The Care Quality Commission
  • Organisation
  • SERVICE PROVIDER

Cambridgeshire Community Services NHS Trust

This is an organisation that runs the health and social care services we inspect

Overall: Outstanding read more about inspection ratings
Important: Services have been transferred to this provider from another provider
Important: Services have been transferred to this provider from another provider
Important: Services have been transferred to this provider from another provider

All Inspections

30 Apr to 5 Jun 2019

During a routine inspection

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.

30 Apr to 5 Jun 2019

During an inspection of Community health services for children, young people and families

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.

30 Apr to 5 Jun 2019

During an inspection of Community end of life care

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.

30 Apr to 5 Jun 2019

During an inspection of Community health sexual health services

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.

27 March 2018

During a routine inspection

  • We rated safe, effective, caring, responsive and well led at core service level as good. In rating the trust, we also considered the current ratings of the other services we did not inspect. Our decision on overall ratings consider, for example, the relative size of services and we use our professional judgement to reach a fair and balanced rating. We rated well led for the trust overall as good.
  • Community health services for adults remained good overall. Safe improved from requires improvement to good. Effective, caring, responsive and well led remained good. We found areas of improvement in relation to staff attendance at mandatory training. Staffing levels had improved and despite some vacancies remaining, managers proactively ensured there were sufficient staff on duty. The disposal of clinical waste in patients own homes however was not in line with the trust’s policy.
  • Community dental services remained good overall. Safe, effective, responsive and well led remained good. Caring improved from good to outstanding. The service had taken steps to mitigate any further risks associated with the reported never events. We saw numerous examples where dental staff demonstrated compassion and delivered patient centred care. The service considered the needs of patients and delivered a service that met the needs of the community. Complaints were fully investigated, and responded to in a timely manner.

27 March 2018

During an inspection of Community dental services

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.

27 March 2018

During an inspection of Community health services for adults

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.

18 June 2015

During an inspection of Community health services for adults

We undertook a responsive inspection because of concerning information we received on the 24 February 2015 to assess the state of the premises at the Laurels sexual health clinic on Newmarket Road in Cambridge.

During the February inspection the premises at the Laurels was found to not be in a suitable state of repair to protect those accessing the premises, including patients and staff, from the risk of preventable harm. We saw that there were a number of unmanaged health and safety risks for example unguarded heaters and cluttered corridors and walkways. The building was also generally poorly maintained. We observed damp and mould in areas accessed by staff and patients. We saw chipping paint, peeling wall paper, unclean patient seating, broken or damaged fixtures and fittings and stained carpets/flooring throughout this building.

Due to our concerns we took enforcement action against the provider which required them to make improvements.

We undertook a follow up inspection of the service on 18 June 2015 to ensure that these actions had been taken. We found that the provider had completed and implemented an action plan and significant improvements had been made. We judged that the provider was now meeting this regulation and therefore we have removed the warning notice.

24 February 2014

During an inspection of Community health services for adults

Following concerns we undertook a responsive inspection to assess the state of the premises at the Laurels sexual health clinic on Newmarket Road in Cambridge.

We found that the premises at the Laurels was not conducive to protect those accessing the premises, including patients and staff, from the risk of preventable harm. We saw that there were a number of unmanaged health and safety risks for example unguarded heaters and cluttered corridors and walkways. The building was also generally unmaintained. We observed and took photographs of damp and mould in areas accessed be staff and patients. We saw chipping paint, peeling wall paper, unclean patient seating, broken or damaged fixtures and fittings and stained carpets/flooring throughout this building.

We found that these issues were known to the provider and although an action plan was in place this was not being implemented or monitored appropriately to ensure people accessing the premises were safeguarded from the risk of harm

28 - 30 May 2014

During an inspection of esb.services_rated.na

The minor injury units (MIU) provided by Cambridgeshire Community Services NHS Trust are situated in the three community hospitals of Wisbech, Ely and Doddington. Treatment is provided for people who walk in with conditions that do not need to be managed at larger Accident and Emergency Units. The service is provided by specialist nursing and paramedic staff who have additional qualifications and training.

