18 July 2023, 19 July 2023, 30 August 2023, 31 August 2023, 1 September 2023
During a routine inspection
Wirral Community NHS Foundation Trust provides a range of primary, community and public health services to the populations of the Wirral, parts of Cheshire, St Helens and Knowsley. The trust works in partnership with other providers in the local health and social care economy to provide care to the communities it serves. Wirral Community NHS Foundation Trust became a foundation trust on 1 May 2016.
The trust serves a population of approximately 693,700 residents across 145,000 households. They employ approximately 1,814 staff, 90% of which are patient-facing. In 2022-23 turnover was £116m. Staff work across over fifty sites; their main locations are St Catherine’s Health Centre, and Victoria Central Health Centre on the Wirral. In May 2023, 11,995 referrals were received for 8,765 persons needing care and 60,460 care contacts were completed with 20,400 patients.
They have an established and stable Executive and non-executive team.
Wirral Community NHS Foundation Trust operate from six locations as well as offering services within people’s homes.
- St Catherine’s Health Centre (Trust Headquarters)
- Victoria Central Health Centre
- Arrowe Park Hospital
- Eastham clinic
- Leasowe Primary care Centre
- Clatterbridge Hospital
The trust has eight core services across community health. They registered their first inpatient adult community wards in April 2020 at the Clatterbridge location (3 wards – 73 beds). Additionally, they have recently acquired two new 0-19 service for Knowsley and St Helens.
Core services covered:
- Community health services for adults
- Community health services for children and young people
- Community end of life services
- Community dental services
- Urgent Care
- Sexual health
- GP Out of hours service
- Community Inpatients
We carried out short notice (24 hours) inspections of three of the core services. We also inspected the well-led key question for the trust overall.
We inspected the community inpatients core service; this core service had not previously been inspected. We also inspected community health services for adults and community sexual health services to monitor their progress following their previous inspection in 2018.
We did not inspect the out of hours provision, urgent care, dental services, community end of life services and community health services for children and young people. This is because we have not received any information of concern since our last inspection of these services. We will continue to monitor them and will re-inspect them as appropriate.
Overall Summary
Our rating of the trust improved. We rated it as good because:
- There had been significant improvements especially regarding governance and information management since our last inspection.
- In rating the trust, we considered the current ratings of those services not inspected at this time.
- The trust had an experienced leadership team with the skills, abilities, and commitment to provide high-quality services. They recognised the training needs of managers at all levels, including themselves, and worked to provide development opportunities for the future of the organisation.
- The board and senior leadership team had set a clear vision and values that were at the heart of all the work within the organisation. They worked hard to make sure staff at all levels understood them in relation to their daily roles.
- The trust strategy was directly linked to the vision and values of the trust. The trust had a clear five-year plan to provide high-quality care with financial stability.
- The trust had a clear structure for overseeing performance, quality and risk, with board members actively aligned to services across the organisation. This gave them greater oversight of issues facing the service and they responded when services needed more support. The board reviewed performance reports that included data about the services, which directors could challenge.
- The trust had effective information systems to consistently collate, analyse and present information. The information was timely, reliable and accessible to all levels of the organisation which meant they could identify risks, challenges and support effective decision making. They were able to access data at neighbourhood level enabling effective risk stratification.
- Staff across the organisation felt respected, supported and valued. They remained focussed on the needs of patients receiving care. Staff felt listened to and able to raise concerns if needed.
- The trust made sure that it included and communicated effectively with patients, staff, the public, and local organisations.
- The trust was committed to improving services by learning from when things go well and when they go wrong, promoting training, research and innovation.
However:
- The trust board recognised there was further work required to improve equality and diversity across the trust and at board level.
- Although response rates were similar to other community trusts, the NHS Staff Survey 2022 showed the trust scored equal or below the average in all themes compared against 16 other community trusts.
- The trust did not have a strategy for meeting the needs of patients with a mental health, learning disability, autism or dementia diagnosis. There was no formal lead with the responsibility for ensuring these patients received the specific care required.
