The Care Quality Commission
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Walsall Healthcare NHS Trust

This is an organisation that runs the health and social care services we inspect

Overall: Requires improvement read more about inspection ratings

All Inspections

20 September 2022, 04 October 2022, 05 October 2022, 09 November 2022, 10 November 2022

During a routine inspection

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.

31 May 2017 (unannounced) 20 – 22 June 2017 (short notice announced)

During an inspection looking at part of the service

Walsall Healthcare NHS Trust provides acute hospital and community health services for people living in Walsall and the surrounding areas. The trust serves a population of around 270,000. Acute hospital services are provided from one site, Walsall Manor Hospital. Walsall Manor Hospital has 550 acute beds. There is a separate midwifery-led birthing unit and the trust’s palliative care centre in Goscote is their base for a wide range of palliative care and end of life services.

Following the 2015 inspection, we rated this trust as ‘inadequate’. We made judgements about eleven services across the trust as well as making judgements about the five key questions we ask. In 2015 we rated the key questions for safety, effective and well led as ‘inadequate’. We rated the key questions, for caring and responsive as 'requires improvement’.

The trust was placed in special measures by the Secretary of State for Health in February 2016 following our announced comprehensive inspection on 8 to 10 September 2015 followed by three unannounced inspection visits after the announced visit on 13, 20 and 24 September 2015. We wanted to ensure services found to be providing inadequate care at the trust did not continue to do so.

After this inspection period ended, the Care Quality Commission served the trust with a Section 29a Warning Notice of the Health and Social Care Act 2008. This outlined the quality of healthcare provided by Walsall healthcare NHS Trust for the following regulated activities required significant improvement:

  • Diagnostic and screening procedures

  • Maternity and midwifery services

  • Surgical procedures

  • Treatment of disease, disorder or injury

The warning notice set out the points of concern and timescales to address this and was wholly related to maternity services. The trust responded to this with a detailed plan for remedial action.

For this inspection, we undertook an unannounced inspection on 31 May 2017 where we inspected community services for adults, children and young people and end of life care. On the day of the unannounced inspection, we announced to the trust we would be returning for a short notice announced inspection on 20 to 22 June 2017. We conducted an announced visit to eight core services at Walsall Manor Hospital, which included: emergency department; medical care services; surgery; critical care; maternity; children and young people services; end of life care and out-patients and diagnostic image services. The inspection team included CQC inspectors and clinical specialist advisors for each service.

We held staff focus groups in the hospital and across community settings before and during the inspection. These included consultants, junior doctors, midwives, nurses, student nurses, healthcare assistants, administrative and clerical staff, and community staff. We also analysed data we already held about the trust to inform our inspection planning.

At this inspection, we saw improvements in ratings for all acute services at Manor Hospital with the exception of maternity and gynaecology services which remained inadequate overall and critical care which remained requires improvement overall. In the community, community health services for adults and children and young people remained at a good rating overall whilst community end of life care improved from good at our last inspection to outstanding overall.

We have rated this trust as requires improvement overall. We made judgements about eleven services across the trust as well as making judgements about the five key questions we ask. We rated the key questions for safety, effective, responsive and well led as requires improvement. We rated the key question for caring as good.

We saw several areas of good practice including:

  • Staff and patients’ relatives told us the dementia lead nurse for the emergency department had made significant improvements for patients living with dementia while they were being cared for in the department.
  • The end of life care service provided access to care and treatment in both the acute and the community settings 24-hours a day, seven days a week.
  • The culture within the outpatients department had changed considerably for the better. Local staff took responsibility and ownership for their own areas and specialities.
  • We saw community engagement by the Walsall Palliative Care Centre was exemplary. A panel of patients and patient relatives to reflect the needs and wishes of the local population had reviewed all the advanced care plan and the individualised care plan. A number of documents senior managers had produced had won national recognition and awards.
  • The teenage pregnancy service had developed a website called ‘Easy SRE’, a toolkit of resources to support sex and relationships education.
  • Within the community health services for children, young people and families, the speech and language therapy team, nursery nurses and transition team had been nominated for national awards.
  • Within community health services for adults, an alert system had been developed to immediately notify the long-term condition teams when vulnerable adults presented in accident and emergency or any of the wards at Walsall Manor Hospital.