We inspected the regulated activities:

  • Diagnostic and screening procedures
  • Treatment of disease, disorder or injury

The service was safe and effective as there were clear policies and protocols for staff to follow which meant patients were given appropriate treatment and risks to their health and welfare were avoided. Current clinical guidance was used and equipment and supplies enabled staff to provide appropriate timely treatment. The service was caring. We observed a caring approach of staff and comments from patients highlighted the good attention and explanation they were given about treatment and follow up. The service was responsive. It was providing treatment within relatively short waiting times. The trust monitored the activity and opening hours, had undertaken a trial of weekend opening in the Wisbech unit and continued to review the service provision with commissioners. The service was well led. Staff were supported by a manager who gave professional and managerial support across all units, and the advanced practitioners supported each other in maintaining a high standard of care. Incidents, or comments from patients, were followed up to learn lessons. We saw that new ways of treating specific injuries were adopted by all units through clear protocol development and the culture of staff, who wanted to provide up to date care.

We spoke with ten patients who were attending the units at the time of our visits. We read comments provided in a visitors book and on cards left at the desk in one unit. Patients were very satisfied with the service, in particular highlighting the short waiting times and the expertise of staff in dealing with their condition or injury. We observed staff providing care, and patients told us that good information was provided to them about their injury and what follow up care would be needed.

28 - 30 May 2014

During an inspection of Community dentist services

Cambridgeshire Community Services NHS Trust provides community dental services across Cambridgeshire and Peterborough.

We inspected the Regulated Activities:

  • Diagnostic and screening procedures
  • Surgical procedures
  • Treatment of disease, disorder or injury

The community dental service had some excellent systems and processes in place to keep people safe. Safety was a priority, staff identified and managed risks to patients, and each centre was very clean and well maintained. The dental service focussed on the needs of patients to ensure their care was effective and in line with best practice.

Patients and their representatives spoke highly of the care provided. They confirmed they had been given privacy and were treated with dignity and respect whilst receiving treatment. However, some told us they found it difficult to get an appointment.

The community dental service was responsive to people’s needs. The maintenance of clear, concise and detailed clinical records confirmed that care and treatment was provided in a way that met the diverse needs of patients. People were seen fairly quickly after referral.

The community dental service was well-led. Initiatives had been established to improve services, and there were quality assurance processes in place. Staff spoken with confirmed that they felt valued and supported in their roles and that managers, both within the dental service and the Trust, were approachable and visible.

28 - 30 May and 7 June 2014

During an inspection of End of life care

Cambridgeshire Community Services NHS Trust delivers community based services to people requiring end of life care and their families, throughout Luton, Cambridgeshire and Peterborough. It provides a range of end of life care services within different care environments including hospice, hospital and care in people’s own homes. It also supports people who are being cared for in care homes.

We inspected the regulated activities:

  • Diagnostic and screening procedures
  • Nursing care
  • Transport services, triage and medical advice provided remotely
  • Treatment of disease, disorder or injury

Services were generally safe. There were arrangements in place to minimise risks to people receiving end of life care and staff working alone in the community. Staffing levels were generally safe in the services we inspected, although staff working in the community often felt under pressure.

Care and treatment were effective, evidence based and focussed on the needs of people requiring end of life care. We saw good examples of collaborative working and innovative practice. 

People receiving end of life care and their families felt well supported and involved with their care. They were able to make decisions relating to their treatment and where they wished to die. Staff were dedicated, compassionate, kind and caring.

End of life care services were responsive to people’s needs. Services were accessible to people from all communities. We saw evidence of effective multidisciplinary team working to ensure people’s end of life care needs were met without avoidable delay.

