Isle of Wight NHS Trust is an integrated trust providing acute, ambulance and mental health services, and community health services. Community health services are provided to a population of approximately 140,000 people living on the Island. Services include community nursing teams, community rehabilitation teams, health visiting, school nursing, community equipment services and sexual health services. These services are provided across the Island in clinics, children’s centres and patient homes. Community inpatient services include general rehabilitation and stroke rehabilitation wards at St Mary’s Hospital.

We carried out this comprehensive inspection because the Isle of Wight NHS Trust is an aspirant Foundation Trust, prioritised by Monitor. The trust community services were inspected as part of the second phase of the new inspection process we are introducing for community health services.

The announced inspection took place between 3 and 6 June 2014, with an unannounced visit on 21 June, between 4pm and 11pm.

Overall, we rated the Isle of Wight NHS Trust community services as ‘requires improvement’. The trust was good for providing caring services. The safety, effectiveness, responsiveness and leadership of the services required improvement.

We rated community health services for children, young people and their families, community adult services, and community inpatient services as 'requires improvement'.

Key findings related to the following:

• There was a high level of patient satisfaction across community services. The majority of people commented on the caring and compassionate approach of staff . Staff were highly motivated and committed, and treated people as individuals.
• There was good multidisciplinary working, and initiatives to support people at home, and avoid admission to hospital. The trust had taken steps to improve access to appropriate services through the development of the Single Point of Access, Referral, Review and Co-ordination (SPARRCS ) team, which was based at the Integrated Care Hub. The Community Stroke Rehabilitation team worked towards specific rehabilitation objectives for patients, and facilitated early discharge from hospital.
• There were elements of good practice across a range of units and teams, but this was not consistent across all services. Some, but not all, teams were benchmarking themselves against other services and taking innovative steps to improve ways of working and productivity, but this needed to be implemented and embedded across all services.
• Staffing establishments were not sufficient in all areas, and there were ongoing challenges in recruiting staff. The arrangements to ensure a safe and consistent out-of-hours district nursing service needed to improve. We were concerned by insufficient medical and nursing staffing on the community inpatient wards, and this was a particular risk when there were inappropriate admissions of more acutely ill patients.
• Risk management systems were in place, and staff were fully aware of their responsibilities in reporting and in implementing new practice. However, the governance of risk management needed to be more robust at all levels of the organisation, as across all core services we found examples of incidents that had not been responded to promptly or adequately.
• The trust had an ongoing programme to improve access to and use of IT across community services, and connectivity issues were a known challenge. Where implemented, the IT system was still not fully functional, and incomplete electronic records created a risk.
• The trust had a statement of vision and values, but community services staff were not consistently aware of these. Local leadership of most community services at team level was good. But there was a disconnect between staff in community services, and the executive team and senior managers, and this impacted upon the culture within which front-line staff were being expected to deliver services. Staff perceived that the community services had a lower profile within the organisation than the acute services.

We have identified areas of outstanding practice. However, there were also areas of poor practice, where the trust MUST make improvements, and other areas of practice, where the trust SHOULD take action to improve. These are identified in this report.

Professor Sir Mike Richards

Chief Inspector of Hospitals

August 2014