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

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

At our last inspection we rated this key question good. At this inspection the rating has remained good.

People were involved in assessments of their needs. Staff reviewed assessments, taking account of people’s communication, personal and health needs. Care was based on latest evidence and good practice. Staff worked with all agencies involved in people’s care for the best outcomes and smooth transitions when moving services. Staff made sure people understood their care and treatment to enable them to give informed consent. Staff involved those important to people to make decisions in people’s best interests where they did not have capacity to make decisions for themselves.

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's care and treatment was effective by assessing and reviewing their health, care, well being and communication needs with them.

The service had seen unprecedented demand for its autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) assessment services in line with the national picture and significantly above the commissioned levels. This had resulted in increased waiting times and numbers and Sirona meeting the waiting list targets. The service provided 'waiting well' initiatives to support children, young people and their families. This included signposting to support services and resources on their website and working with schools to provide support for children prior to referral. Managers told us that despite the increase in numbers of children waiting, they understood their caseloads better, and used a priority rating tool to ensure children were prioritised correctly. Staff have also engaged with parent/carer forums to be transparent about waiting lists and their commissioned remit of providing assessments only.

Children benefited from effective collaboration between teams. Staff explained how the various staff groups worked together to meet people's needs. The service had good links with other external stakeholders such as the local authority and voluntary services. This meant they were able to understand and share information relevant to the people they worked with.

Staff and specialist colleagues had developed templates which provided consistency when assessing children's and family needs and for providing support. These were held on electronic systems and staff used them effectively. We saw information recorded and how it was shared with children and families. Staff used their skills to communicate effectively with children and families and used language in an appropriate way for their understanding.

Staff provided advice on possible next steps and how they could access further support if needed.

We saw that staff worked together to assess and plan on-going care and treatment when families or children moved between teams or services. There were clear protocols for referrals and for the discharge of children and young people. Staff were clear about the referral process and how they could advise families to access the different services that were available

There were a range of opportunities for children and families to access the service for support. School nurses delivered the National Healthy Child Programme and had a dedicated training week in September each year to maintain the relevant skills and knowledge that formed part of public health nursing competency framework. Health visitors and Children and Early Years Practitioners worked with other services to assess children's needs, which followed national guidance.

Baby hubs supported from prebirth to when a child starts school. Parents and carers could drop in to meet members of the health visiting team and other parents. We saw this was used as an opportunity for parents to get advice on weaning. Parents were encouraged to attend as much or as little as they would like, and could attend any of the hubs across Bristol. North Somerset and South Gloucestershire.

During child development reviews, we saw parents were signposted to further services. Discussions were had regarding next visits, how parents could get support once their child reached school age, and were encouraged to reach out for support as and when required.

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

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 people's care and treatment to continuously improve it. Staff ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

However, use of information technology to support safe pathways and transitions was limited. Staff did not always have easy access to information they required. The electronic patient record was not designed specifically for children's services but for primary care. This meant data capture and use was not always easy. However, some mitigations had been made to support staff. The community paediatric team found the IT system was mostly set up to support GP services, which created problems for interrogating data. For example, the service was unable to confirm how many children who attend ADHD assessment clinics have a confirmed diagnosis after their appointment. We also noted that clinicians were not always able to complete notes directly on to the IT system (for children living with cerebral palsy and Downs syndrome), as paper checklists needed to be completed, and then transferred to the IT system later.

A restructure of children's services had brought together different cultures and approaches. Staff were positive about the restructure outcomes. There was a focus on supporting each other, and improved communication and development. There was also a focus on improving outcomes for children, young people and their families. Staff told us they were more involved in the special educational needs and disabilities (SEND) across the region, and felt they were working well with system partners.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff throughout the service had an excellent understanding of the Mental Capacity Act 2005 and consent. They could clearly articulate their responsibilities.

Consent practices and records were actively monitored and reviewed to improve how people were involved in making decisions about their care and treatment. Audits were undertaken within the children’s services to identify areas for improvement .

Staff explained consent to parents and young people they saw in line with provider’s policy. They involved parents when they were able to with a young person’s consent and explained when their confidentiality would be limited to protect the young person's safety.

We saw staff using translation services to get consent at the vaccination clinic, and to clearly explain options to parents and carers of children.