Updated 15 August 2022
First Community Health & Care C.I.C. was established in 2011 as a social enterprise company to provide community healthcare services predominantly in East Surrey and a small part of West Sussex. The provider employs around 500 staff and approximately 70% of staff are shareholders in the company. The core service provided by First Community Health & Care C.I.C. were as follows:
- Community health services for adults
- Community health services for children, young people and families
- Community health for inpatients
- Community urgent care services
First Community Health & Care C.I.C. provides one inpatient rehabilitation ward at Caterham Dene hospital, mostly for patients who were stepping down from acute hospital admissions. It also provided a minor injuries unit at Caterham Dene hospital. The community health service for adults comprised five district nurse teams and a series of specialist teams. Community health services for children, young people and families was made up of three 0-19 health visiting teams, school nursing, children’s safeguarding services and a series of specialist clinics.
We carried out inspections of the four core services provided by First Community Health & Care C.I.C. followed by a well led inspection. The community health services for adults, community health services for children, young people and families and community health services for inpatients core services were last inspected in March 2017. This was the first time the urgent care core service was inspected. It was also the first time we had undertaken a well led inspection of the provider.
Regarding this inspection report it should be noted that this inspection did not include a Use of Resources rating.
This inspection did not include a use of resources rating. Although First Community Health & Care C.I.C. 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 First Community Health & Care as good because:
- Each of the five domains, Safe, Effective, Caring, Responsive and Well Led, are rated as good overall.
- Staff were well supported by supportive and competent leaders across the organisation. Leaders were well supported with their career development and the provider had improved its approach to succession planning for senior leadership posts. Senior leaders below executive level, in associate director and service lead roles, were actively involved in the provider’s governance and strategic work. This helped with their professional development and helped ground senior leaders in the experiences of patients and staff when they needed to make decisions about services.
- The provider had a clear strategic approach and mission, which was well understood by staff. This emphasised that all aspects of the provider’s work and decision making should be undertaken in the context of prioritising people, then the system, then the organisation.
- Staff described an open, transparent and supportive culture that centred on what was best for patients and the wider healthcare system. Staff across the organisation worked hand in hand with partners working in the wider healthcare system, for other providers and for external agencies including the voluntary sector.
- The provider’s governance system effectively provided assurance and helped keep patients safe. It helped the organisation deliver its key transformation programmes and priorities outlined in the annual business plan.
- Despite the provider’s quality improvement approach being in development, we identified numerous examples of improvements that had been driven by staff working in services. For example, staff in the inclusion team had successfully demonstrated the value of the team to commissioners who had agreed to permanently fund the work of the team to benefit the local refugee, asylum seeker and Gypsy, Roma and Traveller populations. Staff at the Minor Injury Unit (MIU) had undertaken a review of the reasons why people presented at the service and subsequently set up a wound dressing clinic to help ease pressure on Emergency nurse Practitioners. Staff had also worked closely with partners to develop the remit of the MIU thereby easing pressure on other parts of the urgent and emergency care pathway, including the local emergency department.
However;
- The provider needed to strengthen its work on Equality, Diversity and Human Rights (EDHR). The board had recently received an annual equality report and the organisation did not yet have a set of equality objectives. The provider was considering how best to represent and understand the views and experiences of staff with protected characteristics.
- The provider was seeking to improve the way the board had oversight of feedback staff gave about the organisation. This was because there were numerous ways staff could provide feedback and these were not yet effectively triangulated. The Freedom to Speak Up Guardian planned to develop a triangulation mechanism and include feedback from multiple sources in their future reports to the board.
- The quality of data needed to be improved. The provider recognised that it needed to develop its business intelligence function to better summarise and represent performance themes and trajectories.
- The provider was working to develop its approaches to user involvement and quality improvement initiatives.
- The provider continued to work closely with commissioners to address substantial waiting times for children’s occupational therapy and speech and language therapy services.