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Provider: Worcestershire Health and Care NHS Trust Good

Read our previous full service inspection reports for Worcestershire Health and Care NHS Trust, published on 18 June 2015.

Inspection Summary


Overall summary & rating

Good

Updated 1 June 2018

Our decisions on overall ratings take into account factors including the relative size of services and we use our professional judgement to reach a fair and balanced rating.

Our rating of the trust stayed the same. We rated it as good because:

  • We rated safe, effective, caring, responsive and well-led as good. Our rating for the trust took into account the previous ratings of services not inspected this time.
  • The trust operated collaboratively as a board, that meant executives and non-executive directors shared responsibility and liability for decision-making.
  • There was a holistic understanding of performance, which sufficiently covered and integrated people’s views with information on quality, operations and finances.
  • The trust board were very visible across all services of the trust. We were told of many examples of how the board visited and supported clinical services.
  • The trust understood the challenges to quality and sustainability, and identified the actions required to address them. This was aligned to the wider health and social care economy of Worcestershire. There was good leadership at trust board and sustainability and transformation partnership level.
  • The trust had refreshed their vision and values for the trust. The strategy and priorities of the trust was aligned to the vision and values, and reflected their part in local sustainability and transformation plans. Staff had an understanding of the vision and values in relation to local services.
  • Overall, the trust was a good place to work in. Staff often told us it was the best organisation they had worked in. The trust was recognised as a disability confident employer and had been named in the top 100 employers of apprentices.
  • Governance systems from ward to board provided good performance management information to make decisions.
  • The trust communicated well with patients, carers, staff and stakeholders. The majority of groups felt included in decisions about service re-design and development. The youth board was a good example of patient involvement and demonstrated that the trust listened to their views and acted on their suggestions.
  • There were robust arrangements in place to identify, record and manage risks. Patients mental and physical health was assessed, and care and treatment planned.
  • The trust worked hard to improve quality and innovation, for example, the digital exemplar programme.
  • Recruitment of staff was a challenge to the trust but they were proactive in attempts to employ people across many of their services.
  • The trust recognised its staff in a number of ways, through a simple thank you to formal awards.
  • There was a culture of learning and research across the trust.

However:

  • In a partnership arrangement with another trust outside of Worcestershire, governance arrangements were complex. However, the trust had learnt lessons and had served notice of the partnership.
  • The policy and procedures for learning from deaths should be reviewed and updated to reflect the gaps we identified.
  • Ward managers in one trust core service could not always identify how many staff had received training, supervision or appraisal.
  • We identified good medicines management across most of the trust however, we saw errors in administration of medication on the acute mental health treatment ward.
  • Although we saw good adherence to, and understanding of the Mental Capacity Act across the trust, there was evidence that decision specific mental capacity assessments were not always fulfilled when staff completed DNACPR forms in community health inpatient services.
Inspection areas

Safe

Good

Updated 1 June 2018

Our rating of safe improved. We took into account the previous ratings of services not inspected this time. We rated it as good because:

  • All areas of the trust were clean and had the necessary equipment for staff to undertake their work.
  • The trust managed risk to patients with regular assessments and audits. Managers and the multidisciplinary teams made changes to the service or their practice when they identified risk to patients. The trust had improved its buildings and processes to reduce ligature risks across services.
  • Although there were staff vacancies across the trust, there were enough staff with the right skills and qualifications to deliver safe care and treatment.
  • Staff had good access to patient records and stored them safely. Staff knew how to keep patients safe and reported incidents, including abuse, when necessary. Staff learnt lessons from incidents.
  • There was good medicines management across most services. However, we found concerns about practice on the acute mental health treatment ward.

However:

  • We found problems with fire safety on one ward. Staff did not adhere to fire safety standards despite prompts to do so.
  • Staff in community health services raised concerns about caseload sizes because of staff vacancies and difficulty in recruiting specialist staff.
  • Staff did not always follow lone working practice in the mental health crisis teams.

