Salts Medilink Stoma Nurse Team Also known as Salts Healthcare Limited

Updated 16 July 2019

Salts Medilink Stoma Care Nurse Team is operated by Salts Healthcare Limited. The service has been registered with CQC since June 2016. The head office is based in Birmingham, West Midlands.

Salts Medilink nursing team serves the communities of the following areas: Airedale, Bradford, East Midlands, East Yorkshire, Northampton, North London, North West England, Plymouth, South Yorkshire, West Midlands and North Yorkshire. The service also has an honorary contract through a service level agreement with two NHS trusts, where nurses are based at the hospital and see patients in the acute setting.

The service primarily provides care to patients over the age of 18 years old. They occasionally accept referrals of patients under 18 years of age, but there are currently no active patients 18 years of age and under on the caseloads across the country. A small percentage of nurses may see one to two patients per year who are under 18 years old. Therefore, we did not inspect community services for children and young people separately.

The service has had a registered manager in post since the provider registered with CQC on 15 June 2016.

Salts Healthcare Limited also has a nurse academy where they provide an accredited stoma care course. The course was developed and launched as part of a degree level of study in September 2013, by Salts and a University. The course has since achieved accreditation at master’s level.

Updated 16 July 2019

Salts Medilink Stoma Care Nurse Team is operated by Salts Healthcare Limited. Salts Healthcare Limited is a British manufacturing company and distributor of stoma appliances and accessories. The Salts Medilink Stoma Care Nurse Team is a team of clinical nurse specialists in stoma care that operate clinical partnerships in 13 locations throughout England. There is no regulated activity carried out at the head office.

The specialist stoma nurse team provide ongoing support and continuity of care for patients within the community setting, through local clinics held on NHS premises or in the patients’ own homes.

We inspected this service using our comprehensive inspection methodology. The inspection was a short-term announced inspection (staff knew we were coming) to ensure the nurse managers were available at the head office and to gain advanced consent from patients to observe care in their homes.

We inspected the head office on 13 May 2019, to look at staff profiles, patient records, policies and procedures, and to speak with the leaders of the nursing team. We also went on home visits with a nurse providing a service within the West Midlands on the same day. We made phone calls to staff and patients from across the country to ask questions and gain feedback on 15 and 16 May 2019.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

The main service provided by this provider was community health services for adults.

We rated the service as Good overall because;

• The service ensured staff and patients were protected from avoidable harm and abuse, whilst ensuring they met legal requirements.

• There were clearly defined and embedded systems to keep people safe that were reliable, minimised the potential for error, reflected national, professional guidance and legislation, and were appropriate for the care setting. These were understood by staff, implemented consistently and reviewed regularly.

• Staff received up to date training in safety systems, processes and practices.

• Staff could access the information they needed to assess, plan and deliver care, treatment and support to patients in a timely way. They had involved partner agencies and carers when sharing information.

• Patients’ care and treatment was planned and delivered in line with current evidence-based guidance, best practice, legislation and professional standards.

• Patients had comprehensive assessments of their needs including clinical, mental health, physical health and wellbeing. Individual patient goals were identified and staff regularly reviewed and updated care and treatment to achieve these.

• There were appropriate referral pathways to ensure all needs were addressed.

• Information about patients’ care and treatment was routinely collected, monitored and used to improve services.

• Staff were qualified and had the skills they needed to carry out their roles effectively, in line with best practice. Learning needs of staff were identified and training was provided to meet these needs.

• Staff were supported to maintain and further develop their professional skills and experience, and to deliver effective care and treatment.

• Staff ensured patients received coordinated care by working collaboratively with external organisations.

• Staff were consistent in supporting patients to live healthier lives, including identifying those who needed extra support. Staff achieved this through a targeted and proactive approach to health promotion and prevention of ill-health. They used every contact with patients to do so.

• Consent to care and treatment was obtained in line with legislation and guidance. Patients were supported to make decisions about their care and treatment.

• Patients were supported, treated with dignity and respect, and were involved as partners in their care, practically and emotionally. Feedback from patients, those close to them and stakeholders was continually positive about the way staff treated people.

• Staff supported patients and those close to them to manage their emotional response to their care and treatment. They recognised patients’ emotional and social needs as being as important as their physical needs.

• Staff communicated with patients and those close to them, in a way that they could understand.

• Patients’ needs were met through the way services were organised and delivered. The importance of flexibility, informed choice and continuity of care was reflected in the service.

• Staff coordinated care and treatment with other services and providers, including liaising with families and carers to ensure all services were informed of any diverse needs that needed to be addressed.

• Staff made reasonable adjustments to remove barriers when patients found it hard to use or access services.

• Patients could access the right care at the right time. Staff took account of patients’ needs, including those with urgent need when managing access to care.

• Patients knew how to give feedback about their experiences and could do so in a range of accessible ways, including how to raise concerns or issues.

• The leadership, governance and culture promoted the delivery of high-quality person-centred care.

• Leaders had the experience, capacity, capability and integrity to ensure the service was delivered in line with the strategy and risks to performance were addressed.

• There was a clear statement of vision and values that had been translated into a realistic strategy with well-defined objectives that were achievable and relevant. These had been developed in collaboration with staff.

• Structures, processes and systems of accountability, including the governance and management of partnerships were clearly set out, understood and effective. Staff were clear about their roles and accountabilities.

• A full and diverse range of people’s views and concerns was encouraged, heard and acted on to shape services and culture. This included staff, patients and those close to them, and external organisations.

• The service was transparent, collaborative and open with all relevant stakeholders about performance, to build a shared understanding of challenges and to ensure the needs of the population it served were met.

• There was a strong focus on continuous learning and improvement that included appropriate use of external accreditation, participation in research and sharing best practice through publication of papers.

However, we also found the following issues that the service provider needs to improve:

• There was no formal deteriorating patient or sepsis policy and procedure to support staff in identifying and managing deteriorating patients.

• Audits were not reported on as a workforce, only on an individual basis.

• The service was not directly auditing compliance against some evidence based practice and national guidelines at the time of our visit, for example hand hygiene.

• There were no formal competency checks to provide evidence of ongoing assurance for experienced staff.

Following this inspection, we told the provider that it should make improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Nigel Acheson

Deputy Chief Inspector of Hospitals

Updated 16 July 2019