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Provider: Cambridgeshire Community Services NHS Trust Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 30 August 2019

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

  • We rated safe, effective, responsive and well led as good. We rated caring and well-led at trust wide level as outstanding.
  • We rated safe in community services for children and young people as requires improvement.
  • We rated two of the core services we inspected as good overall and one as outstanding.
  • During this inspection, we did not inspect community dental services or community adult services. The ratings published following our previous inspection form part of the overall rating awarded to this trust following this inspection.
  • The aggregated rating for well-led at core service level was good. However, we rated well led at trust wide level, which is a separate rating as outstanding.

Inspection areas

Safe

Good

Updated 30 August 2019

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

  • Within end of life care and sexual health services there was a good incident reporting culture. Incidents were investigated and where necessary, external reviews were undertaken. The outcome of incidents and lessons learned were shared as appropriate.
  • Staff protected patients from abuse and services worked well with other agencies to do so. Staff were trained on how to recognise abuse, knew how to respond and received appropriate support from the trust’s safeguarding team.
  • Staff had the right qualifications, skills, training and experience to keep people from avoidable harm and to provide the right care and treatment.
  • Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date, stored securely and easily available to all staff providing care.

However, within community health services for children and young people:

  • The service did not always have enough nursing and health visitor staff. There were higher vacancy levels in some teams and this was leading to increased caseload sizes that impacted on service provision.
  • Incidents were not always investigated in a timely manner, which could impact on learning being identified and changes to practice being introduced.
  • The service did not have a formal policy for undertaking harm reviews when children or young people had experienced significant delays for an appointment or assessment. However, the trust provided examples of the arrangements that were in place to manage waiting lists for children and young people who waited a long time for assessment and treatment in Cambridgeshire and Luton, to ensure that waiting lists were reviewed and patients were prioritised based on risk.
  • Where areas of concern were identified in records audits, it was not always clear what action had been taken as a result. Or that re-audit was undertaken. Documentation for medicines management audits had not been updated to demonstrate that identified actions had been implemented.
  • The service did not always control infection risk well; there were some examples of infection prevent and control systems not being implemented effectively.
  • Staff knowledge regarding sepsis was mixed. The service did not have a sepsis policy and did not carry out any audits relating to sepsis. The trust was aware of a gap in provision of sepsis specific training and since 1 April 2019 had introduced sepsis as part of life support training across all services.
  • Mandatory training completion rates were particularly low for cardiopulmonary resuscitation (CPR) for medical staff (50%).

Effective

Good

Updated 30 August 2019

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

  • Care and treatment were based on national guidance and evidence-based practice. Managers checked to make sure staff followed guidance.
  • Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way. They supported those unable to communicate using suitable assessment tools and gave additional pain relief to ease pain.
  • Staff monitored the effectiveness of care and treatment. They used the findings to make improvements and achieved good outcomes for patients.
  • Managers made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and development.
  • 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.
  • Staff always had access to up-to-date, accurate and comprehensive information on patients’ care and treatment. All staff had access to an electronic records system that they could all update.

Caring

Outstanding

Updated 30 August 2019

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

  • We rated caring within services for children and young people as outstanding.
  • The trust had a visible person-centred culture. Staff were highly motivated and inspired to provide care that was kind and promoted the dignity of patients.
  • Staff provided emotional support for patients.
  • Feedback from patients and their families was positive about the way in which staff provided care and treatment. We observed kind and caring interactions between staff and patients.
  • Staff were non-judgemental in their approach to delivering holistic compassionate care with patients being active partners in their care.
  • Staff considered patient’s personal, cultural, social and spiritual needs when planning care.
  • Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.

Responsive

Good

Updated 30 August 2019

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

  • Services were planned and provided care in a way that met the needs of local people and the communities it served. The trust also worked with others in the wider system and local organisations to plan and provide integrated person-centred care.
  • Services were planned and care was provided in a way that met the needs of local people and the communities served. The trust also worked with others in the wider system and local organisations to plan care.
  • Services were 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.
  • 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 they had received. The trust treated concerns and complaints seriously, investigated them and shared lessons learned with relevant staff.

Well-led

Outstanding

Updated 30 August 2019

Our rating of well-led stayed the same. We rated it as good because:

  • Leaders had the integrity, skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff. They supported staff to develop their skills and take on more senior roles.
  • Services had a vision for what they 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. Leaders and staff understood and knew how to apply them and monitor progress.
  • Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The trust promoted equality and diversity in daily work and provided opportunities for career development. The trust had an open culture where patients, their families and staff could raise concerns without fear.
  • Leaders operated effective governance processes, throughout the trust and with partner organisations. Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of their services.
  • Leaders and teams used systems to manage performance effectively. They identified and escalated relevant risks and issues and identified actions to reduce their impact. They had plans to cope with unexpected events. Staff contributed to decision-making to help avoid financial pressures compromising the quality of care.
  • Services collected reliable data and analysed it. Staff could find the data they needed, in easily accessible formats, to understand performance, make decisions and improvements. The information systems were integrated and secure. Data or notifications were consistently submitted to external organisations as required.
  • 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.
  • All 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.

