We carried out an announced comprehensive inspection on 1 November 2016 and unannounced inspection on 4 November 2016 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

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

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?

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

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

Buckinghamshire has a population of approximately 521,922. The rate of teenage pregnancy and sexually transmitted disease is better than the England average. The level of deprivation in Buckinghamshire is better than the England average.

The Terrence Higgins outreach service delivers a level 2 sexual health service across Buckinghamshire. The service offers clinics for guidance and treatment of sexual health issues including contraceptive services and screening and treatment of sexually transmitted diseases. The range of services included:

• A range of contraception services including oral contraception, emergency contraception and long acting reversible contraception (LARC)
• Screening for a range of sexually transmitted infections (STI’s)
• Human immunodeficiency virus (HIV) prevention and support
• Wellbeing in sexual health (WISH) training for individuals and organisations
• Health promotion
• National C-card condom scheme.

The service was commissioned alongside a local NHS trust to provide an integrated level 2 and 3 sexual health service for Buckinghamshire in April 2016. The service currently provides 10 clinics at a range of locations including colleges, GP surgeries and community centres. From April 2016 to September 2016, the service saw 547 patients, the majority (approximately 77%) were female. The majority (40-45%) of patients are aged 18 to 24 years old.

The service currently employs 13 members of staff. This includes one service manager, three nurses, four youth engagement officers, an HIV and sexual health practitioner, two administration staff, wellbeing in sexual health trainer and results officer. The service had three vacancies at the time of our inspection.

We do not currently have a legal duty to rate single speciality services or the regulated activities they provide but we highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

The service manager is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We spoke with three patients who all provided positive feedback about the service. Patients commented the service was helpful, provided an easy consultation and they would recommend to others.

Our key findings were:

• We observed staff provided kind, compassionate care and maintained the privacy and dignity of patients. This was supported by patient feedback survey results. Staff provided emotional support to all patients and in particular patients living in vulnerable circumstances.
• The service used nationally recognised guidelines to develop services and contributed to two national clinical activity datasets. The patient electronic record generated clinical protocols based on the patient’s condition.
• The service had a system in place to manage medicines including the ordering, storage, dispensing, administration and disposal. However, there were some aspects of this system that did not meet national guidelines. This included the documentation of receipt and checks of medicines, security of key safe and arrangements for the disposal of unwanted or expired medicines.
• There were systems in place to safeguard young people and adults from abuse. Staff were aware of how to make a safeguarding referral and had completed training on child sexual exploitation and female genital mutilation. However, we found not all staff were clear about the policy for reporting sexual assault in adults over the age of 18.
• Governance arrangements were managed jointly between the local service and corporate team. For example, governance meeting were held at board level but day to day management of incidents and performance were managed locally. Although the service did monitor the quality of service provision in some areas, it did not meet the requirements of the corporate audit programme.
• The service referred to advice in national guidance for example the British Association of Sexual Health and HIV (BASHH) and Faculty for Sexual and Reproductive Health (FSRH) to develop services. However, there was no formal process for reviewing new clinical guidelines and applying changes to practice.
• All the clinics we inspected were visibly clean and tidy. We observed staff adhering to basic hand hygiene and personal infection control practices. However, in two clinic locations there was no clinical waste bin and staff had to tie an open waste bag to the sink.
• The service placed outreach services strategically and held events in a variety of locations in order to meet the needs of local people. Staff had developed services for hard to reach groups such ethnic minority female groups. Patients could access the service using a single access telephone number. However, the provision of some clinics had to be altered due to staffing issues. There was no clear protocol for the management of patients who did not attend their appointment.

There were areas where the provider could make improvements and should:

• Review processes in place for medicines management to ensure they meet national guidelines.
• Ensure all staff follow the organisations policy on reporting sexual assault in adults over the age of 18.
• Review the arrangements for managing patients who fail to attend their appointment.
• Review clinical audit arrangements to ensure all areas of the service are monitored for quality assurance.
• Review the process to consider changes to clinical guidelines and how these are applied within clinical practice.