The Care Quality Commission
  • Organisation
  • SERVICE PROVIDER

Shropshire Community Health NHS Trust

This is an organisation that runs the health and social care services we inspect

Overall: Good read more about inspection ratings
Important: Services have been transferred to this provider from another provider

All Inspections

09 Jan to 08 Mar 2019

During an inspection of Community end of life care

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

  • We rated safe, effective, caring, responsive and well-led as good.
  • The trust now had an end of life strategy and staff documented and monitored patients’ medical care through the use of care plans.
  • The service provided mandatory training in key skills to all staff and made sure everyone completed it.
  • Staff were given time to reflect and review their practice and this was recorded in a workbook to demonstrate skills, knowledge and competencies supporting NMC revalidation.
  • The service controlled infection risk well.
  • Records we looked at showed that assessments of patients’ needs were recorded to minimise their risks and maximise their comfort.
  • The service now provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.
  • A staff supervision strategy was now in place to support staff in delivering high quality, safe care.
  • The service now monitored the effectiveness of care and treatment and used the findings to improve them. They compared local results with those of other services to learn from them.
  • Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.
  • Staff provided emotional support to patients to minimise their distress. Families and patients unanimously told us that the staff were all caring and thoughtful.
  • Patients’ individual needs were now appropriately planned and risk assessed.
  • Concerns and complaints were taken seriously, investigated and lessons learned from the results, which were shared with all staff.
  • A wealth of complimentary cards and letters, received from relatives, were displayed in the community wards.
  • Managers had the right skills and abilities to run a service providing high-quality sustainable care. Leaders were visible and approachable.
  • Staff now felt engaged and valued. The leaders had become fully engaged with regards to promoting the strategy. The drive and commitment was evident to all staff involved with the process.
  • Managers promoted a positive culture that supported and valued staff.
  • The service had effective systems for identifying risks.
  • The service engaged well with patients, staff, the public and local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively.

However:

  • The service should ensure progress is made in the implementation of electronic prescribing for prescriptions with the necessary security safeguards.

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.

09 Jan to 08 Mar 2019

During an inspection of Community health inpatient services

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

  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
  • Staffing levels and skill mix were planned and reviewed so that people receive safe care and treatment.
  • The service controlled infection risk well. Staff kept equipment and the premises clean. They used control measures to prevent the spread of infection.
  • The service had suitable premises to meet patient’s needs. The environment was secure. Equipment had been regularly tested for safety in accordance with policy.
  • Staff kept appropriate records of patients’ care and treatment. Records were mostly clear, up-to-date and available to all staff providing care. Records were audited in order to identify areas for improvement.
  • The service stored, prescribed, administered and recorded medicines appropriately. Patients received the right medication at the right dose at the right time.
  • Risks to people who used services were assessed, and their safety was generally monitored and maintained.
  • The service used safety monitoring results appropriately. Managers collected safety information and shared it with staff, patients and visitors.
  • The service generally managed patient safety incidents appropriately. Staff recognised incidents and reported them. Managers investigated incidents and lessons learned were shared with the team and wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.
  • The service demonstrated that it provided care and treatment based on national guidance and evidence of its effectiveness. Managers had policies and processes in place to ensure that sure staff followed guidance and best practice.
  • Staff gave patients enough food and drink to meet their needs and improve their health. The service made adjustments for patients’ religious, cultural and other preferences.
  • Staff assessed and managed patients’ pain and pain assessment tool were in the process of being introduced for people who experience difficulty communicating.
  • The service monitored the effectiveness of care and treatment and used the findings to improve them. They worked with other services to improve outcomes for patients.
  • The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them in order to provide support and monitor the effectiveness of the service.
  • Staff worked together as a team to benefit patients. Doctors, nurses, therapists and other healthcare professionals supported each other to provide care.
  • The service reviewed patient needs to improve their health. Recognised national screening mechanisms were seen to be used as part of the inpatient admission process.
  • Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. They knew how to support patients experiencing mental ill health and those who lacked the capacity to make decisions about their care.
  • Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them with kindness and care.
  • Staff provided emotional support to patients and carers to minimise their distress.
  • Staff involved patients and those close to them in decisions about their care and treatment. The service took action to address issues of patients not feeling involved in their care and treatment, including addressing issues with ward and medical staff.
  • The trust generally planned and provided services in a way that met the needs of local people. There was coordination between the community hospitals, acute services and community services to plan and delivery services which meet people’s needs. The service was reviewing therapy input within the inpatient service to ensure it met people’s needs.
  • The service took account of patients’ individual needs. Services were planned, delivered and coordinated to take account of people with complex needs, for example those living with dementia.
  • There was a general decrease in the percentage of patients who experienced discharges that were delayed.
  • Lessons learned from the results of complaint investigations were shared with staff.
  • The service had leaders at all levels who were visible and approachable with the skills and abilities to run the service. Staff spoke positively about the senior management team and ward managers and they felt supported by them.
  • The service had a vision for what it wanted to achieve and workable plans to turn it into action. Objectives had been developed which were aligned with the trust objectives.
  • Managers across the service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values. Most staff reported they felt respected and valued.
  • The service used a systematic approach to continually improve the quality of its services and safeguard high standards of care by creating an environment of excellence in clinical care.
  • The service had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected.
  • The service collected, analysed, managed and used information well to support all its activities, using secure electronic systems with security safeguards.
  • The service engaged with patients and staff to plan and manage appropriate services.
  • The service engaged well with patients, staff, the public and local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively.

However:

  • The service provided mandatory training in key skills to all staff but did not make sure that everyone completed it. Mandatory training compliance rates were below the trust target, including for safeguarding.
  • We found that some improvements could be made to falls prevention as assistive technology was not readily available for use as a method of mitigating the risk of falling.
  • There were limited outcome measures in use for therapy interventions and this was recognised by the service as an area for improvement.
  • Mental capacity assessments were not undertaken by all nursing staff although managers were in the process of addressing this with additional staff training.
  • Patients could not always access aspects of the service when they needed it; patients admitted at evenings and weekends did not have timely access to routine medical assessment. Therapy services were not readily available over the weekends and staffing issues had resulted in a reduction against planned physiotherapy cover.

09 Jan to 08 Mar 2019

During an inspection of Community health services for adults

  • Staff protected patients from avoidable harm and abuse. They ensured that legal requirements were met.
  • There was a good multidisciplinary and multi-agency approach to coordinated care and treatment for patients.
  • Staff provided effective care and treatment to patients that met their needs and resulted in good patient outcomes.
  • Staff treated patients and those close to them with dignity and respect. They supported patients and their loved ones, and involved them as partners in their care.
  • Services were delivered and organised in a way that met the needs of the local population.
  • The leadership, governance and culture promoted the delivery of high-quality, patient-centred care.

09 Jan to 08 Mar 2019

During an inspection of Community health services for children, young people and families

  • We rated safe, effective, caring, responsive and well-led as good.
  • The service had enough staff with the right skills and training with managers who supported and monitored their performance.
  • There was a positive working culture where learning from incidents was encouraged.
  • There were effective safeguarding procedures in place and multidisciplinary teams worked together to protect vulnerable children.
  • Staff provided individualised, child-centred care. Children, young people and their carers were treated with compassion, dignity and respect. Staff provided appropriate information and support to enable them to make decisions about the care they received.
  • National programmes of care were followed and evidence-based practice was delivered across all children services.
  • There were clear governance structures to monitor the quality of care delivered.

