Wirral Community NHS Foundation Trust Also known as Wirral Community Health and Care NHS Foundation Trust

Updated 13 December 2023

Wirral Community NHS Foundation Trust provides a range of primary, community and public health services to the populations of the Wirral, parts of Cheshire, St Helens and Knowsley. The trust works in partnership with other providers in the local health and social care economy to provide care to the communities it serves. Wirral Community NHS Foundation Trust became a foundation trust on 1 May 2016.

​​The trust serves a population of approximately 693,700 residents across 145,000 households. They employ approximately 1,814 staff, 90% of which are patient-facing. In 2022-23 turnover was £116m. Staff work across over fifty sites; their main locations are St Catherine’s Health Centre, and Victoria Central Health Centre on the Wirral. In May 2023, 11,995 referrals were received for 8,765 persons needing care and 60,460 care contacts were completed with 20,400 patients.

They have an established and stable Executive and non-executive team.

​ ​Wirral Community NHS Foundation Trust operate from six locations as well as offering services within people’s homes.

• St Catherine’s Health Centre (Trust Headquarters)
• Victoria Central Health Centre
• Arrowe Park Hospital
• Eastham clinic
• Leasowe Primary care Centre
• Clatterbridge Hospital

The trust has eight core services across community health. They registered their first inpatient adult community wards in April 2020 at the Clatterbridge location (3 wards – 73 beds). Additionally, they have recently acquired two new 0-19 service for Knowsley and St Helens.

Core services covered:

• Community health services for adults
• Community health services for children and young people
• Community end of life services
• Community dental services
• Urgent Care
• Sexual health
• GP Out of hours service
• Community Inpatients

We carried out short notice (24 hours) inspections of three of the core services. We also inspected the well-led key question for the trust overall.

We inspected the community inpatients core service; this core service had not previously been inspected. We also inspected community health services for adults and community sexual health services to monitor their progress following their previous inspection in 2018.

We did not inspect the out of hours provision, urgent care, dental services, community end of life services and community health services for children and young people. This is because we have not received any information of concern since our last inspection of these services. We will continue to monitor them and will re-inspect them as appropriate.

Overall Summary

Our rating of the trust improved. We rated it as good because:

• There had been significant improvements especially regarding governance and information management since our last inspection.
• In rating the trust, we considered the current ratings of those services not inspected at this time.
• The trust had an experienced leadership team with the skills, abilities, and commitment to provide high-quality services. They recognised the training needs of managers at all levels, including themselves, and worked to provide development opportunities for the future of the organisation.
• The board and senior leadership team had set a clear vision and values that were at the heart of all the work within the organisation. They worked hard to make sure staff at all levels understood them in relation to their daily roles.
• The trust strategy was directly linked to the vision and values of the trust. The trust had a clear five-year plan to provide high-quality care with financial stability.
• The trust had a clear structure for overseeing performance, quality and risk, with board members actively aligned to services across the organisation. This gave them greater oversight of issues facing the service and they responded when services needed more support. The board reviewed performance reports that included data about the services, which directors could challenge.
• The trust had effective information systems to consistently collate, analyse and present information. The information was timely, reliable and accessible to all levels of the organisation which meant they could identify risks, challenges and support effective decision making. They were able to access data at neighbourhood level enabling effective risk stratification.
• Staff across the organisation felt respected, supported and valued. They remained focussed on the needs of patients receiving care. Staff felt listened to and able to raise concerns if needed.
• The trust made sure that it included and communicated effectively with patients, staff, the public, and local organisations.
• The trust was committed to improving services by learning from when things go well and when they go wrong, promoting training, research and innovation.

However:

• The trust board recognised there was further work required to improve equality and diversity across the trust and at board level.
• Although response rates were similar to other community trusts, the NHS Staff Survey 2022 showed the trust scored equal or below the average in all themes compared against 16 other community trusts.
• The trust did not have a strategy for meeting the needs of patients with a mental health, learning disability, autism or dementia diagnosis. There was no formal lead with the responsibility for ensuring these patients received the specific care required.
• The trust governance processes in the community inpatient service did not always ensure staff followed systems and processes to make sure that medicines with a minimum dosage interval were administered as prescribed and monitor the use of thickeners to ensure national guidance was followed.

How we carried out the inspection

Before the inspection visit, we reviewed information that we held about the trust. During the inspection visit, the inspection team:

• visited 9 sites where staff delivered care including all 3 inpatient wards,
• spoke with 116 members of staff,
• spoke with 28 people using the trust’s services,
• spoke with 8 carers or relatives of people using the trust’s services,
• reviewed 29 care records including medicines administration charts,
• observed several meetings including the trust’s board meeting,
• held 7 focus groups with staff, non-executive directors and governors,
• held 2 focus groups with patient representative groups,
• sought feedback from a range of stakeholders including health watch and commissioners,
• and reviewed the trust’s process for fit and proper persons employed.

The inspections of the trust’s core services were led by a CQC operations manager and supported by 5 CQC inspectors, 1 CQC medicines inspector, 1 CQC regulatory officer, 3 specialist professional advisors and 1 expert by experience.