Effective

Good

Updated 1 June 2018

Our rating of effective stayed the same. We took into account the previous ratings of services not inspected this time. We rated it as good because:

  • The trust developed individualised care plans that were patient centred and up to date. Staff regularly reviewed and updated care plans.
  • Staff provided a range of care and treatment interventions that was delivered in line with guidance from the National Institute for Health and Care Excellence (NICE). Staff monitored and reviewed the effectiveness of the medicines prescribed.
  • The trust ensured that patients had good access to physical healthcare, including access to specialists when needed. Staff assessed and met nutritional and hydration needs for patients. Staff supported and encouraged patients to live healthier lives.
  • Multidisciplinary teams across the trust worked well together and patients had access to specialist staff when required.
  • The majority of teams received supervision and appraisal. However, we were not assured that all staff in older people mental health wards had access to regular supervision and appraisal.
  • The majority of teams had good knowledge of the Mental Health Act, the Mental Capacity Act and the Deprivation of Liberty Safeguards. Staff had access to and were up to date with training in the Mental Health Act and Mental Capacity Act. However, not all staff in community health inpatient services understood their roles. We could not find evidence that decision specific mental capacity assessments were always fulfilled when staff completed do not attempt cardio-pulmonary resuscitation (DNACPR) forms.

Caring

Good

Updated 1 June 2018

Our rating of caring stayed the same. We took into account the previous ratings of services not inspected this time. We rated it as good because:

  • Staff were kind, compassionate and respectful when caring for patients and carers. Overall, staff were respectful of patients' privacy and dignity. We saw examples of staff going 'above and beyond' when delivering care and treatment.
  • We heard many stories from patients and carers describing the caring and understanding nature of staff. Most patients and carers we spoke to were involved in their care planning.
  • Patients and carers were able to feedback about the service and care they received in a variety of ways.

Responsive

Good

Updated 1 June 2018

Our rating of responsive stayed the same. We took into account the previous ratings of services not inspected this time. We rated it as good because:

  • Services were planned with local people and staff had a good understanding of the needs of patients in their community.
  • Admission and discharge of patients was well planned and patients were involved in decision about their care pathway. Wards were using the 'Red2Green' initiative to support timely discharge back to the community.
  • Referrals to community teams were triaged and assessments undertaken in a timely way and below expected local and national targets.
  • The majority of buildings met the needs of patients and staff. However, there were small bed-bays in two services that could compromise patient privacy and dignity. For the purpose of this report, we have used the term bed-bay. The CQC defines any room with more than one bed within it as a dormitory.
  • Patients and carers knew how to complain and raise concerns. Accessible information was available to patients and staff to better understand services available to them.

However:

  • Patients did not always have timely access to routine appointments in community health services. Also, some patients had to wait longer than expected for certain services. However, there was limited commissioning for some of the specialist community services which limited the trust’s ability to meet the demand. Across community mental health teams, some patients had to wait for psychological based therapies. Although these waits had reduced due to recruitment of psychology staff.

Well-led

Good

Updated 1 June 2018

Our rating of well-led stayed the same. We took into account the previous ratings of services not inspected this time. We rated it as good because:

  • The vision and values of the trust were reflected in the behaviours and attitudes of staff. Staff knew who most of the senior managers were and spoke highly of their local team leaders. Staff were proud to work in the trust and the County of Worcestershire.
  • Staff consistently described a positive culture across the organisation. Staff raised concerns when they needed to without fear of retribution. They spoke of a learning lessons approach to incidents.
  • Robust governance systems were embedded across services. Managers knew who to report to and received information from the senior team that was relevant to their job.
  • Staff sickness levels in the trust was low. Vacancies across the trust were in line with national figures however, retention of staff was good. Staff had good access to training and most staff accessed supervision and appraisals.
  • Local managers encouraged innovation and engagement with trust initiatives to enhance patient care. Staff had the opportunity to enhance their careers within the trust.
Checks on specific services

