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Provider: Wiltshire Health and Care LLP Good


Inspection carried out on 27, 28 & 29 June, 3, 6, 7 & 10 July 2017

During a routine inspection

When aggregating ratings, our inspection teams follow a set of principles to ensure consistent decisions. The principles will normally apply but will be balanced by inspection teams using their discretion and professional judgement in the light of all of the available evidence.

Letter from the Chief Inspector of Hospitals

Wiltshire Health and Care LLP was inspected during planned and announced visits. We visited many community teams, locations, hospital wards, patients’ homes, and clinics during this time. We returned to a number of locations and teams for unannounced visits.

This inspection was a comprehensive look at all services provided by Wiltshire Health and Care LLP. The core services we inspected were:

  • Community health services for adults
  • Community health inpatient services
  • Community mental health services for people with learning disabilities or autism
  • Urgent care services (minor injury units)

We visited Chippenham, Savernake and Warminster Community Hospitals and inspected four inpatient wards. We went to County Hall in Trowbridge, and Savernake Hospital in Marlborough, where we met patients and staff in the community learning disabilities service. We visited the minor injury units in Chippenham and Trowbridge Community Hospitals. To inspect the community adults’ services, we visited a range of health centres, and community hospitals, and went out with community nursing teams to patients’ homes. We also met with staff and teams at the organisation’s headquarters at Chippenham Community Hospital.

All staff throughout Wiltshire Health and Care were cooperative, helpful and supportive to us at all stages of the inspection.

Our key findings were as follows:

  • We rated the safety of the provider and core services as good overall. There were safety systems and processes to protect patients from avoidable harm and abuse. Patients and their relatives received a sincere apology and explanation when something went wrong. There was openness and transparency about safety, and staff fulfilled their responsibilities to report incidents. However, there had not been a recognisable improvement in some avoidable harm to patients, such as falls and pressure ulcers, although this was from a low number of these incidents. Staffing levels kept people safe and were supplemented by temporary staff. However, this was an area of clear concern and focus for the organisation, which was struggling with vacancies and a high turnover. Nevertheless, this area was improving with ongoing recruitment.
  • We rated the effectiveness of the provider and core services as good overall. Care was planned and delivered in line with evidence-based practice. Patients’ needs were assessed and care was delivered, where required, with a multidisciplinary approach. Patients’ rights were protected. There was commitment to assessing patients’ needs before they were discharged to ensure the outcomes of their care were good. However, although most staff were receiving an annual review of their performance, there was some concern around the value of these appraisals.
  • We rated the caring domain for the provider and core services as good overall. Patients were respected and valued by staff as individuals. Feedback was continually positive about the way staff treated patients and those who supported or spoke for them. Staff were committed to partnership working with patients and putting them at the centre of what the organisation stood for. There were outstanding practices developed for people with cognitive impairment to help them feel safe.
  • We rated the responsiveness of the provider and core services as good overall. Services were organised and delivered to meet patients’ needs. The organisation was committed to playing its role in improving how the whole health and social care economy operated. Wiltshire Health and Care was pivotal in the development of new programmes to ‘fast-track’ patients home. Then to assess them when they were at home rather than in hospital. There was a commitment to deliver care to patients at home where possible, and avoid admission to hospital. Almost all the referral times for patients to be seen were within the national target of 18 weeks.
  • We rated the provider for well-led as requires improvement overall. We rated each of the core services as good for this domain. Our concerns at provider level were around how the commissioned portfolio of work had risks for the quality of work the small team were able to deliver, analyse and provide for assurance. There was insufficient quality to governance information, although we recognised significant improvements being made. The organisation was not able to provide information to us to show how it assured itself that the directors or equivalent people were fit and proper persons. There was no strategy for patient engagement, although this was now a work-in-progress, with board leadership. Nevertheless, there was notable dedication and commitment from the board and leadership of the organisation. There was a clear vision and strategy for the future.

We saw several areas of outstanding practice, including:

  • In Trowbridge Hospital minor injury unit, staff used ‘distraction boxes’ for children. A charity supplied them on the request of a nurse working on the unit. The toys and games could be cleaned and any broken or missing items replaced by the charity. We also saw staff gave children their own colouring book and pencils to keep them amused and which they could take home.
  • The leadership of the specialist community teams.
  • The innovative practices for managing continence care.
  • The responsiveness of the community teams to patients receiving end of life care.
  • The strategies in place to support admission avoidance and early discharge from hospital, such as the high intensity care work and the stroke early discharge team.
  • Patients on Mulberry ward (the stroke unit) at Chippenham Community Hospital were actively involved in planning their stroke rehabilitation in partnership with the ward-based therapy team. Patients had a personalised therapy timetable, which was updated weekly and stored at the bedside to enable relatives/carers to be involved in the patient’s rehabilitation.

  • Staff on Longleat ward at Warminster Community Hospital were using a dementia reminiscence therapy software package. This included an interactive system that could be used by the patient’s bedside. Complex care patients with a cognitive impairment or patients who were living with dementia benefitted from the reminiscence therapy software as it enhanced staff engagement and helped to reduce anxiety and distress.
  • A mural on Longleat ward at Warminster Community Hospital had been created by a local artist. The mural displayed scenes of the local area and was developed in partnership with patients, relatives and staff to support reminiscence activities for patients living with dementia. Feedback from patients and their families was being gathered to support the development of further murals on the ward.
  • All staff on Mulberry ward (the stroke unit) and staff from community hospitals, including kitchen staff, student nurses and volunteers, had attended training with the speech and language therapists in helping patients who had difficulty with swallowing.
  • There were limited facilities on Mulberry ward (the stroke unit) for patients to practice daily living activities following a stroke. Therefore, the occupational therapist had introduced a weekly breakfast club on the ward to enable patients to make their own breakfast in a supported environment.

However, there were also areas of poor practice where the provider needs to make improvements.

Importantly, the provider must:

  • Improve its governance procedures for the minor injury units. Specifically the provider must address low incident reporting rates, irregular team meetings, and no specific risk register. It must improve understanding of the quality and safety performance of the unit for all staff and ensure routine audits, for example, consent, patient records and medicines are regularly undertaken.
  • Demonstrate that directors of the organisation or their equivalent are fit and proper persons to meet the legal requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 5.
  • Ensure systems and processes are established and operated effectively to assess, monitor and improve the quality and safety of the services provided. Within its governance arrangements, the organisation must assess, monitor and mitigate the risks to the health, safety and welfare of patients and others who may be at risk. The senior executive team must ensure they can demonstrate that improvements have been made to care and services from the analysis of accurate data, audit, complaints, and investigations into poor care.

Professor Ted Baker

Chief Inspector of Hospitals

CQC inspections of services

Service reports published 9 October 2017
Inspection carried out on 27, 28 & 29 June and 6 July 2017 During an inspection of Community health services for adults Download report PDF (opens in a new tab)
Inspection carried out on 28, 29 June and 3 July 2017 During an inspection of Community health inpatient services Download report PDF (opens in a new tab)
Inspection carried out on 27-29 June 2017 and 10 July 2017 During an inspection of Reference: Urgent care services not found Download report PDF (opens in a new tab)
Inspection carried out on 27-29 June 2017 During an inspection of Community mental health services with learning disabilities or autism Download report PDF (opens in a new tab)
See more service reports published 9 October 2017