Archived: Dacorum Holistic Healthcare Team

Dacorum Holistic Healthcare Team was established by Dacorum GPs to deliver a fully integrated service to patients combining health, social care and mental health care. This is a local service for the population of Dacorum in Hertfordshire.

Following the inspection, CQC were advised that the provider is now operating solely under the parent name of Dacorum Healthcare Providers Limited from it's offices at Unit 16, Sovereign Park, Cleveland Way, Hemel Hempstead HP2 7DA.

The Team focuses on the physical, social and mental health needs of patients over the age of 18 years, referred to the service by Dacorum GPs.

This was the first inspection of the service. We rated it as good because:

• Mandatory training compliance was at 91% at the time of the inspection. The mandatory training was comprehensive and met the needs of patients and staff. Staff were encouraged to access additional specialised training which was relevant to their role.
• We reviewed ten patient risk assessments during the inspection. Staff completed risk assessments for each patient on referral into the service using a recognised tool, and reviewed this regularly, including after any incident.
• Managers investigated incidents thoroughly. Patients and their families were involved in these investigations. We saw evidence of statements being taken as part of the investigation process.
• Staff followed up-to-date policies to plan and deliver high quality care according to best practice and national guidance. We found that the service had the expected range of policies and followed guidance in several areas, including antipsychotic and analgesics overprescribing – reducing and monitoring.
• Managers and staff carried out a comprehensive programme of repeated clinical audits to check improvement over time. Pharmacists worked on stopping overmedication of patients with a learning disability, autism or both. There were audits to monitor and reduce the antipsychotic medication prescribing.
• We spoke with ten patients and three carers during the inspection. Overall, the feedback was positive, with the clinic staff thought of as caring, compassionate and interactive when dealing with service users and carers.
• Staff supported patients to make informed decisions about their care. We saw evidence of this in patient records which showed person centred goals which were a clear reflection of the patient’s voice. Staff that we spoke with were committed to supporting patients to lead on their recovery.
• The service relieved pressure on the GP and other departments when they could treat patients in a day. A key focus for the service was to treat patients more quickly as the GP surgeries often lacked capacity to offer prompt appointments.
• Managers investigated complaints and identified themes. We carried out a review of the three complaints that had been received over the last twelve months. They had all been acknowledged, investigated and outcomes sent within policy timescales.
• There was compassionate, inclusive and effective leadership at all levels. Leaders had the skills knowledge and experience to consistently deliver high quality personalised care. Leadership development was embedded into the service and there was a strong culture of staff development across all levels of service.
• Staff that we spoke with were very proud of the service and spoke highly of colleagues and managers at all levels.

However:

• The supervision policy said that staff should receive supervision every three months, but data showed that they were not compliant with this and management oversight of this was not sufficiently robust. Compliance with supervision was at 68%.
• There were no clear key performance indicators for the service. It was therefore difficult to measure the success of the service. Managers needed to develop benchmarks and key performance indicators to monitor the service.
• There was a lack of formal strategy and no vision and values. Staff could not say anything about the vision and values across the organisation. There was a lack of monitoring of the service and managers could not monitor whether staff were working to the vision and values of the organisation.
• There were no leaflets or leaflets in different languages which would have been helpful for patients and carers. Management had a lack of oversight of this issue and this could impact on patients’ accessibility to the service and the performance of the organisation
• Access to the interpreter service was not being utilised as it could have been. Patients should have always been given the option to have an interpreter to maintain independence and confidentiality.