Sirona Care & Health C.I.C.

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive - We looked for evidence that people were always at the center of how care was planned and delivered. We checked that the health and care needs of people were understood, and they were actively involved in the planning of their care. We looked at how the provider listened to and involved people who used services.

At our last assessment we rated this key question good. At this assessment the rating has stayed the same. This meant people were at the center of their care, were listened to and involved in their care and treatment.

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.

The service made sure people were at the centre of their care and treatment choices and made decisions in partnership with people. The service responded to any relevant changes in people’s needs but not always in a timely way.

We observed staff discussed care and treatment options with patients. Services were delivered and coordinated in an accessible and responsive way to patients, particularly for those with complex needs. At times, there were often delays with some patients receiving treatment.

Staff told us patients were involved in discussions about their care and consent was sought when referrals were made to other services, such as the NHS Continuing Healthcare (CHC) Fast Track assessment pathway. We observed a community nurse treating a patient with leg ulcers in their own home. Whilst providing care, the nurse discussed the need for a specific treatment with the patient and took time to speak to them about their mobility, care needs and frequency of visits.

Staff routinely involved people who used services and those close to them (including carers and dependents) in planning and making shared decisions about their care and treatment. The patients that we spoke with said that they felt involved in their care and understood what was being provided to them and why. They told us that they felt able to ask questions about their care, and that staff supported them to learn about how to manage their illnesses.

We saw evidence that patients were active partners in their care. Patients were supported to manage their illness whenever possible; for example, a patient was supported to administer their own medicine with the support of a community nurse to ensure they took the right dose of insulin. We observed an allied healthcare professional confirming with a patient about sending copies of letters both to the patient and the GP to help them keep informed of their treatment and care. We also saw a consultation with a patient in an outpatient department and found that care was taken in how the patient was given information. This empowered them to decide appropriate treatment options.

We saw evidence where patients with deteriorating wounds or conditions were not always identified in a timely way, which had resulted in harm. Some patients had their visits deferred if they had been assessed as being amber or green and if demand for the provider’s services was greater than their capacity. Patients were mostly informed of deferred visits and the escalation process.

Patients waited varying timescales to be seen by some of the community health services for adults. The longest wait was for Musculoskeletal (MSK) physiotherapy and neurology with only 53% and 56.5% respectively of patients seen within the 18 weeks of referral. Tissue viability and the long covid service saw all their referrals within 18 weeks. The provider was aware of some patients having to wait to be seen and all were reviewed based on their clinical need.

People could not always access care and treatment at a time to suit them. Significant capacity issues within the podiatry team resulted in some referrals into the service going unactioned, or patients seeking treatment elsewhere.

People in the podiatry service and with the most urgent needs, generally had their care and treatment prioritised. There was a focus on administration staff getting new referrals into the service seen within 18 weeks. However, there remained a risk around follow up patients being appropriately RAG rated and seen in line with their care plans or best practice guidance. For example, administration staff often prioritised new patient appointments over patients whose visits had been deferred and did not always follow up on patients who had been waiting over 4 weeks (or more). The rationale behind this was that longer follow up patients often had shared care with the nursing teams. Staff explained that due to bank, agency and the junior nature of some of the nursing workforce, the knowledge to identify and escalate deteriorating complex foot problems was not consistent. The podiatry service also had issues with some patients being referred to them which didn’t meet their criteria and not being able to refuse them as not all staff were aware of this. We observed this in one clinic we attended where a patient did not meet the criteria, but they were given an appointment resulting in delays for patients who needed to be seen. Following our inspection, information was provided which confirmed this patient had an active wound at the time of referral, but this had resolved by the time of their appointment.

Technology and equipment were used to enhance the delivery of effective care and treatment and to support people’s independence. In all teams we accompanied on visits to observe care and treatment, staff could access not only Sirona records, but care records from the acute NHS provider, GPs and ambulance records. This enabled staff to obtain past consultation notes, letters and diagnostic test results, such as bloods and x-rays which assisted staff with ongoing treatment of the patient.

The service identified and met the information and communication needs of people with a disability or sensory loss. This information was clearly recorded on electronic records which staff accessed before they went out on visits.

We saw community nurses during home visits and other staff in clinics using technology to assist with providing care. Images of wounds were taken and compared to previous images using a specialised wound care app allowing staff to monitor progress. These were stored electronically in the patient notes and could be shared with other care providers if required.

Staff told us that an electronic system was also used to log incidents, and examples were given where concerns led to a multi-disciplinary approach, including safeguarding referrals, capacity assessments and liaising with other healthcare professionals such as tissue viability nurses.