The inspection of the well-led key questions was led by a CQC Deputy Director of Operations and supported by an operations manager, one CQC inspector, one CQC medicines inspector and 1 CQC regulatory officer. The team also received support from four specialist professional advisors and executive reviewers with a background and experience in NHS senior management.

You can find further information about how we carry out our inspections on our website: www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

What people who use the service say

Community inpatients

Patients, family members and carers spoke positively about the service. They told us staff treated them well with compassion and kindness. They described staff as like family who met their needs well and cared about them. A carer who regularly visited to provide pastoral care, described staff as consistently excellent.

Community adults

Feedback from patients, family and carers was very positive. They described staff as caring, friendly, and supportive. They told us they went above and beyond to care for them. They said they were ‘brilliant’ and that they felt able to contact them at any time.

Patients told us they felt safe. They said staff were careful when performing physical interventions and gave them reassurance about any anxieties they had about their treatment. They observed that staff were very professional and said they had complete confidence in the procedures they performed.

Patients told us they felt staff listened to them and were responsive to their views and wishes. They described how staff gave them advice on their care and treatment in an accessible and clear manner. This included explaining the nature, purpose, and side effects of medicines.

Feedback about appointment and waiting times was positive. Patients told us staff arrived on time and that missed appointments were rare. Patients told us staff were flexible about appointment times and tried to arrange these at a time that was convenient for them.

Patients told us staff routinely sought their consent prior to treatment. They also said that staff always respected their privacy and dignity, and that care and treatment was performed in the least restrictive or invasive way.

Patients said they knew how to complain and who to contact if they wished to do so. None of the patients we spoke with told us they had made a complaint or that they had any reason to do so.

Community sexual health services

Feedback from people described staff as helpful, knowledgeable, and supportive. People reported that the health huddles were safe environments with a relaxed atmosphere. They said sessions were informative and that staff were able to bust myths around various topics.

People from the BAME community reported learning about contraceptive and that they felt more informed to make a choice. They felt comfortable and relaxed during talks and learning more about cervical screening.

People consistently said that staff were helpful, and that reception and admin staff were welcoming and put them at ease. They reported that there was consistency with clinical staff during appointments and that there was good follow up from doctors.

Trustwide

We reached out to the trust’s stakeholders to give feedback for the inspection.

We received feedback from commissioners and from Healthwatch.

Stakeholder feedback was consistently positive. They worked collaboratively to develop strategies, for example developing a safe and effective workforce that felt valued and supported. Commissioners had observed caring and compassionate practice delivered with knowledge and professionalism.

They reported that the trust worked hard with dedication to ensure contracts were fulfilled. We were told that they believed the leadership and care exhibited, placed the best interests of the people they supported at the centre of everything they did and that they would often go above and beyond their contractual obligations to deliver an inclusive and effective service.

We were told that members of the executive team were active partners within the Wirral Health and Care partnership undertaking both local and national roles.

Updated 13 December 2023

Updated 6 July 2018

Our rating of this service stayed the same. We rated it as good because:

• Throughout the service staff were caring and passionate about providing good quality services to children, young people and families. Staff spoke with enthusiasm about their roles and specialties and demonstrated dedication to improvement and innovation.
• Staff were suitably qualified with the right skills and experience in order to deliver safe and effective care. The service ensured that there were enough staff to keep people safe from harm and protected from abuse.
• The service planned care effectively with external providers to create and implement care plans which were individualised and took into account the specific needs of individuals.
• Leaders and senior managers within the service engaged with staff in order to shape and improve services. This led to the implementation of bespoke services which better met the needs of the local population and improved morale among staff who felt that their opinions were listened to.
• The strategy of the service was aligned with cost improvement planning. Staff at all levels were clear that cost improvement could not be made to the detriment of service quality or safety.
• Talent mapping had been used as part of staff appraisals in order to provide development opportunities for staff who wished to progress in their careers. This meant that staff in leadership roles were passionate and enthusiastic.
• The culture of the service was focussed around the experiences of people using the services. Staff actively sought feedback from children, young people and families in order to shape and improve services.

However:

• Leadership structures within the service were in their infancy at the time of our inspection. This meant that while areas for improvement had been identified by senior leaders, there had not been time for effective change to have taken place.
• A recent workforce review had been completed without the input of staff with specialist knowledge of the service. This meant that the review findings were not always applicable to the service and time was taken to complete further contextual work in order to develop meaningful recommendations with regards to workforce planning.
• Risks to patient safety were not always identified and acted upon in a timely way. The special school nursing team had been working without policies tailored to care of children with complex needs within the community setting for a number of years.

Updated 11 November 2014

Wirral Community Trust provides a dental service for all age groups who require a specialised approach to their dental care and to those who are unable or do not have access to a General Dental Practice.

The service provides oral health care and dental treatment for children and adults that have an impairment, disability and/or complex medical condition. It also provides a service to oncology patients with head and neck cancer requiring radiotherapy and, a sedation service in selected clinics.

We visited all five dental service locations.  We spent time talking to with patients, observing the care and treatment they received.  We spoke with staff including dentists, nurses and managers.

