Wye Valley NHS Trust

Updated 18 March 2020

Not used

Updated 18 March 2020

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

• We rated safe, effective, responsive and well-led as requires improvement and caring as good.
• We rated seven of the trust’s 13 services as good and five as requires improvement and one as inadequate. In rating the trust, we took into account the current ratings of the five services not inspected this time.
• We rated well-led for the trust overall as requires improvement.
• During this inspection, we did not inspect services for children and young people, acute end of life care and outpatients. We also did not inspect, community health services for children and young people or community dental services. The ratings we published following the previous inspections are part of the overall rating awarded to the trust this time.

Updated 18 March 2020

Updated 18 March 2020

Updated 18 March 2020

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

• The service had 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. The service controlled infection risk well. Staff assessed risks to patients. They managed medicine prescribing well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment. 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, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• 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.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and 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.

However,

• Records were not clear and easily available to all staff providing care. It was difficult to find the most recent information, including risk assessments, and not all patient documentation had been completed fully, updated or was missing. Not all staff had full access to the patient notes system and could only see their departments notes.
• Staff felt that due to staff shortages, they did not have the time needed to complete a full holistic assessment or visit. Capacity also impacted in their ability to fully complete patient documentation.
• The service had not met its target to have 90% of staff trained in basic life support.

Updated 20 January 2016

Overall rating for this core service Good l

Community children and young people’s safety performance was monitored by dashboards and governance processes. When something went wrong there was a process in place to review or investigate incidents involving all staff, children, young people and their families. Lessons were learned and communicated widely to support improvement in all children’s and young people’s services, as well as services that were directly affected. There were clearly defined and embedded systems and processes to keep children and young people safe and safeguarded from abuse. Staff received up-to-date training in safeguarding to an appropriate level. There was active and appropriate engagement in local safeguarding procedures and effective working with other relevant organisations. Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Monitoring and review processes and meetings enabled staff to understand risks and gave a clear and accurate picture of safety.

Staffing levels and skill mix were planned, implemented and reviewed to keep children and young people safe at all times. Any staff shortages were responded to quickly and adequately to ensure staff could manage risks to children and young people who used services.

Risks to children and young people were assessed, monitored and managed on a day-to-day basis. Staff recognised and responded appropriately to changes in risks to children and young people who use services. Risks to safety from service developments, anticipated changes in demand and disruption were assessed, planned for and managed effectively. Plans were in place to respond to emergencies and major situations.

Children and young people had good outcomes because they received effective care and treatment that met their needs. Children and young people’s care and treatment was planned and delivered in line with current evidence-based guidance, best practice and legislation, including the Healthy Child Programme (2009) (HCP). This was monitored to ensure consistency of practice.

There was participation in relevant local audits and other monitoring activities such as service reviews and service accreditation. Accurate and up-to-date information about effectiveness was shared internally and externally and was understood by staff, and used to improve care and treatment and children and young people’s outcomes.

Children were cared for by a multidisciplinary team of dedicated and skilled staff. Staff felt supported and had access to training. Wye Valley NHS Trust was an early implementer site (EIS) for the ‘health visitor implementation plan 2011-2015’.

Children and young people and their parent were supported, treated with dignity and respect, and were involved as partners in their care. Feedback from children, young people and families was positive. Children and young people and families felt supported and said staff cared about them. Children and young people were involved and encouraged in making decisions about their care. They were communicated with and received information in a way they could understand. Staff responded compassionately when children and young people needed help and supported them to meet their basic personal needs. Children and young people’s privacy and confidentiality was respected at all times.

Children and young people’s services were planned and delivered in a way that met the needs of the local population. The importance of flexibility, choice and continuity of care was reflected in the services provided. Building community capacity was a key aspect of the community early implementation service (EIS) plan, this emphasised delivering services in a range of settings to maximise the number of people that had access to a range of services.

The integrated family health services (IFHS) model bridged health and social care. The aim of the service model was to improve children and young people’s outcomes and experience through bringing existing community services from health and social care into a more combined way of working. Children’s and young people’s care and treatment was co-ordinated with other services and other providers.

The trust was working with the clinical commissioning group (CCG) and local authority to ensure children had new offers for respite care, prior to closure of 1 Ledbury Road respite unit in March 2016.

Complaints handling policies and procedures were in place. All complaints to the service were recorded. Information on the trust’s complaints policy and procedures was available on the trust’s internet website.

The leadership, governance and culture of community children and young people’s services promoted the delivery of child-centred care. The trust had a clear statement of vision and values that had been developed through a structured planning process with regular engagement from staff. The IFHS community children and young people’s service was undergoing a significant reorganisation of services. We found that some staff were unclear about the long term strategy for health visiting and school nursing services. The trust board and other levels of governance within community children and families services functioned effectively and interacted with other services appropriately. Structures, processes and systems of accountability, including the governance and management of partnerships, joint working arrangements and shared services, were clearly set out and understood.

Updated 20 January 2016

Overall rating for this core service Good l

We found dental services provided safe and effective care. Patients’ were protected from abuse and avoidable harm. Systems for identifying, investigating and learning from patient safety incidents were in place.

Dental services were effective and focussed on the needs of patients and their oral health care. We found the overall care provided at the service to be good. We observed good examples of effective collaborative working practices within the service. The service was able to meet the needs of the patients who visited the clinics for care and treatment because of the flexible attitude of all members of the service.

Effective multidisciplinary team working ensured patients were provided with care that met their needs and at the right time. This was achieved by thorough effective management of resources.

At the time of inspection we saw no evidence to indicate that the service collected referral to treatment times for urgent and routine referrals, only for patients requiring general anaesthetic. This meant that the services stablished systems and processes did not operate effectively to monitor all the dental services waiting time data. Waiting times for patients requiring general anaesthetic ranged between six and 14 weeks. This met the national 18 week referral to treatment target.

The service was well-led. Organisational, governance and risk management structures were in place. The operational management team of the service were visible and the culture was seen as open and transparent. Staff were aware of the vision and way forward for the organisation and said that they generally felt well supported and that they could raise any concerns.

Updated 18 March 2020

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

• The service did not have enough staff to care for patients and keep them safe. Staff reported being overstretched and unable to complete the necessary recording of all the care interventions and assessments they completed. Staff assessed risks to patients and acted on them but did not always kept good care records to evidence this. The service did not routinely implement all infection prevention control measures, such as staff remaining “bare below the elbow”. The service provided mandatory training in key skills to all staff but did not make sure everyone completed it.
• Staff did not always store patient records securely and did not always update individual patient records in a timely manner. Some staff told us this was because there was not enough time for them to do so.
• There was no clinical audit programme to benchmark and monitor the effectiveness of the service. There were limited measures to monitor and evaluate patient outcomes.

However:

• Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.
• 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.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and 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.

Updated 18 March 2020

Our rating of this service improved. We rated it as good because:

• The service 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. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good 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, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• 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.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and 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.

However

• A syringe driver policy was in place and available to all staff via the intranet. However, at Bromyard Community Hospital and the Hereford District Nursing base staff were not sure where to access an up to date policy and were only able to show us an out of date policy.