09 Jan to 08 Mar 2019

During an inspection of Community urgent care services

  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
  • The service controlled infection risk well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection.
  • The MIU and DAART environments posed some challenges to staff. The trust was aware of these challenges and plans to address these challenges were in progress. Suitable equipment was in place and was appropriately maintained.
  • Staff completed and updated risk assessments for each patient. They kept clear records and asked for support when necessary.
  • An effective early warning system was in place to identify deteriorating patients and appropriate action was taken in response to this.
  • Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date and easily available to all staff providing care.
  • The service followed best practice when prescribing, giving, recording and storing medicines. Patients received the right medication at the right dose at the right time.
  • The service used safety monitoring results well. Staff collected safety information and shared it with staff, patients and visitors. Managers used this to improve the service.
  • The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.
  • The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.
  • Where appropriate, the staff gave patients enough food and drink to meet their needs and improve their health.
  • Staff assessed and monitored patients regularly to see if they were in pain. They supported those unable to communicate using suitable assessment tools and gave additional pain relief to ease pain.
  • Managers monitored the effectiveness of care and treatment and used the findings to improve them. They compared local results with those of other services to learn from them.
  • The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and monitor the effectiveness of the service.
  • Staff of different kinds worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.
  • Patients were supported to live healthier lives and manage their own care and wellbeing needs where appropriate.
  • Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. They understood how and when to assess whether a patient had the capacity to make decisions about their care and followed the trust policy and procedures when a patient could not give consent.
  • Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.
  • Staff provided emotional support to patients to minimise their distress.
  • Staff involved patients and those close to them in decisions about their care and treatment.
  • The trust planned and provided services in a way that met the needs of local people.
  • The service took account of patients’ individual needs. This included the needs of people with a mental health need or learning disability.
  • People could access urgent care services during their opening hours. Waiting times from initial presentation/referral to treatment and arrangements to admit, treat and discharge patients were in line with good practice.
  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with all staff.
  • Managers at all levels in the trust had the right skills and abilities to run a service providing high quality sustainable care.
  • The trust had a vision for what it wanted to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community.
  • Managers across the trust promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
  • The trust used a systematic approach to continually improve the quality of its services and safeguarding high standards of care by creating an environment in which excellence in clinical care would flourish.
  • The trust had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected.
  • The trust collected, analysed, managed and used information well to support all its activities, using secure electronic systems with security safeguards.
  • The trust engaged well with patients, staff, the public and local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively.
  • The trust was committed to improving services by learning from when things went well and when they went wrong, promoting training, research and innovation.

However:

  • The service provided mandatory training in key skills to all staff. However, the trust’s training compliance targets were not always met.
  • The service did not always have enough permanent staff available to provide care and support. However, bank and agency staff were used to mitigate the risk of harm and to ensure patients received the right care and treatment at the right time.
  • The service should ensure that patients’ right to confidentiality and privacy are protected consistently protected.
  • The service should continue to engage with commissioners and other providers to ensure local X-ray services are available to patients when they access urgent care services.

09 Jan to 08 Mar 2019

During an inspection of Community dental services

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

  • Staff were qualified and competent to carry out their roles. They completed mandatory training to support them. There were effective systems in place to safeguard patients from abuse or neglect. Premises and equipment were clean and hygienic and used dental instruments were sterilised according to nationally recognised guidance. As a result of two never events a process had been put in place to reduce the likelihood of these occurring again.
  • Staff provided treatment, advice and care in line with nationally recognised guidance. The service used skill mix effectively through the use of dental therapists and dental nurses with extended duties. Staff worked together as a team and with other healthcare professionals in the best interests of patients. Staff had a good awareness of their responsibilities under the Mental Capacity Act 2005.
  • Staff cared for patients with compassion and kindness. Patient feedback was positive. They told us staff were kind, polite, pleasant and respectful. We observed positive interaction between staff and patients.
  • The service took into account patients’ individual needs. Reasonable adjustments had been made to all clinics which we visited to help wheelchair users or those with limited mobility to access dental treatment. The service had hoisting facilities and a wheelchair tipper. The service provided care and oral hygiene advice to patients at the local orthopaedic hospital. The service dealt with complaints promptly, positively and efficiently.
  • There was a clearly defined management structure. Managers had the right skills to support high quality sustainable care. Systems and processes were in place to help manage the risks associated the carrying on of the regulated activities. Staff engaged with patients, external stakeholders and other healthcare professionals to continually improve the service.

