Chief Inspector of Hospitals publishes report on the quality of care provided by Central Essex Community Services C.I.C.

17 April 2014

England's Chief Inspector of Hospitals, Professor Sir Mike Richards, has published his first report on the quality of care provided by Central Essex Community Services C.I.C. (now known as Provide).

In general, the Care Quality Commission (CQC) inspection found that that Central Essex Community Services C.I.C. provided safe care and that there was effective leadership in most services. However, the regulator has told the service it must improve the way it reports and learns from incidents that may have compromised patient safety.

Since patient care is often provided by a number of different community services, the inspectors looked at how well these services work together. For Central Essex Community Services C.I.C. inspectors found that most of these ‘pathways’ of care met the needs of patients, families and carers. The exception to this was end of life services, where there was a lack of direct consultation with patients, families and carers and where the planning and delivery of services was not always well coordinated between inpatient and community teams.

This is the first report of its kind on health services provided in the community and is the result of a new-style inspection by larger teams that include specialist doctors and nurses as well as people who use services.

Inspectors looked at a range of services provided by Central Essex Community Services C.I.C., including diabetes management, community rehabilitation services, physiotherapy, wound care, respiratory care, child health assessment, immunisation and end of life care.

The majority of people inspectors met were positive about their care, especially in relation to services provided to children and families. Inspectors found some examples of good, innovative practice, such as the care given to patients by the children’s speech and language therapists, which had won a national award.

They found that staff were committed to providing the best care they could and there was effective multidisciplinary team working, providing care that was based on people’s individual needs and on maintaining people’s independence.

The greatest concern with the service was that the systems to manage risk were not good enough. Staff were not always aware of how to identify and consider serious incidents, near miss incidents and risks and what they would do with the information. For example, inspectors found instances where missed community nurse visits or long waits for ambulance transport for deteriorating patients were not reported by staff. In another case, staff were found not to have implemented actions to prevent the risks to ensure syringe drivers were tamper proof. There was also inconsistency in classifying and reporting of pressure ulcer incidents.

Inspectors were concerned to find the staff skill mix, including the ratio between substantive and agency staff at Braintree Community Hospital was inadequate with a high number of agency nurses being employed.

Other areas for improvement include making sure detailed care plans are in place for children and young people and that they, or their families, have been involved in the plan; increasing staff awareness of formal child protection processes and ensuring staff have training to help them understand the needs of people with dementia; ensuring staff understood adult safeguarding procedures, including how to escalate concerns.

Professor Sir Mike Richards, Chief Inspector of Hospitals, said: "This was one of the first inspections where we have looked at such a wide range of services in the community. On all of our inspections, inspectors ask whether a service is safe, effective, caring, responsive to people’s needs, and well-led.

"We found Central Essex Community Services C.I.C. to be generally safe for patients, although we had some concerns about staff awareness of safeguarding systems and about end of life services.

"In general services were effectively meeting the needs of patients, families and carers, with some issues about waiting times in some children’s services.

"Feedback from patients, families and carers gave us confidence that services were caring and we found that staff worked hard to meet people’s individual needs, although more could be done to involve patients, families and carers in the development of services.

"Overall, services were well-led, with staff feeling well supported and showing a commitment to the values of the organisation. I am pleased to see that this was reinforced by a visible leadership who help to motivate staff."

Notes to editors

For media enquiries, call the CQC press office on 020 7448 9401 during office hours or out of hours on 07917 232 143.

For general enquiries, call 03000 61 61 61.

Alongside a report on Central Essex Community Services C.I.C. as a whole, CQC is publishing individual reports on St Peter’s Community Hospital Ward, Halstead Community Hospital Ward and Braintree Community Hospital Ward. The reports are published on CQC’s web site [LINK] 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.

Central Essex Community Services Community Interest Company Central Essex Community Services C.I.C. is a provider of integrated health and social care and supplies a broad range of community services across Essex, Cambridgeshire, Peterborough, and the London boroughs of Waltham Forest and Redbridge.