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The Portland Hospital for Women and Children Good

Inspection Summary


Overall summary & rating

Good

Updated 19 June 2017

The Portland Hospital for Women and Children is the largest private children’s hospital in the UK and is owned and run by HCA International Ltd.

The hospital/service opened in 1983, and has been part of HCA healthcare for the past 10 years. The hospital has 76 in-patient beds, 20 day-case beds and four theatres. It is situated in central London, on Great Portland Street, in the West End, with easy access to public transport and main driving routes. Services are provided from four buildings: 205-209 Great Portland Street, 212 Great Portland Street, 234 Great Portland Street and 215 Great Portland Street. There is also a small paediatric outpatient service located within The Shard.

The Portland Hospital for Women and Children provides surgery, maternity care, services for children and young people, termination of pregnancy services and outpatients and diagnostic imaging. All services at this hospital were inspected during our visit.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 1 – 3 November 2016, along with an unannounced visit to the hospital on 10 November 2016.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

Services we rate

We rated this hospital as good overall because:

  • The hospital was managed by a team who had the confidence of patients and their teams. Both senior and junior nurses as well as doctors working in the service embedded the vision and strategy for the service into practice. Staff were encouraged to voice concerns or new ideas to improve patient experience. New staff spoke excitedly at the prospect of being a part of a team where the Chief Executive Officer (CEO) and Chief Nursing Officer (CNO) really cared and their opinions mattered.

  • Care was planned and delivered in line with current evidence-based guidance, standards and best practice. Information about patient care, treatment and outcomes was routinely collected, monitored and used to improve care.

  • Patients were treated with compassion and their privacy and dignity were maintained. Patient feedback surveys were positive about the care they received whilst in hospital.

  • All patients were provided with individualised care. Translation services were readily available for those whose first language was not English. Meal plans and medications were tailored to the individual, to ensure that cultural and religious needs were met and maintained.

  • Patients could access care when they needed it, often on the same day. There was choice and flexibility around appointments and elective procedures.

  • All complaints were dealt with in an efficient manner within time scales set by the hospital.

  • The midwife led services held meet and greet clinics for patients interested in the hospital maternity services. The sessions were free of charge and allowed the patients to have a tour of the facilities and ask any questions they may have. Patients found this service reassuring and positive. In addition, dedicated Spinal Dorsal Rhizotomy (SDR) open days were held where patients were asked to provide feedback on how services could be improved.

  • There was a midwifery lactation team responsible for the oversight of infant feeding.

    The midwifery lactation team were supernumerary to ward staffing numbers to ensure that women could go home with knowledge and ability to feed their babies confidently and successfully. We saw that the initiation of breast feeding rate was 80%, which was better than the national average of 75%.

  • There was a dedicated family room on both paediatric inpatient ward floors. The children’s outpatients department had tailored their environment for children and scheduled clinics outside of normal hours to accommodate patients and their families.

  • There were systems to keep people safe and to learn from critical incidents. In maternity services, a computerised monitoring tool was used that allowed an overview of emerging themes and lessons learned to be shared widely with staff.

  • The hospital environment was visibly clean and well maintained and there were adequate measures to prevent the spread of infection.

  • There were systems to ensure the safe storage, use and administration of medicines, including controlled drugs. Regular audits took place to ensure that standards and best practice were maintained.

We found areas of outstanding practice in both the children and young people's services and the outpatients department:

  • There were strong displays of innovative techniques from the hospital’s paediatric therapies team. Staff were encouraged to input to innovative change within the service and this was evident in the celebration of new ideas from staff at all levels.

  • Multidisciplinary input in paediatrics was well structured, well coordinated and attended by a wide variety of clinical specialities and therapies. The meetings were structured around the holistic needs of the patients.

  • Services were tailored and planned to fit the needs of the patients using the services. There was an impressive degree of clinical input and care for complex patients.

  • The hospital had implemented a specialist, sensitive birthmark screening and treatment program for paediatric outpatients.

  • The security and safety of patients was important to the service. The service had put in additional measures to ensure that children in their service were protected from harm. The Hugs and Kisses security system tracked and monitored patients throughout their pathway.

  • A new training and practice device was developed in the colposcopy service. This device was sponsored and developed in partnership with a medical equipment manufacturer. The device was designed to be a colposcopy simulator, which had since aided in the training and development of skills for doctors and nurses in both the NHS and independent sectors.

  • The radiology department used a lot of innovative techniques to ensure a smooth process of paediatric diagnostic procedures. This included the implementation of play therapist support and ‘feed and wrap’ scans to negate the need of anaesthesia for children.

  • Consultants representing the hospital regularly provided continued professional development through master classes for GPs . They delivered training conferences four times a year for up to 200 doctors in order to educate and train GPs in issues relating to paediatric and women’s health.

  • The hospital facilitated the training placements for student midwives and student nurses from a London based university. This collaboration resulted in staff developing their teaching skills and students successfully completing their second year with experience in the independent sector.

  • The governance team conducted a comprehensive qualitative research study into the ‘Use of Team Debriefing Following a Serious Incident’. This project resulted in the development and implementation of the HCA Corporate Debriefing policy and staff information leaflet, which resulted in change of practice across all HCA sites.