However:

  • Not all actions identified in the fire risk assessment at Dawley dental centre had been actioned.
  • A blind ended pipe which had been identified in the Legionella risk assessment at Shrewsbury dental centre had not been removed.
  • Glucagon was not stored in a temperature monitored fridge and the expiry dates had not all been adjusted accordingly.
  • The dentists did not obtain signed consent for urgent courses of treatment.

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

March 2016

During an inspection of Child and adolescent mental health wards

We rated this service as requires improvement. This is because:

  • The service did not have sufficient staff to provide effective care. None of the CAMHS teams could provide the full range of psychological therapies recommended by the National Institute for Health and Care Excellence (NICE).
  • Average caseloads within the CAMHS learning disability team exceeded national guidance.
  • The tier 2 Telford and Wrekin service was not fully staffed and was unable to triage referrals to CAMHS or offer interventions on a Friday.
  • Staff did not feel engaged by senior managers. Staff found out about a major CAMHS transformation plan after its public release and did not broadly believe that senior managers understood CAMHS services or listened to their concerns.
  • The trust failed to consistently inform staff about lessons learnt from CAMHS incident investigations.
  • The service did not effectively manage waiting lists. Teams organised waiting lists around where patients lived rather than the urgency of patients’ needs. Staff did not actively monitor for changes to waiting list patient risk levels.
  • The service made limited use of outcome measures and did not undertake regular audits of performance and quality. The service did not use key performance indicators other than referral-to-treatment waiting times to measure and monitor the quality of services.
  • The environment was not suitable for delivering effective care. Soundproofing was ineffective across all CAMHS sites. Conversations and movement were heard between staff offices, consultation rooms and adjacent rooms, disturbing work and compromising confidentiality.

However we also saw that:

  • The service worked around patient, family and carer needs.
  • The teams had flexible appointment times, and carers told us they could access support quickly if needed.
  • Staff were respectful and supportive and adapted their behaviour to match patients’ ages and specific requirements.
  • Staff completed detailed and recovery-focused care records. Staff also worked with patients, families and carers to produce written plans that set out how the service would meet the patient’s care and support needs.
  • The service encouraged and facilitated patient feedback, and made changes based on this feedback where possible.
  • When the service received formal complaints, the trust investigated responded and implemented changes when appropriate.

March 2016

During an inspection of Substance misuse services

We rated this service as requires improvement. This is because:

  • The recording of information about safety within Care planning and Risk Assessment documents was often partial or incomplete. In the paper and clinical notes we reviewed, we found staff had not documented the identified risk and management plans sufficiently well.
  • There were no serious incidents recorded in the previous twelve months. Incidents could be reported on Datix.
  • Trust substance misuse team staff did not use trust systems or processes to learn from safeguarding incidents, instead relying on the local authority to manage and feedback on all safeguarding incidents.
  • The Community Substance Misuse Team (CSMT) had not responded to public health guidance on opiate overdose, shown by the fact it had no programme for delivering Naloxone hydrochloride. Opiates are medicines with effects similar to opium. This includes illicit heroin which is a drug associated with a high risk of overdose. Naloxone is a medication used to block the effects of opiates, especially in overdose. Public health guidance states it is good clinical practice to give this drug to substance misusers and their carers.
  • Multidisciplinary teamwork was inadequate and there was no evidence of case discussion in clinical notes.
  • There had been no clinical supervision of prescribing medics since June 2015.
  • However, we also found the following areas of good practice:
  • Patients reported positive experiences of approachable and caring staff at the CSMT.
  • There were short waiting times for community detoxification although these had recently increased.
  • Community detoxification was carried out in accordance with NICE clinical guidelines.
  • Referral to partnership agencies was high as recorded in the clinical notes.
  • We saw that the service consulted local community pharmacists about patients it referred to them.
  • Electronic prescribing systems and administration were well organised and systems were in place for the timely and accurate production of prescriptions for controlled drugs.
  • Mandatory training records for safeguarding were observed by the inspection team to be up-to-date and meeting trust targets.
  • We saw that supervision and appraisal records were up-to-date.