The service was generally well-led. There was effective decision making at local level, although there was no Trust-wide policy on caring for patients at end of life or after death. The Trust Board and senior managers had oversight of the reported risks and had measures in place to manage them. However, we found that these risks had been overlooked in relation to concerns we found in the mortuary at one hospital. As a result of our concerns, we judged the provider was not meeting Regulation 10, Assessing and monitoring the quality of service provision. We have asked the provider to send us a report that tells us what actions they are taking to meet this essential standard.                    

28 - 30 May and 7 June 2014

During an inspection of Community health inpatient services

Cambridgeshire Community Services NHS Trust provides inpatient rehabilitation care across Cambridgeshire and Peterborough in four hospitals.

We inspected the Regulated Activities:

  • Diagnostic and screening procedures
  • Treatment of disease, disorder or injury

Community health inpatient services  mostly had systems and processes in place to keep patients safe. We observed a clean environment across all wards and there were robust infection prevention and control guidelines in place. All the wards were using the NHS Safety Thermometer system to manage risks to patients, such as falls, pressure ulcers, blood clots, and catheter and urinary tract infections, and to drive improvement in performance.

The Trust had an online incident reporting system, but not all staff were clear on the guidance as to which incidents were reportable. We found there was a lack of systems in place to monitor the safe management of medicines. As a result of our concerns, we judged the provider was not meeting Regulation 13, Management of medicines. We have asked the provider to send us a report that tells us what actions they are taking to meet this essential standard.

The guidance from the National Institite for Health and Care Excellence (NICE) on Stroke rehabilitation was not being followed. Staff were not supported to develop specific skills in this area; attendance at mandatory training was poor. Staff followed a nationally recognised tool for the monitoring and recording of patient observations. However, not all staff were following Trust guidance to ensure deteriorating patients were monitored safely.

Staff were committed and hardworking. All of the patients we spoke with had a positive experience, felt their privacy and dignity was maintained and that things were explained to them in terms they could understand. The interactions we observed between staff and patients were all positive and the staff responded to patients’ needs, including emotional support.

Community inpatient services were responsive to patients’ needs. Staff managed discharge planning using a multidisciplinary approach. Staff felt supported and valued, and were clearly passionate about delivering good care.  However, not all staff received feedback following incidents and learning was not widely shared across community inpatient services.

28 - 30 May and 6 June 2014

During an inspection of Community health services for adults

Community health services for adults are provided by Cambridgeshire Community Services NHS Trust in various locations, including community hospitals, health centres and in people’s homes.

We visited three community hospitals, six health centres, and went on home visits with four District nursing teams. We spoke with 52 people who used the service, or their relatives, and received comments from people who had attended a listening event prior to the inspection. We spoke with 68 staff including: doctors, district nurses, specialist nurses, occupational therapists, physiotherapists, podiatrists, community matrons, healthcare assistants, therapy assistants, and reception and administration staff. We spoke with two volunteer staff.

We inspected the regulated activities:

  • Accommodation for persons who require treatment for substance misuse
  • Diagnostic and screening procedures
  • Family Planning
  • Nursing care
  • Transport services, triage and medical advice provided remotely
  • Treatment of disease, disorder or injury

The community nursing services in Peterborough and Cambridgeshire were last inspected by CQC in December 2013. We found concerns in relation to staffing levels and risk management and told the Trust to take action. At this inspection we found the Trust was making progress with achieving sufficient staffing levels and was now meeting the essential standard in relation to risk management.

People who used the service and staff were protected from abuse and avoidable harm. There were effective systems in place for reporting safety incidents, including allegations of abuse. Staff knew how to report safety incidents. Although there were systems to pass on the outcome and learning from incidents, some staff said this did not always happen.

There were suitable arrangements for the prevention and control of infection, maintenance of the environment and equipment, and the safe management of medicines. People’s personal and confidential information was stored securely. However, there was a low uptake of staff attending training in infection control and information governance. The Trust had identified areas where there were risks related to staffing levels and recruitment and there were plans in place to address these risks. There were appropriate arrangements for lone working.

People who used the service received effective care and treatment that achieved good outcomes, promoted a good quality of life, and was generally based on the best available evidence. Staff were suitably qualified and competent to carry out their roles safely and effectively in line with best practice.  Staff were encouraged and supported to access training appropriate to their roles. However, staff attendance at some training did not meet the Trust’s targets, and some staff felt their opportunities to progress professionally were limited. There was effective multi-disciplinary working within the organisation and with other health and social care providers.

People we spoke with who used the service were positive about the way they were treated by staff. People said they were treated with compassion and respect. We saw staff ensuring that people’s dignity and privacy were upheld. People were mostly involved in making decisions about their care and treatment. We saw that people’s individual preferences, culture and background were respected and taken into account when planning and delivering care. People were encouraged and supported to manage their own care where possible and to maintain their independence. People had appropriate emotional support and were helped to keep in touch with their family and friends.

The Trust delivered appropriate services to meet the needs of different people. People were able to have their care and treatment close to home. People had access to the right care at the right time, including urgent care.  People were encouraged at a local level to provide feedback or make a complaint about their care. Information about how to do this and about the action taken by the Trust in response to feedback was not always prominently displayed.

The Trust’s vision and strategy for delivering high quality care was referred to on their website and in their communications to staff. However, we did not see information about the Trust’s vision, values or strategy prominently displayed in the community hospitals or clinics we visited. This meant the Trust’s vision and strategy may not be accessible to or understood by all staff and people who use the service. Most staff we spoke with said they felt respected, valued and supported by their managers. They were committed to providing good quality care and were proud of their work.

28 - 30 May 2014

During an inspection of Community health services for children, young people and families

Overall rating for this core service: GOOD

Cambridgeshire Community NHS Trust delivers community based and inpatient services to children and young people, and their families, across Cambridgeshire, Luton, South Bedfordshire, parts of Peterborough and Suffolk.

We inspected the Regulated Activities:

  • Diagnostic and screening procedures
  • Treatment of disease, disorder or injury

There were arrangements in place to minimise risks to children and young people receiving care and staff working alone in the community. Staffing levels were generally safe in the services although there was currently pressure on some teams given the high demands and the current staffing capacity.

Services were effective, evidence based and focussed on the needs of children and young people. We saw some examples of very good collaborative work and innovative practice.  The Trust had recognised that staff refresher training was an area to improve and had plans in place to do so.  Effective clinical supervision arrangements were in place across the service. Generally, facilities were suitable for children and young people.  Parents and carers felt well supported and involved with their children’s treatment and told us that staff displayed compassion, kindness and respect at all times.

The children and families service was responsive to people’s needs and people from all communities could access services. There was a range of different services to support and treat children and young people with health, educational and social care needs. Effective multidisciplinary team working, including external partners, ensured children and young people were provided with care that met their needs, at the right time and without avoidable delay. There were challenges to achieving referral to treatment times for occupational therapy, and the looked after children (LAC) service did not always achieve their initial assessments within the required timescale.  Extra resources had been provided so that the occupational therapy service and LAC teams would be able to meet their targets.

The service was in general well–led with effective decision making and strategic planning. The Board and senior managers had oversight of the reported risks and had measures in place to manage these risks.

Children’s inpatient services at Hinchingbrooke hospital were last inspected by CQC at the end of 2013, when we found there were not always enough qualified, skilled and experienced staff to meet patients’ needs. At this inspection we found the provider was now meeting this essential standard.

27 May - 7 June 2014

During a routine inspection

When aggregating ratings, our inspection teams follow a set of principles to ensure consistent decisions. The principles will normally apply but will be balanced by inspection teams using their discretion and professional judgement in the light of all of the available evidence.

We found that the provider was performing at a level which led to a judgement of Good.

