Central Surrey Health Limited

Central Surrey Health was established in 2006 as an employee owned social enterprise company to provide community healthcare services. The provider employs 1675 staff. When staff have worked for the company for a year, they become co-owners. The core services provided by Central Surrey Health are:

• Community health services for adults
• Community health services for children, young people and families
• Community health for inpatients
• Urgent care

Central Surrey Health provides services from 34 sites. The provider delivers NHS community nursing and therapy services for adults living in north west Surrey. These include services into patient homes such as district nursing as well as a wide range of community services in GP surgeries, schools, community health centers, community clinics and community hospitals within north west Surrey.

Central Surrey Health provides NHS children's community health services across Surrey through the Children and Family Health Surrey Partnership.

Community inpatient services are provided at Walton and Woking community hospitals. Each hospital has a 22 bedded ward – Hersham ward in Walton and Alexandra ward in Woking.

Urgent care services are provided at Woking Community Hospital and Ashford Hospital.

We carried out inspections of the four core services provided by Central Surrey Health and a well led inspection. The community health services for adults and community health services for children, young people and families were last inspected in January 2017. This is the first time we have inspected community health for inpatients and urgent care services as a core service. It was also the first time we had undertaken a well-led inspection.

We last inspected Central Surrey Health in 2017 and rated them Good.

Regarding this inspection report it should be noted that this inspection did not include a Use of Resources rating.

Although Central Surrey Health is not an NHS trust, the word trust is used erroneously in several places in the report as the word cannot be removed from the standardised inspection report template.

We rated Central Surrey Health as good because:

• We rated safe, responsive, caring and effective as good. We rated well-led for Central Surrey Health as good.
• We rated all four core services provided by Central Surrey Health as good.
• Leaders had the skills needed for their roles and understood the services they were providing. The non-executive directors (NEDS) offered the support and challenge needed to ensure the board remained focused on the organisation’s objectives.
• The provider had a clear set of values which they had used to underpin the organisation strategy. The board had designed the service strategy to meet the needs of the communities they served. Senior leaders ensured that all stakeholders had the opportunity to influence the strategy and the development of services. Managers ensured services were flexible. The had swapped to virtual appointments where appropriate.
• The organisation had an inclusive and open culture that was patient centred. Senior leaders encouraged staff to innovate and recognised and rewarded the contributions staff made to developing services. Time to Shine awards recognised staff contributions to quality improvement. The provider had engaged patients and other stakeholders to make sure their services met the needs of the local communities.
• There were robust governance systems in place that involved staff from all levels of the organisation. Staff at all levels identified risks, mitigated them and highlighted them across the organisation and wider health community. There were clear pathways for escalating issues to more senior staff including the board. Any identified risk that could not be mitigated by the committee was escalated directly to the board.
• Services had enough staff with the correct training to keep patients and young people safe from abuse. Staff followed infection control procedures and had access to suitable PPE. Staff identified and mitigated risk to patients and recorded this in the patient record. Staff managed incidents well and used any lessons learnt to improve the standard of care the service provided. For example, if staff identified that an equipment part needed to be replaced regularly, they arranged spares for people to ensure their care was not affected.
• The organisation trained staff to ensure they could provide good quality care. There were policies and procedures in place for staff to follow that were based on national good practice guidance. Staff worked well together within their teams, across the providers services and with other care providers.
• Staff respected patients, young people, their families and other carers. They empowered people using their services to be fully involved in their care when appropriate. Staff always treated patients with dignity. Feedback from patients described staff as being caring and professional. The provider collected feedback to help improve services.
• The provider ensured people could give feedback so that staff could plan services to meet the needs of the communities they served. Staff designed services so that people could gain access to the care they needed when they needed it. Staff ensured that patients with the most serious needs were seen without delay.

However:

• The provider had not made enough progress against its action plan to address the concerns identified by the Workforce Racial Equality Standard (WRES) report in 2021. For example, forums for black and minority ethnic staff were being set up during this inspection.
• Senior leaders were not sufficiently visible to staff in front line services, which left staff feeling disconnected from the organisation.
• The employee council, called the Voice, was not fulfilling its role to provide scrutiny and challenge to the board and at the time of the inspection they were not sending members to board meetings. However, the provider was working with them to gain confidence in this role.
• In the community inpatients core service, the provider had not ensured there were suitable evacuation plans in place for patients.

How we carried out the inspection

To fully understand the experience of people who use services, we always ask the following five questions of every service and provider:

• are services safe?

• are services effective?

• are services caring?

• are services responsive?

• are services well-led?

Community health services for adults

The inspection team consisted of one lead inspector, one support inspector and two specialist advisors who were nurses. An expert by experience also spoke with some patients remotely after the inspection.

Before the inspection visit, we reviewed information that we held about the service.

