Gloucestershire Care Services NHS Trust is rated as Requires Improvement

The Chief Inspector of Hospitals has rated Gloucestershire Care Services NHS Trust as Requires Improvement following an inspection by the Care Quality Commission.

A team of inspectors found that the trust was Good for caring but Requires Improvement for providing services that were safe, effective, responsive and well-led. Community inpatient services provided at the trust’s hospitals were found to be Outstanding for caring. Safety in the urgent care service was rated Inadequate.

Gloucestershire Care Services NHS Trust provides services from seven community hospitals, minor injuries and illness units, and dental clinics, and community services for adults, children and young people as well as independent living, sexual health services, therapies, rehabilitation and specialist services.

The Chief Inspector of Hospitals, Professor Sir Mike Richards, said:

“Throughout Gloucestershire Care Services NHS Trust we found that the care offered by staff was kind and compassionate and promoted people’s privacy and dignity. Staff spoke with passion about their work and were proud of what they did.

“However we were concerned about safety in the urgent care service provided by the minor injuries units. We were not assured that people were adequately protected from the risk of harm, and we were not convinced that this had been addressed adequately yet by the trust board.

“Some of the community teams were overstretched because there were not enough experienced nurses or therapists, with long waiting lists for some of these services.

“While there are many good services – we have also been very clear about those areas for improvement, which I expect the trust to address as a priority. We will continue to monitor the trust's performance and we will return in due course to check on their progress.”

The CQC inspection team, which included specialist advisors and experts by experience, visited the trust over a period of several days during June, July and August.

Inspectors found that some patients waited too long to be assessed by a registered nurse on arrival at minor injuries and illness units and that unregistered practitioners were undertaking this task without adequate training or supervision. Some patients waited too long to be assessed by a registered nurse on arrival. Resuscitation trollies and other equipment were not always appropriately checked.

There was a strong caring culture that was embedded throughout the community hospitals. Staff provided compassionate care which was respectful to people’s needs and wishes. Wards were calm and happy places and feedback given to inspectors by patients, carers and relatives was continually positive.

But community health services for adults were not always planned and delivered in a way that met people’s needs. There were long waiting lists for occupational therapy and some physiotherapy services.

The report identifies a number of areas of outstanding practice including:

• The seven day service provided by the children’s community team.
• The volunteer groups were an integral part of the care team within community hospitals. They were having a positive impact on patients’ wellbeing by supporting patients, providing activities, and by representing patients’ perspective at governance meetings.
• There was a systematic approach to falls prevention. Data was collected and analysed and innovative actions were put in place. This was having a significant impact on patient care within the community hospitals.
• The sexual health service was an integrated service, with patients being able to access the necessary care and treatment in one place.

The trust has been told that it must make improvements including:

The trust must ensure that medicines administered to children within the complex care team are administered safely.

There must be a process in place to audit the prescription of medicines by health visitor prescribers.

All documentation relating to the do not attempt cardio-pulmonary resuscitation orders must include the completion of a mental capacity assessment, and reference to discussions with patients and relatives.

The trust must review and take prompt action to ensure that the minor injuries and illness units are consistently staffed by enough experienced and skilled staff.

Patients arriving at minor injuries and illness units must receive prompt assessment (triage) by an appropriately trained and experienced registered nurse.

The Care Quality Commission has already presented its findings to a local quality summit, including NHS commissioners, providers, regulators and other public bodies. The purpose of the quality summit is to develop a plan of action and recommendations based on the inspection team's findings.

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