Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Humber NHS Foundation Trust Out of Hours (OOH) services on the 22 April 2016. We reviewed the services at East Riding Community Hospital and Goole primary care centre where these services are based. Overall the service is rated as good.

Our key findings across all the areas we inspected were as follows:

• All staff were encouraged and supported to record any incidents. There was evidence of good investigation, learning and sharing mechanisms in place.

• There was a clear leadership structure and a stable workforce in place. Staff were aware of their roles and responsibilities and told us the GPs and managers were accessible and supportive.

• Risks to patients were assessed and well managed. There were good governance arrangements and appropriate policies in place.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.

• The primary care centre had excellent facilities and was well equipped to treat patients and meet their needs.
• Vehicles used for home visits were clean, well maintained and equipped.

• The practice had good facilities and was well equipped to treat and meet the needs of patients.

• There was a complaints policy and clear information available for patients who wished to make a complaint.

• The practice sought patient views how improvements could be made to the service, through the NHS Friends and Family Test.

• The ethos of the practice was to deliver good patient centred care.

• The service was aware of and complied with the requirements of the duty of candour (being open and transparent with people who use the service, in relation to care and treatment provided).

However, there were areas of practice where they should make improvements:

• Review the provision of signage inviting patients to request a chaperone.

• Review chaperone training for staff. .

• Review the provision and signage re complaints and health information in the waiting areas of the OOH facility.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Patients at Willerby Hill, in The Humber Centre, had their care and health care needs met because staff followed care and treatment plans and were aware of the changes in their conditions.

The premises on the two wards we saw were safe and suitably maintained and efforts were continuing to ensure ligature points were removed or, where risk still existed to ensure it was minimal and that it was rigorously risk assessed.

We found that staffing levels were appropriate at the time of our visit. We found that staff had been appropriately trained in mandatory and other training courses and were receiving supervision. However, we found that staffing levels and skill competence were at risk of becoming insufficient.

There was effective governance of the location, which involved audits and surveys. The overall governance within The Humber NHS Foundation Trust was 'strong'.

We visited Derwent Ward at The Humber Centre, where we spoke with four patients, three staff and the ward charge nurse. We were informed that the ward manager had left at the end of the summer. This vacancy was being covered by the ward manager of another ward in The Humber Centre. We did not meet this person.

We looked at some case files and looked around the ward. We visited this ward because we had received information that gave us cause for concern. These concerns have been mentioned and discussed in the body of the report.

We found that patients were satisfied with the overall services they received, but they had comments to make about poor interactions between patients and staff. One patient said, “It is ok here, it’s a bit slow, but some of the staff are good. I don’t like being here. You have to ask for everything.” Another patient said, “It’s more than satisfactory, you get what you need to get you well.”

We found that the physical environment was not safe for patients with suicidal thoughts. We found that staffing levels were sufficient, but staff had experienced challenging situations from patients who had shown high levels of support needs.

We found that documentation was satisfactorily completed and that records were up to date. We found that some patients had not had leave and though we did not see any staff engaging in interactions with patients we were told that two staff had been spending time with them.

A team of eight, Care Quality Commission (CQC), inspectors completed a site visit to The Humber Centre at Willerby Hill, on 2 December 2011. One of the team was a Mental Health Act Commissioner and another was a Mental Health Act Operations Manager. The inspectors split into teams of two and visited four of the units, Swale, Ouse, Ullswater and Derwent.

We spoke with patients on each of the units and apart from one comment, patients told us they were treated with respect and dignity. They told us they could make choices about aspects of their lives within the limitations placed on them by detention under the Mental Health Act (MHA) 1983. Comments were, “The staff speak to us with respect, they have a laugh with us” and “They can treat you with dignity – some days are better than others.” One patient said, “It’s difficult to get a hot drink between 3.30pm and 7pm, but there are always cold drinks available.”

Patients told us they received information about the section of the MHA they were detained under and staff reminded them about this at intervals.

Patients described the range of activities and occupations they participated in and what therapeutic interventions they received. They said these were dependent on which unit they were accommodated on. Comments were, “There are loads of activities”, “We’ve been to football and golf today”, “There is very little to do on the ward” and “There’s a gym, but the treadmill is broken and the weight machine needs fixing.”

Patients said they were encouraged to take part in planning their care and in identifying with staff what risks would be appropriate and manageable to take. They told us they received copies of their care plan. Patients said they could see a doctor quite quickly when they requested it, “You can generally see the doctor within one or two days if you need to.”

Patients told us they felt safe within the units and would be able to tell staff or management if they had any concerns.

Patients said they were asked their opinions about the running of the units and they could attend meetings to express their views. On the whole they said they were happy with the environment.