Lewisham and Greenwich NHS Trust

Updated 3 July 2020

Lewisham and Greenwich NHS Trust was formed on 1 October 2013. It provides services to a population of more than 666,000 people living across the London boroughs of Lewisham, Greenwich and Bexley. The trust provides acute services to the people living in Greenwich and Bexley and acute and community services to people mainly living in Lewisham and has some services at Queen Mary’s Hospital in Sidcup.

The trust has two hospital locations; Queen Elizabeth Hospital (QEH) in Greenwich and University Hospital Lewisham (UHL) in Lewisham. Lewisham and Greenwich NHS Trust has 857 inpatient beds including 50 children’s beds and 48 day care beds. It employs over 6,500 staff.

The hospitals are located in the London Boroughs of Lewisham (UHL) and Greenwich (QEH). Services are commissioned by the respective clinical commissioning groups (CCGs) for those boroughs and the Bexley CCG at QEH.

The trust provides all eight core services at both hospitals; urgent and emergency care; medical care; surgery; critical care; services for children and young people; maternity, outpatients and end of life care. The trust also provides gynaecology and diagnostic imaging.

Updated 3 July 2020

Our rating of the trust stayed the same. We rated it as requires improvement because:

We rated safe and responsive as requires improvement. Effective, caring and well-led were rated good.

Updated 3 July 2020

Updated 3 July 2020

Updated 17 August 2017

Overall rating for this core service GOOD

We rated safe, effective, caring, responsive and well led as good.This was because

• Staff used trust wide systems to report and record safety incidents. These were escalated and investigated appropriately and learning was shared.
• Staff used patient risk and care assessments to identify and respond to risks. There were daily discussions of complex patients.
• Community staff were knowledgeable about safeguarding procedures and knew who they would report any concerns to.
• Community nursing staff had access to specialised equipment to meet patients’ needs when required.
• The service had a number of policies and procedures in place which were based on the national institute for health and care excellence (NICE) or other nationally or internationally recognised guidelines.
• Patients had their pain assessed and monitored depending on their needs. There were processes for obtaining pain relief for patients if required.
• Patients were assessed for their nutrition needs and action plans with referrals to appropriate health care providers were made.
• Staff had received an annual appraisal and had opportunities for their personal development as a result. There were numerous examples of staff being trained and developed, and while some training had been on hold previously, this was no longer the case.
• Staff sought consent before undertaking any care interventions. Records showed evidence that consent was gained for care and treatment.
• Staff were clear about their roles and responsibilities regarding the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.
• Patients we spoke with were positive about the staff that provided care and treatment. They told us they had confidence in the staff and the advice they received.
• We observed the way patients were treated, both in the home and in clinic settings. We observed staff using a respectful, compassionate and kind approach; patients gave positive feedback about the care they had received and the manner, which it had been given to them.
• Patients and relatives we spoke with confirmed that they felt involved in their care. Patients told us the staff had explained their treatment options to them, and they were aware of what was happening with their care.
• The friends and family test (FFT) for Lewisham adult community services for the period November 2015 and October 2016 showed that 98% of patients would recommend the service.

• Most services were achieving the 18 week referral to treatment targets pathway. There were many examples of teams working responsively and collaboratively to meet their patients’ needs and to provide care within the patients’ home environment.

• Patient equality and diversity was taken into account, Patient information could be provided in different languages. Staff could access translation services as and when required.
• The service provided a range of specialist therapeutic interventions

• The service worked closely with commissioners, local authorities, people who used services, primary care services and other local providers to ensure it understood the needs of the population it served in order to plan and deliver services.
• Governance structures were in place within adult community services. There were local governance meetings that fed into neighbourhood meetings and Divisional governance meetings.. Clinical dashboards and performance checkpoint reports were used to monitor of incidents, complaints, risks and performance.
• Risks were identified on the risk register and local risk logs and action was being taken to mitigate the risks. For example, staff in community sexual health services identified that a lack of laboratory capacity and challenges with the electronic records system meant there was a risk patients would not receive test results in a timely manner. This involved the intermittent failure of the text message system. In response an IT analyst was working with the systems team to identify and resolve the issue and an alternative communication strategy had been temporarily implemented. Most staff were aware of what concerns were included on the divisional risk register.
• The vision and strategy for community services for adults was closely aligned to the trusts to wider vision and strategy.
• Staff we spoke with told us that they felt valued and respected; and said there was an open and transparent culture.
• There were opportunities for further learning and development. Staff told us they were motivated and they were able to progress.

However:

• There were significant vacancies across the adult community services. The overall vacancy rate was 38%.
• Completion of mandatory training with the adult community services was 77% which was below the trusts target of 85%.
• The response rate to the staff survey was low at 15%. The staff friends and family test (FFT) for Lewisham adult community services for the period December 2015 to September 2016 showed that 71% of staff would recommend the trust to friends and family as a place to receive care or treatment and 63% of staff would recommend it as a place to work.

Updated 17 August 2017

Overall rating for this core service Outstanding

We rated community children and young people’s (CCYP) services outstanding because:

• Community children and young people’s safety performance was monitored and when something went wrong there was a process in place to review or investigate incidents involving all relevant staff, children and young people (CYP) and their families. Lessons were learned and communicated widely to support improvement in other areas as well as services that were directly affected.
• There were clearly defined and embedded systems and processes to keep children and young people safe and safeguarded from abuse. Staff received up-to-date training in safeguarding to an appropriate level. Staff took a proactive approach to safeguarding; and took steps to prevent abuse from occurring, and responded appropriately to any signs or allegations. There was active and appropriate engagement in local safeguarding procedures and effective working with other relevant organisations.
• Openness and transparency about safety was encouraged. Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.
• Staffing levels and skill mix were planned, implemented and reviewed to keep children and young people safe at all times. Any staff shortages were responded to quickly to ensure staff could manage risks to CYP who used services. However, there was a freeze on the recruitment to the School Nursing Service (SNS) team due to tendering of the service.
• Risks to CYP were assessed, monitored and managed on a day-to-day basis. Staff recognised and responded appropriately to changes in risks to CYP who use services. Risks to safety from service developments, anticipated changes in demand and disruption were assessed, planned for and managed effectively.
• Outcomes for CYP who used services were consistently better than expected when compared with other similar services. CYP care and treatment was planned and delivered in line with current evidence-based guidance, best practice and legislation, including the Healthy Child Programme (HCP). This was monitored to ensure consistency of practice.
• There was a truly holistic approach to assessing, planning and delivering care and treatment to CYP who used services. The safe use of innovative and pioneering approaches to care and how it was delivered were actively encouraged. CYP had comprehensive assessments of their needs, including consideration of their mental health, physical health and wellbeing, and nutrition and hydration needs.
• All staff were actively engaged in activities to monitor and improve quality and outcomes. Opportunities to participate in benchmarking, peer review, and research were proactively pursued. Including health visitors achieving level 3 United Nations Children’s Fund (UNICEF) baby friendly accreditation for breastfeeding. Accurate and up-to-date information about effectiveness was shared internally and externally and was understood by staff, and used to improve care and treatment and CYP outcomes.
• The continuing development of staff skills, competence and knowledge was recognised as being integral to ensuring high quality care. Staff were proactively supported to acquire new skills and share best practice.
• Staff, teams and services were committed to working collaboratively and had found innovative and efficient ways to deliver more joined-up care to CYP. For example, at Kaleidoscope children were cared for by a multidisciplinary team (MDT) of dedicated and skilled staff.
• There was a holistic approach to planning people’s discharge, transfer or transition to other services, which was done at the earliest possible stage. Arrangements fully reflected individual circumstances and preferences.
• The systems to manage and share the information that was needed to deliver effective care were fully integrated and provided real-time information across teams and services.
• Consent practices and records were actively monitored and reviewed to improve how CYP and families were involved in making decisions about their care and treatment.
• Parents spoke highly of the care CYP received and told us they felt involved in their children’s care. We observed a number of examples of compassion and kindness by staff.
• The trust received confirmation on the 17 March 2017 that they had been successful in their tender to continue to provide HVS and FNP services. However, a third sector provider had been commissioned to provide SNS services.
• CCYPS were planned and delivered in a way that met the needs of the local population. The CCYPS service planning emphasised delivering services in a range of settings to maximise reach into communities.
• The needs of CYP were taken into account when planning and delivering services. The CCYPS model bridged health and social care. The aim of the service model was to improve CYPs outcomes and experience through bringing existing community services from health and social care into a more combined way of working. CYP care and treatment was co-ordinated with other services and other providers.
• Complaints handling policies and procedures were in place. All complaints to the service were recorded. Information on the trust’s complaints policy and procedures was available on the trust’s internet website.
• CCYPS local leadership, governance and culture were used to drive and improve the delivery of high quality person-centred care. The CCYPS was undergoing a significant reorganisation of services. Managers and team leaders demonstrated a clear understanding of their role and position in the trust. However, we found that some staff were unclear about the long term strategy for SNS and community nursing services.
• Governance and performance management arrangements were proactively reviewed at a local level and reflected best practice.
• Local leaders had an inspiring shared purpose, strove to deliver and motivate staff to succeed. Comprehensive and successful leadership strategies were in place to ensure delivery and to develop the desired culture.
• There were high levels of staff satisfaction across all equality groups in CCYPS. Staff were proud of CCYPS as a place to work and spoke highly of the culture. There were consistently high levels of constructive engagement with staff, including all equality groups. Staff at all levels were actively encouraged to raise concerns.
• There was strong collaboration and support across CCYPS and a common focus on improving quality of care and people’s experiences.
• The leadership drove continuous improvement and staff were accountable for delivering change. Safe innovation was celebrated. There was a clear proactive approach to seeking out and embedding new and more sustainable models of care. For example, Kaleidoscope in Lewisham provided a “one stop shop” for children with complex needs. CCYPS were also involved in a number of research projects with both London based and National research units.

However, we also found:

• There was a lack of security on the main entrance at Kaleidoscope.
• CCYPS there were 66.61 (81%) whole time equivalent (WTE) nursing staff in place which was less than what was determined by the trust to provide effective and safe care. There was also a freeze on recruitment to the community nursing team and school nursing service (SNS) due to tendering. However, this was mitigated by the use of bank staff.
• The tendering process had an impact on staff morale, especially in regards to SNS.