Livi UK

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Medicines optimisation

We found that the service was providing safe services because: • The service had an embedded learning culture with which all staff were familiar. • There were clear patient pathways in place. • The service had clear safeguarding processes. • Staffing at the service was safe. • Clear medicines management procedures were in place, including monitoring of prescribing.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Service users who provided feedback did not express an opinion about the learning culture of the service.

All of the staff we spoke to were aware of how to raise incidents. Staff we spoke to detailed how learning was shared with them on both an individual basis, and organisation wide. Leaders detailed how they supported the process, and staff as required.

There was a system for recording and acting on significant events and incidents. There were adequate systems for reviewing and investigating when things went wrong. The service learned and shared lessons, identified themes and took action to improve safety in the service. The service learned from external safety events and patient safety alerts. The service had an effective mechanism in place to disseminate alerts to all members of the team including sessional staff. Learning was used to make improvements to the service.

Service users who provided feedback did not express an opinion about systems of care.

The staff we spoke to were all aware of care pathways, including referrals and taking on care of those patients who had been discharged from other services. Leaders at the service shared relevant information with staff in team meetings.

The service had sought feedback from partner organisations in relation to the use of safe, systems and pathways. They reported that they were satisfied that these processes were clear and were being followed.

The service had processes in place to ensure that referrals were managed quickly. There were also systems in place to ensure that where care was shared, information was shared between organisations, for example where blood tests and monitoring were undertaken by another provider.

Staff at the service to whom we spoke were aware of how to make safeguarding referrals, and knew the identity of leads if further advice was needed. Leaders told us how advice was available to health advisors and clinicians as required.

The service worked with other agencies to support patients and protect them from neglect and abuse. Staff took steps to protect patients from abuse, neglect, harassment, discrimination and breaches of their dignity and respect. The provider carried out staff checks at the time of recruitment and on an ongoing basis where appropriate. Disclosure and Barring Service (DBS) checks were undertaken where required. (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable). All staff received up-to-date safeguarding and safety training appropriate to their role. They knew how to identify and report concerns.

Service users providing feedback did not express opinions about the service's approach to risk management.

Leaders told us that staff were informed in managing risk, and that standing items such as safeguarding and incidents were discussed at meetings. Staff reported that they were included in risk management, and that they were happy to report when things went wrong.

There were process in place for risks to be discussed with all staff. The provider had processes in place across all three services that it delivered (NHS consultations, private consultations, and those provided in conjunction with insurance company partners) to ensure that patients who had most urgent needs were prioritized.

Service users were happy with the speed and convenience of online appointments but some mentioned difficulties, such as the limited range of matters that could be treated via online appointments.

The nature of the service is that it operates from an office, with many staff working from home, so there were no clinical environments to review.

The premises from which the service is based had been risk assessed, and the service had undertaken a full range of other risk assessments to assure themselves that the service that it was providing was safe for patients and staff.

Service users did not raise concerns about the number of qualified staff available.

Leaders detailed how staffing at the service was based around supply and demand analysis of the three services provided. Staff to whom we spoke told us that they felt that there was sufficient staffing at the service.

The service had a range of workforce planning measures in place to ensure that the correct level of staffing was in place. The service had a clear induction program. Staff told us that the induction when they started at the service had been helpful. Staff also received 1 to 1 and team support from managers, and received appraisals. All staff were appropriately qualified.

Service users giving feedback did not raise concerns about medicines optimisation.

The nature of the service is that they were not routinely monitoring long term conditions. Although digital NHS appointments were offered at the service, and leaders told us that medicines for long term conditions could be prescribed providing the requisite tests had taken place at the GP surgery for whom they were providing the service.

No medicines were kept at the service, and all prescriptions provided to the three distinct services that were provided were sent electronically to the pharmacy of the patient’s choice. The service had clear prescribing policies for each of the services that were provided, and there were specific medicines that were not prescribed, including those that were controlled at schedule three and four. The service undertook auditing of prescribing to ensure that policies were being followed, including an audit specific to medicines that had been prescribed outside of guidance.