Acute wards for adults of working age and psychiatric intensive care units

Good

Updated 1 June 2018

  • We rated effective, caring, responsive and well led as good and safe as requires improvement.
  • Risks had been identified and were mitigated through the purchase of specialist equipment and working practices. Ward areas and bedrooms were clean and well presented.
  • There was plenty of staff for patients to have one to one time with their named nurses. Staff were qualified and experienced to undertake their roles. Records were complete, contained all the information required to deliver care and were stored securely.
  • Care was provided in line with national guidance including that set out by the National Institute of Health and Care Excellence. Patients had access to a range of treatment options and nationally recognised tools were used to monitor their effectiveness.
  • Staff received an adequate induction and mandatory training annually.
  • We observed staff offering support and care to the patients on the wards. Patients stated that they felt well cared for and that they would recommend the service. Staff understood the needs of the individual patients and treated them with respect. Carers and family members were encouraged to engage in the recovery process.
  • Patients we spoke to stated that they knew how to use the complaints process and that they would feel comfortable to do so if required. Advocacy services were in place to support patients who felt they needed to raise concerns or make formal complaints.
  • Information gathered as a result of investigations into complaints or incidents had been fed back to staff and there was evidence that this information had informed change.

However:

  • Staff did not always adhere to health and safety protocols. We saw that a number of fire doors had been propped open on Holt Ward.
  • There were practices in place around the administration of medication on Hillcrest that could have caused errors.
  • Patients on Holt Ward did not have access to their own bedrooms and toilets were locked off. This required that patients found a member of staff to unlock the door before they could access them. Some observation practice could have compromised patient dignity.

Wards for older people with mental health problems

Good

Updated 1 June 2018

Our rating of this service stayed the same. We rated it as good because:

  • We rated safe, caring, responsive and well-led as good and effective as requires improvement.
  • Staff identified and appropriately managed environmental risks. The wards had access to emergency and medical equipment that was regularly checked and well maintained. The level of cleanliness in all three wards was of exceptionally high standard.
  • The wards had enough staff that were experienced and qualified, and had the right skills and knowledge to provide safe patient care. Staff reported incidents appropriately and shared lessons learnt from the investigations. The wards had regular and effective multidisciplinary team meetings and worked well with other external organisations.
  • All patients had up-to-date, comprehensive risk, physical health and mental health assessments that informed risk management and care plans. Staff regularly reviewed and updated care plans that were personalised, holistic and recovery orientated.
  • Staff followed good practice in medicines management and monitored and reviewed the effectiveness of the medicines prescribed in line with the national guidance. Patients had good access to physical healthcare, including access to specialists, and their nutritional and hydration needs were met.
  • Staff treated patients with kindness, dignity and respect. Staff understood the needs of individual patients and involved them and their relatives in their care and treatment. Staff enabled patients and families to give feedback about the service.
  • The service had plans to escalate discharges and avoid unnecessary delays. Patients had access to information about their care and treatment and could be provided in an accessible format or different languages. Staff knew how to protect patients who raised concerns from discrimination and harassment.
  • The service had robust governance processes to manage quality and safety. The managers had the skills, knowledge and experience to perform their roles and supported and valued staff to contribute to the strategy of the trust.

However:

  • In our last inspection in January 2015, we asked the trust that this service should ensure that managers give regular formal supervision to staff. When we inspected this time we found staff were still not receiving regular supervision.
  • Athelon ward was an old design building with a mixture of single beds and small bed-bays which meant that privacy and dignity for patients in the bed-bays could be compromised.
  • Staff did not give patients copies of their care plans and not all patients could make a call in private.

Community health services for adults

Good

Updated 1 June 2018

  • Our rating of this service stayed the same. We rated it as good because:
  • We rated safe, effective, caring, responsive and well led as good.
  • Patients were protected from avoidable harm and abuse, systems were in place to investigate incidents and concerns and staff received suitable training in safety systems. Risk assessments were completed and care plans implemented to keep patients safe and promote wellbeing.
  • Care and treatment were planned and delivered in line with evidence based guidance and standards, and systems were in place to ensure trust policies reflected the latest guidance.
  • Patients were happy with the care they received and were very complimentary about the staff who cared for them. We observed care being delivered in a kind and caring way, by staff who demonstrated compassion and experience.
  • We observed robust multidisciplinary working to provide co-ordinated patient care.
  • Most patients were seen for an initial assessment in a timely manner once they had been referred.
  • The needs of patients were taken into account when planning and delivering services. Staff were flexible to meet the needs of patients.
  • Patients were given information about how to make a complaint or raise a concern. There were systems in place to evaluate and investigate complaints.
  • Staff were aware of the organisation’s values and strategy.
  • There were robust governance and risk management systems in place.
  • Staff were innovative and worked with external organisations to examine where local improvements could be made.
  • Despite the work pressures staff were compassionate, sensitive and kind to people who use the service.
  • Senior managers provided good leadership and were visible and accessible to both people who use the service and staff.