During the inspection, the inspection team:

• visited three community nursing team bases in Woking, Staines, and Weybridge
• visited a complex wound care clinic and podiatry clinic
• visited a Parkinson’s disease group
• spoke with nine senior leaders including heads of service, operational and clinical leads.
• spoke with 19 staff face to face and 16 in an online focus group. These included nurses, students, HCAs (healthcare assistants), nurse associates, speech and language therapists, podiatrists, and students
• spoke with 27 patients and families who were using services or their carers/relatives.
• reviewed 14 patient care and treatment records.
• observed three shift handover meetings for community nursing teams.
• Observed two staff allocation meetings
• observed 10 schedules of care in patients’ homes.
• observed staff providing care to patients in clinic settings.
• held three focus groups to capture staff who were unavailable on the days of the inspection.
• looked at a range of policies, procedures and other documents related to the running of the services.

What people who use the service say

All patients were complimentary of the staff and care they had received from the teams.

Patients described caring and compassionate staff who always had time to listen to them even when they were busy.

Patients knew they were in safe hands and had good outcomes from care they had received.

Some patients described staff as outstanding and like family as they show such concern and go the extra mile to help them.

Patients did not have any complaints but felt able to raise them if ever they did.

Staff were well thought of, and patients spoke fondly about staff and the difference they made to their lives.

Community health services for children, young people and families

The team that inspected the children’s and young people service comprised of two CQC inspectors, one CQC medicines inspector (remotely), two specialist advisors, and one expert by experience (remotely). The expert by experience had lived experience as a family carer of a child or young person (CYP) who uses health services. The specialist advisors had experience of health visiting, school nursing and children’s community nursing.

Before the inspection visit, we reviewed information that we held about the service.

During the inspection visit, the inspection team:

• Looked at the quality of the premises, community clinics and school nursing environments that we visited
• Spoke with 16 parents and carers and two young people
• Spoke with two associate directors, a service manager, five clinical service managers and four clinical team leaders for the therapy, 0-19 services, specialist community children’s nursing, school nursing and specialist school nursing teams
• Spoke with 55 staff across the teams including therapy, children’s community nursing, continuing care, continence, family nurse partnership, youth offending, immunisation, specialist school nursing, school nursing, nursery nursing, health visiting, safeguarding and administration. These were carried out via onsite interviews as well as virtual staff focus groups where staff could join and give feedback on the service
• Observed a sample of clinical practice and home visits including a new birth visit, tongue tie procedure, enuresis clinic, a school clinic and an Ages & Stages Questionnaire (ASQ) assessment
• Attended a transformation webinar for all staff
• Looked at over 10 treatment records of people including medicines records; and
• Looked at a range of policies, procedures and other documents relating to the running of the service.

What people who use the service say

They told us that staff went above and beyond in terms of their flexibility in meeting the needs of children, young people and their families.

Parents and carers told us staff were approachable, supportive and responsive and easy to contact. They reported that staff listened to them and kept in touch, they were knowledgeable and reassuring.

Parents and carers told us they were fully involved in decision making and received regular updates. All parents and carers told us that there was nothing they would improve on.

They all confirmed that there was good communication and that if they needed access to consultants, this was done in a timely way. They also described receiving carers support during difficult times.

Community health inpatient services

Our inspection team comprised two CQC inspectors, a specialist advisor with a nursing background and an expert by experience.

During the inspection visit the team:

• Conducted a tour of both wards to review the environment and observe how staff were caring for patients
• Reviewed eight care records
• Reviewed 12 medicines charts
• Observed a daily board round meeting and an infection outbreak meeting
• Spoke with 17 staff, including a ward doctor, the inpatients service manager, the therapy services manager, the senior matron, two nurses, healthcare assistants, a senior physiotherapist, a management graduate, a discharge co-ordinator, an occupational therapist, a matron, a ward clerk, the therapy team leader and a member of the domestic team
• Spoke with 14 patients
• Spoke with nine relatives
• Reviewed two incident reports and
• Reviewed a range of policies and documents relating to the running of the service.

What people who use the service say

People who use the service were unanimously positive about the care they received and the staff. They told us that they were always treated with dignity and respect and that they felt involved in their care. They told us that the staff were very responsive, and that nothing seemed too much trouble. They told us that the hospital was always very clean.

Community urgent care services

Our inspection team comprised of two CQC inspectors.

Before the inspection visit, we reviewed information that we held about the location.

During the inspection visit, the inspection team:

• Looked at the quality of the environment and observed how staff were caring for clients.
• Spoke with eight patients and carers.
• Spoke with the clinical leads at both Woking and Ashford walk-in centres.
• Spoke with the service manager.
• Spoke with 10 other staff members: we held two focus groups.
• Observed patient consultation with staff.
• Looked at 10 care and treatment records (paper records as the centres were experiencing a national outage of the electronic patient record system).
• Looked at a range of policies, procedures and other documents relating to the running of the service.

What people who use the service say

Patients told us that staff treated them with dignity and respect and explained their condition in a way they could understand. Staff had time for people even when they were busy and never tried to rush people.

The well led inspection team comprised of two executive reviewers, one for one day and one for two days, who were executives of NHS trust, one specialist advisor with professional experience in board-level governance, one CQC head of hospital inspection, one CQC inspection manager and two CQC inspectors.

You can find further information about how we carry out our inspections on our website: www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.