Walsall Healthcare NHS Trust

Updated 25 January 2023

Walsall Healthcare NHS Trust provides local general hospital and community services to around 260,000 people in Walsall and the surrounding areas. The trust is the only provider of NHS acute care in Walsall, providing inpatients and outpatients at the Manor Hospital as well as a wide range of services in the community.

Walsall Healthcare NHS Trust is working in collaboration with the Royal Wolverhampton NHS Trust under the leadership of a joint chair and chief executive.

Between 20 September 2022 and 10 November 2022, we carried out an unannounced inspection of three of the acute services provided by this trust as part of our continual checks on the safety and quality of healthcare services. We also inspected the well-led key question for the trust overall.

We inspected Children and Young Persons services using our focused inspection methodology. We also inspected Medical and Surgical services. We inspected these services, at Manor Hospital, as our intelligence suggested there may have been a deterioration in the safety and quality of care provided. In addition, in Medical services, we needed to follow up a section 29a warning notice, issued to the trust in March 2021, as we found significant improvement was required to the nurse staffing of the service, the governance of the service and how they provided patients with a safe discharge.

We did not inspect any other services at Walsall Healthcare NHS Trust because our monitoring process had not highlighted any concerns. We will re-inspect these services as appropriate.

Our comprehensive inspections of NHS trusts have shown a strong link between the quality of overall management of a trust and the quality of its services. For that reason, we look at the quality of leadership at every level. Our findings are in the section headed ‘is this organisation well-led’. We inspected the well-led key question between 9 and 10 November 2022. A financial governance review was also carried out at the same time as the well-led inspection, this was undertaken by NHS England. There was not a separate ‘Use of Resources’ assessment in advance of this inspection.

Following our core service inspection, we served a Warning Notice under Section 29A of the Health and Social Care Act 2008. This warning notice served to notify the trust that the Care Quality Commission had formed the view that the quality of health care provided by Walsall Healthcare NHS Trust in relation to the management of medicines, including prescribing, administration, recording and storage, in Medical services required significant improvement.

Our rating of services stayed the same. We rated them as requires improvement because:

• We rated safe, effective, responsive and well-led as requires improvement and caring as outstanding.
• We rated two of the trust’s acute services as good and one as requires improvement.
• In rating the trust, we took into account the current ratings of the five acute services and four community services not inspected this time.
• Safe processes and systems were not always in place to manage the prescribing, administration and storage of patients’ medicines and medicine related documents. Services did not always control infection risk well. Care records were not always complete. In the Surgery service staff did not always assess risks to patients in relation to venous thromboembolism (VTE).
• In the Medical Care service, arrangements to ensure assessment of patient’s mental capacity or deprivation of liberty were not robust.
• Services for children and young people did not always take account of patients’ individual needs.
• Service leaders did not always run services well and information systems were not always reliable.

However:

• We found improvements during our inspection of how well led the organisation was.
• Services mostly had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. Staff mostly assessed risks to patients and acted on them. Services managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided kind care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives and had access to good information. Key services were available seven days a week.
• Across all services staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• Although people could not always access the service when they needed it, the trust was working hard to ensure waiting times from referral to treatment and arrangements to admit, treat and discharge patients were in line with national standards.
• Services planned care to meet the needs of local people and made it easy for people to give feedback.
• Leaders supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

How we carried out the inspection

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.

Updated 25 July 2019

Updated 25 July 2019

Updated 20 December 2017

Following the last inspection in September 2015, we rated this service good for effective, caring, responsive and well led and requires improvement for safe. This was because;

• Demand for community nursing had increased and low priority patient visits were cancelled and rebooked.
• Completion and availability of patient records such as risk assessments was variable across teams.

However, at this inspection we saw the service had built on their good work within all areas and made significant improvements in the safe domain. This resulted in an outstanding rating for the well led domain and a good rating for safe, effective, caring and responsive domains. The overall rating for this service was good.

Overall rating for this core service:  GOOD

Walsall Healthcare NHS Trust provides acute hospital services at Walsall Manor Hospital and community services for adults with long-term conditions throughout Walsall and surrounding areas. We found that community services worked in partnership with the hospital to prevent unnecessary hospital admissions and when required and to promote early discharge from hospital.

We found that community services for adults with long-term disabilities were good. However, we identified that staff had not had either safeguarding training to the required level and may not undertake timely actions to protect people.

We spoke with 22 patients, 10 carers and relatives, and 66 staff across a range of roles within the trust. We held staff focus groups the week before our inspection and 46 community staff attended. We looked at 15 patient records.        

Updated 20 December 2017

Following the last inspection in September 2015, we rated the service as good overall. We rated effective, caring, responsive and well led as good and safe as requires improvement. This was because;

• Children, young people and families were at an increased risk of avoidable harm due to the numerous electronic systems in place to record information.

• Complete and robust information was not always available for multi-agency decisions about children at risk of abuse.

