Central and North West London NHS Foundation Trust

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

This means we looked for evidence that the service met people’s needs.

This is the first assessment for this service. This key question has been rated Good.

This meant people’s needs were met through good organisation and delivery.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service made sure people were at the centre of their care and treatment choices and staff decided, in partnership with them, how to respond to any relevant changes in their needs.

Staff ensured all relevant healthcare professionals and other relevant bodies were involved in planning the care and treatment of people with complex needs. Records showed that staff had based patient care around individual needs and preferences.

If the patient was under their GP, staff would approach the GP for advice or the hospital at home consultant, if the patient was under the care of the Single point of access. This was discussed with the responsible consultant before a decision was made. Staff updated the patient’s GP with any agreed intervention.

Staff carried out interventions within the community to reduce the need for patients to visit a hospital for assessment. Staff interventions included ECGs(electrocardiograms) to test the patient’s heartbeat for any irregularities and to inform clinical escalation and decision making.Staff also used bladder scanners. These were portable ultrasound machines, designed for non-invasive ultrasound imaging of the bladder to test for urinary retention and support clinical decision-making. National guidance recommends using a bladder scanner in preference to an indwelling catheter when checking post-void residual urine, because it is more comfortable and has fewer adverse effects for patients. Carers and patients gave positive feedback about the use of the bladder scanners at home to avoid potential hospital admissions.

Carers and patients said the service was very responsive and they were not waiting for long periods of time to access the service or for interventions to take place. Interventions were carried out quickly.

The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

Patient care was joined up, staff worked with other partners to meet patients’ needs. The service had strong partnerships with the local acute hospitals. Staff from one of the local hospitals attended the service’s morning handover meeting to ensure that there was continuity of care between the acute hospital and the urgent community care service, with many patients being discharged from the hospital into the community. Staff spoke positively about the partnerships with the local hospitals.

Managers planned and organised services so they met the changing needs of the local population. Managers recognised that patients accessing the service had increasingly complex physical health needs. At the handover meeting any patients who required review by the Hospital at Home team would be identified and staff could obtain advice from the consultant about complex patients. Staff could not access a consultant for advice in the evenings or weekends but were able to access an out of hours Urgent Care GP. Managers had planned to address this and were looking at what provision could be provided out of hours and on weekends.

When a patient was admitted to the service, a notification letter was sent to their GP. Staff communicated with the GP during or after visiting the patient to discuss interventions, results and care and treatment options agreed with patients.On discharge from the UCR service, staff completed and sent a clinical handover to the patient’s GP, outlining the care delivered by the service and confirming any changes to the patient’s management plan.

The service had systems to help care for patients in need of additional support or specialist intervention.

The service was inclusive and took account of patients’ individual needs and preferences. Staff made reasonable adjustments to help patients access services. They coordinated care with other services and providers. One carer told us that staff had arranged a memory clinic appointment when her relative had suspected dementia.

Staff supported patients living with dementia and learning disabilities by using ‘This is me’ documents and patient passports. Staff liaised with families and carers to help meet these needs.

Staff understood and applied the policy on meeting the information and communication needs of patients with a disability or sensory loss. Patient communication methods were discussed in the daily handover to ensure that staff were aware of how to meet these needs when visiting a patient.

The service supplied appropriate information, in formats that were tailored to individual needs.

The service complied with Accessible Information Standards. Staff identified patients’ communications needs as part of the full initial assessment. Patients could request information to be provided in a large print, in braille or in an audio format.

Staff ensured that patients could obtain information on treatments and local services. Patients were provided with an information leaflet about the service, which included information on how to raise complaints and concerns.

Carers told us that staff provided them with information and updates of any test results for patients and any future appointments arranged.

The service ensured that the information leaflet was available in languages spoken by patients. Managers ensured that staff and patients had easy access to interpreters and signers where there was a language barrier identified.

The service made it easy for people to share feedback and ideas or raise complaints about their care, treatment and support. The service involved patients in decisions about their care and told them what’s changed as a result.

The service had 2 written complaints in the last 12 months. Neither of these were escalated to the formal complaints procedure for the trust and were appropriately responded to by the service. One complaint related to communication, access to the service and clinical prescribing and test results. Another complaint concerned delays in accessing the service due to telephone line issues.

Managers had used learning from concerns and complaints to improve the service. The service had nurses that were non-medical prescribers and could obtain advice from the hospital at home consultant to review test results but were reminded to communicate with GPs as the responsible medical practitioner for the patient.

The service had also improved communication between staff and GPs and were in the process of implementing an improved electronic communication system between staff and the GPs. Managers were in the process of improving the telephone line.

Carers and patients told us that they would know how to raise concerns if they felt the need to and information was provided in the service leaflet. When patients complained or raised concerns, they received feedback.

Staff received feedback of complaints and acted on the findings. Complaints were discussed in the quarterly governance meeting and the monthly staff team meetings.

The service made sure that everyone could access the care, support and treatment they need when they need it.

Staff ensured carers and families were regularly updated about the patient’s progress, where appropriate. Patients and carers told us that they were called with updates of any test results and any appointments made for further investigations.

Managers monitored waiting times and made sure patients could access services when needed and received treatment within agreed timeframes and national targets. The service assessed new patients and triaged for them to be seen within 2 hours for urgent patients and up to 4 hours for less urgent referrals depending on need.

The service often went above their expected targets. The service was expected to meet 70% of their 2-hour patient response rate, the latest outcome dashboard showed that they were meeting 84% of this target.

Managers and staff worked to make sure patients did not stay within the service longer than they needed to and worked closely with other services to transfer their care over to them.

The service did not cancel appointments. Patients and carers told us that they knew what time to expect staff as staff would phone them to inform them what time they would visit.

The service recognised that referrals to the service did not reflect the borough demographics of Camden and had a quality improvement project to increase the number of referrals for people from ethnic minorities into the service by 50%. Most referrals were received as White British, despite this group representing 49% of Camden’s overall population. The service planned to address this by improve the recording of ethnicity on referrals and further promote the service to local GP surgeries.

The service actively sought and listened to information about people who are most likely to experience inequality in experience or outcomes. They tailored the care, support and treatment in response to this.

Staff within the service and the wider organisation promoted a culture in which the people using the service felt empowered to give their views. Staff were trained in equality, diversity, inclusion and human rights.

The provider had undertaken equality impact assessments of their policies and procedures to ensure they did not place vulnerable people or people with protected characteristics at a disadvantage. The service had a quality improvement project to increase the number of referrals from ethnic minorities to better reflect the borough demographics.

Patients were supported to make informed decisions about their future care and treatment.

Staff enabled patients to make advanced decisions to refuse treatment, sometimes called a living will, when appropriate. Staff ensured that existing advanced decisions were followed for patients.

Staff followed patients’ wishes where they had a do not attempt cardiopulmonary resuscitation order (DNACPR) in place. This meant that if the patient’s heart or breathing stopped, resuscitation should not be attempted.

Care for people who were nearing the end of their life was managed and communicated by staff in a sensitive and dignified way.