17 April 2014
From 3 to 6 February 2014 Bridgewater Community Healthcare NHS Trust was inspected by the Care Quality Commission (CQC) to allow them to make a judgement on the quality of care we provide.
We were one of the first community trusts to experience this new style of inspection from the CQC. We found the inspection team to be very thorough and they met many staff across the Trust and spoke to a number of patients.
The CQC inspected the following services:
- Services for children and families
- Services for adults with long-term conditions
- Community dental services
- District nursing services
- End-of-life care
- Other services including walk-in centres, wheelchair services, musculoskeletal services and adult learning disability services
- Services for adults requiring community inpatient services – Newton Community Hospital, St Helens and Padgate House, Warrington
Positive key findings
We were pleased to see that the CQC felt that we do the following things well:
- Patients were overwhelmingly positive about the quality of service they received and patient feedback suggests staff are caring and compassionate.
- Staff were observed treating patients with dignity and respect and were passionate about the service they delivered.
- Patients say they were involved in planning their care and provided with enough information to make informed decisions.
- Overall our services were deemed to be safe with systems in place to identify, investigate and learn from incidents in most areas.
- Care is provided in line with evidence based guidance and policy and there is training to support this.
- Services were responsive to people’s needs in most areas and patient satisfaction rates were high across the Trust. Where things had gone wrong the Trust sought opportunities to learn from patient’s experiences.
- The Board has a clear focus on quality of care and there is a patient story at each Board meeting – giving both the positive and negative experiences of care provided by the Trust.
- The Board has a clear vision for the organisation and receives regular reports covering quality and effectiveness through the Trust’s governance systems and processes.
- There is evidence of good multidisciplinary working between staff in different health professions and evidence of joint working between the Trust and partner agencies.
- Premises used by the Trust were clean and well maintained with procedures for the management of clinical waste and prevention of infection in place.
- Staff are surveyed quarterly to record satisfaction levels and staff are aware of the vision of the Trust and kept updated on what the Trust is doing in response to feedback.
Areas for improvement
As we expected, the report identifies some specific areas where we need to make improvements to systems and processes and we are already making progress towards delivering these. We welcome the insight provided by the CQC. The issues highlighted are related to specific areas of administration and we are confident that none have resulted in any harm to patients, their families or carers.
The following information summarises the areas where the CQC has said we must and should improve and also some areas where we could introduce improvements. We have also listed the actions we are taking in response:
- The CQC advised that our only inpatient facility at Newton Community Hospital had not protected people through effective operation of systems to identify, assess and manage risks related to the health, welfare and safety of service users. The CQC advised that we must address this issue.
- We are re-running our training on the incident reporting system and process for all staff in the Trust to ensure all staff have received a refresher.
- We have ensured that our Trust risk register incorporates all risks and that these are managed and escalated as necessary.
- We are also auditing the process used to investigate incidents and reviewing our register of staff trained to undertake this activity.
- We must develop effective reporting mechanisms to ensure the Board is fully aware of activity and performance at Newton Community Hospital.
- We have developed an effective process for quality reporting, overseen by the Trust’s Executive Nurse/Director of Governance and the Trust’s Quality and Safety Committee which is a Board sub-committee.
- In partnership with commissioners we should agree and develop a clear vision for the future of Newton Community Hospital.
- A review of intermediate care in St Helens has already been completed in conjunction with commissioners which will lead to action plans and commissioning intentions.
- We should ensure that training is provided that particularly supports the needs of staff working in an inpatient facility.
- We are reviewing all levels of training provided to staff working in this facility.
- We should review staffing levels at Newton Community Hospital in light of the current demands on the facility.
- We completed a review of the mix of staffing and skills required in late 2013 and are routinely applying Royal College of Nursing safe staffing levels guidance.
- We should provide clarity to staff regarding the management of vacancies and recruitment to roles.
- We had already identified some delays within our recruitment process and are updating our Recruitment and Selection Policy in response.
- We have also introduced recruitment meetings for each of our clinical directorates to ensure recruitment is tracked and any delays to recruitment are minimised.
- As part of our performance framework we regularly monitor waiting times and are aware that in some specific services our patients have talked to us about waiting times and we will take action where necessary.
- We should take action to ensure that teams do not work in isolation and that we have better mechanisms for sharing learning and resources across the Trust.
- We believe that the introduction of new management structures based on clinical functions rather than geography will help to address this.
- We have also recently introduced a Lessons Learned feature in our monthly Team Brief to ensure that learning from incidents and complaints is shared across the Trust.
- We should continue to develop IT systems to support integration across the Trust.
- We are working on plans for a Trust-wide network and systems that enable better integration.
- We should ensure all our staff are fully trained to identify, report and review incidents and that full investigations (Root Cause Analysis) are carried out.
- We are re-running our training on the incident reporting system and process. We are also auditing the process used to investigate incidents (Root Cause Analysis) and reviewing our register of staff trained to undertake this activity.
- We should improve our recording, on paper records, of patient wishes regarding Do Not Attempt Cardiopulmonary resuscitation.
- Our Medical Director is implementing a new recording process which is in line with regional guidelines.
- We could ensure that there is formal feedback from patients where this does not already take place, including creating child friendly documents where necessary.
- Our “Talk to Us” patient survey form is being rolled out for consistent use across all services for adults and we are looking a different methods of collating patient feedback.
- We are continuing to develop our Patient Partners engagement programme.
- A child friendly feedback form has also been developed and is being finalised.
- We could improve our mechanisms for collating patient safety data and other indicators for our services providing end of life
- We have scheduled end of life pathway training sessions and will look at adopting a set of national indicators.
- We could think more about how we transfer information to managers taking on responsibility for new services so they are fully briefed from the outset.
- We are developing a specific risk log to support handovers to staff taking on new roles.
- We are also introducing systems to brief managers moving to a new role on all the issues and priorities for their services.
View the CQC press release.
Read our media statement on the inspection report.
Our prison healthcare service provided at HMP Young Offenders Institute Hindley which was inspected on 10 and 11 March 2014 was also deemed to be fully compliant by the CQC. The CQC report from this inspection is extremely positive and is available to view on the CQC’s website.