Checks on specific services

Community health services for adults

Good

Updated 20 June 2018

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

  • The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Lessons were shared and staff apologised and gave patients honest information and suitable support when things went wrong.
  • The service monitored safety, shared information with staff, patients and visitors and used it to improve the service.
  • The service had suitable premises and equipment and looked after them well.
  • Staff kept clear appropriate records of patients’ care and treatment that were available to all staff providing care.
  • Staff protected patients from abuse and the service worked well with other agencies to do so. Staff were trained on how to recognise and report abuse, knew how to respond, and were well supported by the safeguarding team.
  • The service ensured that staff completed mandatory training in key skills. This had improved since the last inspection.
  • All staff had the right qualifications, skills, training and experience to keep people safe from avoidable harm and abuse and to provide the right care and treatment.
  • The service generally controlled infection risk well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection when caring for patients.
  • The service provided care and treatment based on national guidance and monitored evidence of its effectiveness.
  • Staff of different kinds worked together to benefit patients. Support staff, nurses and other healthcare professionals supported each other to provide good care.
  • Staff had access to electronic, up-to-date, accurate and comprehensive information on patients’ care and treatment.
  • Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. They knew how to support patients experiencing mental ill health and those who lacked the capacity to make decisions about their care.
  • Staff treated patients with dignity, respect and compassion. Feedback from patients confirmed that staff treated them well and with kindness.
  • Staff involved patients and those close to them in decisions about their care and treatment.
  • Staff provided emotional support to patients to minimise their distress.
  • The trust planned and provided services to meet the needs of local people. It provided access to the service when they needed it and took account of the patients’ individual needs.
  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, which were shared with all staff.
  • The trust had managers at all levels with the right skills and abilities to run a service providing high-quality sustainable care.
  • The trust had a vision for what it wanted to achieve and workable plans to turn it into action.
  • Managers across the trust promoted a positive culture that supported and valued staff.
  • The trust engaged well with patients, staff, the public and local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively
  • The trust collected, analysed, managed and used information well to support its activities to continually improve the quality of its services.
  • The trust had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected.
  • The trust was committed to improving services by learning from when things go well and when they go wrong, promoting training, and innovation.
  • The service had clinical staff vacancies (12% qualified nurses and 13% allied health professionals) but staff were flexible in working practice to support colleagues.
  • NHS safety thermometer data indicated the service performed marginally below its own targets and the national average in delivering harm free care.

However:

  • Community nursing handover meetings were meant to be held daily but they often only happened twice a week due to pressures within the service.
  • There was inconsistent knowledge and practice around the disposal of clinical waste (including contaminated material) at patient’s homes.
  • Complaints were not always resolved in line with the trust target of 25-days.
  • Senior managers displayed a lack of oversight in some areas such as knowledge of complaints and clinical waste disposal processes.
  • There was a disconnect between one specific community nursing team and operational leads with staff expressing dissatisfaction with their work-life balance. The executive team were aware of this and were taking steps to address the concerns.

Community health services for children, young people and families

Good

Updated 30 August 2019

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

  • Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date and easily available to all staff providing care.
  • The service managed patient safety incidents well. Staff recognised and reported incidents and near misses.
  • The service provided care and treatment based on national guidance and evidence-based practice.
  • The service made sure staff were competent for their roles.
  • Doctors, nurses and other healthcare professionals worked together as a team to benefit patients.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
  • 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.
  • The service was inclusive and took account of children, young people and their family’s individual needs and preferences.
  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with all staff.
  • The service met the assessment to treatment target for all 16 services with national or local targets.
  • Staff were proud of the organisation as a place to work and spoke highly of the culture.
  • Services were developed with the full participation of families, staff and external partners as equal partners.
  • There was a strong focus on continuous learning and improvement across the service.
  • Leaders were knowledgeable, visible and approachable.

However:

  • The service did not always have enough nursing and health visitor staff. There were high vacancy levels in some teams and this was leading to increased caseload sizes and impacting on service provision.
  • The service did not always control infection risk well; there were some examples of infection prevent and control systems not being implemented effectively.
  • Staff knowledge regarding sepsis was mixed. The service did not have a sepsis policy and did not carry out any audits relating to sepsis. The trust was aware of a gap in provision of sepsis specific training and since 1 April 2019 had introduced sepsis as part of the life support training across all services.
  • The service did not have a formal policy in place for carrying out harm reviews when children or young people had experienced significant delays for an appointment or assessment. However, the trust provided examples of the arrangements that were in place to manage waiting lists for children and young people who waited a long time for assessment and treatment in Cambridgeshire and Luton, to ensure that waiting lists were reviewed and patients were prioritised based on risk.
  • The service was not able to consistently meet targets for mandated visits in the healthy child programme and reviews for looked after children.
  • The trust did not have a lead who was accountable for implementing transition strategies and policies.
  • The service was not always managing information effectively. The service did not always ensure that information gathered through audits was used effectively and did not have an effective monitoring system to ensure incidents were closed in a timely manner.

Community end of life care

Good

Updated 30 August 2019

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

  • The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately.
  • The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and abuse and to provide the right care and treatment.
  • The nurse staffing for the specialist palliative care team (SPCT) was in line with national guidance.
  • The service had suitable premises and equipment and looked after them.
  • The service provided care and treatment based on national guidance and evidence of its effectiveness.
  • Staff in the SPCT informally monitored discussion of preferred place of death and preferred place of care/death and audited this data.
  • Staff treated patients with compassion, dignity and respect. Feedback from patients confirmed that staff treated them well and with kindness.
  • Staff involved patients and those close to them in decisions about their care and treatment.
  • Staff provided emotional support for patients to minimise their distress. The service gave patients and carers information on what to expect and sign posted or referred patients and their families to relevant information, service and support, including counselling services.
  • The service planned and provided services in a way that met the needs of local people.
  • Leaders at all levels demonstrated high levels of experience, capacity, and capability needed to deliver excellent and sustainable care.

However:

  • The service did not have a local clinical audit programme in place to measure the effectiveness of the service provided.
  • There was no formal arrangement in place for the provision of medical support to the SPCT from consultant in palliative medicine. The current arrangement was informal, and the service level agreement was not signed by both parties.

Community health sexual health services

Outstanding

Updated 30 August 2019

We rated it as outstanding because:

  • 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.
  • Staff provided good care and treatment, gave patients enough to eat and drink, and gave them 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. Key services were available seven days a week.
  • 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 planned care to meet the needs of local people, 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.

Community dental services

Good

Updated 20 June 2018

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

  • There was a patient-centered culture. Staff were highly motivated and offered care that was kind and promoted patients’ dignity. Relationships between people who used the service, those close to them and staff were strong, caring and supportive.
  • Staff cared for patients based on national guidance and evidence, monitored the effectiveness of care and treatment and used the findings to improve them. Staff delivered care with kindness and compassion and involved patients in their care planning. Feedback from patients confirmed staff treated them well and with kindness. Patients told us that staff went the extra mile and the care they received exceeded their expectations.
  • Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. They knew how to support patients experiencing mental health issues and those who lacked the capacity to make decisions about their care. Staff consistently strived to ensure patients had all the information they required in any format they wanted to enable them to make an informed decision about their care.
  • The service managed patient safety incidents and used safety monitoring results well. Staff recognised and reported incidents and managers investigated them and shared lessons learned. Staff apologised and gave patients honest information and suitable support when things went wrong.
  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff of different services worked together as a team to benefit patients. All staff had access to up-to-date, accurate, and comprehensive information on patients’ care and treatment.
  • The service had appropriate staff with the right qualifications, skills, training, and experience to keep people safe and to provide the right care and treatment. This was an improvement on our last inspection where the trust did not have the appropriate establishment for dental nurses. Staff were competent for their roles and managers provided supervision, appraisal, and support.
  • The service treated concerns and complaints seriously, investigated them, learned lessons from the results and shared them with all staff. The service had improved the way it acted on negative feedback from patients since our last inspection. The service was committed to improving patient care by learning when things went well and when they went wrong.
  • The service had managers at all levels with the right skills and abilities to run a service providing safe care. Managers across the trust promoted a positive culture that supported and valued staff.
  • The service collected, analysed, managed, and used information well to support all its activities, using secure electronic systems where possible. The service identified risks and developed ways to eliminate or reduce them. .

However:

  • Staff stored paper based patient dental records at Brookfield’s in unsecured filing cabinets in areas accessible by patients.
  • Staff did not secure the clinical waste bin at the Brookfield’s location and it was accessible to the public.
  • Staff did not manage controlled drugs and fridge monitoring consistently across all the trust sites we visited.