- The trust governance processes in the community inpatient service did not always ensure staff followed systems and processes to make sure that medicines with a minimum dosage interval were administered as prescribed and monitor the use of thickeners to ensure national guidance was followed.
How we carried out the inspection
Before the inspection visit, we reviewed information that we held about the trust. During the inspection visit, the inspection team:
- visited 9 sites where staff delivered care including all 3 inpatient wards,
- spoke with 116 members of staff,
- spoke with 28 people using the trust’s services,
- spoke with 8 carers or relatives of people using the trust’s services,
- reviewed 29 care records including medicines administration charts,
- observed several meetings including the trust’s board meeting,
- held 7 focus groups with staff, non-executive directors and governors,
- held 2 focus groups with patient representative groups,
- sought feedback from a range of stakeholders including health watch and commissioners,
- and reviewed the trust’s process for fit and proper persons employed.
The inspections of the trust’s core services were led by a CQC operations manager and supported by 5 CQC inspectors, 1 CQC medicines inspector, 1 CQC regulatory officer, 3 specialist professional advisors and 1 expert by experience.
The inspection of the well-led key questions was led by a CQC Deputy Director of Operations and supported by an operations manager, one CQC inspector, one CQC medicines inspector and 1 CQC regulatory officer. The team also received support from four specialist professional advisors and executive reviewers with a background and experience in NHS senior management.
You can find further information about how we carry out our inspections on our website: www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.
What people who use the service say
Community inpatients
Patients, family members and carers spoke positively about the service. They told us staff treated them well with compassion and kindness. They described staff as like family who met their needs well and cared about them. A carer who regularly visited to provide pastoral care, described staff as consistently excellent.
Community adults
Feedback from patients, family and carers was very positive. They described staff as caring, friendly, and supportive. They told us they went above and beyond to care for them. They said they were ‘brilliant’ and that they felt able to contact them at any time.
Patients told us they felt safe. They said staff were careful when performing physical interventions and gave them reassurance about any anxieties they had about their treatment. They observed that staff were very professional and said they had complete confidence in the procedures they performed.
Patients told us they felt staff listened to them and were responsive to their views and wishes. They described how staff gave them advice on their care and treatment in an accessible and clear manner. This included explaining the nature, purpose, and side effects of medicines.
Feedback about appointment and waiting times was positive. Patients told us staff arrived on time and that missed appointments were rare. Patients told us staff were flexible about appointment times and tried to arrange these at a time that was convenient for them.
Patients told us staff routinely sought their consent prior to treatment. They also said that staff always respected their privacy and dignity, and that care and treatment was performed in the least restrictive or invasive way.
Patients said they knew how to complain and who to contact if they wished to do so. None of the patients we spoke with told us they had made a complaint or that they had any reason to do so.
Community sexual health services
Feedback from people described staff as helpful, knowledgeable, and supportive. People reported that the health huddles were safe environments with a relaxed atmosphere. They said sessions were informative and that staff were able to bust myths around various topics.
People from the BAME community reported learning about contraceptive and that they felt more informed to make a choice. They felt comfortable and relaxed during talks and learning more about cervical screening.
People consistently said that staff were helpful, and that reception and admin staff were welcoming and put them at ease. They reported that there was consistency with clinical staff during appointments and that there was good follow up from doctors.
Trustwide
We reached out to the trust’s stakeholders to give feedback for the inspection.
We received feedback from commissioners and from Healthwatch.
Stakeholder feedback was consistently positive. They worked collaboratively to develop strategies, for example developing a safe and effective workforce that felt valued and supported. Commissioners had observed caring and compassionate practice delivered with knowledge and professionalism.
They reported that the trust worked hard with dedication to ensure contracts were fulfilled. We were told that they believed the leadership and care exhibited, placed the best interests of the people they supported at the centre of everything they did and that they would often go above and beyond their contractual obligations to deliver an inclusive and effective service.
We were told that members of the executive team were active partners within the Wirral Health and Care partnership undertaking both local and national roles.