Saint Mary's Hospital

We carried out this announced inspection of Saint Mary’s Sexual Assault Referral Centre (SARC) over three days on 7, 8 and 9 September 2021 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection to check whether the registered provider was meeting the legal requirements in the Health and Social Care Act 2008 and associated regulations. Four CQC inspectors carried out the inspection. To reduce the risks presented by Covid-19, we used a combination of remote and face to face interviews.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?

• Is it effective?

• Is it caring?

• Is it responsive to people’s needs?

• Is it well-led?

These questions form the framework for the areas we look at during the inspection.

Background

Saint Mary’s sexual assault referral centre (SARC) is located within Saint Mary’s Oxford Road Hospital grounds with discrete sign posting. Patients are always met and accompanied to the suite by a staff member. The SARC is in an old building, access for anyone using a wheelchair needs to be managed, as there is no lift directly to the centre on the first floor of the building. Staff assist patients to the suite via the main hospital. There is parking available on site for patients although it is limited.

The SARC services are a directorate of Saint Mary’s Hospital Manchester which is a managed clinical service within Manchester University NHS Foundation Trust (MFT).

Saint Mary’s SARC commissioning contracts are managed by the police and NHS England and Improvement (NHSE/I). They commission Saint Mary’s SARC to provide a forensic service to all genders and all ages. People who access the service who live in Greater Manchester (GM) or have been sexually assaulted in GM also access aftercare services there. We will explain the aftercare services further on in this report. Saint Mary’s is commissioned to provide a forensic medical service to Cheshire residents and those patients are referred to local services for aftercare.

Patients accessing the SARC can be referred by professionals or self refer, although children under 14 years of age must be referred by children’s social care or police . Aftercare at Saint Mary’s SARC includes advice regarding sexually transmitted infections (STI), specific paediatric STI clinics, access to crisis support workers, independent sexual violence advisors (ISVA’s) and counsellors. The staff group are multi-disciplinary and are made up of forensic physicians, crisis support workers (CSW), ISVAs, a counselling team, administrative support and a children’s team. The children’s team consists of ISVA's, counsellors and a young person's advocate who specialises in child sexual exploitation.

There are three forensic examination rooms. Each of these has access to a forensically cleaned bathroom and waiting room. There are additional comfortable waiting areas and suitable rooms for counselling services.

There are 22 forensic physicians that undertake forensic examinations at the SARC. They are from a range of specialisms that cover general practice, paediatric and child health and obstetrics and gynaecology. SARC leaders appreciated the different skills and partnership benefits that the forensic medical examiners (FMEs) brought and they felt this contributes to good patient outcomes. Most FMEs have completed the Forensic Medical Examination in Rape and Sexual Assault (FMERSA) course and over half are members or fellows of the Faculty of Forensic and Legal Medicine (FFLM). Some FMEs teach on the FMERSA and some of those are examiners on the course.

MFT is responsible for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

During the inspection we spoke with nine staff. We looked at policies and procedures and other records about how the service is managed. We reviewed comments cards that we had asked patients to complete to get their feedback on the service.

Throughout this report we have used the term ‘patients’ to describe people who use the service to reflect our inspection of the clinical aspects of the SARC’.

Our key findings were:

• The service had systems to help them manage risk.
• The staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• Staff identified vulnerable patients and those assessments informed aftercare.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The appointment/referral system met clients’ needs.
• The service had effective leadership and a strong culture of continuous improvement.
• Staff felt involved and supported and worked well as a team.
• The service asked staff and clients for feedback about the services they provided.
• There were suitable information governance arrangements.
• The service appeared clean and well maintained.
• The staff had infection control procedures which reflected published guidance.

There were areas where the provider could make improvements. They should:

• Be assured that the frequency of Disclosure and Barring Service (DBS) checks is proportionate to the work that SARC staff deliver