We carried out this announced inspection on 11 and 12 February 2020 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection to check whether the registered provider was meeting the legal requirements in the Health and Social Care Act 2008 and associated regulations. The inspection was carried out by two CQC inspectors with one CQC specialist professional advisor.
To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:
• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?
These questions form the framework for the areas we look at during the inspection.
Background
In the West Midlands, services for the support and examination of people who have experienced sexual assault are co-commissioned by NHS England and Warwickshire, West Mercia and West Midlands Offices of the Police and Crime Commissioner. NHS England commissioning managers take the lead in contract management and coordination. A new contract for sexual assault examination services commenced on 1 April 2018 with G4S Health Services (UK) Limited (G4S) commissioned as the new provider.
The Blue Sky Centre in Nuneaton provides the forensic medical examination service for adults with an option that young people aged 16 and 17 years old can access this service instead of regional paediatric services if appropriate. A different provider holds the regional paediatric contract for sexual assault referral services in the West Midlands, this service uses the Blue Sky Centre by agreement for child appointments.
West Midlands-wide independent sexual violence advisor (ISVA) and counselling services can be accessed through the Blue Sky Centre. These services are also co-commissioned with NHS England acting as coordinating commissioners.
The Blue Sky Centre is located within George Eliot hospital in central Nuneaton. The building was designed and built as a sexual assault referral centre in 2013 and began operating in April 2013. Although building ownership is in transition to Warwickshire Police.
Car parking is available outside the centre with level access for people who use wheelchairs.
The staff team consists of a mix of permanent and flexible (flexi) staff to cover the rota. Permanent staff include a centre manager who is a crisis worker, a deputy centre manager, also a crisis worker, two forensic nurse examiners (FNE) and one crisis worker also acting in a coordinator role. Flexi staff include two FNEs, four doctors who are forensic medical examiners (FME) and five further crisis workers. Some FMEs were self-employed and some G4S employees. The team consisted of male and female forensic practitioners and crisis workers. Several new staff had recently been recruited and were undergoing vetting with inductions planned. Two of the nurse examiners had recently attained diplomas in the Forensic and Clinical Aspects of Sexual Assault (DipFCASA).
The service has two forensic examination suites, one of these was used regularly by the paediatric service.
This report uses the term ‘forensic practitioner’ to describe both FME and FNEs.
The service is provided by G4S Health Services (UK) Limited (G4S) and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run. The registered manager at The Blue Sky Centre was the centre manager.
We spoke with six staff, NHS England and police commissioners as well as staff from partner organisations during the inspection. Throughout this report we have used the term ‘patients’ to describe people who use the service to reflect our inspection of the clinical aspects of the SARC. We sampled 14 patient records during the inspection and reviewed patient feedback obtained by the service over the last few years.
We looked at policies and procedures and other records about how the service is managed.
Our key findings were:
- The service had effective systems to manage risk.
- The service had suitable safeguarding processes that reflected national guidance.
- The service had safe and effective staff recruitment procedures.
- Staff records did not provide adequate assurance that all forensic practitioners were appropriately trained or supported through peer review.
- Appropriate medicines and emergency equipment were available.
- The clinical staff provided patient care and treatment in line with current guidelines.
- Effective partnership arrangements and pathways had been developed to provide the care and support for people who had experienced sexual assault throughout Coventry and Warwickshire and wider areas.
- Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
- The appointment and referral systems met the needs of patients and appointments were facilitated within forensic timescales.
- The service had effective leadership and a culture of continuous improvement.
- Staff felt involved and supported and worked well as a team.
- Patient feedback about the service was positive and patients’ suggestions were used to improve the service.
- The service was clean and well maintained and staff followed infection control procedures which reflected published guidance.
There were areas where the provider must make improvements. They MUST:
- Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
There were also areas where the provider could make improvements. They SHOULD:
- Implement an effective audit processes that promotes a cycle of continuous learning.