Archived: The Horizon SARC

Background

Mountain Healthcare Limited (MHL) provides sexual assault referral centre (SARC) services in different parts of the country. NHS England has commissioned MHL to provide the ‘West Midlands Children and Young Person Sexual Assault Service’ for children who live in the West Midlands geographical area covering 14 local authorities and four police forces. This SARC provides forensic medical examinations and some related health services for children aged under 18 who have experienced sexual assault or abuse. This service is registered with CQC as The Horizon SARC. We have referred to children who use the service as ‘patients’ predominantly in this report.

The service is provided from five sites based on a ‘hub and spoke’ model. The principal, or ‘hub’ site is The Horizon SARC in Walsall where the provider retains patients’ records; the hub site is the location registered with CQC. There are four ‘spoke’ sites; Grange Park SARC in Stoke-on-Trent, The Glade SARC at Bransford in Worcester, the Blue Sky Centre in Nuneaton and a facility at the Birmingham Children's Hospital. The latter site had been closed since the beginning of restrictions arising from the COVID 19 pandemic and so was not included in our inspection. Each of these sites is controlled by the provider of the adult SARC service for the areas in which they are situated; G4S Health Services (UK) Limited (G4S). We have separately inspected and reported on the services provided by G4S from those locations

The Horizon SARC is available for patients who report sexual abuse or assault that occurred on a ‘recent’ basis (within the previous 21 days) or on a ‘non-recent’ basis (outside that timeframe). All patients who report a recent assault or abuse visit the Walsall site for their examination and this is accessible 24 hours each day. Patients who report a ‘non-recent’ assault or abuse can visit a daily clinic at whichever of the Walsall, Stoke, Bransford or Nuneaton sites is most convenient for them. The non-recent service rotates from site-to-site each day and is accessible between 9am and 5pm Monday to Friday by prior appointment.

All patients may be referred through safeguarding procedures or may be brought by the local police. Patients aged 13 and over may also choose to refer themselves subject to certain safeguards as set out later in this report. Patients aged 16 and 17 can also choose to use the adult SARC service for the area they live in.

The service is also available for young adults with complex needs up to the age of 25 although none of the patients who had used the service since May 2020 were over the age of 17.

The service is accessible for both patients and professionals through the provider’s 24-hour single point of access known as the ‘Pathway and support service’.

All patients see a crisis worker and a sexual offence examiner when they attend the service. G4S are sub-contracted to MHL to provide crisis workers for the children and young person’s service and to work alongside MHL sexual offence examiners using MHL procedures.

Patients under 13 years of age who have experienced either recent or non-recent abuse are seen by doctors known as forensic medical examiners (FME). FMEs also carry out all examinations of patients aged 13 and over who have reported non-recent sexual assault.

All FMEs are part of a rota that covers The Horizon SARC as well as the rotas that cover other SARC locations run by MHL. Six of the 11 FMEs who are on the Horizon SARC rota are members of the Faculty of Forensic and Legal Medicine of the Royal College of Physicians (the FFLM).

Patients aged 13 and over who have experienced recent sexual assault are seen by forensic nurse examiners (FNE). There are five members of the FNE team that work solely at this SARC.

The SARC refers all patients to children’s independent sexual violence adviser (ChISVA) services provided by a local advocacy and advice organisation following their initial examination. Patients are also referred to therapeutic and counselling services where this is required.

The service is also commissioned to provide sexually transmitted infection (STI) screening for all patients who use the SARC aged under 13 in the West Midlands area. The service refers all other patients aged 13 and over to local genitourinary medicine (GUM) and sexual health services in the area where they live.

As MHL are a limited company, they must have a manager registered with the Care Quality Commission as part of the conditions of their registration. Registered managers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the provider runs the service. The registered manager for this service is the organisation’s medical director who is also part of the MHL senior leadership team. However, a centre manager, who is part of the FNE team, conducts the day-to-day management of the SARC.

During the inspection we spoke with the provider’s senior leadership team that have overall responsibility for the service, including the registered manager. We also spoke with two of the FMEs, three of the FNEs (including the centre manager) and one of the crisis workers.

We carried out visits to the Walsall hub site and each of the spoke sites at Bransford, Stoke and Nuneaton to review the environment and facilities for patients. We also looked at the policies and procedures that staff use at the SARC.

We reviewed the records of eight of the patients who had used the service since May 2020, and we left comment cards at all four sites in the two weeks prior to our visit.

Our key findings were

• Staff knew how to deal with emergencies and appropriate medicines and life-saving equipment were available.
• The physical environment was clean, well maintained, and staff used infection control procedures which reflected published guidance.
• The provider operated safe staff recruitment procedures.
• The clinical staff provided patients’ care and treatment in line with current guidelines except where we have set out below.
• Staff treated patients with dignity, respect and compassion and took care to protect their privacy and personal information.
• The single point of access referral system met patients’ needs.
• Staff received a range of specialist training for their role, felt well-supported and worked together as a team.
• The provider learned lessons from positive, adverse and irregular events.
• The service asked staff and patients for feedback about the services they provided.
• The staff complied with appropriate information governance arrangements.

We identified regulations the provider was not meeting and have issued warning notices under section 29 Health and Social Care Act 2008. The provider must:

• Carry out, and document, comprehensive assessments of patients to enable staff to provide safe care and treatment to meet their needs.
• Improve the way staff are enabled to identify and respond to potential safeguarding risks.
• Improve the arrangements for assessing and monitoring the quality and safety of services for patients.

Full details of the regulation/s the provider was not meeting are at the end of this report.

We identified areas where the provider should make improvements. The provider should:

• Demonstrate the involvement of patients in their assessments by ensuring that children’s voices are better represented in documentation.
• Take steps to develop the website for the service so that it presents consistent information about how to access the service.