The Royal Wolverhampton NHS Trust

Updated 14 February 2020

(Source: Routine Provider Information Request (RPIR) – Sites tab)

Updated 14 February 2020

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

• We rated caring as outstanding; effective, responsive and well led as good and safe as requires improvement.
• We took into account the current ratings of the eight core services across the two acute locations and the two community core services not inspected at this time. Hence, 14 services across the trust are rated overall as good, one services are rated requires improvement and two services are rated as outstanding
• The overall ratings for Cannock Chase Hospital improved, while New Cross Hospital remained the same.

Updated 27 June 2018

Updated 27 June 2018

Updated 14 February 2020

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

• Patient feedback was always extremely positive throughout the inspection. Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service was responsive to the needs of the population and relieved pressure on wider healthcare community. The service took account of patients’ individual needs and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.
• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, 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.
• Managers monitored the effectiveness of the service and ensured staff were competent and had access to further learning. Staff worked extremely 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. Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Key services were available seven days a week

Updated 13 December 2016

We found that services were safe, effective, responsive, caring and well led. Achieving a overall rating of outstanding. The staff were enthusiastic, well supervised, compassionate and competent in their roles. During the inspection we met with managers, staff, children and parents in a range of community settings. We observed care being delivered in schools, outpatient clinics and in the patient’s own home. Staff from Wolverhampton Community NHS worked with other professionals and external organisations such as Child Adolescent Mental Health Service (CAMHS) and social services. There was clear evidence that the services for children and young people were delivered in line with best practice guidance and local agreement. The staff we spoke with told us that they felt they were valued members of a professional team; they told us the patient care was first and foremost of all they did and they aspired to be the best, this reflected the trusts vision and values.

We saw robust safeguarding procedures in place supported by a flow chart. An MDT approach to safeguarding alerts was seen. Staff had received safeguarding training.

There was a positive reporting culture with evidence of learning from incidents and complaints which improved the quality and safety of services. All staff had completed mandatory training which was recorded as 90% or above; in line with the trust’s target. Clinical staff had also completed specific child related training relevant to their role. From parents we heard of excellent communication between the services dealing with children and young people. We observed staff supporting children and young people in a compassionate manner ensuring they listened to them and cared for them in a respectful way; which was again confirmed by parents, young people and children who told us they felt the staff were kind, friendly, always professional and very supportive.

Environmental observations evidenced a consistently high level of cleanliness across the sites we visited. Infection control audits and cleaning schedules demonstrated that infection control practices were in place and effective. The trust supported all staff to ensure that their mandatory training was completed in a timely way and that individual training needs were addressed. Staff received regular supervision and annual appraisals; they praised the management for the level of support they were offered. We saw that during staff meetings the lone working policy had been discussed to remind staff of the risks related to their work.

The service received a low level of complaints; people we spoke with during the inspection were very complimentary about the staff and the quality of the service they received. Staff told us that early resolution of complaints avoided formal complaints being received.

The service had amalgamated with the acute service to promote a seam-free service. We heard how staff had dealt with the changes and restructuring in a positive way. We saw that the leadership of all the services was robust and senior managers were well respected; staff told us they felt fully engaged with the management and were proud to follow excellent role models.

We spoke with over 150 people during the inspection including school nurses, therapists, health visitors, family nurse partnership, physiotherapists, consultant paediatricians and administration staff. We spoke with parents/carers and young people. We spoke with young people who used the services and their parents. We observed how children and young people were being cared for. We looked at and reviewed twelve care and treatment records.

Updated 14 February 2020

Our rating of this service went down. We rated it as requires improvement because:

• The service did not always have enough nursing and support staff with the right qualifications, skills, training and experience.
• Staff did not always keep detailed records of patients’ care and treatment. Records were not always clear, up-to-date or stored securely.
• The service did not always use systems and processes to safely prescribe, administer, record and store medicines.  

• Not all staff had undertaken competency assessments relevant to their roles.
• Staff did not always follow national guidance to gain patients’ consent or document their wishes.  They did not always used agreed personalised measures that limit patients' liberty effectively.

However

• Staff completed and updated risk assessments for each patient and removed or minimised risks. Staff identified and quickly acted upon patients at risk of deterioration. 

• Staff monitored the effectiveness of care and treatment. They used the findings to make improvements and achieved good outcomes for patients.  
• All those responsible for delivering care worked together as a team to benefit patients. They supported each other to provide good care and communicated effectively with other agencies. 
• Staff provided emotional support to patients, families and carers to minimise their distress. They understood patients’ personal, cultural and religious needs. 

• Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment. 
• Services were planned and provided care in a way that met the needs of most local people.
• People could access the service when they needed it and received the right care in a timely way.   
• It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff.

Updated 3 September 2015

Good l

Overall we judged ‘End of Life care that people received as good.

Strategies had been developed for improving the end of life care that people received and teams worked together to ensure people were cared for in their preferred place of care.

The trust had introduced a new approach to providing care for people in their last days of life. This was being implemented across hospital and community nursing services (CNS) and aimed to integrate care at the end of life across the whole service. The new approach replaced the Liverpool care pathway following the 2013 review entitled ‘More care less pathway’. Providers were required to replace the Liverpool care pathway by July 2014. The trust were rolling out the new approach by training up to 50 staff a month and identifying staff who could act as champions who would support implementation.

People’s needs were anticipated and care plans were put in place to assess and meet their needs. Effective pathways had been developed for referrals and discharging people who wished to be cared for at home. The pathway for discharging people home quickly was designed to ensure community nursing staff were able to meet the person’s needs before they were discharged. For example, there were processes in place to ensure the person had the medicines and equipment they needed.

The care provided was evidence based and clinical guidelines had been put in place which had been developed by groups of expert clinicians. These ensured patients received high quality, effective care. The professional nurse lead for palliative care was responsible for ensuring hospital and community services followed national policies and guidelines.. Records were fully available to the Multi-Disciplinary Team(MDT) involved in care. Patients could access qualified staff at night and a night sitting service could be provided.

Community nursing service staff (CNS) spoke passionately about caring for people at the end of life and showed compassion for the person and their family. There were processes in place to enable the CNS staff to assess and monitor the person’s emotional needs as well as their physical needs. There was a strong culture of reporting and learning from incidents. The service responded to identified risks and maintained a risk register. The service also anticipated risks for example the cover required in the event of severe weather.

The service reviewed CNS staff caseloads to ensure the service had sufficient capacity to care for people at the end of life. Team leaders discussed workload and were able to provide cover within teams and cover for each other by staff working extra shifts.

Patients spoke positively about being able to contact the service when they needed to. They appreciated having one number to call and being able to speak with staff who were helpful and polite. Some patients would have preferred an approximate time in the appointment day.

CNS staff were released to attend role specific and mandatory training.

CNS staff spoke highly about their managers and said they felt well supported. Community staff who cared for people at the end of life were supported to cope with the emotional challenges when a patient had died. They also felt well supported by the specialist palliative care team based at the hospice.

Managers and staff told us there was a clear commitment to service improvement and innovation.

We spoke with a total of 26 patients in the community, six relatives, 17 community nurses, four healthcare assistants and two palliative care consultants. We also reviewed six sets of patient records.