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Provider: South Warwickshire NHS Foundation Trust Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 4 December 2019

  • We rated safe, effective, caring as good, and responsive and well led as outstanding. We found all four of the core services inspected as outstanding for being well led. In rating the trust, we took into account the current ratings of the eight services not inspected this time.
  • We rated well-led for the trust overall as outstanding.
  • Staff treated patients and their families with great compassion and kindness, respected their privacy and dignity, and took account of their individual needs. Patients and their families were truly respected and valued as individuals by an exceptional service. Staff found innovative ways to provide emotional support to patients, families and carers to minimise their distress. Staff routinely empowered patients to have a voice and ensured a person centred approach and went above and beyond to support them. Feedback about services was extremely positive.
  • There was compassionate, inclusive and effective leadership at all levels. Leaders had the skills and abilities to run the service and deliver high-quality, patient centred care. Staff understood the trust’s vision and values, and their role in achieving them. Staff felt truly respected, supported and valued. They were highly motivated and committed to improving the quality and sustainability of care and people’s experiences. Staff at all levels were clear and passionate about their roles and accountabilities and had regular opportunities to meet, discuss and learn. The trust engaged well with patients, families, the local community and external partners to help improve services. All staff were highly committed to continually learning and improving services. There was a strong record of sharing work locally, nationally and internationally.
  • Patients’ individual needs and preferences were central to the delivery of tailored services. Staff worked collaboratively with others in the wider system and local organisations to plan care and improve services. There was a proactive approach to understanding the needs and preferences of different groups of people and to delivering care in a way that met those needs, which was accessible and promoted equality. People could access the service when they needed it, in a way and time that suited them and received the right care at the right time. It was easy for people to give feedback and raise concerns about care received.
  • The trust had enough staff to care for patients and keep them safe. Staff understood how to protect patients from abuse and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The trust managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
  • Staff provided great care and treatment and prescribed pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.

However:

  • Not all staff were up-to-date with mandatory and safeguarding training, but it was improving. Appraisal completion rates were below the trust target for allied health professional, nursing support and administrative staff groups in some areas.
  • Some people could always not access the therapy service when they needed it. The service had effective plans in place to prioritise and mitigate this.
  • Not all equipment in the emergency department (ED) was checked, and records kept that in line with trust policy and monitor all chemicals are stored safely.
  • Consultant hours in the ED did not meet national guidance.
  • Staff did not always complete or update risk assessments for each patient in medical care and did not always identify clear actions to remove or minimise risks.
Inspection areas

Safe

Good

Updated 4 December 2019

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

  • We saw general improvements in the safety of services provided in all areas, and there was a clear focus on patient safety.
  • All four core services inspected were rated as good for the safe key question.

Effective

Good

Updated 4 December 2019

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

  • All areas inspected were providing evidence based care and monitoring the outcome of care so that further improvements could be made.
  • All four core services inspected were rated as good for the effective key question.

Caring

Good

Updated 4 December 2019

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

  • All staff were caring and compassionate in all areas visited.
  • We rated caring for Medical Care at Warwick Hospital and Community Children and Young People’s services as outstanding.

Responsive

Outstanding

Updated 4 December 2019

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

  • We saw improvements in access and flow in and patients were receiving timely assessment and treatment.
  • We rated responsive for Urgent and Emergency Care at Warwick Hospital, Community Health Services for Adults and Community Children and Young People’s services as outstanding.

Well-led

Outstanding

Updated 4 December 2019

Our rating of well-led improved. We rated it as outstanding because:

  • We found all four of the core services inspected as outstanding for being well led.
  • We rated well-led for the trust overall as outstanding.
Assessment of the use of resources

Use of resources summary

Outstanding

Updated 4 December 2019

This was the first time we have inspected and rated use of resources. We rated it as outstanding because:

  • The trust demonstrated that innovation and continuous improvements underpinned clinical services delivery, with various examples of productivity improvements achieved, which had enabled the trust to continue delivering services sustainably, despite rising demand and capacity restrictions. the trust had a track record of delivering services within available resources and consistently achieving surpluses. 
Combined rating

Combined rating summary

Outstanding

Updated 4 December 2019

This was the first time we have awarded a combined quality and of use of resources rating. We rated it as outstanding because:

  • For the trust’s quality ratings, the responsive and well key questions were rated as outstanding. Safe, effective and caring were rated as good overall.
  • All four core services inspected were rated as outstanding overall.
  • Use of resources was rated as outstanding.
Checks on specific services

Community health inpatient services

Good

Updated 19 August 2016

We rated community in patient services as good because:

  • We saw that community inpatient services were safe, effective, caring, responsive and well-led. All care provided revolved around patient rehabilitation and reablement. Feedback from patients and relatives was very positive and we observed staff were caring and compassionate in their approach.

