Whittington Health NHS Trust

Updated 20 March 2020

Whittington Health was established in April 2011 bringing together Islington and Haringey community services with Whittington Hospital’s acute services to form a new Integrated Care Organisation (ICO). Whittington Health provides acute and community services to 500,000 people living in Islington and Haringey as well as other London boroughs including Barnet, Enfield, Camden and Hackney. The hospital has 346 beds.

Updated 20 March 2020

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

• We rated effective, responsive, and well-led as good, safe as requires improvement and caring as outstanding.
• We rated four of the five services inspected as good, and one as requires improvement.
• In rating the trust, we also took into account the current ratings of the services not inspected this time. We found improvements during this inspection that meant the overall rating for the trust’s community services had now improved from good to outstanding.
• As an integrated care organisation, the trust was leading the way in the provision of well-integrated community, mental health and acute hospital services. The trust planned services effectively to meet the needs of the local population. For example, the trust had an emergency response ‘Hospital at Home’ team who worked with health and social care partners to prevent patients having to be admitted to the hospital. By investing in community services for elderly patients, the trust had been successful in reducing the number of patients who needed to be readmitted to hospital. As a result, the trust was one of the best performing trusts in the country for emergency readmission rates.
• The trust had enough staff to care for patients and keep them safe. The trust managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers. Staff went the extra mile to make sure their approach was friendly and inclusive. Patients and their families were treated as equal partners and empowered to make decisions about care and treatment.
• The trust planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access services when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. The trust level leadership team had the appropriate range of skills, knowledge and experience. The trust had effective structures, systems and processes in place to support the delivery of its strategy. Most staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Previous concerns around bullying and harassment had reduced and staff survey involvement and outcomes had improved. Staff were clear about their roles and accountabilities. Overall, the trust engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However:

• Not all staff had completed mandatory training in key skills. In some areas, staff did not always control infection risk well. Staff did not always fully assess and record risks to patients with mental health conditions. In some areas, staff did not always follow best practice when storing and disposing of medicines.

Our full Inspection report summarising what we found and the supporting Evidence appendix containing detailed evidence and data about the trust is available on our website –

Updated 20 March 2020

Updated 20 March 2020

Updated 8 July 2016

We rated community services for adults as good overall because;

• All community staff were aware of the trust’s incident reporting processes and there were mechanisms in place to learn from incidents. District Nurses (DNs) were aware of their duty to report pressure ulcers. Community services across the trust were described to us as high demand in relation to capacity. The DN service had a high staff turnover rate but there were a number of measures in place that managed the safety issues that arose from this. Staffing pressures and low team morale were more acutely felt in some teams and this had an effect on the service.
• Current evidence based guidance, standards and published best practice were identified and used in the delivery of care. The trust had done much to improve staff competency through a number of positive initiatives although some essential items needed further development. We found good and widespread examples of multidisciplinary working and clear understanding of care pathways among the community teams.
• We found compassionate and respectful care was present in all interactions we observed, in what were busy teams working in what were challenging environments.
• The trust’s integrated care approach was designed to meet the wide ranging needs of different patient groups. Community services were provided by staff groups who were generally culturally and ethnically representative of local populations. The DN services were observed to be very supportive of the older patients they visited and understood the needs of working with this patient group.
• The trust’s vision and values around providing integrated patient centred care were reflected by the community staff we observed and spoke with. Community staff felt well supported by the managers of community services.
• There were governance processes and lines of reporting to the executive team on quality for all three directorates with community services, with risk and quality issues discussed in local team meetings.
• All staff reported that meeting demand with current capacity was a challenge, which was only set to increase with further development of integrated community services within the trust. Community staff generally felt there was a lack of understanding of their role by both trust leaders and their professional counterparts who were hospital based.