However, there were also areas of poor practice where the trust needs to make improvements.

Action the hospital MUST take to improve

Maternity and Gynaecology

  • Risks are explained when consenting women for procedures.
  • The service uses an acuity tool to evidence safe staffing.
  • Action plans are monitored and managed for serious incidents.
  • Lessons are shared effectively to enable staffing learning from serious incidents, incidents and complaints.
  • Staff follow best practice national guidance.

Urgent and Emergency Services

  • Take action to improve ED staff’s compliance with mandatory training.
  • ED completes the action plan compiled following the CQC inspection carried out in September 2015.

Critical care

  • Plans are in place for staff within the critical care unit to complete mandatory training. This includes appropriate levels of safeguarding training.
  • All staff working within the outreach team are competent to do so.

Children and young people

  • All local guidelines are updated and regularly reviewed for staff to follow.

Outpatients and Diagnostic Imaging

  • Staff undertake required mandatory and safeguarding training as required for their role.
  • All staff within outpatients have the required competencies to effectively care for patients, and evidence of competence is documented.
  • All staff receive an appraisal in line with local policy.
  • Patients medical records are kept secure at all times.
  • All outpatient clinics are suitable for the purpose for which they are being used.

End of life care

  • Attendance for mandatory training is improved.
  • Undertake required safeguarding training as required for their individual role.
  • All staff are trained and competent when administering medications via syringe driver.

Medical care

  • Mandatory training is up-to-date including safeguarding training at the required level.
  • There are sufficient numbers of suitably qualified, competent, skilled and experienced staff to keep patients safe.

Surgery

  • All professional staff working with children have safeguarding level 3 training.
  • All staff are up-to-date with safeguarding adults.
  • The safeguarding adults and safeguarding children policies are up-to-date and include relevant references to external guidance.
  • Patient records are completed, that entries are legible and each entry is signed, dated with staff names and job role printed.
  • All shifts have the correct skill mix for wards to run safely.
  • All staff are up-to-date with mandatory training.

Community Services for Children and Young People

The trust must:

  • Ensure blind cords are secured in all areas where children and young people may attend.
  • Ensure patient records remain confidential and stored securely.
  • Continue to follow standard operating procedures with medicines in special schools.

Professor Edward Baker

Chief Inspector of Hospitals

31 May & 21 June 2017

During an inspection of Community end of life care

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.

1 May 2017, 20 – 22 June 2017 and 4 July 2017

During an inspection of Community health services for adults

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.        

1 May 2017, 20 – 22 June 2017, 4 July 2017

During an inspection of Community health services for children, young people and families

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.

8 – 10 September 2015

During a routine inspection

Walsall Healthcare NHS Trust provides acute hospital and community health services for people living in Walsall and the surrounding areas and the trust serves a population of around 260,000. Acute hospital services are provided from one site, Walsall Manor Hospital which has 606 inpatient beds made up of 536 acute and general beds, 57 maternity beds and 13 critical care adult beds. There is a separate midwifery-led birthing unit and a specialist palliative care centre in the community.

We carried out this announced comprehensive inspection on 8 to 10 September 2015. We held two public listening events in the week preceding the inspection visit and met with individuals and groups of local people and analysed data we already held about the trust to inform our inspection planning. Teams, which included CQC inspectors and clinical experts, visited Walsall Manor Hospital and inspected eight core services: emergency department, medical services, surgery services, critical care services, maternity services, children and young people services, end of life services and outpatients and diagnostic services. We also inspected three out of four community services: adult services, children, young people and families and end of life care services. We did not inspect community inpatient services as this service was registered with the local authority. We also carried out three unannounced inspection visits after the announced visit on 13, 20 and 24 September 2015.

