Sirona Care & Health C.I.C.

On this page

• 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

Effective - We looked for evidence staff were following evidence-based care and treatment, so people had the best outcomes from their care and treatment.

At our last assessment we rated this key question as good. At this assessment the rating remain at good. This meant people’s outcomes were always consistently good.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

The service planned and mostly delivered people’s care and treatment in line with legislation and current evidence-based good practice and standards.

People's physical, mental health and social needs were not always holistically assessed, although patients had their care, treatment and support delivered in line with legislation, standards and evidence-based guidance, including NICE and other expert professional bodies.

We saw staff had access to pathways and procedures when assessing and planning care which was evidence based and current. Standard operating procedures and care pathways were used both by staff visiting patients in the community but also by staff who met patients in outpatient clinics. The majority of services were following best practice guidance and standards. For example, the wound care team were in the process of working with other providers locally to implement a joint formulary based on peer review to align pathways and treatments.

The falls policy was based on the Multifactorial risk assessment for older people at risk of falling which was from the NICE guidance on falls for older people.

The provider had recently implemented the use of a wound app care to photograph and document wounds in the community. The wound care app scanned the whole area and stored a high-resolution image which was then able to determine if the wound was healing or deteriorating. If the wound was deteriorating it would be added to the list for review by the wound care team, however the wound care team said it was for the community staff to refer to them and not rely on this part of the wound care app. Feedback we received during the inspection and from reviewing a patient safety incident showed it was time consuming to complete all the documentation on the app and this had to be repeated if the patient had more than 1 wound. Following the roll out of the wound care app the provider had submitted their benefits paper project and the findings for two national awards.

For community nursing services, we saw the use of recognised tools such as The Waterlow Score (a screening tool used to assess patients’ risk of developing a pressure ulcer) and MUST (a malnutrition universal screening tool) in assessments for patients. However, these were not always reviewed in a timely manner. Since the inspection the provider had been preparing to introduce the national Purpose - T tool which will replace Waterlow. An implementation plan was in place with a phased roll out to teams starting at the end of June 2025. This formed part of the Pressure Injury Reduction Strategy 25-27.

The MUST was completed as part of the standard nutritional risk assessment for patients. This helped staff assess the risk of malnutrition or if patients were losing weight whilst in the care of the service; this meant that staff could discuss diet, nutritional supplements or aids required to ensure patients had a sufficient nutritional intake to help manage their condition or maintain a healthy weight. People's nutrition and hydration needs (including those related to culture and religion) were not always identified, monitored and met. For example, one patient had been identified as being overweight according to MUST risk assessment based on weight. However, through discussion it was identified they had a very limited diet, which could have impacted their wound healing. This had not been identified by several nurses visiting this patient and only through conversation with a specialist nurse.

The care planning, that we observed was based on individual patient needs, was appropriate and relevant. However, risk assessments were not always updated and care plans amended in a timely manner. This meant that changes in patients' conditions were not always identified at an early stage so timely action can be implemented to reduce the risks. Most nurses did not make contemporaneous notes at the time of their visit and instead, typed up their case notes on return to base. Staff told us this was due to time constraints and often IT connectivity issues. Managers explained alternative, more portable options for note taking were being looked at and this was a known issue. There was a clinical records policy which directed staff on completion of contemporaneous records as soon as was possible and no later than 24 hours. All nurses we observed typed up their notes within this time frame. Since the inspection the provider had reviewed the policy and carried out a retrospective audit which demonstrated since January until May 2025, 90% of records were completed in line with policy. Specific staff guidance and a new template had also been introduced to support staff when it was not possible to record care at the point of delivery into the digital record.

In physiotherapy, people had clear outcome goals which were personalised. As part of the physiotherapy interface team assessments, patients were supported to manage expectations and had their pathways fully explained to them, so they knew what they were having done and why. For example, a patient came in requesting an MRI of a joint. However, with the physiotherapist’s guidance and knowledge, the patient was supported to understand where on their pathway this imaging would be requested if indicated, and why.

Podiatry staff explained it was best practice to have double clinics where 2 podiatrists saw patients. This allowed them to consult with each other and share learning. However, estates challenges were cited as one of the biggest barriers preventing this as they mostly used premises not belonging to the provider.

The musculoskeletal (MSK) physiotherapy service was involved in a Getting It Right First Time (GIRFT) project (The Getting It Right First Time (GIRFT) programme is a national NHS England programme designed to improve the treatment and care of patients through in-depth review of services, benchmarking, and presenting a data-driven evidence base to support change) to look a capacity and demand utilising community based one stop events where services such as physiotherapy and other services such as weight management, smoking cessation and health promotion interventions would be available.