  Following this inspection we saw there had been improvements made in the effective domain, however we had concerns relating to areas within safe.

We have rated this service as good overall. This was because:

• We saw that there had been improvements since the last inspection with the storage and availability of patient records. Staff also told us that the patient administration systems were used more effectively for the needs of the services.

• We saw there had been improvements with lone working procedures and staff had either been provided with or offered mobile telephones to use whilst working in the community.

• Staff were clear of when to report incidents, knew the process to do so and we saw examples of appropriate investigations and learning from incidents across services.

• We saw many examples of excellent multi-disciplinary working and all staff told us this was very strong across all CYP services.

• We observed and families told us that compassionate care was provided by staff across the service.

• There was an open and honest culture and all staff we spoke with were patient focussed and motivated to provided quality care.

• The transition team had been nominated for three national awards and had been highly commended by the Health Service Journal in 2016.

• We saw innovative ways of working such as the ‘little learners’ group set up by speech and language therapists and the roll out of a minor illnesses app to support parents who may have concerns.

However:

• We saw that registered nurses had not completed or checked medication administration charts for children and young people (CYP) in special schools in accordance with the standard operating procedure (SOP). However, when we returned for the unannounced visit all of the charts had been checked and the SOP changed in accordance with the trust medicines policy.

• We saw that a piece of equipment at a patient’s home was overdue for service by four months. Staff told us this had not been exchanged due to the patient being admitted to hospital however, we did not see evidence that risks of use of the equipment had been mitigated.

• We heard examples where staff had acted outside of the scope of professional boundaries.

• We saw that the completion of mandatory training topics including adult basic life support, fire safety and adult protection were below the trust compliance rate.

Updated 20 December 2017

Following the last inspection in September 2015, we rated this service as good across all five domains resulting in an overall rating of good. However, during this inspection we saw the service had built on their good work within all areas and made significant improvements across the board. This resulted in an outstanding rating for the caring, responsive and well led domains and good for safe and effective domains, achieving an outstanding rating overall.

Overall rating for this core service Outstanding

• In order to assess the level of service provided to patients at the end of their life, their families and carers we visited the Walsall Palliative Care Centre, we spoke with nursing staff, doctors and managers about their work and how they were supported. We accompanied nursing and therapy staff on home visits to patients, which enabled us to assess the service provided and to talk with patients and their families and friends in their home environment.

• We completed a short notice announced visit on 31 May 2017 having informed the trust on the previous evening. During that visit, we announced a further visit which we undertook on 21 June 2017.

• We spoke with a total of 24 staff and 26 patients/carers. We looked at seven patient health records and we reviewed other records and documents about the provision of the service including training, management of staff and provision and maintenance of equipment.

• We compared what we found against national guidance and best practice. The World Health Organisation (WHO) define End of Life Care as: ‘an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.’

• Our judgement of the service provided in the community by the trust, fulfilled the WHO definition and met the NICE guidance.

• We found the Individualised End of Life Care Plan which the trust had ratified since our last visit to be an exemplary document. The plan ensured that patients received individualised care based on their own personal needs and wishes. The plan had been recognised nationally and had been awarded the Royal College of Physicians – Excellence in Patient Care award.

• Accompanying documentation in the form of guides for staff and health professionals and guides for patients and family members in relation to End of Life Care and planning had also received national recognition and awards. ‘Thinking about End of Life Care’ had received a BMA Patient Information award for user involvement.

• The services palliative care multi-disciplinary team procedures had been recognised by the International Journal of Palliative Nursing and had won the ‘Palliative Care Team of the Year’ award for Specialist Palliative Care MDT 2017.

• Incidents were reviewed and learning shared within and across teams.

• Staff received regular clinical supervision and were encouraged to develop personal skills that would complement or enhance the team’s ability to provide holistic care to patients and support to their families.

• Local audits were used to identify where services could be improved and learning was widely shared across the teams.

• The departments approach to risk assessments was outstanding. Patient’s health and their environment were assessed regularly to ensure that they and staff attending them were safe. Patients attending the Day Hospice were assessed each time they attended. Risk assessments were completed in respect of activities to ensure that they were safe and appropriate for the patients concerned.

• Staff displayed empathy with patients and their families.

• Patients were at the centre of their own care, they and their family members were able influence how, when and where they were treated. They were encouraged to retain their independence helped with their dignity and provided with the support and symptom control, which enabled them to remain with their families and continue to make the most of their time.

• Nurses, doctors and support staff all used the mantra ‘Every moment counts’.

• Transition services were tailored to meet the needs of young people and introduce them to the services available as they entered adulthood.

• Clear management structures were in place for teams based upon geographical areas of work.

• Staff had confidence in their managers and believed they provided appropriate support and guidance; this was evidenced by training records, annual reviews and clinical supervisions.

• Audits were completed on all aspects of the service and learning was shared within teams.

Updated 25 July 2019