However:

  • The service had challenges in recruiting sufficient specialist staff which meant that the service, in particular specialist community nursing, was understaffed at times which had an impact on caseloads. However, we saw no evidence that patient care was compromised.

Mental health crisis services and health-based places of safety

Good

Updated 1 June 2018

Our rating of this service stayed the same. We rated it as good because:

  • We rated safe, effective, caring, responsive and well-led as good.
  • The service kept people safe from avoidable harm by ensuring sufficient staff with the right training, supervision, knowledge and skills. Risk assessments were thorough and staff planned patient care around their needs. Staff had good awareness of safeguarding issues, incidents were reported, and lessons learnt cascaded to staff.
  • Staff used best practice and national guidance to complete comprehensive assessments of their patients, and communicated their needs within the multidisciplinary team, the wider trust and with their external partners to ensure patients received effective and consistent care and treatment.
  • Patients told us staff treated them respectfully and they were involved in their own care. They felt they were listened to and both patients and carers were provided with relevant information and support to manage their condition.
  • The teams responded to patients quickly and managed their caseload effectively to ensure they could provide care when the patient required it. Teams were meeting their targets and dealt with complaints effectively.
  • There were good governance arrangements in place and experienced managers and staff monitored the quality of the service they provided through the use of audits, patient feedback, incidents and complaints and key performance indicators. Staff were positive about the trust and had developed innovative ideas with their teams.

However:

  • The trust lone working policy was inconsistently applied across the home treatment teams, which meant staff could be at risk if colleagues did not know of their whereabouts.
  • Staff in the home treatment teams did not monitor the temperature of the rooms where medicines were stored. This meant that staff could not be sure that medicines had remained within optimum temperature ranges and their efficacy had not been compromised. However the trust rectified this immediately when we informed them.
  • Patient involvement in care planning was variable across the home treatment teams, and not all patients had received a copy of their care plan, however the service had recently implemented a ‘getting well’ plan to improve this.

Community health inpatient services

Good

Updated 1 June 2018

  • Our rating of this service stayed the same. We rated it as good because:
  • We rated well-led as outstanding, safe, caring and responsive as good, and effective as requires improvement.
  • The service kept people safe by ensuring sufficient staff with the right training, supervision, knowledge and skills were in place. Risk assessments to patients were thorough and staff planned care accordingly. Staff followed infection control procedures and wards were clean. Medicines management was effective. Incidents were investigated and managers ensured that staff learning was in place.
  • Staff used best practice and national guidance to complete comprehensive assessments of their patients. Staff were suitably skilled and worked well within multidisciplinary teams. Patients physical health and hydration needs were appropriately met. Measures were in place to effectively monitor treatment outcomes.
  • Patients’ told us staff treated them respectfully and they were involved in their own care. Staff provided emotional support to patients.
  • The trust planned and provided services in a way that met the needs of local people and were delivered where possible in a way to ensure flexibility, choice and continuity of care. The service took account of patients’ individual needs. Waiting times for treatment and arrangements to admit, treat and discharge patients were in line with good practice. The service treated concerns and complaints seriously and lessons learnt were shared with all staff.
  • Quality improvement initiatives were evident across this core service. This has led to improvements in the quality of care and the leadership managers offered to therapy staff. Staff reflected the vision and values of the trust, and there was a positive culture of support and involvement for patients, carers and staff. The trust had effective systems for identifying risks and planned to eliminate or reduce them. The trust was committed to improving services by learning from when things go well and when they do go wrong, promoting training, research and innovation.

However:

  • We could not find evidence that decision specific mental capacity assessments were always fulfilled when staff completed do not attempt cardio-pulmonary resuscitation (DNACPR) forms.

