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Provider: Northumbria Healthcare NHS Foundation Trust Outstanding

On 16 October 2019, we published a report on how well Northumbria Healthcare NHS Foundation Trust uses its resources. The ratings from this report are:

  • Use of resources: Outstanding  
  • Combined rating: Outstanding  

Read more about use of resources ratings

Inspection Summary


Overall summary & rating

Outstanding

Updated 16 October 2019

  • We rated effective, caring and responsive as outstanding and safe and well-led were rated as good. Four ratings stayed the same as our previous inspection in 2016.
  • In rating the trust, we took in to account the current ratings of the services that we did not inspect during this inspection but that we had rated in our previous inspection.
  • We rated well led for the trust overall as good. This was not an aggregation of the core service ratings for well led.
  • 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.
Inspection areas

Safe

Good

Updated 16 October 2019

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

Effective

Outstanding

Updated 16 October 2019

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

  • At our previous inspection we found improvements were required regarding the use of the maternity dashboard. At this inspection we found staff monitored the effectiveness of care and treatment using an electronic maternity dashboard. They used the findings to make improvements and achieved good outcomes for women.
  • The continuing development of the staff skills, competence and knowledge is recognised as being integral to ensuring high-quality care in maternity services. Staff are proactively supported and encouraged to acquire new skills, use their transferable skills, and share best practice.
  • Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent. They knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health. They used agreed personalised measures that limit patients’ liberty where it was in the patient’s best interest.
  • Key services were available seven days a week to support timely patient care.
  • The service achieved grade B overall in the Sentinel Stroke National Audit Programme (SSNAP).

However:

  • Mental Capacity Act Level 2 and Deprivation of Liberty Safeguards training did not meet the trust target for both medical and nursing staff. Staff were not given protected time to complete this training.
  • NSECH ED did not meet RCEM audit standards including Severe asthma, Consultant sign off and Severe sepsis and septic shock. The department had not undertaken any further audits for consultant sign off or severe asthma to assure themselves that practice had improved. Action plans were in place however these were not detailed and there was little assurance that actions were robust or that re-audit was required.

Caring

Outstanding

Updated 16 October 2019

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

  • Feedback from patients and families was positive with good patient survey results.
  • People who used the service and those close to them were active partners in their care. Staff were fully committed to working in partnership with people. They supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.
  • Staff always empowered people who used the service to have a voice. They showed determination and creativity to overcome obstacles to delivering care. People’s individual preferences and needs were reflected in how care was delivered.
  • Feedback from people who used the service, those who were close to them, and stakeholders, was continually positive about the way staff treated people. People told us that staff went the extra mile and their care and support exceeded their expectations.
  • Staff recognised and respected the totality of people’s needs. They always took people’s personal, cultural, social and religious needs into account, and found innovative ways to meet them. People’s emotional and social needs were seen as being as important as their physical needs.
  • Staff recognised that people need to have access to, and links with, their advocacy and support networks in the community and they supported people to do this.

However:

  • Staff did not always ensure people’s dignity was preserved.

Responsive

Outstanding

Updated 16 October 2019

Our rating of responsive stayed the same. We rated it as outstanding because:

  • At our previous inspection in 2015, the maternity service had gone through a significant reconfiguration to a new model of care, which saw delivery services amalgamated and all high risk deliveries provided at the NSECH site. At this inspection we found there were clear and robust policies in place to ensure that patients were risk assessed and then seen at the right place at the right time.
  • At our previous inspection there was no pregnancy assessment unit (PAU) on site and women were triaged on the birthing centre. Staff had been concerned at that time there was a reduced capacity on the birthing centre for labouring women and the number of staff able to look after them. At this inspection there was a formal PAU available from 8am to 10pm daily with plans to open the unit 24 hours a day.
  • 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.
  • Midwives had developed good relationships with the homeless community, travellers and women living with addictions. Staff were able to visit traveller’s sites and care for women in their own homes and within their own community. We saw safeguarding records of women and families living with addiction involving multiple teams who put the woman and baby’s needs to the fore.
  • The service planned and provided care in a way that met the needs of local people and the communities served. It also worked with others in the wider system and local organisations to plan care.
  • We saw that information leaflets and advice posters were available on the units we visited. These included discharge information, specialist services and general advice about nutrition and hydration.
  • The emergency department met the standard for median time to treatment for patients for all 12 months from March 2018 to February 2019 and was better than the England average. There were no patients who had waited in the department for more than 12 hours from decision to admit over the same time period.
  • The emergency department had met the four hour target for eight of the 12 months from March 2018 to February 2019.

