Urgent Treatment Centre

This service is rated as Requires Improvement overall.

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Requires Improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires Improvement

We carried out an short notice announced comprehensive inspection at Mersey Care NHS Foundation Trust and the following Walk in Centres were visited.

• Old Swan NHS Walk in Centre at Crystal Close, St Oswald Street, L13 2GA
• Liverpool City Centre NHS Walk in Centre at 6 David Lewis Street, Liverpool, L1 4AP
• Smithdown Road Children’s NHS Walk in Centre at Smithdown Road Liverpool L15 2LF

These inspections were carried out on the 20, 21 and 22 November 2018 as part of our inspection programme.

At this inspection we found:

• The Walk in Centres are part of Mersey Care NHS Foundation Trust. As part of the trust governance arrangements there were structures, processes and systems of accountability in place to support the delivery of the trust strategy, ensure good quality and patient safety. However, these were still in their infancy and required further improvement. For example, many policies and protocols were from the previous provider organisation. The management team was aware of this and the trust transformation plan had target dates for replacing these.
• The service did not have an overall comprehensive programme of quality improvement activities that included the Walk in Centres. However, there were monitoring systems whereby key performance indicators were reviewed monthly.
• The service had appropriate systems to safeguard children and vulnerable adults from abuse. Systems for assessing, monitoring and mitigating the various risks relating to the safety of the premises were inconsistent across each Walk in Centre.
• There were systems to assess, report, monitor and manage risks to patient safety. Staff we spoke with told us that feedback about the reported incidents needed to improve.
• The service did not have reliable systems for appropriate and safe handling of medicines.
• Care and treatment was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• There was limited evidence at each of the Walk in-Centres to show the service made improvements through the use of completed clinical audits.
• Staff had the right qualifications, skills, knowledge and experience to do their job when they start their employment and on a continual basis. However, the trust was experiencing high sickness, retention rates and staff vacancies and this resulted in the regular movement of clinical staff across the centres.
• Staff were supported to meet the requirements of professional revalidation where necessary.
• Clinical supervision arrangements were not robust and nurses did not receive protected time to complete this. The provider did not undertake audits/reviews of clinical decision making, including non-medical prescribing to determine the competence of staff employed in advanced roles.
• Staff involved and treated people with compassion, kindness, dignity and respect. In particular, staff displayed an encouraging, sensitive and supportive attitude for children and young people at Smithdown Road Children's NHS Walk in Centre.
• Patients could access care and treatment from the service within an appropriate timescale for their needs. However, some waiting times had increased. Where the service was not meeting the set targets, the provider was monitoring this.
• The service took complaints and concerns seriously and responded to them appropriately to improve the quality of care. There was confusion amongst staff about what information should be given to patients when they wanted to make a formal complaint.
• Local leaders had the capacity and skills to deliver high-quality, sustainable care.
• There was a focus on continuous learning and improvement at all levels across the Walk in Centres.

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure care and treatment is provided in a safe way to patients with regards to ensuring there are systems to make sure that documents to authorise medicines are completed.
• Ensure persons employed in the provision of the regulated activity receive the appropriate supervision necessary to enable them to carry out their duties.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

• Review the significant event reporting systems to ensure staff receive feedback when an incident has been reported.
• Review the systems and processes in place to ensure the right skill mix is in place across each of the Walk in Centres when staff are moved to cover for staff absence. This review should include the views of all clinical staff.
• Review the suitability of the premises and ensure all areas are fit for the purpose for which they are being used. The provider should review the fire safety risk assessments for the Liverpool Walk in Centre and ensure that any actions required are complete and ongoing fire safety management is effective.
• Review the system in place for disseminating safety alerts to all members to ensure there is evidence and monitoring in place that actions when required have been completed.
• Review the waiting times for patients for initial assessment/triage to treatments. The provider should improve these waiting times so that services are responsive to the needs of children and young people across each of the Walk in Centre locations.
• Review the service complaint handling procedures and establish an accessible system for informing patients how to make a complaint.