March 2016

During an inspection of Community dental services

We have rated this service as good. This is because:

  • Services were effective, evidence based and focused on patients’ needs.
  • The continuing development of staff was seen as integral to providing high quality care and all staff received professional development appropriate to their role and learning needs.
  • The service was responsive to patients’ needs; people could access services in a timely way that suited them.
  • Effective multidisciplinary team working and links between clinics ensured patients received appropriate care at the right times and without avoidable delays.
  • Patients from all communities could access treatment if they met the service’s criteria.
  • The local management team were visible and the culture was seen as open and transparent.
  • Systems for identifying, investigating and learning from patient safety incidents were in place.
  • Infection control procedures were in place, equipment was clean and well maintained.
  • We saw good examples of staff providing compassionate and effective care.

March 2016

During an inspection of esb.services_rated.urgent care services

We have rated this service as requires improvement. This is because:

  • There were not always staff on duty with all the appropriate skills and no formal arrangements for clinical supervision of lead nurses or supervision from paediatric doctors although each MIU saw children and babies.
  • Arrangements for feeding back to staff and for learning from incidents were variable.
  • There were inconsistencies in safe staffing levels and high numbers of staff absence from work
  • Care and treatment was mostly based on evidence based guidance but staff were not trained in dealing with sepsis.
  • The service had not compared its performance against other similar services or undertaken any local checks of how well it does.
  • The trust’s scheme to support patients with dementia through their treatment pathways was not understood by MIU staff
  • X-ray services were not always available at the same times an MIU was open which meant patients had to be referred elsewhere.

However, we also saw that:

  • The MIU’s all consistently met national targets for response times.
  • Services were planned and delivered to meet the needs of the local population and there was evidence of the service working with local commissioners to improve access for patients.
  • Staff were kind and professional in their approach and attentive to patients’ needs.
  • Patients felt informed and involved in their care and decisions about their care.

March 2016

During an inspection of Community health services for adults

We have rated this service as requires improvement. This is because:

  • Staffing levels were below establishment and capacity to meet demand was stretched. Staff availability to meet patients’ visits was a challenge. This also meant that there was not always sufficient time for handover and team meetings, and staff were not always able to share information in a systematic and safe way.
  • There was inconsistent information regarding the outcomes for people who use services, data was collected but not regularly collated and analysed.
  • Staff were supported to maintain and develop skills but accessing training could be problematic due to funding and work pressure issues. Staff did not have access to timely and meaningful clinical supervision.
  • There was a lack of consistency in staff’s understanding of the Mental Capacity Act and Deprivation of Liberty Safeguards.
  • The vision and strategy was not clear to some staff and they were unable to see their role in the future development of the service. Governance systems and processes were in place, including recording of risks but not all risks were identified or had action taken to mitigate them.
  • Staff told us they felt supported at a local level but team leaders felt less well supported and some teams described working in isolation. Staff were passionate about the service they delivered but were concerned that resources were stretched and this was impacting on staff morale.

However we also saw that:

  • Staff treated patients with kindness, dignity and respect. Feedback from people using services was positive and staff helped patients and those close to them to cope emotionally with their care and treatment.
  • Staff understood their responsibilities to raise concerns and report incidents and staff told us they received feedback, safeguarding was embedded in the service and medicines were stored, managed and administered appropriately and safely. Records were complete and up to date and maintained to a good standard.
  • Care and treatment was planned and delivered in line with current evidence based guidance.
  • There was effective use of telemedicine, enabling staff to support patients who wished to remain at home.
  • We saw good examples of multidisciplinary working across teams and sectors.
  • Services were planned and delivered in a way that met the needs of the local population. Patients were able to access care in a timely way, waiting times for appointments and treatment were managed appropriately.
  • The values for the service were well developed and encompassed compassion, respect and dignity.

