Agenda item

CQC Inspection of Community Nursing Services in Harrow

Report of the Acting Director of Operations (Outer North West Division), Central London Community Healthcare NHS Trust.



Members received a report from Jackie Allain, the Acting Director of Operations NHS CLC and Samantha Howard, Divisional Director of Nursing and Therapies which provided an overview of the CQC’s findings following their inspection of the Community Nursing service in Harrow in October 2022, report of their findings published in December 2022 and the Trust’s planned action to meet the required areas for improvement.  The report had the following highlights:


Positive Findings


·                 Statutory and mandatory training uptake was high

·                 Staff were trained how to protect patients from abuse

·                 Infection risk was well managed and appropriate controls were in place

·                 Clinical waste was managed well by staff

·                 Staff took precautions and actions to protect themselves and patients

·                 Medicine storage and prescription systems/processes were in place

·                 Staff knew how and when to report patient safety incidents

·                 Managers investigated incidents and shared lessons learned

·                 When things went wrong staff apologised and gave suitable support

·                 Actions from patient safety alerts were implemented and monitored


Areas for Improvement


·                 The service did not have enough nursing staff

·                 All locality teams had high vacancies which put staff under pressure [CQC noted that staffing levels had recently been increased and that there was an active recruitment campaign]

·                 Records not always completed with enough detail

·                 Some handover meetings were brief and lacking in detail.

·                 Lack of leadership oversight on a case of neglect [which should have been reported to the local authority]

·                 Audits and supervised visits were not occurring regularly

·                 Capacity decisions were not consistently documented

·                 Referrals for potential neglect not always made to the local authority


Inspection Outcome


·                 The rating in the ‘Safe’ domain for Community health services for adults had changed from ‘Good’ to ‘Required Improvement’

·                 The overall rating for the core service remained ‘Good’

·                 The overall rating for the Trust remained ‘Good’

·                 The full report can be viewed at:


CQC Recommendation Plans


Must Do


·                 ensure that clinical documentation was completed in sufficient detail in the Harrow community nursing teams

·                 ensure that clinical documentation was completed in sufficient detail in the Harrow community nursing teams


Should Do


·                 ensure that all handovers include all necessary key information to keep patients safe.

·                 ensure that formal assessments of patients’ capacity were appropriately recorded.

·                 ensure staff report safeguarding concerns to the local authority when they were required to do so.


Members asked the following questions:


A Member asked about the challenge with “handovers” and why comprehensive information was not being handed at the end of a shift.


The director explained that it was due to staff shortages.  A Member advised that in addition to a verbal handover, staff could check the notes to ensure that vital information was not missed out during the handover process.  The director explained that a template had now been given to staff to ensure that the information needed is captured and handed over at the end of a shift.


A Member asked about current vacancies and staff shortages.  The director explained that some teams had up to 40% vacancy on training nurses.  There was a huge shortage of qualified district nurses across all organisations. CLCH had removed a specific nursing qualification as essential recruitment criteria.  This had helped fill five out of six vacancies.  Also, the international recruitment had helped alleviate the shortage and fill vacancies.  A grant from Aging Well had helped finance more agency nurses.


A Member asked how to be certain that what was listed in the Must Do criteria of the report had been done.  The Director explained that an action plan had been submitted to the CDC to address the issues raised in the report.  The action plan had measurable actions that would be internally monitored through a quality action team and discussed at monthly meetings with the CDC.


A Member asked why the inspection outcome was designated as “good” with the number of highlighted needed improvements.  The director explained that the inspection in October was around “Safe Domain” but an LED inspection which was different from CQC’s perspective was expected for the whole organisation.


A Member asked for further explanations about the lack of leadership oversight.  The comment was clarified by officers, the observation referred to senior management and how that cascaded through the organisation, and it noted that the report had acknowledged that staff morale was not low.  Another Member suggested that an updated report on the progress made on the issues highlighted especially around leadership and staff shortages be presented to the committee after the June deadline (for addressing issues raised in the report) in November.


The Chair commended the positive sections of the report and asked if the identified areas for improvement such as handover, had any impact on patient safety.  It was explained that patient safety was heavily monitored through patient safety and risk groups, a quality forum and a 48-hour meeting.  The 48-hour meeting was called immediately after an incident to establish facts and get to the root cause of the issue, what went wrong and could have done better with action plans and any future action taken was monitored and measured against action plans and closure dates.


A Member expressed concerns that the issues highlighted in the report were already identified before the inspection, but no action was undertaken to address them until the inspection, and they wondered if there were other sections of the service where this was currently happening.


A Member asked if there were any safeguards in place for nurses visiting the communities alone.  It was explained that all nurses had an alarm that when activated goes to the control centre at Epsom where the Police is alerted.  A red card system was also in place for patients who were continually being abusive or were continually doing things that were not acceptable.  They would be informed that services would no longer provided until set conditions put into place to help support staff were met.  Additionally, there was a set process for safeguarding supervision.


RESOLVED:  That the report be noted.

Supporting documents: