Provide Community Interest Company

Updated 15 May 2019

Provide is a community interest company (social enterprise), which delivers a range of health and social care services in the community. A social enterprise is a business with social objectives whose surpluses are principally reinvested in the business or community, rather than being driven by the need to maximise profit for shareholders and owners. Care is provided in a variety of community settings, including community hospitals, community clinics, schools, nursing homes and primary care settings, as well as within peoples’ homes. Provide employs over 985 people and serves communities with a total population of over 4.5 million people.

Updated 15 May 2019

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

• Community health inpatient services stayed the same as good overall. The questions of safe, effective, caring, responsive and well led stayed as good. The service understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff completed and updated risk assessments for each patient. People’s care and treatment is planned and delivered in line with current evidence-based guidance, standards, best practice. Staff cared for patients with compassion. The service had clear admission criteria and liaised closely with the local NHS trust.
• Community health adult  services improved from good to outstanding overall. The questions of safety, effective and well led stayed the same as good. Caring and responsive improved to outstanding. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection. The service had suitable premises and equipment and looked after them well. Staff of different kinds worked together as a team to benefit patients. Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. We found examples where staff had exceeded patient expectations and staff had gone the extra mile to provide excellent care to their patients. There was a proactive approach to understanding the needs and preferences of different groups of people and to delivering care in a way that met those needs.

Updated 15 May 2019

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

• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.
• The service maintained equipment and facilities well. Staff knew their roles and responsibilities in protecting patients from healthcare associated infections and to control the spread of these infections.
• The service managed their staffing to safely care for patients despite local recruitment issues. They had regular bank and agency staff to fill any gaps in rotas and reviewed their staffing needs on a weekly basis.
• The service planned for emergencies and staff understood their roles if one should happen.
• The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support. The service used safety monitoring results well. Staff collected safety information and shared it with staff. The service used information to improve services.
• The service provided care and treatment based on national guidance and evidence of effectiveness. Managers checked to make sure staff followed guidance.
• Staff of different kinds worked together as a team to benefit patients. Nurses, therapists and support staff worked with professionals from other services to provide good care. Staff supported patients to receive enough food and drink to meet their needs and improve their health.
• The service monitored the effectiveness of care and treatment and used the findings to improve them. Staff 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.
• Staff understood their roles and responsibilities under 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.
• Feedback from patients was continually positive about the way staff treat people. We found examples where staff had exceeded patient expectations and staff had gone the extra mile to provide excellent care to their patients.
• There was a strong, visible person-centred culture. Staff were highly motivated and inspired to offer care that was kind and promoted people’s dignity.
• Staff recognised that patients’ emotional and social needs were as important as their physical needs. We observed staff asking patients open questions about the way they were feeling and gave them an opportunity to respond by actively listened to their answers.
• People were truly respected and valued as individuals and were empowered as partners in their care. Staff were committed to working in partnership with people. Staff took the time to explain and interact with patients, they were sensitive to patients’ needs offering explanations and being supportive when patients expressed concerns.
• The organisation’s planned and provided services in a way that met the needs of local people. The service was tailored to meet the needs of individual people and delivered in a way to ensure flexibility, choice and continuity of care.
• People’s individual needs were central to the delivery of tailored services. The service took account of and understood the needs of individual patients. Services reflected the needs of the population served and staff used innovative approaches to achieve this with the resources available.
• Services were flexible, provided informed choice and ensured continuity of care.
• There was a proactive approach to understanding the needs and preferences of different groups of people and to delivering care in a way that met those needs.
• People could access services and appointments in a way and at a time that suited them. Waiting times from referral to assessment exceeded their targets and arrangements to treat and discharge patients were in line with good practice.
• The service treated concerns and complaints seriously, investigated them and learned lessons from the results, which were shared with all staff. The service demonstrated where improvements had been made as a result of learning from reviews.
• The service had managers at all levels with the right skills and abilities to run a service providing high-quality sustainable care. Managers across the service promoted a positive culture that supported and valued staff creating a sense of common purpose based on shared values.
• The organisation had a vision for what it wanted to achieve and workable plans to turn it into action, developed with involvement from staff, patients, and key groups representing the local community.
• The organisation had a systematic approach to continually improve quality and safeguard high standards of care and treatment by creating an environment in which excellence in clinical care would flourish.
• The service had effective systems for identifying risks and planning to eliminate or reduce them. The organisation collected, analysed, managed and used information well to support all of its activities, using secure electronic systems with security safeguards.
• The organisation engaged well with patients, staff and the public to plan and manage appropriate services and collaborated with partner organisations effectively.