However:

  • Patients under the specialties of general medicine and geriatric medicine attending in an emergency stayed longer in hospital than the national average.
  • During our last inspection we were assured that patients were not transferred between wards at night. However, at this inspection, from January to December 2018, 927 patients moved wards at night. Senior management told us patients were moved to other wards within the hospital due to bed pressures.
  • The access and flow through the emergency department was a challenge. Senior staff worked to improve flow via access to other wards however there were often bottle necks at ambulance triage and finding patients beds on wards.

Well-led

Good

Updated 16 October 2019

  • Leaders had the integrity, skills and abilities to run the service. They understood and managed the priorities and issues the service faced. Most were visible and approachable in the service for patients and staff.
  • The service had a vision for what it wanted to achieve and a strategy to turn it into action, developed with all relevant stakeholders. The vision and strategy were focused on sustainability of services and aligned to local plans within the wider health economy.
  • Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. There was a positive culture throughout the organisation. Staff told us they were proud to work for the organisation.
  • The roles of the non-executive directors were clear and effective. Non-executive directors chaired board sub committees and they also sat on other committees.
  • Financial performance had remained consistently strong with the trust delivering over and above plan in 2017/18 & 2018/19.
  • Leaders and staff actively and openly engaged with patients, staff, equality groups, the public and local organisations to plan and manage services. They collaborated with partner organisations to help improve services for patients.

  • Staff were committed to continually learning and improving services. They had a good understanding of quality improvement methods and the skills to use them. Leaders encouraged innovation and participation in research.

However:

  • We found gaps in assurance processes for programmes and strategy between the business units and board.
  • Across the trust compliance with mandatory training rates were not met, action on this was inconsistent across core services.
  • We did not see evidence of learning from incidents was consistent throughout the organisation and over 50% of action plans for SIs and SLEs were overdue.
  • We did not see that all relevant risks were monitored, escalated and mitigated.
  • The trust did not have oversight of certain assurances around staffing for level 2 patients and the frequency of observations on the electronic track and trigger system.
  • Mortality reviews did not provide a large enough sample to be assured that all learning would be captured.
  • Complaints were not investigated within timescales set by the trust.
Assessment of the use of resources

Use of resources summary

Outstanding

Updated 16 October 2019

Combined rating
Checks on specific services

Community dental services

Outstanding

Updated 5 May 2016

Overall rating for this core service Outstanding 

We rated the dental services at this trust as outstanding because:

Services were effective, evidence based and focused on patients’ needs. We saw examples of excellent collaborative team working. We also saw examples of innovative working including an orthodontic service that catered primarily for the needs of vulnerable children such as those with disabilities and complex medical conditions. The service had also co-developed with colleagues in the North East Oral Health Promotion Group, a comprehensive resource pack to support the maintenance of oral health of elderly residents in care homes. The service had implemented an award scheme in care homes across Northumberland with the aim of assuring improved oral health in a care home setting. 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. Staff, registered with the General Dental Council had frequent continuing professional development and met their professional registration requirements.