We have rated this trust as ‘inadequate’. We made judgements about eleven services across the trust as well as making judgements about the five key questions we ask. We rated the key questions for safety, effective and well led as ‘inadequate’. We rated the key questions, for caring and responsive as 'requires improvement’.

Our key findings were as follows:

  • Maternity services had multiple issues with staffing, delivery of care and treatment and people were at high risk of avoidable harm. The service had limited capacity and staffing resources which impacted negatively on patient experience and compromised patient safety.

  • The latest MBRRACE report presented results for still births, neonatal mortality and extended perinatal mortality rates for 2013. Standardised results for Walsall were slightly higher than their comparator group. MBRRACE recommended that Walsall should consider a local review to better understand factors that may contribute to these results. In response to this the trust with its partners in the CCG and Public Health had participated in a detailed local study and agreed an action plan both of which have been shared with the Trust Board in public following our inspection.

  • The Emergency Department (ED) triage process was ineffective, there was a shortage of qualified paediatric nurses and no paediatric consultant based in ED. There were regular delays with patient handover from ambulance to ED. The trust had been consistently performing worse (5 to 9 minutes) than the England average (median 3 to 6 minutes) for the time to initial assessment of patients between January 2013 and April 2015.

  • The percentage of patients seen within the national four hour target to see, treat and admit or discharge 95%, was worse than the standard or national average for almost all of the period between April 2014 and May 2015. We saw the percentage of emergency hospital admissions waiting four to twelve hours from the decision to admit until being admitted (18 to 50%) was consistently above the England average of 5 to 15% between April 2014 and April 2015.

  • Incident reporting, particularly feedback to staff was variable across the trust. There was a mixed approach to incident reporting which differed between services. The trust promoted incident feedback to staff through various methods. However, this was dependent upon individual service managers to disseminate lessons learned and staff’s capacity to engage.

  • Previous concerns relating to the trust’s management of duty of candour had improved. We looked at several serious incident records which demonstrated the trust had adopted a more open and rigorous approach to the duty of candour regulation and its process.

  • Staff were caring and compassionate towards patients and their relatives. We did however see that in both ED and Maternity the excessive workload led to the standards of caring falling below that we would expect. Patient’s dignity and privacy was largely ensured and we saw many examples of good care across the trust from staff at all levels.

  • Community services for Adults, Children, Young people and Families and End of Life Care, were rated as good overall. Governance structure and risk management were well embedded and general leadership of community teams was supportive and nurturing.

  • The trust took part in all the national clinical audits they were eligible for, and had a formal clinical audit programme, where national guidance was audited and local priorities for audit were identified.

  • The Summary Hospital-level Mortality Indicator (SHMI) is the ratio between the actual number of patients who die following hospitalisation at the trust and the number that would be expected to die. It was recognised that the SHMI for Walsall Manor Hospital had increased over an extended period of time, March 2015 was 107.41, April 2015 was 110.54 and May was 102.64. This represented a risk to patient safety.

  • The trust was still seeing the effects of implementation of the new electronic patient administration system nearly 18 months previous. Improvements had been made however, the trust was still struggling with simple tasks, (e.g. making patient appointments) as well as experiencing difficulties in gathering accurate information for decision making and performance management.

  • The culture of the trust was described by many staff as poor. Morale was low across many wards and departments and we heard examples of senior managers and in some cases executive members taking a heavy handed approach to problem solving. Despite ‘low morale’ staff demonstrated a positive approach to patient care and a genuine compassion to deliver the best care possible.

  • Divisional and corporate risk registers did not accurately reflect identified risks trust wide.