Updated 8 March 2017

Overall rating for this core service

We rated the specialist children’s service and the children’s public health service as good because:

• There were arrangements to minimise and mitigate the risks to children and young people receiving care.
• The organisation had met the 2015 staffing target in response to the National Health Visitor Implementation plan. The National Health Visitor Implementation Plan ‘A Call to Action’ aimed to expand and strengthen Health Visiting services.
• Staff met the organisations mandatory level three safeguarding training target of 95%. There was a good awareness of safeguarding procedures, which meant staff had the ability to protect children and young people from abuse and avoidable harm.
• Staff reported and investigated Incidents appropriately; however, learning from incidents was inconsistent.
• There were care pathways and transition arrangements for young people with complex care needs moving to adult services.
• Staff had achieved the organisations target (90%) for appraisals, meaning staff had their learning needs identified and/or supported to undertake training and development.
• There were policies and procedures in place to support staff and ensure they delivered services effectively and efficiently.
• We saw effective multi-disciplinary working including with external partners and good arrangements around consent.
• Staff treated children, young people and their families with dignity and respect and were involved as partners in their care.
• Staff provided children with Information about care and treatment in such a way they could make informed choices.
• Staff were dedicated to achieving the best care for their patients and worked hard to achieve this.
• Emotional support was available for patients in need. Staff were compassionate, committed and flexible to meet the needs of their patients.
• Services were planned and delivered for children and young people, to meet the needs of the local population.
• Services were flexible and staff took into account the needs of different people.
• The service had a clear vision and strategy.
• We found a positive, patient-focused culture, leaders were supportive and staff felt valued.

Updated 15 May 2019

• The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.
• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
• Staff kept detailed patients’ records and these records were clear, up-to-date and easily available to all staff providing care.
• The service followed best practice when prescribing, giving, recording and storing medicines. Patients received the right medication at the right dose at the right time.
• Staff assessed patients to ensure they received enough food and drink to meet their needs and improve their health. They used special nutritional and hydration assessments when necessary.
• The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.
• Staff treated patients with compassion and respect. Privacy and dignity was maintained when treating the patient. Staff also provided emotional support to patients, relatives and those close to patients to minimise distress.
• The service treated concerns and complaints seriously, investigated them and learned lessons from the results, which were shared with all staff.

However, we also found:

• A lack of a formal checking process for defibrillators and oxygen cylinders.
• Not all clinicians could access to the incident reporting system
• Whilst the service was providing pain relief to patients, pain scores were not being formally recorded in patient records in a systematic way.

Updated 8 March 2017

We rated end of life care as good overall because:

• Openness and transparency about safety was encouraged.
• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses and where incidents had been raised actions were taken to improve processes.
• Safeguarding was given sufficient priority. Staff had a good understanding of how to protect patients from abuse. Staff described what safeguarding was and the process to follow if they suspected a patient was at risk of avoidable harm or abuse.
• Arrangements to minimise risks to patients were in place with measures to prevent falls, malnutrition and pressure ulcers. We observed staff followed good infection and prevention control practices.
• Staff recognised and responded to the changing needs of patients with anticipatory medications readily available and care needs assessed and reviewed appropriately.
• Specialist equipment needed to provide care and treatment to patients in their home was appropriate and fit for purpose so that patients were safe. Syringe drivers were mostly maintained and used in accordance with professional recommendations.
• End of life care was planned and delivered in line with best practice guidance. Care and treatment was planned and delivered in a personalised and holistic way and care plans took into account patients health and social care needs.
• Our observation of practice, review of records and discussion with staff confirmed there were effective multidisciplinary team (MDT) working practices. Staff worked collaboratively to understand and meet the range and complexity of patients’ needs.
• Staff understood the relevant consent and decision-making requirements of legislation and guidance, including the Mental Capacity Act 2005.
• We observed a holistic person-centred approach to patient care. Patients were treated with compassion, kindness, dignity and respect.
• Without exception, feedback from patients and relatives was positive.
• Without exception, staff were not only committed to providing sensitive care to patients, but also for the well-being of their families.
• Staff provided emotional support for patients and their families, and signposted them to other sources of support where appropriate.
• As part of the care provision for children with palliative care needs, the provider delivered respite care services for Essex Palliative Integrated Care Children’s Respite Service (EPIC). EPIC was part of Provides children’s specialist services business unit and sat within the children’s specialists services.
• The provider engaged with external organisations and the local community to ensure the services met the needs of patients and those close to them who required end of life care.
• Patients could access the service in a timely manner that suited their individual needs.
• Data provided by the trust showed the end of life care service received one complaint between November 2015 and November 2016 specific to the service.
• The leadership, governance and culture mostly promoted the delivery of high quality person-centred care.
• The locality leads, clinical nurse specialists and community staff were able to articulate the purpose of their service, to provide care and support for patients in their last year of life, and their role within the integrated locality team. All staff, including very senior managers understood the importance of end of life care.
• There were good governance structures in place for end of life care through the integrated governance structure.
• The lead for end of life care was visible, and there was good local support and leadership for end of life care. Staff had confidence in their managers to ensure training and expertise knowledge was available to improve end of life care experiences for patients and those who were close to them.
• There was good public and staff engagement throughout end of life care services.

However;

• There was no safety performance dashboard related to end of life care. This meant there was no visual aid to advise staff. A dashboard is a toolset developed by the National Health Service (NHS) to provide clinicians with relevant and timely information they need to inform daily decisions that improve the quality of patient care. The toolset gives clinicians access to data that is being captured locally, in a visual and usable format. The safety dashboard displays local relevant safety information alongside relevant national data.