Technology was also used to support timely access to services. The Single Point of Access (SPA) provided a phone and e-mail service for patients who required healthcare support mainly in their own homes. The SPA service manager told us the aim was to answer urgent calls within 2 minutes and to triage referrals within 30 minutes. Some processes were automated, with a robotic telephony service used to speed up blood referrals. This has resulted in efficiency savings that were used to support other areas in the service for the benefit of patients.

The SPA also had various referral pathways into the service which allowed a multitude of healthcare professionals including paramedics and GPs to refer patients for ongoing assessment and care.

Staff mostly had enough equipment and consumables to carry out their jobs effectively. Nurses planned each visits using information held on their electronic notes system. This ensured they took the correct dressings and equipment to the correct patient.

Some patients raised concerns that not all staff had the correct dressing which meant they had to leave and come back at another time. This had an impact on both the patient and the member of staff.

We did not look at Care provision, Integration and continuity during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Providing Information during this assessment. The score for this quality statement is based on the previous rating for Responsive.

The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result. The service provided several ways for patients to share their feedback with them. Patients receiving care in their own homes were able to give valid feedback by using leaflets with QR codes and other contact details were left following visits. The provider told us they have nearly completed their easy read versions of their complaints leaflet, accessible complaints leaflet and video to enable more people to give their feedback on their care and treatment. Since the inspection the provider had introduced a standard stock list that all community staff would carry.

The service obtained patient feedback through the ‘friends and family’ test. From April 2024 to December 2024, most patients who had replied would recommend the service to their family and friends. The provider identified 3 areas for improvement and these included waiting times, communication processes and providing toys in waiting rooms for children. An action plan had been developed to address these.

The provider told us they had development plans for their 'People’s Voice' to create a much broader database of people with lived experience they could draw on for specific subject matter groups as they arise. Following the inspection the provider sent us copies of surveys they sent to different groups of patients. This included end of life care, breathing group and diabetes courses provided. For example, for the diabetes service provided structured educational ‘living with diabetes’ and out of the 747 patients who attended, 423 rated it as ‘excellent’ and ‘251’ rated it as good.

Staff involved people who used services and those close to them (including carers and dependents) in planning and making shared decisions about their care and treatment. The patients we spoke with said that they felt involved in their care and understood what was being provided to them and why. They told us that they felt able to ask questions about their care, and staff supported them to learn about how to manage their illnesses

During the assessment, we observed 7 specialist clinic appointments. Staff consistently provided patients with information about the care they were receiving. All patients we observed were asked if they had any questions by staff who were treating them. We observed strong professional to patient relationships that were supportive of the patient’s needs. During 1 clinic appointment, the patient required urgent referral to a local NHS hospital. The member of staff involved the patient in the decision-making process, telling them why it was important for an urgent referral. This was all done through the computer system which the NHS hospital had access to, resulting in less delays for the patient.

On home visits we observed patients being included in discussions about their care and treatment, and where applicable, relatives and carers were also involved. Patients told us they felt they were always empowered to make decisions about their care. They said they felt fully included and their opinions respected.

People who used the service knew how to make a complaint or raise concerns and felt comfortable and supported to do so in their own way. During one home visit, a patient expressed some concerns to us, which we fed back to the provider who then arranged a visit from a locality manager to discuss these.

When people raised concerns, they were actively encouraged to make a complaint, and staff empowered them to speak up. Patients we spoke with, although had not had cause to raise a complaint, told us they would have no hesitation in doing so and knew where to go to complain or raise a concern. Most patients told us they would speak to their nurse or therapists in the first instance.

Most patients we spoke with were aware of the emergency contact number which they could access for advice, alongside primary care services. However, one patient with a complex wound had not been advised of what to do if their sterile dressing became torn or loose.

Managers of the specialist services we visited demonstrated an embedded approach to managing concerns. It was normal practice to ring a person who had raised a concern to discuss the situation. We were told that this regularly resulted in concerns not being taken further. Staff we spoke with viewed concerns and complaints as opportunities to improve and learn.

There was an effective system for the management of complaints. The service had recently employed 2 family liaison officers who formed a bridge between families and patients, and the service. The role had only existed since July 2024, but the officers had already been involved in 2 complaints. They explained they were able to spend time with the families and supported them to understand the complaint response and any accompanying investigation. They also ensured families and patients were given ample time to have their own questions asked and answered. The provider had received 69 complaints and 300 concerns from January 2024 to December 2024. The main themes were quality of care and service provision.

We did not look at Equity in access during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Equity in experiences and outcomes during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Planning for the future during this assessment. The score for this quality statement is based on the previous rating for Responsive.