Croydon Health Services NHS Trust

Updated 11 February 2020

Croydon Health Services NHS trust was formed in July 2010 with the integration of Mayday Healthcare NHS trust with Croydon Community Health Services. The trust provides integrated NHS services to care for people at home, in schools, and health clinics across the borough as well as at Croydon University Hospital (CUH) and Purley War Memorial Hospital (PWMH).

The trust has 449 inpatient beds, 20 inpatient wards and 37 day case beds. The emergency department is at Croydon University Hospital. Purley War Memorial Hospital does not have any inpatient beds and services provided include phlebotomy and outpatient clinics.

The trust employs more than 3,800 staff and has a dedicated team of 420 volunteers.

CUH performs around 26,000 surgical operations every year and provides more than 100 specialist services, including conditions affecting the heart and treatment for musculoskeletal disorders.

Croydon Clinical Commissioning Group (CCG) is the lead commissioner. At the time of the inspection the trust was integrating with Croydon CCG and had created several joint executive posts and shared some functions to create an integrated for health and care in Croydon.’

We last inspected the trust in September 2018 and it was rated requires improvement overall.

Updated 11 February 2020

Our rating of the trust stayed the same. We rated it as requires improvement because:

We rated safe, effective, caring, responsive and well-led as requires improvement.

trust, we took into account the current ratings of the services not inspected this time.

Updated 11 February 2020

Updated 11 February 2020

Updated 28 September 2018

Our rating of this service stayed the same. We rated it as requires improvement because:

• Staffing levels were consistently lower than the recommended numbers for the domiciliary speech and language therapy (SALT) team. This had not improved since the last inspection.
• The trust did not have integrated electronic patient record systems to enable a shared care record. This had not improved since the last inspection.
• The service did not always take account of patients’ individual needs. Information on how to access services and other information leaflets were not easily accessible in other languages. Staff told us they regularly used relatives to translate during drop in sessions.
• The service was not meeting referral to treatment times. This was a significant issue for the domiciliary SALT team and there had been no improvement since the last inspection.
• The service did not always have a satisfactory system to book appointments. In a podiatry clinic, patients were required to ring and book their next appointment and this posed a risk that a person may forget to do this.
• The trust did not ensure that all staff had the equipment they required to work safely. The trust’s roll out of phone to the community nurses teams had not been completed.
• The trust did not ensure that patients always had access to interpreters when required.
• The use of personal phones by staff to contact patients presented a significant data protection risk.
• Some of the data provided by the trust lacked depth and granularity, in particular staffing and audit information. The service did not provide sufficient data around patient outcomes and therefore missed opportunities to identify potential risks to patients.

However:

• The service managed patient safety incidents well. Incidents were reported and investigated appropriately. Lessons learned were shared across teams and the wider service.
• Staff kept appropriate records, paper and electronic, of patients’ care and treatment. Records were clear and up to date.
• Staff carried out risk assessments for all patients on initial and subsequent visits. Appropriate assessment tools were used to identify and help manage patient risks.
• Clinical rooms we visited were clean and tidy. We saw evidence of regular and compliant infection control audits across the community adults services.
• Multidisciplinary working was embedded across community adult services.
• The service provided care and treatment based on national guidance and evidence of its effectiveness.
• The service made sure staff were competent for their roles. Staff were well trained, received appropriate supervisions and showed overall good compliance for appraisal rates.
• Staff encouraged patients to proactively manage their own health. Staff were passionate about supporting patients to improve their own health and wellbeing.
• Staff cared for patients with compassion. Feedback from patients confirmed that staff treated patients kindly and with dignity.
• Staff involved patients and those close to them in decisions about their care and treatment.
• All staff we spoke with told us that there was an open and honest culture. Staff were encouraged to report incidents and there was a no blame culture when incidents were reported.

Updated 28 September 2018

Our rating of this service stayed the same. We rated it as requires improvement because:

• The service did not always comply with infection control policies. Staff were not always adhering to the bare below the elbow policy and audits findings were not always actioned.
• The caseload numbers for health visitors was consistently higher than the recommended numbers. This had not improved since the last inspection.
• The multidisciplinary working was not fully embedded in the child development centre. This was an ongoing concern since 2016.
• We did not see evidence that that all services monitored the effectiveness of care and treatment and used the findings to improve them. They did not compare local results with those of other services to learn from them.
• The service was not consistently meeting the national and local targets for completion of assessments within a set timescale.
• The service did not have a policy in place to coordinate the transition between children and adult services that covered all the services offered. Where transition plans were in place, this did not comply with National Institute for Health and Care Excellence (NICE) guidance for when this process should start.
• The service did not consistently plan and provide all services in a way that met the needs of all local people.
• The service did not always take account of patients’ individual needs. Information on how to access services and other information leaflets were not available in other languages. Staff told us they regularly use relatives to interpret during drop in sessions.
• Although a risk register was in place, we did not see evidence actions had been taken to mitigate these risks to an acceptable level.
• The trust collected, analysed, managed and used information to monitor performance against local indicators. However performance for health visitors had been below the expected national and local indicators for the last 12 months.
• The audit process was not well embedded to assure the leadership team that services were being provided in line local and national guidelines. There was limited audit activity and the actions from audit findings were not consistently followed through.

However:

• 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 prescribed, gave, recorded and stored medicines well. Patients received the right medication at the right dose at the right time.
• Staff kept appropriate records electronic record of patients’ care and treatment. Records were clear, up-to-date and available to all staff providing care via mobile devices at the point of care.
• 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.
• 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.
• The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and monitor the effectiveness of the service.
• The service provided care and treatment based on national guidance and evidence of its effectiveness. Staff were aware of guidelines relevant to their service.
• Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.
• Staff involved patients and those close to them in decisions about their care and treatment.
• Staff provided emotional support to patients to minimise their distress.
• The service treated concerns and complaints seriously, investigated them and learned lessons from the results, which were shared with all staff.
• Managers across the trust promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values. Staff were complimentary of the local leadership team.
• The trust engaged well with patients, staff, the public and local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively.