Archived: Brook Wigan and Leigh

Brook Wigan and Leigh provides a sexual health and well-being service for young people aged under 25 in Wigan and the surrounding areas. The service is recognised as a level 2 contraception and sexual health service (CASH).

We inspected Brook Wigan and Leigh using our comprehensive inspection methodology. We carried out the announced part of the inspection on 26 and 27 January 2017. We also carried out an unannounced inspection on 1 February 2017.

We do not currently have a legal duty to rate independent sexual health services or the regulated activities they provide but we highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

We found the following areas of good practice:

• There were clear processes in place to protect vulnerable patients and those identified at risk of abuse. Patients received care in visibly clean and appropriately maintained premises. Suitable equipment was available to support patients care and treatment.

• The service followed national guidelines and participated in clinical audits in order to improve care and treatment pathways. Staff worked well together as part of a multidisciplinary team and collaborated with external organisations to deliver patient’s care and treatment effectively.

• Care and treatment was provided by suitably qualified and competent staff. The staffing levels and skills mix was sufficient to meet patients’ needs and staff assessed and responded to patient risks. The majority of staff (85%) had completed their appraisals.

• We spoke with six patients and received feedback from 50 patients through comments cards received during the inspection. They all spoke positively about the care and treatment they received. Patient satisfaction surveys also showed patients were positive about the services.

• Patient consent was obtained prior to commencing treatment. Patients were kept involved in their care and staff provided emotional support when needed. Complaints about the services were resolved in a timely manner and shared with staff to aid learning.

• Services were planned and delivered to meet patient needs. The services were accessible through three clinical sites, outreach and education services. Services had flexible opening times which included evening and weekend clinics.

• There were systems in place to support vulnerable patients. Complaints about the services were resolved in a timely manner and information about complaints was shared with staff to aid learning.

• There was a clear governance structure in place with routine staff meetings and corporate level committees where the service’s risks and performance was reviewed. Key risks to the services were recorded and managed through the use of local and corporate level risk registers.

• There was visible local leadership. The registered manager was due to leave the organisation in February 2017 and a replacement service manager from one the provider’s other clinics had been identified to take over this role.

• Staff were positive about the culture within services and the level of support they received from the management team.

However, we also found the following issues that the service provider needs to improve:

• The majority of staff had completed mandatory training in topics such as basic life support, safeguarding and infection control. However, records showed none of the eligible staff had completed mandatory training for manual handling or fire safety. There were plans for staff to receive this training during March 2017.

• The failure of the electronic patient record system in December 2016 meant some historical patient information could not be fully retrieved. There were plans to implement a replacement electronic patient record system by April 2017.
• In most cases, staff could retrieve patient information through paper based records. However, 197 patients attending the service between 19 December 2016 and 26 January 2017 had to be reassessed with a new record because their historical records could not be located.
• The loss of the electronic system meant staff working in the outreach clinics could not easily identify if a patient had previously visited any of the service’s other clinics. Staff told us they relied on these patients to inform them of previous visits or treatments.

• Staff working at the outreach clinics experienced connectivity issues when working remotely (via laptops). This meant they had limited or no access to the provider’s electronic records systems, intranet based policies and other applicable documents.

• Medical staff working in the service did not routinely receive formal medical appraisal through the service.
• There were four incidents reported by the service between January 2016 and January 2017. Staff were able to describe the remedial actions taken to address these issues. However, two of the incident records were poorly documented and did not detail the investigation findings, define responsibilities and timelines for completing remedial actions or include documented evidence to show whether these actions had been completed.
• Staff did not always complete medication reconciliation logs correctly when removing medicines from storage. There were discrepancies in the medication logs indicating the actual medication stock did not reconcile with the recorded quantity.

• The identified concerns around medication reconciliation record errors and remote IT accessibility issues had not been formally reported using the incident reporting system. This meant there was no record of how often these issues had occurred or how to improve these.

• The service reported high staff sickness levels due to staff on long-term sick leave. This impacted in increased workloads for the remaining staff and an increase in patient waiting times during July 2016 to September 2016 compared with the previous nine months.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We have also issued the provider with two requirement notices that affected the sexual health services. Details are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals (North Region)