North East London NHS Foundation Trust

Ratings - Community health services for adults

• Overall

  Good

• Safe

  Good

• Effective

  Good

• Caring

  Good

• Responsive

  Good

• Well-led

  Good

Our view of the service

We carried out short notice announced inspection of community health services for adults as part of our continual checks on the safety and quality of healthcare services. We visited community health services for adults in Havering, Barking and Dagenham, Redbridge and across Essex. We visited 9 district nursing teams, 2 tissue viability/leg ulcer services, 1 respiratory service and 1 diabetes long-term conditions team. We were on site inspecting these services over on the 19, 20, 21, 26, 27 28 November 2024. We gave verbal feedback which we confirmed in a letter to the trust shortly after our inspection.

As part of the inspection, we visited 9 district nursing teams, 4 specialist teams, the tissue viability clinic, leg ulcer services, respiratory services, and the diabetes clinic – long-term conditions team. We spoke to 38 patients, 7 carers and relatives and received 22 comment cards from patients. We reviewed 49 patients’ care and treatment records. We attended home visits with district nurses, physiotherapists and tissue viability nurses, including observing medication administration. We carried out a tour of the environment at each site we visited. We observed handover meetings, a patient safety meeting, pressure ulcer meeting, monthly shared learning meeting, risk meetings, safety huddles, and integrated case management meetings. We also spoke with 61 staff members, including Integrated care managers, community matrons, community therapy team, associate director of nursing services, single point of access triage practitioner, non-medical prescribers, operational managers, team leaders, deputy clinical nurse, occupational therapists, support workers, health care assistants, respiratory nurses, tissue viability nurses and diabetes specialist nurses, pathway coordinator and band 3-7 nurses.

We had previously inspected community health services for adults in October 2017. As a result of that inspection, we had rated the safe domain as requires improvement. The provider was in breach of Regulation 18, as staff did not have regular clinical supervision or appraisals. We had rated the effective, caring, responsive and well led domains as good. Our overall rating was good.

At this inspection our ratings changed. Our rating for safe improved, this domain was rated as good and there was no longer a breach in regulation. Ratings for effective, caring, responsive and well led stayed the same and were rated as good. Our overall rating stayed the same and the service was rated as good.

• We found improvements with staff being consistently supervised, appraised and their competences assessed. Compliance with mandatory training was high and staff could access a range of specialist training appropriate to their role. Staff were suitably trained and competent to administer medicines. Staff were committed to continually learning and improving services. Staff used quality improvement methods to make improvements in care and the quality of services provided.
• Feedback from patients and carers about the service they received was mostly very positive. They were treated with dignity and respect. Patients and carers said they found staff helpful and kind and said their treatment was clearly explained. Where a patient’s condition deteriorated, patients told us that staff responded promptly and appropriately.
• Managers investigated incidents and shared lessons learned with the whole team and the wider service. Staff were able to give examples of learning from incidents. Staff completed comprehensive risk assessments which were regularly reviewed. Identified risks were managed or mitigated appropriately. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
• People we spoke to felt involved in their care planning. Staff we spoke to understood peoples’ strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics. The service displayed information leaflets in various languages, reflective of their local communities. Team bases had information displayed about chaperones and staff made sure patients were aware they could request a chaperone. The trust listened to people who were most likely to experience inequity and aimed to develop services to address this. People working in services reflected the diversity of the communities they worked in.
• Patients were encouraged to feedback on services and engage in their development through local and trust wide engagement networks. The service treated concerns and complaints seriously, investigated them and learned lessons. Patients, relatives and carers knew how to complain or raise concerns.
• Governance processes operated effectively at team level and performance and risk were managed well. There were robust structures, processes, and systems of accountability in place to monitor the performance of the service. Staff adhered to infection control principles and where appropriate used personal protective equipment. Managers and staff carried out a comprehensive programme of regular audits to check compliance and improvement over time to support the delivery of care. Staff in specialist clinics had systems to follow up patients who did not attend. Deferred visits rarely happened.

However:

• Some patients (15%) commented that communication could be improved. They said telephone messages were not always passed on or responded to. For a small number of patients who did not share a language with the person delivering a care, an appropriate interpreter was not always booked. Other patients commented that staff changes could impact upon consistency of care.
• Improvements were needed in the policies and processes in place for the management of medicines and secure stationary kept in staff’s homes. Improvements were also needed to ensure that peoples drug allergy information was accurately and consistently recorded.

People's experience of this service

We spoke to 38 patients, 7 carers/relatives and received 22 comment cards. Feedback from patients and carers across all teams was mostly positive. Patients and carers we spoke with were satisfied with the care they received and felt involved in making decisions. Carers and patients empathised with nurses' busy schedules and appreciated their helpfulness, kindness and positive attitude. Patients expressed satisfaction with the explanation of treatments and progress reports they were given. Staff responded promptly to requests from patients, for example, a patient felt a wound was getting worse, staff made arrangements to see them the same day.

Just over 15% of patient and carer feedback covering the Havering, Barking Dagenham and Redbridge teams stated that communication from district nursing teams needed to improve. For example, time frames for visits; response to out of hours calls from patients and keeping patients updated when staff were running late. Some patients told us when they contacted Havering District CHS Central team messages were not always passed on and patients found themselves having to call back.

Some patients commented on a lack of consistency in care in the district nursing teams, with some patients and carers stating that they had to remind staff what was in their care plans. Some patients in the London teams reported that there was a language barrier between them and the nurses. They could not always understand each other as staff did not always book interpreters for appointments and had to rely on relatives.