England's Chief Inspector of Hospitals has told Shropshire Community Health NHS Trust that it must make improvements following an inspection by the Care Quality Commission.
Shropshire Community Health NHS Trust was rated as Requires Improvement overall following an inspection which took place in March this year.
The trust was rated as Good for being caring and Requires Improvement for being safe, effective, responsive and well-led.
Shropshire Community Health NHS Trust provides a range of community-based health services to around 455,000 adults and children in Shropshire, Telford and Wrekin.
CQC inspected community inpatient services; services for adults; services for children, young people and their families; end-of life-care services; children and adolescent mental health services; community substance misuse; minor injury units and dental services.
CQC’s Chief Inspector of Hospitals, Professor Sir Mike Richards, said:
“Our inspectors found that several improvements were needed at Shropshire Community Health NHS Trust but we also observed many areas of good care across several departments.
“There were insufficient numbers of suitably qualified, competent, skilled and experienced staff to meet the needs of people using the service within the children and adolescent mental health service’s learning disability team.
“Increased patient acuity in the community hospitals was not considered when staffing levels were planned so patients requiring support and assistance did not always receive this appropriately. Staffing and skill mix levels within each community nursing team were not reviewed systematically and at regular intervals to ensure that patients’ needs were met.
“The trust had no strategy for end of life care. Governance systems and processes were not sufficiently established and operated to enable the trust to assess, monitor and improve the quality and safety of end of life care services. This is why leadership for end of life care was judged to be Inadequate. However, the service was rated as Good for being caring and responsive.
“In addition, some staff’s understanding of the arrangements to enable quick identification of a deteriorating patient especially children in the minor injuries unit were not consistently in place across all four units.
“Our inspection team also observed many areas of good care across the trust. For example we saw that investigations were carried out when things went wrong. Inspectors saw examples of where lessons had been learnt and where Duty of Candour had been applied.
“Staff across all services treated patients with kindness, dignity and respect; we observed many examples of positive interactions between staff, patients and those close to them.
“The trust’s Admiral Nurses in Telford ran workshops for carers of people living with dementia. They provided opportunities for carers to share their experiences and offered training on areas such as communication and nutrition. The workshops also featured guest speakers giving advice on legal and practical issues about caring for people living with dementia.
“Since our inspection we have been monitoring the trust and working closely with NHS Improvement and other stakeholders.
“The trust leadership knows what it needs to do to bring about improvement and our inspectors will return at a later date to check on what progress has been made.”
Full reports for the trust will be published on CQC’s website tomorrow (Wednesday) at the following link: www.cqc.org.uk/provider/R1D
Across the trust, the inspection team found several areas where improvements must be made, including:
- The trust must develop and implement an overall vision and strategy for end of life care services.
- The admission criteria for community hospitals must be reviewed to or ensure it is complied with.
- The trust must ensure that when local social care arrangements are required for a patient’s discharge, further collaborative working is required. For example, an increase in therapist teams to support patients with complex needs is needed to promote timely discharge.
- Staffing levels and skill mix must be reviewed in community adult nursing, child and adolescent mental health services and minor injury services to ensure that staffing meets patients’ needs.
Inspectors also witnessed some good practice across the trust, including:
- The trust effectively used telemedicine to help patients living in very rural areas remain at home.
- Photographs of pressure ulcer and skin damage were reviewed which enabled the tissue viability nurses to provide timely advice on required treatment to prevent further harm to the patient.
- The tissue viability service had demonstrated that changes to two layer compression bandaging did not compromise wound healing. This meant patient comfort increased and provided cost savings to the trust.
- The trust’s diabetes patient education programme provided excellent patient outcomes for the management of their condition. CQC’s inspection team informed the trust of its findings immediately after the inspection so that it could take steps to make any improvements.
Ends
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