The service was extremely responsive to patients’ needs; people could access services in a timely way that suited them. Service waiting times for each clinic and the waiting times for general anaesthesia at each hospital showed that waiting times for the first available appointment were within one to three weeks dependant on the clinic. The waiting times for special needs adults under general anaesthesia were 6 weeks or less. However, patients requiring urgent care could be seen earlier. 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 dental service had been recognised for pioneering work involving looked after children across North Tyneside and had received a national award by the Patient Experience Network for this work. The service had a proactive approach to understanding the needs of different groups of people. We found that the oral health promotion team had developed a patient information booklet explaining the patient journey for dentistry through the eyes of a patient with learning disabilities. Learning disability patients had taken a joint lead role in developing the booklet

The service was very well-led with organisational, governance and risk management structures in place.

These governance arrangements were proactively reviewed and reflected best practice. There was strong leadership of the service, with an emphasis on driving continuous improvement. The local management team were visible and the culture was seen as open and transparent. There was strong collaboration and support across all of the service with a strong emphasis on improving the quality of care.

Staff were aware of the way forward and vision for the organisation and said that they felt well supported and could raise any concerns with their line manager. Staff at all levels were actively encouraged to raise concerns. There were high levels of staff satisfaction across all staff groups. Team meetings and staff surveys demonstrated that the service engaged all staff.

Staff protected patients from abuse and avoidable harm. Systems for identifying, investigating and learning from patient safety incidents were in place. Infection control procedures were in place. The environment and equipment were clean and well maintained.

Patients, relatives and carers said they had positive experiences of care within the service. We saw good examples of staff providing compassionate and effective care. We also saw effective interactions taking place between individual staff members. We found staff to be hard working, caring and committed to the care and treatment they provided. Staff spoke with passion about their work and conveyed their dedication to what they did.

Community mental health services with learning disabilities or autism

Outstanding

Updated 2 August 2017

  • There was a proactive approach to anticipating and managing risks to people who use the services. This was embedded and recognised as being the responsibility of all staff. People who use and those close to them were actively involved in managing their own risks.

  • There was a holistic approach to assessing, planning, and delivering care and treatment to people who use services. The use of innovative approaches to care was actively encouraged. New evidence based techniques and technologies were used to support the delivery of the service.

  • There was continued development of staff skills, competence, and knowledge. Staff were proactively supported to acquire new skills and share best practice.

  • The service was committed to working collaboratively and had developed innovative and efficient ways to deliver more joined-up care to people who use the service.

  • There was a holistic approach to planning people’s discharge, transfer, or transition to other services. Arrangements fully reflected patient needs.

  • There was participation in relevant local and national audits, including clinical audits and other monitoring activities such as reviews of services, benchmarking, peer review and service accreditation.

  • There was a strong, visible person-centred culture. Staff were highly motivated and inspired to offer care that is kind and promotes people’s dignity. Relationships between people who use the service, those close to them and staff were strong, caring, and supportive. These relationships were highly valued by staff and promoted by leaders

  • People’s individual needs and preferences were central to the planning and delivery of services. The services were flexible, provided choice, and ensured continuity of care.

  • Leaders had an inspiring shared purpose, and motivated staff to succeed. Comprehensive and successful leadership strategies were in place to ensure delivery and to develop the desired culture.

  • There were high levels of staff satisfaction across the service. Staff were proud of the organisation as a place to work and spoke highly of the management and culture. Staff at all levels were actively encouraged to raise concerns.

Specialist community mental health services for children and young people

Good

Updated 17 February 2017

We rated specialist community mental health services for children and young people as good because:

  • The service had clear criteria for referrals into the service with timescales for assessment for urgent, priority and routine referrals.

  • Initial assessments were thorough and included a full assessment of risk and staff used a range of assessment and diagnostic tools for specific areas of need.

  • The service delivered a wide range of psychological interventions recommended by National Institute for Health and Care Excellence to meet the needs of children and young people who used the service.

  • Staff delivered care in a thoughtful and sensitive way that was adaptive to the needs of the young person. Interactions were at an appropriate level for young people which focussed on recovery and respected young people’s needs.

  • Feedback from people who use services and their carers was positive about the care they received.

  • Staff were passionate, enthusiastic and dedicated to their work with children and young people.

