Archived: South West SOE Service

We carried out this announced inspection on 5th and 6th of April and the 12th April 2022 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection to check whether the registered provider was meeting the legal requirements in the Health and Social Care Act 2008 and associated regulations. The inspection was led by a CQC inspector, eight team inspectors and supported by a specialist professional advisor.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?

• Is it effective?

• Is it caring?

• Is it responsive to people’s needs?

• Is it well-led?

These questions form the framework for the areas we look at during the inspection.

Are services safe?

We found that this service was not providing safe care in accordance with the relevant regulations. The impact of our concerns, in terms of the safety of clinical care, is minor for patients using the service. Once the shortcomings have been put right the likelihood of them occurring in the future is low. We have told the provider to take action (see full details of this action in the Requirement Notices at the end of this report). We will be following up on our concerns to ensure they have been put right by the provider.

Are services effective?

We found that this service was providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this service was providing caring services in accordance with the relevant regulations.

Are services responsive to people’s needs?

We found that this service was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this service was providing well-led care in accordance with the relevant regulations.

Background

The South West (SW) Sexual Offence Examiners (SOE) service provides forensic medical examiners and forensic nurse examiners to six Sexual Assault Referral Centres (SARCs) across the South West of England. The SARCs are based within:

• Exeter
• Truro
• Plymouth
• Gloucester
• Bristol
• Swindon

The Police and Crime Commissioner commissions the SW SOE Service. The service is available 24 hours a day, seven days a week (including public holidays) to provide advice to police, agencies and the public. The service delivers acute forensic examinations and provides support following recent sexual assault and sexual violence. The G4S service is commissioned to see adults and children 24 hours a day, seven days a week. During working hours there are separate services working alongside G4S that are commissioned to see Children under 18 within working hours and some limited hours over weekend days. These separate services provide telephone advice for Children under 18 years 24 hours a day, seven days a week..

For the purpose of this inspection we inspected the South West SOE provision of doctors and nurses (who will be referred to as SOEs throughout the report) to perform forensic medical examinations only, and not the activity or staff that were based within the SARCs as the SARC staff were employed by different providers.

At the time of inspection there was a regional clinical lead doctor, 12 doctors (including four in the shadowing process) and 26 nurses (with four also in the shadowing process) across the SW SOE service providing forensic medical examinations. The regional clinical lead was a member of the Faculty of Forensic and Legal Medicine (FFLM) and five doctors had obtained membership by examination (MFFLM) of the FFLM and one nurse had completed the FFLM licentiate examination.

All six of the SARCs were situated in buildings that were accessible for wheelchair users, with disabled parking spaces provided outside. Lifts were available where the SARCs were not situated on one level. All SARCs contained discreet entrances. Some of the SARCs had one forensic examination area where others had two. All had separate forensic bathrooms with a toilet and shower. All had appropriate environments for the age range of patients who used the six SARC sites. In the Bristol SARC there was a separate room from those provided for adults, for children under 18 years old to receive their examinations. In Exeter SARC there was a separate room from the acute forensic room where children under 18 years old attending historic clinics, are examined separately.

During the inspection we spoke with the registered manager who is also the regional clinical lead, 21 SOEs (three of which were lead nurses for their area) two crisis workers and two SARC managers employed by external providers. We also spoke with a commissioner who commissions the SARCs but not the SW SOE Service. We also reviewed policies, reports and examined 45 patient records to learn about how the provider managed the service.

We left comment cards at each of the six locations the week prior to our visit and received six completed feedback cards.

G4S provide the forensic medical service, and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run. The registered manager for the SW SOE Service was the regional clinical lead for the provider.

Before we inspected the SW SOE Service, the provider informed us the contract to provide forensic medical examinations was due to end on 31st September 2022, and the provider would no longer be providing SOEs to perform forensic medical examinations from that date onwards.

Throughout this report we have used the term ‘patients’ to describe people who use the service to reflect our inspection of the clinical aspects of the SARC.

Our key findings were:

• The SOEs had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children. However, the SOEs did not always follow up safeguarding referrals to ensure the patients were appropriately safeguarded.
• Patients records mostly evidenced a holistic approach to assessing patients’ needs. However, in some records examined there was a lack of the patients’ voice to describe their journey through the service.
• The environments mostly appeared clean and well maintained, although we found the Bristol SARC to have forensic areas which were not clean.
• The provider had systems to help them manage risks presented to the service.
• SOEs provided patients’ care and treatment in line with current guidelines.
• The staff had infection control procedures which reflected published guidance and had adapted to Covid-19 guidance to ensure services remained available to patients throughout the pandemic.
• The provider had thorough staff recruitment procedures.
• SOEs knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available in all the SARCs they worked within.
• SOEs treated patients with dignity and respect and took care to protect their privacy and personal information.
• The service had effective leadership and a culture of continuous improvement.
• SOEs felt involved and supported and worked well as a team.
• The service worked in partnership with external agencies and asked staff and patients for feedback about the services they provided.
• Patient feedback was positive about the support they received from the SOEs
• The service dealt with complaints positively and efficiently.
• The service had suitable information governance arrangements.

We identified regulations the provider was not meeting. They must:

• Ensure that each SARC site they visit is forensically clean to reduce the risk of the spread of infection and contaminated samples. (Regulation 15 Premises and equipment).

Full details of the regulation/s the provider is not meeting are at the end of this report.

There were areas where the provider should make improvements:

• SOEs should follow up all safeguarding referrals to ensure the patient is appropriately safeguarded against harm.
• SOEs should improve the representation of the patients’ voice within the patient records to ensure the patient’s wishes would have been adhered to and the belief they have been listened to.
• All local team meetings should be minuted to ensure information flow from the floor level to board level.
• SOEs should be assured all SARC environments have been appropriately risk assessed for ligature risks.