Derbyshire Community Health Services NHS Trust Head Quarters (HQ) is based at Newholme Hospital in Bakewell, Derbyshire. It was first registered with CQC on 31 March 2011 to provide the regulated activities: Diagnostic and screening procedures, Family planning, Nursing care, Surgical procedures, and Treatment of disease, disorder or injury.

The Trust delivers a variety of community services from its Head Quarters across Derbyshire and in parts of Leicestershire, including community nursing and therapies, urgent care, rehabilitation, care of people with a learning disability, services for children and families, end of life care, podiatry, dental services, outpatients and day case surgery.

Head Quarters (HQ) was inspected by the CQC in 2013. We found the provider was not meeting the essential standard, respecting and involving people in their care. At this inspection in 2014, we found the provider was now meeting this standard. We inspected Buxton Hospital minor injury unit twice in 2013. At the last inspection in July 2013 we found the provider was not meeting the essential standard, supporting workers. At this inspection in 2014, we found the provider was now meeting this essential standard, and the findings of the inspection are reported here under minor injury units.

We inspected the following core services:

• Community services for children and families
• Community services for adults with long-term conditions
• End-of-life Care

We also inspected:

• Learning disability services
• Minor injury units
• Dental services
• Elective care services

Patients were overwhelmingly positive about the care and treatment they received. Patients were routinely viewed as partners in their care and decision making was personalised to meet their short and long term needs. However, in some services care plans were not always sufficiently detailed and there were not always the right risk assessments in place to promote people’s welfare and safety.

Patients and their families were treated with compassion and respect, and were involved in their care and well informed. There was a focus on promoting independence and self-management.

Care and treatment was safe because there were systems for identifying, investigating and learning from untoward incidents. Staff had received training in safeguarding vulnerable adults and were confident about reporting their concerns. There were systems in place to ensure the safety of staff working alone in the community, but these were not consistent across the Trust.

Care and treatment were evidence based and followed recognised and approved care pathways. In many areas we found integrated pathways of care that were working very well, and care was centred on the patient. There were good information sharing systems, so that people received joined up care from different professionals, although this did not work so well with providers across county boundaries.

Staffing levels were generally suitable but arrangements were not always sufficient to ensure that staff had manageable caseloads and that patients could access therapy services when they needed to. The Trust responded to changing local priorities and addressed the demands on services. In several areas there were weekend, evening and early morning clinics or educational courses, to improve access for patients. There were long waiting times for certain dental treatments and access to some outpatient or specialist therapists.

Discharge planning from community hospitals was effective with regular multidisciplinary discharge meetings that were used positively and involved all relevant health and social care staff.

There were organisational governance and risk management structures in place. Staff felt included in the Trust’s vision and felt supported to raise concerns. There was open and supportive leadership at all management levels throughout the Trust.