Newholme Hospital

Updated 20 May 2014

Derbyshire Community Health Services NHS Trust Head Quarters (HQ) is based at Newholme Hospital in Bakewell, Derbyshire. It was first registered with CQC on 31 March 2011 to provide the regulated activities: Diagnostic and screening procedures, Family planning, Nursing care, Surgical procedures, and Treatment of disease, disorder or injury.

The Trust delivers a variety of community services from its Head Quarters to approximately 1.1 million people across Derbyshire and in parts of Leicestershire, with more than 1.5 million contacts each year. Its services include community nursing and therapies, urgent care, rehabilitation, care of people with a learning disability, services for children and families, end of life care, podiatry, sexual health, health psychology, dental services, outpatients and day case surgery.

In Derbyshire its services are delivered across six localities: Amber Valley, Erewash, Chesterfield, Derbyshire Dales, High Peak, North East Derbyshire and South Derbyshire. In Leicestershire and Rutland the services are delivered at nine hospitals and 15 dental clinics.

Head Quarters (HQ) has been inspected once since registration, and was found non-compliant with Regulation 17, Respecting and involving people. Buxton Hospital minor injury unit was inspected twice in 2013, and at the last inspection in July 2013 was found non-compliant with Regulation 23, Supporting workers.

Updated 20 May 2014

Derbyshire Community Health Services NHS Trust Head Quarters (HQ) is based at Newholme Hospital in Bakewell, Derbyshire. It was first registered with CQC on 31 March 2011 to provide the regulated activities: Diagnostic and screening procedures, Family planning, Nursing care, Surgical procedures, and Treatment of disease, disorder or injury.

The Trust delivers a variety of community services from its Head Quarters across Derbyshire and in parts of Leicestershire, including community nursing and therapies, urgent care, rehabilitation, care of people with a learning disability, services for children and families, end of life care, podiatry, dental services, outpatients and day case surgery.

Head Quarters (HQ) was inspected by the CQC in 2013. We found the provider was not meeting the essential standard, respecting and involving people in their care. At this inspection in 2014, we found the provider was now meeting this standard. We inspected Buxton Hospital minor injury unit twice in 2013. At the last inspection in July 2013 we found the provider was not meeting the essential standard, supporting workers. At this inspection in 2014, we found the provider was now meeting this essential standard, and the findings of the inspection are reported here under minor injury units.

We inspected the following core services:

• Community services for children and families
• Community services for adults with long-term conditions
• End-of-life Care

We also inspected:

• Learning disability services
• Minor injury units
• Dental services
• Elective care services

Patients were overwhelmingly positive about the care and treatment they received. Patients were routinely viewed as partners in their care and decision making was personalised to meet their short and long term needs. However, in some services care plans were not always sufficiently detailed and there were not always the right risk assessments in place to promote people’s welfare and safety.

Patients and their families were treated with compassion and respect, and were involved in their care and well informed. There was a focus on promoting independence and self-management.

Care and treatment was safe because there were systems for identifying, investigating and learning from untoward incidents. Staff had received training in safeguarding vulnerable adults and were confident about reporting their concerns. There were systems in place to ensure the safety of staff working alone in the community, but these were not consistent across the Trust.

Care and treatment were evidence based and followed recognised and approved care pathways. In many areas we found integrated pathways of care that were working very well, and care was centred on the patient. There were good information sharing systems, so that people received joined up care from different professionals, although this did not work so well with providers across county boundaries.

Staffing levels were generally suitable but arrangements were not always sufficient to ensure that staff had manageable caseloads and that patients could access therapy services when they needed to. The Trust responded to changing local priorities and addressed the demands on services. In several areas there were weekend, evening and early morning clinics or educational courses, to improve access for patients. There were long waiting times for certain dental treatments and access to some outpatient or specialist therapists.

Discharge planning from community hospitals was effective with regular multidisciplinary discharge meetings that were used positively and involved all relevant health and social care staff.

There were organisational governance and risk management structures in place. Staff felt included in the Trust’s vision and felt supported to raise concerns. There was open and supportive leadership at all management levels throughout the Trust.

Updated 20 May 2014

Patients receiving care and treatment for long terms conditions were overwhelmingly positive about the care they received from dedicated, compassionate staff. Especially at home, patients were routinely viewed as partners in their care and decision making was personalised to meet their short and long term needs.

Overall there were effective and reliable systems in place to enable staff to deliver safe care. Staff completed suitable risk assessments and appropriate screening tools. However, support for staff working alone in the community was not consistent.

Care and treatment were evidence based and followed recognised and approved care pathways. In many areas we found integrated pathways of care that were working very well, and care was centred on the patient. Specialist nurses and therapists worked with a degree of autonomy in the community, while able to access advice from or make referrals to other professionals easily.

Professionals in community teams worked well together. Staffing levels were generally suitable but staff did not always have manageable caseloads and waiting lists for some therapy services were very long due to reduced staff numbers.

The Trust responded to changing local priorities and addressed the demands on services. In several areas there were weekend, evening and early morning clinics or educational courses, to improve access for patients who were working. Discharge planning from community hospitals was effective with regular multidisciplinary discharge meetings that were used positively and involved all relevant health and social care staff.

Managers reinforced the Trust’s vision and values. They showed strong management skills, enabled regular staff training, group clinical supervision, and personal and professional support.

Updated 20 May 2014

Care provided to children, young people and families was safe because there were systems for identifying, investigating and learning from safety incidents. Staff were well trained in safeguarding and protecting children from abuse and confident of their own roles and responsibilities. However, not all staff had received training in domestic abuse. Staff received regular safeguarding clinical supervision to support them in the care they provided to children at risk of abuse. They worked in collaboration with other services and disciplines to safeguard children and young people.

Care was effective, focussed on people’s needs, evidence based and followed approved national guidance and nationally recognised assessment tools. There was effective information sharing between midwifery, health visiting and school nursing services which ensured the smooth transition of children from one service to another. However, there appeared not to be consistent communication from trusts in neighbouring counties, informing health visitors of forth coming births.

People were involved in and central to making decisions about the care and support they needed. Staff provided compassionate and empathetic care; people had positive experiences of care and felt fully supported by children’s community services.

Staff responded to peoples’ needs promptly and provided dedicated care to vulnerable groups such as travelling families. The Trust used social media to meet the communication needs of young people and parents and to increase access to the health visiting service. However, there had been no consultation with people regarding the planned reduction in the number of well baby clinics.

There were organisational, governance and risk management structures in place. Staff told us there was two way communication between staff and managers. Staff felt included in the organisation’s vision and supported to raise concerns.

Updated 20 May 2014

Patients receiving end of life care were protected from abuse and avoidable harm by the systems, processes and practices in place. Staff had received training in safeguarding vulnerable adults and were confident about reporting their concerns.

Care provided to patients was effective and focussed on their needs. Care was evidence based and followed national guidance. There was effective collaboration between staff providing end of life care, including staff from other organisations.

Patients receiving end of life care were treated with dignity and respect by staff delivering the service. The majority of patients were satisfied with the service provided. Most patients and their families felt involved in discussions about care. However, we found that patients or their representatives were not always fully involved in discussions about ‘Do Not Resuscitate’ decisions.

Patients received care and treatment to meet their needs, including timely provision of medicines and equipment, and had access to end of life care services through several routes.

There were organisational, governance and risk management structures in place. Staff told us there was effective communication between staff and managers. Staff felt included in the organisation’s vision and supported to raise concerns.