Updated 20 March 2020

Our rating of this service improved. We rated it as good because:

• Compliance with mandatory training, safeguarding training and staff appraisals had improved. All team managers robustly monitored training and appraisal compliance.
• The service had made considerable improvements in working towards meeting the national targets for the Healthy Child Programme which included new birth face to face visits, one- and two-year development reviews.
• The service had made considerable improvements in meeting target times for people accessing the service. However, the service was facing challenges in the autism pathway and waiting times had exceeded the trust target of 18 weeks. This was due to an increase in referrals by 50%. The service leads were working with commissioners to address this and the local teams were managing the waiting lists by carrying out therapist-led assessments and workshops for parents on the waiting list.
• The environment at the Northern Health Centre had improved. Managers were working closely with the estate department to ensure the environment was safe.
• Managers had improved hygiene processes to reduce risks to people using the service. Cleaning schedules were in place and hand hygiene audits were being carried out.
• Learning from incidents had improved. Staff discussed any learning from incidents at team meetings and at one to one sessions.
• There were effective safeguarding procedures in place and multidisciplinary teams worked together to protect vulnerable children.
• Risks to children and young people using the service were assessed and their safety was managed so they were protected from avoidable harm.
• Records and care plans were individualised, clear, accurate, up to date and completed in a timely manner.
• The service had enough staff with the right skills and training with managers who supported and monitored their performance. There were good opportunities for specialist training and professional development.
• Staff provided individualised child-centred care. Children, young people and their carers were treated with compassion, dignity and respect. Staff provided appropriate information and support to enable them to make decisions about the care they received.
• National programmes of care were followed and evidence-based practice was delivered across all children’s services.
• Staff from different disciplines worked well together to benefit children, young people and their families. They provided a range of care and treatment interventions consistent with national guidance on best practice. Teams collaborated with each other and with external agencies.
• The service collected, analysed, managed and used information well to support all its activities. Managers had access to the information they needed to provide safe and effective care and used that information to good effect.

Updated 8 July 2016

We gave an overall rating for the community dental service of outstanding because:

Feedback from people who used the service, and those close to them, was continually positive about the way staff treated people. Patients and their relatives told us that staff went the extra mile and the care they received exceeded their expectations. Staff provided care with compassion. They communicated with patients in a way they could understand and enabled them to manage their own oral health and care when they could.

The service was well-led and had a clear, patient-centred vision. Leaders worked with other organisations to improve care outcomes and tackle health inequalities.

There was a clear and effective governance structure. Staff were well supported by their managers, and managers encouraged, listened to and acted on staff feedback.  Staff were proud of the service they provided and spoke highly of the culture.

Staff had the knowledge, skills and competence to carry out their roles and responsibilities effectively. Many dentists and nurses had additional dental qualifications, for example four dentists were specialists in special care dentistry. We saw examples of effective multidisciplinary working and evidence-based care and treatment. Staff obtained consent to care and treatment in line with legislation and guidance.

The service was responsive to the needs of patients. Staff provided home visits for patients who were unable to attend clinic. There were hoists, wheelchair platforms and a bariatric chair available. The service had a walk-in urgent dental clinic which provided care for patients with an urgent dental problem such as pain, swelling or bleeding.

There were systems in place for identifying, investigating and learning from patient safety incidents. Staff understood their responsibility to raise concerns and report incidents and near-misses and managers supported them to do so. Procedures were in place to keep patients safe from abuse. We found good practice and procedures in place for cleanliness, hygiene and infection control.

Updated 8 July 2016

We gave an overall rating for end of life care as outstanding because;

Whittington Health had their own children’s palliative care service called Lifeforce. The service was a multi-disciplinary team delivering care and support to families who have a child with a life limiting or life threatening condition living in the boroughs of Camden, Haringey and Islington. We found that the service were providing a very high quality of care to the children and families on their caseload. The few areas where there was room for improvement was recognised by the team and plans were in place to make further improvements.

Staff were aware of the processes for reporting any incidents and there was a strong culture of learning from incidents and complaints to improve the quality of the service provided. Staff were fully aware of the safeguarding policies and procedures and could clearly tell us what they would do if they had any concerns. Staff reported there was good access to further training specific to their roles and all mandatory traning targets had been met. We observed risk assessments and emergency care planning. These were managed on an individual basis as needs changed.

Standard documentation based on the ‘Together for Short Lives’ protocols was used across the service and was shared with relevant stakeholders.