However:

  • Interview rooms were not fitted with alarms and staff did not have access to personal alarms. At the Albion Road clinic, the door from reception area to staff offices and rooms where staff saw patients was not secure.

  • Although risk was reviewed with young people and within multi-disciplinary teams, it was not easy to access this from the information in the care records.

  • The involvement of young people and parents was not well documented within care records.

  • There was insufficient hand washing and sanitising equipment at Albion Road and Baliol Centre.

Community health inpatient services

Good

Updated 5 May 2016

We rated community inpatient services as good because:

The service prioritised patient protection from avoidable harm and abuse. There were clearly defined and embedded systems, processes and standard operating procedures to keep people safe and safeguarded from abuse. We saw evidence of an open and transparent culture in relation to incident reporting. Opportunities were available to learn from investigations and the service was aware of areas in which it needed to improve, such as falls. The department was clean and there was an active infection control and prevention audits, which showed high scoring outcomes. Risks to people who used services were assessed, monitored and managed on a day-to-day basis. Escalation and deterioration plans were in place for patients when staff had concerns regarding a patients condition and wellbeing. All wards had good staffing levels and frontline staff told us their managers supported them if they needed to increase their staffing numbers when patient dependency increased.

The trust’s contribution to local and national audit was in line with the national average, and evidence of changes made by specialities in response to their outcomes was available and had been actioned. Accurate and up-to-date information was shared with staff and used to improve care and treatment and people’s outcomes. People’s care and treatment was planned and delivered in line with current evidence-based guidance, standards, best practice and legislation. People had good assessments of their needs, which included consideration of clinical needs, mental health, physical health and wellbeing, and nutrition and hydration needs. Staff were qualified and had the skills they needed to carry out their roles effectively and in line with best practice. Staff were supported to maintain and further develop their professional skills and experience. We saw strong and respectful multidisciplinary team working during our inspection and feedback from all disciplines emphasised this. They worked closely with the local authority when planning discharge of complex patients and when raising safeguarding alerts.

We observed the treatment of patients to be compassionate, dignified, and respectful throughout our inspection. Feedback from numerous patients across all five of the community locations was exceptional. We heard that staff went

the extra mile to be supportiv

e, to assist patients over and above routine tasks and ensure that patients were fully included in all decision making regarding their health and wellbeing. Relatives said they felt involved in their care and had the opportunity to speak with the doctor looking after their family member. Staff spoke with passion about their work and were proud of what they did. Complaints and concerns were taken seriously and responded to in a timely way. Improvements were made to the quality of care as a result of complaints and concerns.

There was a clear vision and strategy for the service, which was well developed and well understood throughout the department. The behaviours and actions of staff working in the division mirrored the trust values of ‘patient’s first, safe and high quality care, and responsibility and accountability’ of which we saw multiple examples of during our inspection. There was evidence of ownership of services and patient centred care was clearly a priority. Risks and potential risks discussions were ongoing and there was a governance structure for formal escalation where appropriate. Many of the wards were piloting a scheme called ‘Board to Ward’, which encouraged staff to develop safety and quality priorities specific to them and lead on improvements. It provided an opportunity to focus on the issues that matter at ward level, with staff having ownership in deciding what priorities should be, and how to meet these goals.

Community urgent care services

Good

Updated 5 May 2016

We rated urgent care as good because:

The service prioritised patient protection from avoidable harm and abuse. There was a genuinely open culture for both staff and patients to raise concerns and receive appropriate response, feedback and learning. We found ongoing progression towards safety goals including high standards of training, skill and experience. Medicine management and the recording of medical information was of a high standard and well maintained. Training and appraisal rates exceeded trust targets as a whole and we saw the staff were highly competent. Staff were openly encouraged to progress their training both internal and externally. We saw examples of staff being encouraged to undertake university degree courses and progress to Emergency Nurse Practitioner levels.

