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CQC rates Croydon Health Services NHS Trust as Requires Improvement

27/09/2018

The Care Quality Commission has rated Croydon Health Services NHS Trust as Requires Improvement overall.

CQC rated the trust Requires Improvement for being safe, effective, responsive and well-led. It was rated Good for being caring, following the inspection in July 2018.

During this inspection CQC visited Croydon University Hospital to inspect the medical care provided by the trust. In addition, CQC inspected the community health services for adults and community health services for children and young people. The information CQC held on these areas indicated the need for inclusion in this inspection: at the last inspection in June 2015 they were rated Requires Improvement.

Inspectors found that in medical care there were many patients being moved at night. The medical care service relied on bank and agency staff to cover gaps in staffing. Some of these were not appropriately inducted onto wards.

Some concerns that had been found during CQC's previous inspection had not been resolved, including waiting times for access to the domiciliary speech and language team.

There were also some maintenance issues. Repairs to windows on one ward had been waiting for six months. Wards within the medical care service had little public health information on the national priorities to improve the population's health on smoking cessation, obesity, drug and alcohol dependency, dementia and cancer.

In community services for children and young people (CYP) inspectors found the caseload numbers were well above the recommended number for health visitors to safely manage. This was a finding at the inspection in June 2016. Processes to monitor and review the quality of care in CYP services were not robust and in services for adults the trust did not provide outcome information for adults.

Performance for CYP services had been below national and local indicators for the last year.

The roll out of phones for community adult nurses was not complete and some staff were using their own phones which potentially compromised their safety and was a data protection risk.

In both community services CQC found there was a lack of use of interpreters and an over reliance on family members to interpret which is not line with best practice.

The trust must now:

• Improve the medical care service. It must work to improve access and flow and that patients are cared for in the correct ward.

• In community services for adults the trust must take steps to integrate its electronic patient record systems to enable a shared care record, including social care and GP records. The trust must ensure patients have access to interpreters when required.

• The trust must ensure lone working community staff have phones.

• In community services for children and young people the trust must ensure that information provided to patient is available in other languages.

• Take steps to reduce the high caseload for health visitors.

• The trust must develop a clear audit plan to ensure services are being delivered in line with local and national guidelines.

However, inspectors did find some areas of outstanding care. The community Speech and Language Therapy Team (SALT) was involved in a virtual reality research project aimed at carrying out aphasia rehabilitation remotely. And the trust's homeless health team, based at the Rainbow Health Centre, ran a project to find accommodation for asylum seekers and homeless people.

Professor Ted Baker, England's Chief Inspector of Hospitals said: "I am disappointed that there has been no change in the overall rating at Croydon Health Services NHS Trust - it is again rated Requires Improvement overall.

"Some of the concerns we highlighted at our last inspection have still not been addressed and we will be keeping a close eye on the trust to ensure improvements are made in the future.

"We did find some outstanding practice at the trust. The trust's homeless health team provided in-reach and outreach programmes to both support asylum seekers and homeless people. This service took a holistic approach which included coordinating accommodation for service users."

You can read the report in full when they are published on the CQC's website at https://www.cqc.org.uk/provider/RJ6

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