Relatives reported that they found staff very caring and supportive and we reviewed some excellent feedback especially from the services’ exceptional Memory Day event. Patients’ needs were looked at on an individual basis and the service showed us and we observed good examples of responsive care.

Staff were very passionate about their roles and local leadership was excellent. Staff felt supported in their roles and could discuss any issues they had with senior leaders. The teamwork was evident throughout the visit and staff often mentioned how they supported each other. The supervision offered by the team psychology members was essential in enabling staff to provide effective end of life care in difficult circumstances. All the staff we spoke with had been in their roles for many years and were justifiably proud of the end of life care they provided, whilst always looking for further improvements to be made.

Updated 8 July 2016

Information about the service

Simmons House was an in-patient adolescent psychiatric unit, for young people between 13 and 18 years of age. It consisted of a mixed gender 12 bed unit.

The unit could admit patients in an emergency or for a planned longer outcome-focussed admission of between six and nine months. The length of stay at Simmons House depended on the young person's needs and collaborative aims and goals.

Adolescents and their families or carers received an individually planned and structured treatment package combining as needed the following; Psychiatric assessment and medication, nursing input and care, family therapy, individual therapy and individual psychology, occupational therapy and group work and education.

The service was commissioned by NHS England and took patients from across the country. The admitted patients had a variety of mental health needs.

Before the inspection visit, we reviewed the information that we held about these services.

During the inspection visit, the inspection team: Visited the unit and looked at the quality of both the environment and observed how staff were caring for young people. Spoke with six young people who were patients at Simmons House. Spoke with one parent/carer. Spoke with the two managers. Spoke with 12 members of staff including doctors, nurses, therapy staff and support workers. Attended and observed one handover meeting.

We also looked at 12 drug charts. Looked at seven care records for young people. Looked at a range of policies, procedures and other documents relating to the running of the service.

Updated 20 March 2020

Our rating of this service stayed the same. We rated it as good because:

• Young people were treated as equal partners in their own care and staff were committed to this. The service was dedicated to empowering young people to shape the service, so it met their needs. Managers and staff went the extra mile to make sure their approach was friendly and inclusive and respected the privacy and dignity of all patients and their families. The service adopted a truly holistic family-based approach and empowered parents to support their own children.
• Staff worked exceptionally well together as a multidisciplinary team and with external organisations to provide preventative support and interventions. A full range of specialists were available to meet the needs of young people using the service and provide further support to their families and carers.
• The service provided safe care in clean and well-maintained premises. There were enough skilled staff available to give each patient the time they needed. Staff managed waiting lists to ensure that young people who required urgent care were seen promptly. Staff assessed and managed risk well and followed good practice with respect to safeguarding.
• The service provided a range of treatments to meet the needs of young people informed by best-practice. Clinical audits were used to evaluate the quality of care they provided. Managers ensured that staff received training, supervision and appraisal and delivered effective care.
• Staff understood the principles underpinning capacity, competence and consent as they apply to children and young people and managed and recorded decisions relating to these principles.
• The service was accessible. Staff assessed and treated patients who required urgent care promptly and those who did not require urgent care did not wait too long to start treatment. The criteria for referral to the service did not exclude children and young people who would have benefitted from care.
• Leaders in the service were capable and had created positive change to better support staff. Governance processes were in place to ensure that the service ran smoothly, and issues were dealt with quickly. Teams were dedicated to continuous learning and used engagement with young people using the service and other stakeholders to actively ways to improve.

However:

• The service did not meet the overall waiting time from referral to treatment. Children and young people waited on average 13 weeks for an appointment rather than the target of eight weeks set by commissioners. The trust were embedding a new model of care and working closely with commissioners to monitor progress. Waiting times had significantly improved over the previous year.
• Some managers could not readily access the most recent version of their team’s data dashboard.
• Staff working across multiple record keeping systems with partner organisations faced some challenges that increased the risk of inconsistency and recording errors and meant staff spent longer transferring information from one system to another.
• Due to some vacancies in individual teams some staff said it was difficult to deliver their full work load. The recent launch of the new SEMH model had compounded this as some staff had to offer extra initial support to external partner organisations. Managers were working to address the issue and provided support to minimise the effects on team capacity.