Community-based mental health services for adults of working age

Good

Updated 1 June 2018

  • We rated safe, effective, caring, responsive and well led as good.
  • The service, and the staff working for it, exuded a positive atmosphere. The service had undergone a major re-organisation in 2017 and staff and managers acknowledged this had been an enormous challenge.  Even though some staff still expressed reservations about the effectiveness of the change, all staff we spoke with were positive about working for the service.
  • Patients and carers were positive about the service, particularly praising the sensitive, helpful, patient-focused approach of staff. The service engaged with patients and carers, communicating openly, giving information and ensuring they were able to give feedback and were listened to.
  • There were sufficient numbers of staff to support patients safely. Staff had manageable caseloads and were able to respond promptly to any changing needs of patients. Care and treatment records were kept up to date and informed and reflected good practice.
  • The service worked effectively with other agencies and supported patients in engaging with the wider community, and in increasing their own well-being by supporting healthy living choices and initiatives
  • The service learnt from incidents and complaints and used these as part of making improvements in safety and effectiveness.
  • There was a wide range of health professionals to meet needs, with a wide range of experience and skills. The service had addressed a shortage of psychiatrists and psychologists by recent recruitment.
  • Multi-disciplinary team meetings worked effectively with all health professionals working together in the best interests of individual patients. Professionals from other agencies were also effectively involved.
  • The service monitored the physical health of patients, paying particular attention to any effects from medicines used to treat their mental health.
  • Management offered good support to staff at all levels. New staff were properly inducted and staff received appropriate supervision and appraisals. Managers supported staff through the re-organisation of the service and offered support to staff who whose performance was affected by the challenges of adapting to the changes
  • The service had a clear operational policy, so all that staff were clear on their role, and the aims of the service. All staff comments and work reflected the fact that the service was patient focused and recovery focused.

However:

  • There was still a waiting list for psychology assessments, for both screening and full assessments in some areas. This had been reduced and the service was confident that the appointment of new permanent psychologists would help reduce this further.

Long stay or rehabilitation mental health wards for working age adults

Outstanding

Updated 1 June 2018

Our rating of this service improved. We rated it as outstanding because:

  • We rated caring, responsive and well-led as outstanding, and safe and effective as good.
  • Since the last inspection, the wards had acted on our feedback and there had been significant improvement in the quality of patient care. The wards had comprehensive ligature risk assessments and action plans in place. The self-administration of medicines policy was being followed. The wards completed clinical audits and regularly monitored the quality and effectiveness of the wards.
  • All staff had received training on the Mental Health Act and the Code of Practice and systems were in place to monitor and check all MHA documentation adhered to the requirements of the MHA. All staff had received training in the effective use of the Mental Capacity Act and Deprivation of Liberty Safeguards. 
  • Safety was managed well on the wards; systems in place to monitor safe and the quality of the wards. The wards met safe staffing levels to keep patients safe. All patients had comprehensive risk assessments and management plans in place, which were reviewed and updated regularly. Staff raised safeguarding concerns and reported incidents. The fire alarm system at Keith Winter House was audible throughout the building.

  • All patients had care plans, which were recovery focussed, personalised, holistic and updated regularly. Rating scales and outcome tools were used to measure and monitor a patient’s progress in treatment. Staff had the skills and competencies to deliver effective care and received regular supervision and annual appraisals.
  • Staff treated patients with dignity and respect, were kind and compassionate and support the patient to understand and manage their care and treatment. Staff had built a very good rapport with patients, supported the patients to achieve their goals and ensured all their needs were met.
  • Patients were encouraged and supported to develop skills to prepare them to live independently in the community. Each patient had discharge plans in place that involved other agencies and providers, who engaged with the patients to achieve the plan. Patients engaged with a range of activities on the wards and in the community to build on the skills needed to live independently and had access to volunteering schemes, education and employment.
  • Managers demonstrated strong leadership of the wards. The staff respected the managers, felt supported and were given the opportunities for career and professional development. The wards developed a culture of openness and staff were encouraged to raise concerns, and were fully involved in developing and delivering improvements to practice.