  • The trust had failed to implement the new checks and tests necessary to fulfil the requirement for all directors to be ‘fit and proper’ persons. This statutory requirement came into effect in November 2014. We saw no checks had been carried out for any directors within the trust and there was no Fit and Proper Person Policy in place. Following the announced inspection, the trust had taken remedial action to satisfy statutory requirements which demonstrated compliance with the Fit and Proper Person Regulation before the inspection period ended.

  • The Trust described to us what they referred to as a “perfect storm” in 2014 as a result of significant increases in emergency and obstetric activity and problems following the replacement of the patient administration system. The Trust Board recognised that the organisation faced significant quality and performance challenges in 2015 and had launched an Improvement Plan (“Improving for Patients; Improving for Colleagues; Improving for the Long-Term”). The plan included a programme of work to develop the two to five year strategy for the Trust and its services. The plan had been launched in June and as in its early stages at the time of our inspection in September 2015.

Importantly, the trust must:

  • Improve the governance of incident reporting systems to ensure that processes are embedded across the Trust.

  • Improve duty of candour training to ensure staff have a clear understanding of the process.

  • Implement systematic training for complaints investigation,improve the RCA process and dissemination of lessons learned to front line staff and their managers.

  • Ensure there are adequate numbers of qualified staff across all services, particularly in: maternity services, emergency department and medical services to meet the needs of patients to protect them from abuse and avoidable harm.

  • The trust must ensure there is an adequate supply of equipment in good working order and fit for purpose across all services. Any mitigation to replace equipment must have clear reasons, regular review and an up –to-date action plan clearly demonstrating alternative options and timescales to support actions.

  • The trust must ensure equipment is stored appropriately; all fire exits must be kept free without compromising patient and staff safety and staff can access equipment when required.

  • Mental Capacity Assessments (MCA), Deprivation of Liberty Safeguards (DoLS) and Do Not Attempt CPR (DNACPR) assessments to be carried out in a timely manner and supported by appropriate documentation.

  • Review the patient administration system to minimise problems associated with missed patient appointments. Ensure data is accurate and the system is a reliable resource for staff to use which meets the need of patients using the service.

  • Ensure health records are completed appropriately and patient data is confidentially managed. Patient confidentiality is maintained at all times across all service.

After the inspection period ended, the Care Quality Commission issued the trust with a Section 29a warning notice outlining there was significant improvement required. This set out the points of concern and timescales to address this. The trust has responded to this with a detailed plan for remedial action.

Professor Sir Mike Richards

Chief Inspector of Hospitals

8-10 September 2015

During an inspection of Community health services for adults

Patients received compassionate care. Staff discussed planned care and treatment with patients and provided information to reinforce understanding. Incidents were reported and investigated thoroughly, outcomes were communicated both to staff and to patients and relatives who were involved. There was a culture of openness in reporting and a ‘no-blame’ policy to encourage learning.

The demand for community nursing was increasing and this meant low priority visits (such as three monthly checks on patients’ skin or reassessments of continence needs) were cancelled and rebooked or alternative approaches taken.

The accurate and timely completion of patient risk assessments was variable which was largely due to community nurses unable to meet patient demand. Staff were aware of their responsibilities to ensure patient safety.

The majority of community staff had good access to training and development opportunities. There was a system to check nurse competencies in procedures such as specialist bandages for leg ulcers. There were good examples of multidisciplinary working to enhance patient care and avoid unnecessary admissions to hospital.

Community services were planned and were mostly responsive to the needs of the people of Walsall and the surrounding area. Community services supported people to receive care either in or close to their home, and at the time that they needed it. There were good initiatives in place to prevent unnecessary hospital admissions.

The leadership was knowledgeable about quality issues and recognised challenges such as the increased demand on community services. Staff said their direct line managers and Professional Lead/Care Group Manager Community were supportive and provided leadership.

We spoke with 43 patients, 28 carers or relatives and 49 staff across a range of roles within the trust and we looked at 20 patient records.

8-10 September 2015

During an inspection of Community health services for children, young people and families

Children and young people (CYP) services were rated as good overall. We rated the service as good for effective, caring, responsive and well led domains and requires improvement for the safe domain.

During the inspection we met with managers, staff, children and parents in a range of community settings. We observed care being delivered in a special school, in clinics and in children’s own homes. We talked with staff working across a range of services. CYP staff also worked with other professionals and external organisations such as CAMHS (child and adolescent mental health services) and social services.

There was evidence that the services for children and young people were delivered in line with best practice guidance and local agreement. Staff were dedicated, professional and well supported by recent changes to the management structure. Staff told us that they were a valued member of their respective teams. We saw that care was centred on the child and individualised across all CYP services.

There was an effective system in place to report and learn from adverse incidents, errors and near misses. The majority of staff told us they received feedback about the action taken when they reported issues. We saw care was delivered to promote dignity and respect, and found staff were very responsive to children and their families’ needs.

There was a robust safeguarding process in place with good safeguarding supervision for all staff. We saw infection control practices across CYP services was good. Several electronic systems and handwritten notes were used across the service. This presented a risk for accessing complete and robust information when required.

Staffing levels across CYP services were good. We saw the trust had ongoing challenges with recruitment of community paediatricians. Staff had the right qualifications, skills and knowledge to do their job. There were high numbers of newly qualified health visitors in post but they were supported with a good preceptorship programme. Staff were hindered in their roles when working away from their office bases by a lack of mobile IT equipment.

Care was effective and evidence based. There was evidence of strong multidisciplinary working within the trust and across other agencies.

Staff expressed satisfaction with the levels of support from their local managers. There were clear lines of management in place and structures for assuring quality. Staff told us that on the whole they thought the executive team were doing well in leading the trust but there was a lack of visible executive clinical leadership.

CYP services received very few complaints and people we spoke to during the inspection were very complimentary about the staff and the quality of the service they received.

8-10 September 2015

During an inspection of Community end of life care

In order to assess the level of service provided to end of life care patients, their families and carers we visited team bases and health services and spoke with nursing staff, doctors and managers about their work and how they were supported.

We accompanied staff on home visits to enable us to assess the service provided and to talk with patient’s families and friends in their home environment.

We spoke with a total of 12 staff and 18 patients/carers and we also spoke with six patients by telephone.

We looked at 18 patient health records and other records and documents about the provision of the service, training and management of staff and provision and maintenance of equipment.

We liaised with colleagues in our Adult Social Care directorate who inspected the Hospice Service at St Giles Walsall Hospice . We did this to see how effective care was when patients moved between services.

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.’

The National Institute for Health and Care Excellence (NICE) Quality Standards QS [13] provide 16 quality standards on which health care providers are encouraged to base their services and so provide patients with a seamless, first class service.

The National Clinical Guidance Centre, published a consultation document Care of the Dying Adult, in July 2015, outlining 67 recommendations in relation to the provision of care for dying adults. The guidance was commissioned by NICE.

Our judgement of the service provided in the community by the trust, fulfilled the WHO definition and met the NICE guidance. Areas of guidance contained in the Care of the Dying paper which were not already part of the service were under consultation. In some respects the service was very good. However, we did identify areas where the service could improve although the areas concerned did not impact on patients or their families.

Use of resources

These reports look at how NHS hospital trusts use resources, and give recommendations for improvement where needed. They are based on assessments carried out by NHS Improvement, alongside scheduled inspections led by CQC. We’re currently piloting how we work together to confirm the findings of these assessments and present the reports and ratings alongside our other inspection information. The Use of Resources reports include a ‘shadow’ (indicative) rating for the trust’s use of resources.

Intelligent Monitoring

We use our system of intelligent monitoring of indicators to direct our resources to where they are most needed. Our analysts have developed this monitoring to give our inspectors a clear picture of the areas of care that need to be followed up. Together with local information from partners and the public, this monitoring helps us to decide when, where and what to inspect.