26 April 2022
During an inspection looking at part of the service
We carried out an announced focused inspection of Sheridan Teal House on 26 April 2022. We undertook this inspection as part of a system-wide inspection looking at a range of urgent and emergency care providers in West Yorkshire. This was an unrated inspection.
A summary of CQC findings on urgent and emergency care services in West Yorkshire
Urgent and emergency care services across England have been and continue to be under sustained pressure. In response, CQC is undertaking a series of coordinated inspections, monitoring calls and analysis of data to identify how services in a local area work together to ensure patients receive safe, effective and timely care. We have summarised our findings for West Yorkshire below:
West Yorkshire.
Provision of urgent and emergency care in West Yorkshire was supported by multiple provider services, stakeholders, commissioners and local authorities.
We spoke with staff in services across primary care, integrated urgent care, community, acute, mental health, ambulance services and adult social care. Staff continued to work under sustained pressure across health and social care and system leaders were working together to support their workforce and to identify opportunities to improve. System partners worked together to find new ways of working, linking with community services to meet the needs of their communities; however, people continued to experience delays in accessing care and treatment.
During our inspections, some staff and patients reported difficulties with providing and accessing telephone appointments in GP practices. Some of these issues were caused by telephony systems which were being resolved locally. We found inconsistencies with triage processes in primary care which could result in people being inappropriately signposted to urgent and emergency care services. However, a number of staff working in social care services reported good engagement with local GPs.
We visited some community services in West Yorkshire and found these were generally well run. Service leaders were working collaboratively to identify opportunities to improve patient pathways across urgent and emergency care. These improvements focused on meeting the needs of local communities and alleviating pressure on other services. There were strong partnerships with social care and community teams, so patients had the right support in place on discharge.
However, we inspected one intermediate care service and found it could only take referrals from an acute trust, which meant there were no step-up facilities for patients in the community. The service struggled for ward space to deliver therapeutic activities and there were no communal spaces for patients to meet together or engage in group therapy. Plans were in place to provide additional facilities and to reconfigure the existing layout to provide communal spaces.
The NHS111 service was experiencing significant staffing challenges and were in the process of recruiting a high number of new staff. Staff working in this service had experienced an increase in demand, particularly from people trying to access dental treatment although a system was in place to manage the need for dental advice and assessment. Due to demand and capacity issues, performance was poor in some key areas, such as providing a call back to patients from a clinician.
The ambulance service had an improvement programme in place focused on performance and staffing. Whilst we saw some improvement in ambulance response times and handover delays, performance remained below target. We identified impact on other services due to the availability of 999 responses; for example, a maternity service had to close temporarily to keep women safe, due to system escalation and because ambulance responses couldn’t be guaranteed in an emergency. Staff working in social care services also experienced lengthy delays in ambulance response times which further impacted on their ability to provide care to their residents.
We inspected some mental health services in Wakefield which were delivering person-centred care and responded to urgent needs in a timely way. Staff worked in multi-disciplinary teams and collaborated with system partners.
People’s experiences of Emergency Departments were varied depending on which service they accessed. Some Emergency Departments had long delays whilst others performed relatively well. In services struggling to meet demand, patient flow was a key factor. Poor patient flow was primarily caused by delays in discharge with a high number of people fit for discharge unable to access community or social care services.
Staff working in some social care services reported significant challenges in relation to unsafe discharge processes, this included a lack of information to support their transfer of care and we were told of examples when this resulted in people having to return to hospital. Local stakeholders had a good understanding of this problem and were looking to improve pathways and discharge planning.
Staffing and capacity issues in both care homes and domiciliary social care services have at times impacted on timely and safe discharge from hospital.
We found services were under continued pressure and people experienced difficulties accessing urgent and emergency care services in West Yorkshire. System and service leaders across West Yorkshire were working together to seek opportunities for improvement by providing services and pathways to meet people’s needs in the community; however, progress was needed to demonstrate significant improvement in people’s experience of accessing urgent and emergency care.
At the inspection of Sheridan Teal House we found:
- Systems were in place to manage risk so that safety incidents were less likely to happen.
- The provider routinely reviewed the effectiveness and appropriateness of the care provided and ensured that care and treatment was delivered according to evidence- based guidelines.
- Performance was closely monitored by the provider. Most key indicators relating to out of hours, and urgent and emergency treatment services showed performance in line with national and local targets. However, the proportion of patients receiving a face-to-face consultation within their residence according to assessed need was outside the agreed target of 95% in some cases. Results for March 2022 showed:
- 28.4% of patients assessed as requiring a face-to-face consultation within their residence within 1 hour actually received this consultation within this timescale.
- 84.4% of patients assessed as requiring a face-to-face consultation within their residence within 4 hours actually received this consultation within this timescale.
- 93.9% of patients assessed as requiring a face-to-face consultation within their residence within 8 hours actually received this consultation within this timescale.
- The provider had an understanding of the challenges faced by their service. This included meeting patient demand to adhere to national and local targets, and workforce planning including meeting staffing levels.
- Staff working at the service had the information they needed to support consistent and safe management of patients’ health needs. Care was coordinated with others, and information sharing processes with other health and care partners were in place.
- The service had an overarching governance framework in place, including policies and protocols.
- There was a strong focus on continuous learning and improvement at all levels of the organisation.
- The provider delivered additional services such as NHS 111 Online Emergency Department Validation which sought to reduce unnecessary presentation to Emergency Departments. Of the cases assessed and validated in March 2022 only 17.7% of patients were referred to an ED or directly admitted to hospital.
Whilst we found no breaches of regulations, the provider should:
- Continue to monitor delivery against key performance indicators, and plan mitigating actions to ensure national standards and local targets are met.
Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care