Technology and equipment were used to enhance the delivery of effective care and treatment and to support people’s independence. In all teams we visited, and care and treatment we observed, we saw staff could access not only Sirona records, but care records from the acute NHS provider, GPs and ambulance records so they could obtain past consultation notes and letters, and diagnostic tests, such as blood and x-rays results.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

The service routinely monitored most people’s care and treatment to improve it. Staff tried to ensure outcomes were positive and consistent, and they met clinical expectations.

There was a clear approach to monitoring, auditing and benchmarking the quality of services and the outcomes for people receiving care and treatment. The service engaged with both national audits, internal audits and audits requested by commissioners. We reviewed some of the audits to benchmark the services against other similar services and to investigate how the audits’ results were used to improve practice if required.

The service participated in several national audits such as ‘National COPD audit: ‘Pulmonary Rehabilitation: Steps to breathe better’ (2015), National Audit for Intermediate Care (NAIC). The provider had plans to start collecting data for the Sentinel Stroke National Audit Programme (SSNAP). We saw evidence in minutes of meetings that the audit outcomes were discussed in the relevant quality meetings.

Information about the outcomes of people’s care and treatment (both physical and psychological where appropriate) were routinely collected and monitored. For example, physiotherapy services used a 14-point national outcome questionnaire to evaluate the effectiveness of patients’ treatment and used the data for service improvement.

Senior staff told us about a pilot where they had successfully handed over the administration of insulin to care home staff. There was a strict criteria for this pilot, with the outcome being staff had developed the skills necessary for the monitoring the resident’s diabetes. This helped to reduce the impact on the integrated community nurse teams. The pilot was now being rolled out across all Integrated Network Teams within the organisation.

One of the biggest uses of the integrated nursing team’s time was the oversight of insulin administration for many patients. Senior staff explained each patient needed two 30-minute visits per day. In the handovers we observed, we saw every nurse on shift had carried out between 3-5 visits relating to insulin administration in the first half of their shift. Staff also explained there had been changes to manufacturer equipment which meant previously some patients had been able to administer their own insulin using a large dial, however, changes to the equipment meant they could no longer do this and now required community nursing support.

The falls team had conducted a small audit of 19 patients who were discharged from their service at 3, 6 and 12-months intervals. The outcome was only 1 patient had a fall within 6 months. The learning point taken from this was for the service to look at how they explain exercises so patients could continue this long term.

The stroke team were benchmarking themselves against the ‘National service model for an integrated community stroke service’ and evidenced that they were meeting or were on track to meet the guidelines.

The Respiratory Service was preparing to submit for initial assessment for accreditation to The Pulmonary Rehabilitation Services Accreditation Scheme (PRSAS). This is an accreditation programme aiming to recognise excellence in Pulmonary Rehabilitation (PR) services.

The podiatry service was not using its amputation rates to monitor its safety performance. We saw from the investigation report, this was recorded as an action and when staff had previously requested the amputation data as a measure of safety, senior leaders had told them it was reported by the acute service where the amputation was undertaken. We requested up to date amputation data from the provider which showed the service had an above national average amputation rate in 2023 for lower leg amputations in patients with type 2 diabetes. The system also had above national average rates for minor amputations across all categories of patients (Type1 diabetes is a lifelong condition where the body’s immune system attacks and destroys the cells that produce insulin. Type 2 diabetes is where the body does not produce enough insulin, or the body’s cells do not react to insulin properly which is a lifelong condition). There had previously been a diabetic foot oversight group for the whole region, but this had been stood down by the integrated care board. Since the inspection, a Rapid Quality Review had been held and it had been agreed that the BNSSG (Bristol, North Somerset and South Gloucestershire) System Long Term Conditions Operational Delivery Group would bring together system partners to deliver an approach to have oversight of system actions.

Not all services were monitoring all outcomes for patients. A patient safety incident investigation had identified the podiatry service had no established key performance indicators (KPIs) for monitoring its service provision. Since the inspection the provider had developed a local KPI for Podiatry follow up caseload monitoring.

Information collected showed that following the roll out of the wound care app that lower limb wounds (venous ulcers) had seen an average reduction in healing times across the organisation from 31 to 24 weeks and 61% of all wounds on average were healed within 12 weeks of referral or first use of the wound care app.

The long covid service was assessing their service against national guidance NICE Guideline NG188: COVID-19 rapid guideline: managing the long-term effects of COVID-19. They were able to provide evidence they were meeting this.

The single point of access service had peer reviewed themselves against another similar service within the southwest. They did this to see how they performed compared to a service like themselves. Senior staff felt their service provision performed very well against other services.

We did not look at Consent to care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.