March 2016

During an inspection of Community health services for children, young people and families

We have rated this service as good. This is because:

  • The service had effective safeguarding procedures in place and staff had received safeguarding children training appropriate to the role they performed.
  • Staff across the service knew how to report incidents and were encouraged to do so. Learning from incidents was shared amongst staff and between teams in a number of formats.
  • Staff provided individualised and patient centred care. C hildren, parents and carers were positive about the care that staff provided and the way that staff treated them. People told us and we saw that staff always did more than was needed when they provided care.
  • Staff felt committed to empowering young people through providing them with appropriate information and support to enable them to make decisions around the care they received.
  • Children, young people and their carers told us that staff treated them with compassion, dignity and respect. They were involved in discussions about treatment and care options and able to make decisions.
  • Information was provided in a number of formats to enable young people to understand the care available to them and help them to make decisions about the care they wanted to receive
  • Evidence based practice was delivered across all services and national programmes of care were followed. Staff assessed patient needs thoroughly before care and treatment started and staff took part in competency based training programmes.
  • We saw strong local leadership with the majority of staff we spoke to telling us that they felt supported by their direct line manager.

March 2016

During an inspection of Community health inpatient services

We have rated this service as ‘requires improvement’. This is because:

  • Although services were planned and delivered to meet the needs of the local population, the admission criteria was not being complied with and the community hospital vision was not fully implemented.
  • Patient’s discharge were delayed due to social care arrangements being locally restricted.
  • People with complex needs were assessed yet their support from therapist teams was not sufficient to support a timely discharge into the community.
  • Dementia friendly environments had been developed to support in patients; we identified and staff told us the need for diversional therapies was required to offer specialist intervention.
  • Staffing levels were reported monthly but the patient acuity and dependency was reported bi-annually which meant that staffing levels were not adjusted to meet the needs of the patients on a regular basis.
  • Recommendations following external audits had not been fully achieved.
  • Not all staff felt valued or listened to with the management of staff in some areas not supportive.
  • Patient records were not always kept secure.
  • Nursing staff received no formal clinical supervision. Clinical skills were not observed by managers to gain assurances of the staff competencies.
  • We saw several examples of poor outcomes for patients including lack of support during meal times and personal hygiene issues not promptly addressed (Whitchurch Hospital).

However we also saw that:

  • Infection control and prevention processes delivered low rates of infection.
  • Patient safety was promoted through individual risk assessment from admission and their safety was monitored as part of the individual care plan including appropriate pain relief.
  • The hospitals followed local and professional guidance and most of the staff were familiar with the policies and procedures.
  • The Friends and Family Test (FFT) scores showed patients and carers were consistently satisfied with the care and treatment they received.
  • Patients told us they were treated well by the staff in a kind and compassionate manner.
  • Link nurses met with relatives of patients diagnosed with dementia to review consent and discuss the butterfly scheme which was promoted on the ward.

March 2016

During an inspection of End of life care

We have rated this service overall as requiring improvement. This is because:

  • Systems or processes were not sufficiently established and operated to effectively ensure the trust was able to assess, monitor and improve the quality and safety of end of life care.

  • There was no risk register specific to end of life care.

  • There was no method of categorising end of life care incidents and complaints to monitor themes and share learning.

  • On some prescription charts, guidelines stating the limits to frequency of dosages of anticipatory medicines were not always present.

  • Plans did not provide sufficient information to identify the personal wishes and preferences of patients and their families.There was a lack of assessments of patient’s cultural, spiritual and emotional needs.

  • There was no structured end of life care training plan or register of training to ascertain the skills of staff in different roles and teams. The trust had implemented the end of life care plan prior to ensuring sufficient numbers of staff had received training on how to use it.

However we also saw that:

  • End of life care provision was caring and responsive to patients’ individual needs and requirements. Relatives told us how good the care was and that staff were kind, compassionate, caring and considered the patient's dignity.