Accelerate CIC is a community interest company that provides specialist wound and lymphoedema services in Tower Hamlets and City and Hackney. It provides services to people in their own homes and sees people at a treatment centre based in each of the two areas.

Its head office is located at Mile End Hospital. It was set up in 2011, initially covering the Tower Hamlets area. Since this time it has grown from seven to 30 employees in line with contractual growth. Its current scope of practice covers:

In Tower Hamlets it provides a nurse led specialist wound service where 95% of people are seen in their own homes. There is a treatment centre on site at Mile End Hospital where the remainder of people are seen. There is also a specialist lymphoedema service which is nursing and physiotherapy led. 50% are seen in their own homes and 50% at the treatment centre.

In City and Hackney the service has a base and treatment centre in rooms rented at Saint Joseph’s Hospice. The ratio of people seen at the treatment centre and in their own homes in Tower Hamlets, also applies in Hackney.

The service is open from Monday to Friday; 9am-5pm. There is a local community focus on what happens to patients at home. The services link up with other providers such as the two local NHS community health providers, GPs, nursing homes and community nursing, who are the coordinators of care.

There are specialist nurses in both wound and lymphoedema care. These are part of the wider multidisciplinary team that consists of a 0.4

whole time equivalent

consultant dermatologist, a senior podiatrist, two physiotherapists, plus two contracted clinicians from a local provider; a clinical psychologist 0.2

whole time equivalent

and a monthly clinic with a plastic surgeon. The multidisciplinary team practices from the treatment centres where specialist nursing is also present. Visits to people in their own homes take place where the need arises.

Highly complex patients are referred from across the greater London area for assessment in the treatment centre

. 

As part of this inspection we interviewed senior managers including the chief executive and chair of the board. We spoke with key members of staff including specialist nurses and members of the multidisciplinary team. We requested information on the service prior to our inspection and gathered information on the day.

We visited people in their own homes with members of staff, in both Tower Hamlets and Hackney. We visited the treatment centres. We spoke with sixteen patients and carers during the inspection. We left patient comment cards with the service and invited patients to give us opinions on any aspect of their care. We received 16 comment cards back.

Services we do not rate

We regulate independent community health services but do not currently have legal powers to apply the duty to rate all of them. Our methodology for small and medium community healthcare providers is based on not rating as there are no service specific frameworks to support consistent ratings decisions. However, we do take regulatory action as necessary, highlight good practice and issues that service providers need to improve.

We found the following areas of outstanding practice:

• Staff were encouraged and supported to submit clinical and academic journal articles to national publications which was seen as a great way of sharing learning and studying a specific topic. Staff were identified for these so they fulfilled a role in the national agenda in wound and lymphoedema care.
• Staff knew their patient group, had a holistic approach to care and advised patients on whole care needs. Self care was promoted and patients were involved in decisions about their care in an exceptional way. We observed staff explaining care and treatment to patients using appropriate language, the patients’ conditions and the physiology behind it. Staff respected individual choices and offered appropriate treatment choices.
• There were a number of initiatives that directly involved patients and their views. The team and management were passionate about their speciality and organisational culture centred on the needs and experience of people who used services.
• The service were experts in compression therapy and fed in to NHS England work streams in wound assessment, management and working with commissioners. Education programmes took place for practice nurses in community NHS trusts looking at baseline skills and champions.

We found the following areas of good practice:

• The team and management were passionate about the speciality and the organisational culture was centred on the needs and experiences of people who used services. We observed this in practice; in the treatment centres and in the community.

• Incidents were appropriately reported, reviewed and learnt from. Relevant information was shared with other teams. Items that related to safety performance were recorded and themes identified on a tracker.

• There were good standards of prevention and control of infection through nurse practice, audit and action.

• As well as there being a team of specialist nurses, there was a multidisciplinary team who practiced from the treatment centres. We observed good working relationships between different professions and there were clear lines of communication with key professional partners such as community nursing and GPs.

• Staff understood the needs of their patient group. Difficult to treat wounds and complex lymphoedema were managed with good care planning.

• We spoke with 16 patients and relatives during the inspection and received comment cards from a further 16 patients afterwards. All were positive and complimentary about the service. Patients told us that staff were encouraging, sensitive and supportive.

• We observed nursing staff delivering compassionate care. Staff delivered care in an unrushed and holistic manner. Patients were clearly involved in decisions about their care. We observed staff explaining care and treatment to patients, the patients’ conditions and the physiology behind it using appropriate language.

• The governance and reporting structure showed clear lines of accountability and clear lines of reporting from the board to clinical leads. There were clear lines of leadership accountability, with the clinical director and chief executive taking a ‘hands on’ approach.

• Contract review meetings recognised that the population needs were changing and that service specification needed updating to meet local needs. The service was working collaboratively with a local NHS trust that provided community health services and the local GP care group to review population needs and identify gaps.

• There were clear vision and values that had been produced by the whole team and linked to the service’s strategy.

However, we also found the following issues that the service provider should consider for improvement:

• The training record did not accurately reflect what training had taken place. There was a software system used by the service to record staff training which relied upon staff manually inputting their own training attendance which had not occurred in a number of records.

• Although incorporated into assessments and covered in training, staff we spoke with understood their responsibilities for obtaining and recording consent but had limited understanding of the Mental Capacity Act and Deprivation of Liberty Safeguards.

Following this inspection, we told the provider that it should consider making some improvements, even though a regulation had not been breached. We have not issued the provider with any requirement notices. Details are at the end of the report.

Amanda Stanford

Deputy Chief Inspector of Hospitals (London)

We spoke with three people who used the service and two relatives, all of whom spoke positively about the service and the staff and professionals they saw. One person using the service said, "I have faith now I will get better. It's definitely a good service. My leg healed for the first time after years." Staff sought people's consent before providing care and explained what the treatment would involve. One person said, "I do have enough time with them. Nothing is too much trouble. They sit and explain things." The service provided people with information about how to make a complaint. Complaints were investigated and used as a learning tool to improve the service.

The service was provided by a multi-disciplinary team and led by specialist nurses. During the inspection we spoke with the manager, two nurses, a psychologist and a consultant dermatologist. The team had good links with local health services and provided training to other teams on complex wound care and lymphoedema. They had developed a centralised dressings service which helped to identify people with unmet need. There were effective procedures to prevent and control the spread of infection both in the clinic environment and when visiting people at home. Staff had access to sterile supplies and ensured equipment was clean before use. The provider had safe and effective recruitment procedures including an induction programme for new members of staff.

We spoke with three people who use the service and a relative - all spoke highly of the care they received. One said "I have confidence in the staff and have no concerns". After referral peoples needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

The manager confirmed that feedback was encouraged and individual meetings would be arranged to discuss any issues. There had only been one occasion when a meeting had been requested with a relative and the outcome was positive.

We met five members of staff from a range of roles within the team. All confirmed there were regular team meetings and good communications.

Staff told us they had good opportunities for training and felt well supported. There was always a senior manager available if they needed additional advice or support. Staffing levels were suitable to meet the needs of the service. We reviewed a sample of training records and saw that staff were provided with mandatory training from accredited companies.

Two people who use the service told us they were involved in planning their care and their wishes were respected. The two care plans seen contained detailed information regarding the individual's preferences. They also confirmed they had received detailed written information about the service and the options of care available to them.