We were pleased to find many areas of very good practice across all core service areas. Staff took an active role in delivering and promoting safety, learning and improvement. There was a clear picture of safety across most services. However in isolated areas there were inadequate infection prevention and control procedures and medicines management. Staffing establishments were actively reviewed but were not sufficient in all areas. Some staff teams were stretched and unable to meet people’s needs in a timely way. The provider had in place strategies to manage risks and improve recruitment.

Care and treatment were effectively meeting the needs of patients, families and carers through evidence based practice, guidance and care pathways. There was very good multi-disciplinary working and initiatives to support people at home and avoid admission to hospital. Staff demonstrated a good understanding of the social and economic factors and cultural diversity of their local communities so that sensitive and respectful care could be provided. Staff monitored outcomes using a range of audits, assessments and feedback mechanisms.

Overall, staff were appropriately qualified and competent to carry out their roles safely and effectively in line with best practice. However, in some areas of rehabilitation staff did not have appropriate training and levels of staff attendance at mandatory training and appraisals were below the Trust’s targets.

People using the services were treated with compassion, dignity and respect. People were consistently positive about their experiences of receiving care. We noted that there were mutually respectful working relationships between different professional groups.  Patients were involved in planning their care and were supported to manage their own health and care when they could and to maintain their independence. There were systems in place within all teams for learning from experiences, concerns and complaints.

People were able to access care and treatment close to home in local community hospitals, clinics and treatment centres. District and community nursing services were flexible and worked across professional and organisational boundaries. The Trust ran a number of successful projects, including with other providers, which helped prevent hospital admissions. Trust staff generally had good working relationships with partner organisations, such as social services and the voluntary sector.

The Trust had a clear statement of vision and values. Staff were not consistently aware of these although the organisational values were widely demonstrated by staff across the Trust. The Trust had a two year operational plan for 2014-16 that set out intentions for quality, recruitment, finance and sustainability. Overall we found staff groups were aware of the current transformation programmes. Staff reported an open culture at the trust which gave them confidence to report concerns. Most but not all staff we spoke with felt they were consulted about changes to services and were able to contribute to service developments.

There was an effective governance system and the Trust used a range of tools to monitor quality and risk. In most clinical teams, senior staff showed a good awareness and understanding of governance arrangements, and they maintained local performance data, risk registers and audits. Most but not all teams were benchmarking themselves against other service areas in the Trust. In North Cambridgeshire Hospital, there was a lack of oversight of the mortuary and the Trust could not provide evidence that risks had been managed, or the quality of the service monitored. We raised these concerns at the time of the inspection and the Trust took immediate action to close the mortuary and put in place alternative arrangements for the care of deceased patients.

There was good clinical leadership throughout all units, and a visible, strong leadership at Board level. Work was ongoing to clarify and strengthen the Trust’s strategic direction and governance structures to ensure the safe transfer in and out of services as a result of procurements which will take effect later in 2014 and early 2015.

We reviewed the Trust’s outstanding non-compliance with the essential standards of quality and safety. We found the Trust was now compliant with Regulation 22, Staffing, at Hinchingbrooke Hospital and with Regulation 10, Assessing and monitoring the quality of service provision at Head Quarters. We also found the Trust was making progress with addressing shortfalls of staffing in the community nursing services.

As a result of the concerns identified during this inspection, we judged the provider was not meeting Regulation 10, Assessing and monitoring the quality of service provision in End of Life Care, and Regulation 13, Medicines management on Inpatient wards. These findings are detailed in the core service reports. We have asked the provider to send us a report that tells us what actions they are taking to meet these essential standards.

Joint inspection reports with Ofsted

We carry out joint inspections with Ofsted. As part of each inspection, we look at the way health services provide care and treatment to people.

Other types of report

As well as standard inspection, intelligent monitoring and Mental Health Act Commissioner reports, there are other types of report that we have published under special circumstances.