We considered this to be an exemplary service with robust systems for identifying, investigating and learning from patient safety incidents and a strong emphasis within the service on reducing harm or prevent harm from occurring.  Services were very effective, evidence based and focussed on the needs of the patients. Patients, families and carers felt well supported and involved with their treatment plans.  Staff displayed high levels of compassion, kindness and respect at all times.  The service was responsive to people’s needs and people from all communities could access treatment. Staff were forward thinking and innovative in their approach.

Updated 13 December 2023

Updated 11 November 2014

The overall rating for this service was good.

The Wirral Specialist Palliative Care(SPC) /End of Life Care Team was established to ensure that systems and processes were in place as identified within the National End of Life Care Strategy (DH, 2008). They facilitated the delivery of high quality end of life care. End of life care helped all those with advanced, incurable illness to live as well as possible until they died. The team offered advisory support to both the patient and family throughout the last phase of life and into bereavement.

During the inspection we spoke on the telephone with six patients in their own home. We met and spoke with four patients and their carers living in the community and we spoke with six patients receiving day care in Wirral Hospice St Johns. We received overwhelming positive feedback from patients and relatives. They all told us they were appreciative of the support and care shown to them and their families. Patients and their informal carers told us they liked having the contact and lifeline with the nurses and the team of staff.

A telephone triage system had been introduced and proved successful. The system whereby a nurse received all the referrals and ensured a visit by one of the team was arranged within two working days for patient support in community settings and four hours for those in hospital.

All palliative care patients diagnosed as being in the last year of life were commenced on an advanced care plan in the form of a patient and carer assessment, Patient And Care Assessment (PACA). The PACA was a comprehensive, holistic assessment which was in place to record the changing needs of patients and carers and their individual preferences. In their advisory role the SPC team supported patients to be pain free. They promoted the use of anticipatory prescribing to ensure analgesia was available when necessary.

On average each nurse had 20 to 25 patients on their case load at any one time. They saw approximately six patients per working day. Since April 2014 the team had been adopted by Macmillan, including the social worker, occupational therapist, physiotherapist and the administration staff.  Since registering with Macmillan, the team had benefitted from professional development and the provision of on-going education and advice.  

Multi-disciplinary Team (MDT) meetings were held weekly to discuss individual patient care . MDT meetings enabled co-ordination, communication and education. We saw that day centre facilities were available to support community patients at Wirral Hospice St John’s. We met and spoke with patients at the day centre. The patients told us the care and support was excellent; faultless.

We heard and read many examples of the team offering exemplary compassionate and heartfelt care.

Survey questionnaires were given to patients and families when in contact with the specialist palliative care team. Although the team received a wealth of praise and recognition for their work the questionnaire return was poor. The staff felt this was due to the grieving process.

Updated 6 July 2018

Our rating of this service stayed the same. We rated it as good because:

• Staff were caring and passionate about providing good quality services to people using the urgent care service. Staff spoke with enthusiasm about their roles and demonstrated dedication to providing timely and effective care.
• Staff were suitably qualified and had most of the right skills and experience in order to deliver safe and effective care. The service ensured that there were enough staff to keep people safe from harm and protected from abuse.
• The service sought to improve the efficiency and quality of community urgent care by developing pathways for patients with minor fractures and suspected deep vein thrombosis without the need for referral to the acute trust.
• The staff we spoke to understood their responsibilities to raise concerns, record safety incidents and near misses and knew how to report these. However they were less familiar with the duty of candour.
• People’s care and treatment was planned and delivered in line with current evidence-based guidance, standards and best practice. We saw that clinical guidelines followed national guidelines and clinical practice was monitored for compliance and consistency.
• The average percentage of all cases triaged September to December 2017 within 30 minutes was 88%. This was below target (95%) but improvement plans were in place to increase the flexibility of nursing roles to improve patient flow.
• There was an effective governance structure in place and a systematic approach to monitoring, reporting and improving the quality of care.

However:

• There were arrangements in place to identify, record and manage risks, but not all risks raised by staff and managers were recorded on the register.
• We had concerns relating to the quality of paediatric life support training and the number of staff trained in it and there was a lack of assurance that competence in cardiopulmonary resuscitation skills was assessed according to the Resuscitation Council standard.
• In urgent care 77% of qualified nursing staff had completed the appropriate level of adult safeguarding training. This was below the trust’s target of 90%. Staff also demonstrated a lack of awareness of mental capacity assessment.
• Systems to manage patient group directions needed strengthening. There was insufficient assurance that all nursing staff received regular clinical reviews.
• Patients gave us a mixed response about the level of privacy experienced at the walk in centre reception desks.
• Facilities for children in each walk in centre waiting room were limited. At each site, parents told us they felt there was little to occupy children while they waited.
• We were unable to evidence regular team meetings took place for walk in centre staff, that divisional management attended or that there was a standard communication mechanism such as a newsletter, when meetings could not take place.
• There was a lack of evidence that the voices of all staff were heard and acted upon around skill mix, working extra hours and access to in-house training. Managers were aware of these concerns but it was not clear what progress was being made to resolve these issues.

Updated 13 December 2023