  • Admissions and discharges were well managed. Delayed transfers of care were mainly due to family choice, lack of nursing home places and waiting for packages of care.

  • Staff were aware of specific needs individual patients had and were able to put in place appropriate arrangements, where possible. Staff were knowledgeable about the complaints process and what action they would take.

  • Risks and issues described by staff corresponded to those reported and were understood by leaders.

  • There was a clear vision and strategy for the future of the service. Leaders were clear of their roles and accountabilities. There was a strong focus on continuous learning and improvement at all staff levels. Staff shared innovations and improvement work that they were involved with.

  • Staff on the Central England Rehabilitation Unit (CERU) had developed an assessment tool called Sensory Tool to Assess Responsiveness (STAR). STAR is a tool aimed at providing an accurate diagnosis of prolonged disordered consciousness and establishing any means of communication in the patient.

Community health services for children, young people and families

Outstanding

Updated 4 December 2019

  • Staff treated patients and their families with great compassion and kindness, respected their privacy and dignity, and took account of their individual needs. Patients and their families were truly respected and valued as individuals by an exceptional service. Staff found innovative ways to provide emotional support to patients, families and carers to minimise their distress. Staff routinely empowered children and young people to have a voice and ensured a family centered approach and went above and beyond to support them. Feedback about the service was extremely positive.
  • There was compassionate, inclusive and effective leadership at all levels. Leaders had the skills and abilities to run the service and deliver high-quality, child and family centered care. Staff understood the service’s vision and values, and their role in achieving them. Staff felt truly respected, supported and valued. They were highly motivated and committed to improving the quality and sustainability of care and people’s experiences. Staff at all levels were clear and passionate about their roles and accountabilities and had regular opportunities to meet, discuss and learn. The service engaged very well with patients, families, the local community and external partners to help improve services. All staff were highly committed to continually learning and improving services. There was a strong record of sharing work locally, nationally and internationally.
  • Children, young people and families individual needs and preferences were central to the delivery of tailored services. Staff worked collaboratively with others in the wider system and local organisations to plan care and improve services. There was a proactive approach to understanding the needs and preferences of different groups of people and to delivering care in a way that met those needs, which was accessible and promoted equality. People could access the service when they needed it, in a way and time that suited them and received the right care at the right time. It was easy for people to give feedback and raise concerns about care received.
  • The service had enough staff to care for patients and keep them safe. Staff understood how to protect patients from abuse and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
  • Staff provided good care and treatment and prescribed pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.

However:

  • Not all staff were up-to-date with mandatory and safeguarding training. Completion rates for some courses did not meet the trust target.
  • Appraisal completion rates were below the trust target for allied health professional, nursing support and administrative staff groups.

Community health services for adults

Outstanding

Updated 4 December 2019

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

  • Staff understood how to protect patients from abuse. The service controlled infection risk well. The premises and equipment kept people safe. Staff completed and updated risk assessments for each patient and removed or minimised risks. Staff kept detailed records of patients’ care and treatment. Medicines were safely prescribed, administered, recorded and stored. The service used monitoring results well to improve safety. The service managed patient safety incidents well.
  • The service provided care and treatment based on national guidance and evidence-based practice. Staff regularly checked if patients were eating and drinking enough to stay healthy and help with their recovery. Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way. Staff monitored the effectiveness of care and treatment. All those responsible for delivering care worked together as a team to benefit patients. Staff gave patients practical support and advice to lead healthier lives. Staff supported patients to make informed decisions about their care and treatment.
  • Staff treated patients with compassion and kindness. Staff provided emotional support to patients, families and carers to minimise their distress. Staff supported and involved patients, families and carers.
  • The service proactively planned and provided care in a way that met the needs of local people and the communities served. The service was fully inclusive and took account of patients’ individual needs and preferences. It was easy for people to give feedback and raise concerns about care received. People could access the service when they needed it and receive the right care in a timely way. People almost all received timely access to initial assessment and treatment. The integrated single point of access service was working well, and we noted the reduction in the calls’ abandonment rates.
  • Leaders had the experience, integrity, skills and abilities to run the service. The service had a clear vision for what it wanted to achieve and a realistic strategy to turn it into action. Staff felt respected, supported and valued. Leaders operated embedded and effective governance processes, throughout the service and with partner organisations. Leaders and teams used systems to manage performance effectively. The service collected reliable data and analysed it. Leaders and staff actively and openly engaged with patients, staff, equality groups, the public and local organisations to plan and manage services. All staff were committed to continually learning and improving services.

However,

  • Not all staff were not up to date with mandatory training. The service did not have enough staff in all areas, but patients’ needs were being met.
  • Completion rates did not meet the service target for Prevent training.
  • Some people could always not access the therapy service when they needed it. The service had effective plans in place to prioritise and mitigate this.

Community end of life care

Good

Updated 8 March 2018

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