Our CQC report. Key findings and Warrington local briefing. Embargoed for public view until 6th February 2017

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1 Our CQC report Key findings and Warrington local briefing Embargoed for public view until 6th February 2017

2 Overview The Care Quality Commission visited Bridgewater for their announced comprehensive inspection in May and June 2016 They visited services across the boroughs we serve talking to staff, patients and public and observing care in practice The report is published on February 6th when it will be formally released to public and stakeholders The report looks at all our diverse services across the range of boroughs we provide care in This borough summary provides an overview of key findings across the trust and specific areas relevant to Warrington.

3 Overall rating The overall rating for Bridgewater is requires improvement

4 Context - Scores across the CQC matrix Across the matrix of 40 domain scores that the CQC provide for our services it shows an overall spread of ratings of: Inadequate Requires Imp Good Outstanding

5 The CQC matrix

6 Adults 1510 staff Inspectors witnessed staff giving compassionate care and involving patients All patients had a named nurse and risks to patient were discussed at daily handover meetings In Warrington joint working with social care and the acute trust was evident A weighting tool across the trust supported good care by measuring acuity of patients and tailoring services Warrington staff told the inspectors of additional safeguarding training with the local council around young palliative care and drug and alcohol issues Staff in Warrington described an open culture and the structure as 'amazing'

7 Children's 650 staff Staff treat children with kindness, dignity and respect in an age appropriate way and involve them in decisions around their care There was good multidisciplinary working and an evidence based approach to care There was a good culture of openness, reporting and investigation of incidents Healthy Child Programme targets in Warrington were at 74% of children having a review against target of 85% (but had improved from 50% the previous quarter) Main issue impacting scores in this area was an issue around review of patients inherited by the trust from another provider in the St Helens area. Bridgewater prioritised and solved issue by end July 2016

8 Inpatients 66 staff CQC rated our community inpatient and intermediate care services including Padgate House as good - and the caring as outstanding. Inspectors noted that we performed better when comparing NHS Safety Thermometer data to similar providers. Staffing levels were good and records showed a minimum of 95% shift fill rates. PLACE assessements recorded a cleanliness assessment of 99.4% which is better than the England average. Feedback from people who used the services was continuously positive, patients and relatives spoke highly of staff and the care that was delivered. Many believed that staff went above and beyond.

9 Sexual health 34 staff The CQC said that staff made a difference and took great pride in the their services in Warrington Sexual Health with patients expressing high satisfaction rates for the care they receive Medicines were appropriately managed, premises were clean and well maintained and national best practice was followed in clinics Inspectors liked the 'mystery shopper' test to measure service satisfaction and the use of social media to reach patients in the community Chlamydia screening was not meeting monthly targets but inspectors saw clear controls and targets in place.

10 End of Life End of life care services were planned and organised well at local level Care was delivered by highly skilled, dedicated practitioners who considered the needs of all patients in their care However, the CQC found there was no vision or strategy in place across the trust for end of life care or steering group. We have addressed this with the appointment of an EOL lead in the trust The CQC also said that we need to improve our medicines management in EOL - specifically around issues when GPs administer beyond agreed local medication algorithms and ensuring our staff challenge when this happens.

11 What service users told the inspectors Service user feedback taken directly from the report was very positive and the CQC found that 97% of patients recommend services. Quotes included: "I came with my son every other week to see the community nurses and the staff here are always very polite and helpful, I cannot fault anything" - Children's services "They looked after my mother with utmost dignity and respect, I will be forever grateful" - End of Life care services "The nurses are lovely, reliable and help me to cope" - Adult services "The service saved me a long wait in A&E" - Urgent Care

12 Trust key action areas Based on the CQC's feedback the key areas we have already addressed trust wide since the inspection have included: Strengthening governance for end of life care and medication management services with the appointment of new clinical leads in these key areas and the development of trust wide strategies Prioritising 1,420 community paediatric follow-up appointments in just six months in St Helens to clear waiting times that we inherited when they took over the service Strengthening home birth services in Halton with our midwives now able to provide oxygen at home in case it is needed in an emergency Ensuring patients are triaged quickly in line with national guidance in our urgent care and walk-in centres.

13 Next steps The report is published on 6th Feb on the CQC website and information is strictly embargoed until then We have been working with the CQC with action plans in place to address areas where concerns were raised post inspection and they have been satisfied by progress made Our quality summit for the report will take place on 20th February and invites have been issued. This will develop a further plan of action as the trust works towards its goal of moving to good and outstanding.

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