All staff were aware of their personal accountability in managing risk and took responsibility as a team to ensure that risk management plans were followed, maintained and changes discussed with senior staff. Specific areas of training identified by anticipating risk had been undertaken. We found that all staff were actively engaged in activities to monitor and improve quality outcomes. The trusts contribution to local and national audit was in line with the national average, and evidence of changes made by specialities in response to their outcomes was available and had been actioned.

There was a holistic approach to assessing, planning and delivering care and treatment. The telemedicine service, introduced by the trust in May 2013, used the latest digital technology to help treat fractures in Berwick and Alnwick. Specifically trained staff at each infirmary conducted a live video conferencing linkup to specialist doctors in Wansbeck General Hospital. This saved patients from travelling long distances for appointments and meant the rural population could receive treatment locally. This benefitted patients of all ages and increased multidisciplinary joined-up working with other hospital locations. We observed the telemedicine service provide real-time information across teams and services resulting in quicker treatment times and outcomes.

We found staff to be hard working, caring and committed to delivering a good quality service. They spoke with passion about their work and were proud of what they did. Staff clearly recognised the versatility of people’s needs and were skilled in dealing with vulnerable individuals with complex physical and mental health needs. There was a high emphasis on staff and public engagement. The trust encouraged members of the public to leave feedback, either formally or through social media. The patients we spoke to said they felt very confident about raising concerns or making suggestions.

There was a clear vision and strategy for the service, which was well developed and well understood throughout the department. The behaviours and actions of staff working in the service mirrored the trust values of ‘patients first’, safe high quality care, responsibility and accountability. We saw multiple examples of this during the inspection. There was clear ownership of services and patient-centred care was a priority.

Community health services for children, young people and families

Outstanding

Updated 5 May 2016

Overall, we rated community health services for children, young people and families as outstanding because:

Managers and staff created a strong, visible, person-centred culture and were highly motivated and inspired to offer the best possible care to children and young people, including meeting their emotional needs. Staff were very passionate about their role and, in some cases, went beyond the call of duty to provide care and support to families. There was respect for the different personal, cultural, social and religious needs of the children and young people they cared for, and care and treatment was focussed on the individual person rather than the condition or service.

Families were very positive about the service they received. They described staff as being very caring, compassionate, understanding and supportive. Children and young people were able to see a healthcare professional when they needed to and received the right care at the right time. Services were flexible, provided choice and ensured continuity of care. The care and treatment of children and young people achieved good outcomes and promoted a good quality of life. Staff proactively collected and monitored this data and used the information to improve the care they delivered.

The culture was open and transparent with a clear focus on putting children and young people at the centre of their care. Services had good strategies and plans, each with service-specific objectives and goals to meet the needs of children and young people and deliver a high quality service. These plans directly linked with the overarching trust vision and goals.

Staff protected children and young people from avoidable harm and abuse. Managers and staff discussed incidents regularly at monthly meetings and took appropriate action to prevent them from happening again. Staff regularly received safeguarding supervision from managers and the trust safeguarding children team, who also kept services updated on outcomes and learning from serious case reviews. The clinics, health centres, children’s centres and school premises we visited were clean and staff followed national guidance in relation to hand hygiene and infection prevention and control. Staff managed medicines safely and the quality of healthcare records was good. Clinical leads and service managers audited records annually and outcomes shared with individuals and the wider team.

Managers and staff managed caseloads well, and there were effective handovers between health visitors and school nurses to keep children safe at all times. On a day-to-day basis, staff assessed, monitored and managed risks to children and young people and this included risks to children who were subject to a child protection plan or who had complex health needs.

Staff were very positive about working for the trust and leadership was excellent across all services. There was a clear management structure and managers were visible and involved in the day-to-day running of services. Staff could contact them whenever they needed to and received regular supervision from line managers and clinical leads. The trust provided opportunities for training and development and staff were well trained and highly motivated to offer the best possible care to children and young people.

