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Provider: Shropshire Community Health NHS Trust Good

Reports


Inspection carried out on 09 Jan to 08 Mar 2019

During a routine inspection

  • All six core services were rated as good overall

Our full inspection report summarising what we found and the supporting evidence appendix containing detailed evidence and data about the trust is available on our website – www.cqc.org.uk/R1D//reports.


CQC inspections of services

Service reports published 1 August 2019
Inspection carried out on N/A During an inspection of Reference: Child and adolescent mental health wards not found
Inspection carried out on N/A During an inspection of Reference: Substance misuse services not found
Inspection carried out on 09 Jan to 08 Mar 2019 During an inspection of Community health services for children, young people and families Download report PDF (opens in a new tab)
Inspection carried out on N/A During an inspection of Reference: Child and adolescent mental health wards not found
Inspection carried out on N/A During an inspection of Reference: Child and adolescent mental health wards not found
Inspection carried out on 09 Jan to 08 Mar 2019 During an inspection of Community health inpatient services Download report PDF (opens in a new tab)
Inspection carried out on 09 Jan to 08 Mar 2019 During an inspection of Community dental services Download report PDF (opens in a new tab)
Inspection carried out on N/A During an inspection of Reference: Child and adolescent mental health wards not found
Inspection carried out on N/A During an inspection of Reference: Substance misuse services not found
Inspection carried out on N/A During an inspection of Reference: Substance misuse services not found
Inspection carried out on N/A During an inspection of Reference: Substance misuse services not found
Inspection carried out on 09 Jan to 08 Mar 2019 During an inspection of Community health services for adults Download report PDF (opens in a new tab)
Inspection carried out on N/A During an inspection of Reference: Substance misuse services not found
Inspection carried out on N/A During an inspection of Reference: Child and adolescent mental health wards not found
Inspection carried out on 09 Jan to 08 Mar 2019 During an inspection of Community end of life care Download report PDF (opens in a new tab)
Inspection carried out on 09 Jan to 08 Mar 2019 During an inspection of Community urgent care services Download report PDF (opens in a new tab)
Inspection carried out on N/A During an inspection of Reference: Substance misuse services not found
Inspection carried out on N/A During an inspection of Reference: Child and adolescent mental health wards not found
Inspection carried out on N/A During an inspection of Reference: Child and adolescent mental health wards not found
Inspection carried out on N/A During an inspection of Reference: Substance misuse services not found
See more service reports published 1 August 2019
Service reports published 7 September 2016
Inspection carried out on March 2016 During an inspection of Community dental services Download report PDF (opens in a new tab)
Inspection carried out on March 2016 During an inspection of Community health inpatient services Download report PDF (opens in a new tab)
Inspection carried out on March 2016 During an inspection of Community health services for children, young people and families Download report PDF (opens in a new tab)
Inspection carried out on March 2016 During an inspection of Community health services for adults Download report PDF (opens in a new tab)
Inspection carried out on March 2016 During an inspection of Community urgent care services Download report PDF (opens in a new tab)
See more service reports published 7 September 2016
Inspection carried out on March 2016

During a routine inspection

Shropshire Community Health NHS Trust provides a range of community-based health services for adults and children in Shropshire, Telford and Wrekin, and some services to people in surrounding areas. It has four community hospitals, four minor injury units and seven community dental locations. Community services are delivered from 130 different locations across the county.

The trust covers a geographical area of 1,235 square miles, a population of 455,000 and employs more than 1,600 staff.

We inspected this service as part of the comprehensive inspection programme. We carried out an announced visit from 7 to 11 March and we carried out unannounced visits on 13 and 24 March 2016.

During our announced visit, we carried out a full inspection of the trust testing whether services are safe, effective, caring, responsive to people’s needs and well led. We looked at all the services it provided. We inspected community inpatient services; services for adults; services for children, young people and their families; end-of life-care services; CAMHS, community substance misuse, minor injury units (MIU) and dental services.

The community substance misuse service was due to transfer to a new provider on 1 April 2016. During our inspection we became concerned in relation to some of the governance systems in the service. For example, the prescribing GP had had no formal clinical supervision from the trust’s medical director since June 2015 (nine months). The UK Guidelines on Clinical Management states; that all NHS staff have an obligation to update their knowledge and skills base and to be appraised regularly. We used our statutory powers to requested further information from the trust regarding this service.

Overall, we rated the trust as Requires Improvement for Safe, Effective, Responsive and Well-Led, and we rated it as good for Caring.

Overall, we rated the trust as Requires Improvement.

Our key findings were as follows:

  • Some parts of the trust experienced understaffing and the skill mix did not always reflect the dependency or caseloads of the service. This meant that team meetings, supervision and handover could not always taken place in a structured way.
  • We were concerned that systems and processes for responding to changing risks in a patient’s condition in the minor injury units were not consistent and patients could be a risk whilst waiting for treatment. Arrangements for treating unwell children under the age of two years were not robust.
  • We saw that investigations were carried out when things went wrong. We saw examples of where lessons had been learnt and where Duty of Candour had been applied. Staff understood their responsibilities to raise concerns and were encouraged to do so by the trust.
  • Safeguarding procedures were embedded in the organisation, led by a strong team. Staff adhered to policies and over 90% of all staff had completed training for safeguarding adults and children to level 1.
  • There was no overall strategy for end of life care. An evidence based care plan for end of life care patients had not been effectively implemented; care was variable and did not consistently follow evidence based practice. Governance arrangements did not enable the trust to monitor the quality of end of life care and improve services.
  • Staff across all services were very caring and treated patients with kindness, dignity and respect. Staff communicated in ways that helped patients and their carers understand their care and helped patients and those close to them to cope emotionally with their care and treatment.
  • The operation of systems for governance and quality measure were inconsistent and not always robust in end of life care and community substance misuse services.

We saw several areas of good practice, including:

  • The effective use of telemedicine to help patients living in very rural areas to remain at home
  • Photographs of pressure ulcer and skin damage were reviewed which enabled the tissue viability nurses to provide timely advice on required treatment to prevent further harm to the patient.
  • The tissue viability service had demonstrated that changes to two layer compression bandaging did not compromise wound healing, gave increased patient comfort and provided cost savings to the trust.
  • Diabetes patient education programme provided excellent patient outcomes for the management of their diabetes.

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

Importantly, the provider must:

  • Develop and implement an overall vision and strategy for end of life care services.
  • Ensure that the operation of systems for governance and quality measure are consistently implemented and that rigorous and constructive challenge is used to hold services to account.
  • Review staffing levels and skill mix in community adult nursing, CAMHS and minor injury services to ensure that staffing meets patients’ needs.
  • Review systems and processes for responding to changing risks in a patient’s condition in the minor injury units to ensure risks to patients are minimised at all times.
  • Review arrangements for responding to changing risks in a patient’s condition in the minor injury units.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Joint inspection reports with Ofsted

We carry out joint inspections with Ofsted. As part of each inspection, we look at the way health services provide care and treatment to people.