Specialist community mental health services for children and young people

Good

Updated 28 June 2016

We gave specialist community mental health services for children and young people an overall rating of good because they had made improvements since the last comprehensive inspection in January 2015. Some of these improvements include:

  • Staff vacancy rates had reduced and recruitment to posts continued. Administration roles had been filled to support CAMHS delivery of care. Staff shortages had been taken off the trust risk register.
  • The service had moved towards an electronic patient records system and records were kept securely.
  • A single point of access to CAMHS was embedded across the county, meaning that referrals were triaged quickly and young people in crisis were responded to appropriately.
  • Waiting times for assessment were within trust and commissioner targets. CAMHS monitored waiting times through a spread sheet and multi-disciplinary team meetings.
  • Risk assessments were of good quality and person centred, although three new referrals to the Wyre Forest team in November 2015 did not have a risk assessment. Staff were using accredited risk assessment tools.
  • Young people were allocated a care coordinator who supported clinical and risk issues prior to accessing psychological therapies.
  • Staff were flexible to meet the needs of young people, for example, they had a choice of appointment times and staff held therapeutic groups in different trust buildings to suit local need.
  • Access to, and recording of supervision was more consistent across services.

  • Staff received training on the Mental Health Act and the Code of Practice. Staff demonstrated an understanding of the Mental Capacity Act and Deprivation of Liberty Safeguards. Staff had a good understanding of how to identify and report safeguarding concerns.

  • Staff had access to, and most staff attended, de-escalation, safety & disengagement, and conflict resolution training.

  • Staff continued to use the nationally recognised 'Choice and Partnership Approach'.

  • The trust had engaged young people to join a youth trust board and they were engaged with service re-design.

  • Services at Worcester south had undergone redesign and redecoration.

  • Regular team meetings were held and staff supported each other.

  • Staff told us, and we saw from the staff survey that, they were motivated at work and had good support from immediate managers.

  • Although young people who required specialist inpatient treatment were admitted outside of Worcestershire, the trust liaised with NHS England to facilitate appropriate admission and provided contact to support discharge.

Waiting times to access specialist psychological treatment was reduced, however, some young people were waiting over 25 weeks.

Wards for people with a learning disability or autism

Good

Updated 18 June 2015

The overall rating for wards for people with learning disabilities was that these services were good.

  • The staff we interviewed were able to demonstrate to us that they had an understanding of the Mental Capacity Act 2005 (MCA) and also the Deprivation of Liberty Safeguards (DoLS).

  • We saw that there were policies and procedures in relation to the MCA and DoLS to ensure that people who could not make decisions for themselves were protected. We saw from the records we looked at that where people lacked the capacity to make decisions about something, that best interest meetings were held.

  • Care records covered a range of needs and had been regularly reviewed to ensure staff had up to date information. There were also detailed assessments about the person's health that included specific care plans.

  • We observed that staff were able to support people with dignity and respect in a safe and caring manner. We found that people who needed help to manage their anxiety were effectively supported by staff. We saw that when required other health professionals had been involved to help develop strategies for doing this.

  • All of the people we spoke with were positive about the care provided and how the services were managed. Systems were in place to monitor and review people’s experiences and complaints which ensured improvements were made where necessary.

  • Staff were trained and experienced and showed high levels of motivation and commitment. We saw that staff were warm, friendly and supportive in the way that they spoke with and cared for the people using the service.

  • All staff were able to tell us about people’s needs, and were positive about how the service was managed.

  • The carers and relatives we spoke with were very happy with the service provided and all felt that people were provided with safe and effective care.

  • When people’s needs changed all of the locations inspected were able to demonstrate that they responded and where necessary work with other professionals to ensure that needs were met.

Community-based mental health services for older people

Good

Updated 18 June 2015

We rated community services for people with mental health problems as good because:

Teams were committed and effective in treating older people with mental health problems. Where integration of mental and physical health aspects of the service had been combined, services were particularly effective, as people’s holistic needs could be more readily seen and managed. People using the service showed high levels of satisfaction. Staff showed high levels of motivation, and were well supported and trained.

The mental health team at Warndon clinic in Worcester, by contrast to other teams, showed low morale, telling us they were working in an unsuitable environment without sufficient support. Warndon clinic itself appeared overcrowded and cramped.

Where medications were stored, proper records were not always kept of this medication to ensure it was safely kept and used.

Community health services for children, young people and families

Good

Updated 18 June 2015

Overall this core service was rated as good. We found community health services for children, young people and their families were safe, effective, caring, responsive and well led. .

Worcestershire Health and Care NHS Trust delivers community based services to children, young people and their families throughout Worcestershire.