End of life care

Outstanding

Updated 5 May 2016

Overall, we rated community end of life care as outstanding because:

The feedback from people who used the service and those who were close to them was extremely positive about the care received by patients nearing the end of life. We saw that staff were motivated to go the extra mile to meet patient’s needs and the care patients received exceeded their expectations. Results from the 2014 cancer patient experience survey showed Northumbria Healthcare NHS Foundation Trust was in the top ten best performance trusts. Families were very positive about staff and the service they received. The service demonstrated a high level of compassionate care to patients and their families. We saw that staff were motivated to go ‘the extra mile’ to meet patients’ needs. We observed a commitment to providing care that was of a consistently high standard and focused on meeting the emotional, spiritual and psychological needs of patients as well as their physical needs.

There was a clear vision and strategy that focused on the early identification of patients at the end of life, patients being cared for in their preferred place of care and the use of partnership working to develop services. The strategy clearly communicated the vision of integrated services across the community and acute sectors to support patients being cared for in their preferred place of care. There was end of life care representation/leadership at trust board level and we saw evidence of active engagement in end of life care at board level. There were innovative approaches being implemented to achieve the joined up service within acute and community end of life teams. There was comprehensive leadership within the palliative care service with clearly defined leadership roles. They were passionate about the service and encouraged staff to deliver high quality care. Local managers were proactive and came from a clinical background. They demonstrated an understanding of the current issues facing the service. There was a clear sense of pride and belonging amongst staff at all levels within the end of life care teams. Each person’s role was seen as being equally as important as the next. Staff appeared to have a genuine respect for each other within the team. Staff we spoke with demonstrated a commitment to the delivery of good quality end of life care. There was evidence that staff felt proud of the care they were able to give and there was positive feedback from nursing and care staff as to the level of support they received from the specialist palliative care team.

The trust was in the top ten and came 6th out of all trusts in England for the quality of care reported by the Cancer Patient Experience Survey 2014.

Staff understood their responsibilities to raise concerns and to record safety incidents. There was an open culture in reporting incidents and there were systems in place to learn from incidents and reduce the chances of them happening again. There was good identification of patients at risk of deterioration and we saw evidence of the use of emergency health care plans in ensuring that all patients had a plan in place should their condition deteriorate. There was appropriate equipment available in patients’ homes and use of anticipatory prescribing of medicines at the end of life. Mandatory training levels were good, with all community palliative care staff up to date across all localities.

The trust provided effective end of life care to patients. Patients in need of end of life care were identified at an early stage in their care, and staff were alerted to patients who were known to the community team or on a palliative care register. The trust had implemented the Care of the Dying Patient document which was being used as a guide to delivering high quality end of life care.

Policies and guidelines were all evidence based and we saw excellent examples of multi-disciplinary and multi-agency working and collaboration.

The partnership with Marie Curie provided additional flexibility to enable specialist palliative care staff to provide support to patients at the end of life. This was irrespective of the complexities of their condition. Also there were strong links between the hospital liaison service, Marie Curie and the specialist palliative care staff. There were integrated person-centred pathways that involved these different service providers. Services were flexible, provided choice and ensured continuity of care.

Wards for older people with mental health problems

Good

Updated 5 May 2016

We rated wards for older people with mental health problems as good because:

  • assessments were comprehensive, carried out in a timely manner and regularly reviewed.
  • care and treatment was delivered in line with current evidence based guidance. A system of audit was in place to monitor compliance.
  • staff displayed a good understanding of their roles and responsibilities in relation to safeguarding. Safeguarding processes were robust.
  • ward shift establishment were developed using a staffing analysis tool. Actual staffing levels matched the identified need.
  • there were systems in place to ensure adherence with the Mental Health Act and Mental Capacity Act.
  • care plans were up to date and personalised.
  • patients and carers were involved in decisions about care and treatment.
  • feedback from patients, family members and carers was positive.
  • staff felt supported in their roles and worked effectively as a multidisciplinary team.
  • there was a good governance structure in place and an open and transparent culture evident on the wards.

However:

  • the two mixed sex wards were not compliant with same sex accommodation guidelines. However, the trust were aware of this issue and were due to move into new accommodation by March 2016. The new premises are compliant with same sex accommodation guidelines.
  • all staff received line management and caseload supervision.

Community health services for adults

Outstanding

Updated 5 May 2016

Overall rating for this core service Outstanding

We rated community adult services as outstanding because:

National guidance, the National Institute of Health and Care Excellence (NICE) and professional bodies were complied with and that staff showed awareness of relevant guidance in their work. Staff were actively engaged in activities to monitor and improve quality and outcomes. For example, the tissue viability service (TVS) used the SSKIN bundle, this was a five step model to reduce incidents of pressure ulcers and endorsed by NHS England. The service had gone further in pioneering their own pressure ulcer and skin integrity ‘aide memoire’ for staff to assist in identifying patients at risk of developing pressure ulcers. This had resulted in the trust moving from being a national outlier for pressure ulcer care to consistently performing better than the national average. Quality of care was monitored through audits, which informed the development of local guidance and practice. We found that patients could access all professionals relevant to their care through a system of truly integrated multi-disciplinary teams; and that patients’ care was co-ordinated and managed. There were systems to gain people’s consent prior to care and treatment. Where patients lacked the capacity to give consent, there were arrangements to ensure that staff acted in accordance with their legal obligations. There were robust systems to ensure professional staff remained registered with the relevant professional body.

Patients and carers we spoke with were overwhelmingly positive about their experience of care and treatment, and feedback gathered by the organisation showed high levels of satisfaction. Words and phrases such as “tremendous,” “cheerful and considerate,” “extremely happy with the care,” were used extensively in their feedback. We viewed the Community Services Business Unit (CSBU) Friends and Family Test (FFT) results November 2015; 99% of patients said they were treated with dignity and respect. We reviewed results from the FFT for the period July – September 2015 for 24 Community Adult Services Teams. The average score for people who responded that they would be likely to recommend community services was 99%. We observed all staff responding to people with kindness and compassion. Patients told us they were treated with dignity and respect, and that they were involved in the planning and delivery of their care to the extent they wished to be. Staff were prepared to and did go the ‘extra mile’ for patients.

The involvement of other organisations and the local community was integral to how services were planned and ensured that services meet people’s needs. We found that community adult services had a model of integrated community teams across health and social care to ensure people received truly joined up working that was responsive to patients’ individual needs. There was a focus of providing services close to where people lived and at times that were convenient to them. There was provision to ensure that essential services were available out-of-hours, and there were no major issues with waiting lists.

There was a clear vision and values that were shared by staff and demonstrated in their work. There was a clear articulation of the strategic direction for the service and staff felt engaged with the strategy. Consideration was given to ensure that developments were sustainable. We found evidence of innovative practice and research including partnership working with industry. The leadership drove continuous improvement and staff were accountable for delivering change. There was a clear proactive approach to seeking out and embedding new and more sustainable models of care. There were systems to ensure good governance and monitoring of standards and performance. There was an effective escalation and cascading of information from the board to front-line workers, and vice-versa. We found that there was a positive culture, with staff and managers feeling proud of their work and achievements and speaking well of their colleagues and the organisation.

We found that community adult services (CAS) achieved a good standard of safety. This was because there were robust methods of reporting, investigating and learning from incidents and near misses that were well understood by staff and embedded in their daily work. There were plans to deal with major incident or events that would disrupt the delivery of care. We saw evidence that CAS staff were making appropriate adult safeguarding referrals. There were processes and systems that protected patients from the risk of infection, and the risks associated with equipment used in their care and treatment. There were safe systems of medicines management. Records were accurate, comprehensive and current, and supported the delivery of safe care. We saw that between 85% and 100% of mandatory training had been completed across CAS against a trust target of 85%. Staffing numbers were reviewed, an active recruitment programme was in progress and arrangements to ensure any staffing shortfalls were managed on an on-going basis to minimise the impact on patients.