Guys and St Thomas NHS Foundation Trust provided adult community services to support people in staying healthy, to help them manage their long term conditions, acute care delivered in people’s homes to avoid hospital admission and following discharge from hospital to support them at home. Services were provided in clinics, outpatient departments and in people’s homes.
The service required improvement in the effective and well-led domains.
The trust infection prevention and control policy had not been followed in Dulwich community hospital and Bowley close rehabilitation service.
Shortage of experienced nursing and therapy staff left some teams overstretched. Record keeping was inconsistent. This meant that before they visited nursing staff did not always have a clear understanding of a patient’s health status when giving treatment. Staff did not always complete a personalised care plan.
In some community teams staff were out of date with their mandatory training.
There was a clear incident reporting system in place and learning was shared between teams. Community nursing staff had access to specialised equipment to meet patients’ needs when required. The service used effective hand hygiene procedures.
Staff gained consent for treatment and involved patients and relatives in decisions. However, healthcare staff tended to refer to other agencies when mental capacity assessments were required. There was a lack of understanding of who the decision maker was and how this information should be recorded.
Staff experienced some difficulties accessing information because the electronic record keeping system was slow and not always available due to connectivity problems. Different health teams had access to different patient record systems, which complicated the process of obtaining up to date information about patients. The Health Inclusion Team did not use the RIO system. They used the EMIS IT system. The Enhanced Rapid Response team, the Supported Discharge Team and the @home team all used RIO and could see the district nursing records.
We found some examples of effective services and improved patient outcomes due to evidence based practice and commitment of staff to promote patient’s independence. Staff used evidence based care informed by NICE guidelines. Teams worked together in a coordinated way and made appropriate referrals to specialised services. The service participated in audits and developed action plans to improve.
There was good multi-disciplinary working with a strong focus within teams and clinics to reduce hospital admission and promote early discharge. Services were commissioned and designed with this purpose.
Patients received a caring service.
Staff were kind and respectful towards them. Staff treated patients with dignity, involved patients and their families in their care and supported them during times of crisis. Staff gave clear explanations for treatment and encouraged patients to reach their goals.
Patients and relatives expressed satisfaction with the service and we found a caring and compassionate approach from staff in the areas we visited. We saw examples of initiatives and ways of working across localities that were providing patients with good access to services and treatment.
Community health services for adults were responsive.
We saw there were examples of very responsive and accessible services such as rapid referral and quick assessment. These were provided by rapid response teams, the “@home” and “supported discharge” teams who worked closely together.
Improvements made by some teams had identified areas where easy access and increased support for example, provision of Foot health training in diabetes patients had significantly reduced the incidence of avoidable foot pressure ulcers.
Patient responses to trust surveys we saw told us they were very happy with the response of services where for example they had been seen immediately and their treatment commenced to prevent hospital admission.
Staff considered the needs of people who may have difficulty accessing services and adapted their care approach to show respect for cultural factors. There was evidence of learning from the complaints received from patients and families.
Many aspects of the service were well led but some aspects of risk management and public engagement needed to be improved.
Staff in adult community services told us they were well supported by local team leaders and managers. Staff across the trust had opportunities to review the quality of care and the way that teams worked. They told us they felt empowered to develop local solutions based on good practice.
There was a clear vision for the service and examples of innovation. Risk registers reflected the key areas of concern to frontline and management staff.