Our key findings were as follows:

  • Staff were caring, compassionate and respectful.
  • Arrangements had been put in place to minimise risks to children and young people receiving care.
  • There were some concerns about the consultation of staff and parents regarding the transfer of children and young people from North Worcestershire to Birmingham Community Healthcare (BCHC).
  • The services within the children and young people, families (C&YPF) service delivery unit had undergone a period of change which had introduced new ways of working. There were / had been shortfalls in staffing levels. Staffing shortfalls had been identified on the risk register which meant that these risks had been escalated to and monitored at trust board level.
  • Systems were in place to monitor quality and people’s outcomes.
  • We observed potential gaps in service provision for example access problems for some parents to child development centres.
  • Individual management of the different divisions providing services to children, young people and families were generally well led.

We saw some good practice including:

  • A ‘Young Person’s Board’ had been created and the speech and language therapy services had been redesigned to include a talking walk-in facility.
  • One staff member from the speech and language therapy team was awarded the ‘Shine a Light’ directorate award for communication services for children.
  • There were many examples of good collaborative working within the multi-disciplinary team.

However, there were also some areas where the trust needs to make improvements:

  • There were gaps in record keeping within some of the records we reviewed.
  • There were shortfalls in the use of evidence based pathways for health visiting service and ‘The Healthy Child Programme (2009)’ had not been delivered in the reception classes of Wyre Forest Special School.
  • We found that staff clinical supervision and management supervision had not been embedded across the service delivery unit.
  • We visited the minor injury units (MIUs) throughout Worcestershire and found that there was inconsistent evidence demonstrating that consent had been obtained and recorded.
  • We saw that improvements were required in relation to the facilities for children and young people within the minor injury units we visited.
  • We were informed that leadership within the health visiting team was not dynamic or motivational and that there had been a slow response to staff queries. This was especially evident with regard to the proposed changes in health visiting provision.

End of life care

Good

Updated 18 June 2015

Overall rating for this core service Good

This was a good service offering compassionate palliative care and treatment for patients in community hospitals, other community care settings or in their own homes.

The staff were passionate about their work and highly motivated to provide the best possible care to meet the needs and preferences of patients and their families.

We spoke with patients and their families and one relative said, ‘‘the care is excellent, I can’t fault it’

The service had improved documentation and processes for advance care planning.

They were working within a number of national programmes such as NHS Improving Quality approach set out in the document ‘One Chance to Get it Right’. The service was also improving the quality of service by implementing high impact actions for improving choices: ‘Where to die when the time comes’.

Staff were highly competent and were able to report incidents and learn from incidents and complaints to improve safety for patients. Staffing levels were good for and consultant advice and support was available out of hours. The community nursing teams offered a service seven days a week. The leadership of the service was committed and innovative and they collaborated well with local independent providers of hospice services.

Community mental health services with learning disabilities or autism

Updated 18 June 2015

We did not rate this core service. The inspection team did not collect sufficient information to ensure, with a high degree of confidence, the rating applied is robust. However, we have outlined our findings below.

  • The staff we interviewed were able to demonstrate that they had an understanding of the Mental Capacity Act 2005 (MCA) and also the Deprivation of Liberty Safeguards (DoLS).

  • We saw that there were policies and procedures in relation to the MCA and DoLS to ensure that people who could not make decisions for themselves were protected.

  • We saw from the records we looked at that where people lacked the capacity to make decisions a best interest meetings were held.

  • Care records covered a range of needs and had been regularly reviewed to ensure staff had up to date information. There were also detailed assessments about the person's health that included specific care plans.

  • When required other health professionals had been involved to help ensure that people’s complex needs could be met.

  • All of the people we spoke with were positive about the care provided and how the services were managed.

  • Systems were in place to monitor and review people’s experiences and complaints which ensured improvements were made where necessary.

  • Staff were trained and experienced and showed high levels of motivation and commitment.

  • We saw that staff were warm, friendly and supportive in the way that they spoke with and cared for the people using the service.

  • All staff were able to tell us about people’s needs, and were positive about how the service was managed.

  • The carers and relatives we spoke with were very happy with the service provided and all felt that people were provided with safe and effective care.

  • When people’s needs changed all of the teams inspected were able to demonstrate that they responded and where necessary worked with other professionals to ensure that needs were met.