  • We were provided with a number of positive examples of staff development, which all included staff members from support services (identified by the CEO and other managers) as wanting to join clinical services. The staff members were supported and provided with funding to complete qualifications, allowing them to join as clinical staff.

  • We were shown evidence of activities and excursions organised by the therapies department to support parents and children’s psychosocial wellbeing that were planned based on individual patient needs. Trips to venues such as Regents Park and London Zoo were arranged to meet specific clinical patient goals.

However, we also found the following issues that the service provider needs to improve:

  • There was lack of space in some clinical areas in the main hospital building. Some staff were concerned that this may impede the care being provided to the patients. In theatres, items were stored in corridors as there was not sufficient storage space.

  • There was no integrated record keeping system, which meant that not all staff had access to up-to-date risk assessments and notes. This included agency staff and resident medical officers (RMOs), who may be attending for an emergency. Post-inspection, we were informed that the hospital was investing in a new record keeping system to ensure that patient records were consolidated in future.

  • There was a high use of bank staff across the children and young people’s (CYP) service. Frequently, bank staff were not available, which in turn led to a high usage of agency staff. However, bank and agency staff  had an induction and shadowed a permanent member of staff on their first shift. They received the same training as permanent staff.

  • We identified risks in the resuscitation trolleys throughout the paediatric service as they contained equipment and medicines for both adults and children. We observed a copy of the risk assessment and found

    they were in accordance with the UK Resuscitation Council guidelines to ensure appropriate use for both patient types.

  • There was poor documentation from consultants in the maternity service in six of the 12 sets of notes we looked at.

  • On the labour ward, medical gases were stored in an area which did not have appropriate signage on the door.

  • Compliance rates of pre-assessment before surgery were low, ranging between 50% and 78% in the two months prior to our inspection. To improve this, the hospital recruited a dedicated pre-assessment nurse, scheduled to start in January 2017.

  • The last staff survey showed a decline in staff satisfaction and staff commitment. The rate of ward and theatre staff turnover was above the average of other similar hospitals (July 2015 to June 2016).

  • There was a resident on-call theatre team available out-of-hours for primarily obstetric patients. The same team also covered gynaecology emergencies. The absence of a second theatre team on-call was on the hospital’s risk register and most surgical patients were day cases with low pre-operative risk profiles.

  • In the outpatients department, we found that changes in working practices arising from incident learning were not embedded into written policies or procedures in a timely manner.

  • Mandatory training rates for staff in the outpatient department did not meet the hospital target of 90% compliance. Not all maternity staff were trained in the appropriate level of safeguarding.

Services we do not rate

We do not currently have a legal duty to rate termination of pregnancy, or the regulated activities they provide but we highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

We found the following areas of good practice:

  • Infection prevention and control (IPC) measures ensured that both the wards and theatres were clean and suitable for purpose.

  • Medicines were managed and stored appropriately. Pain relief and antibiotic medications were given to women post-procedure to manage their symptoms.

  • Documentation was concise and clear. We saw evidence that legislation relating to the termination of pregnancy (TOP) was followed in all the cases we examined.

  • Staff we spoke with were knowledgeable about safeguarding and knew how to recognise if a woman was at risk or had been exposed to abuse, and how to escalate concerns. They were up-to-date with appropriate levels of training.

  • There were enough nurses in the wards and theatres for staff to perform their roles safely. There was 24 hour, seven-days a week, resident medical officer (RMO) cover for the wards.

  • Hospital policies were current and appropriately referenced relevant national guidance. The TOPS policy had recently been reviewed and updated.

  • Consultants gave women verbal and written information on what to expect during and following a TOP procedure. Nurses on the ward also provided information about what women may experience. Women were able to contact the ward 24/7 after discharge for support or advice. Counselling was available to all women before, during and after they had received treatment, as required. This was from an external provider.

  • Nurses shared responsibility for completing audits to monitor compliance and improvement. Records of all TOP procedures were maintained on a spreadsheet to monitor that all Department of Health (DH) Required Standard Operating Procedures (RSOPs) were met.

  • Consent and capacity were considered by nurses when a women was admitted for a TOP procedure. All staff demonstrated a working knowledge of the Mental Capacity Act (MCA) and its implications.

  • Patient’s privacy was maintained throughout their stay, as they were admitted to single occupancy rooms. Feedback from women about the gynaecology wards was consistently positive, although it was not possible to identify women undergoing TOP from returns.

  • All women referred to the service received timely treatment, often beginning the same day they had their initial appointment.

  • Women were given enough information to make an informed choice about the sensitive disposal of pregnancy remains and time to consider this. Appropriate storage arrangements were in place.

However, we also found the following issues that the service provider needs to improve:

  • Not all women having surgical terminations had a pre-operative assessment. The hospital had recruited a nurse into a post to perform these, but this was not yet in place.

  • The hospital could not be assured that consultants were all returning the HSA4 forms to the Department of Health within 14 days because consultants did not always copy the form to the ward.

Following this inspection, we told the provider that they should make some improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection areas

Safe

Good

Updated 19 June 2017

We rated safe as good because:

  • There were systems for the reporting and investigation of safety incidents that were well understood by staff. Openness and transparency were encouraged. Both junior and senior nurses were well aware of the duty of candour.

  • Staff followed infection prevention control (IPC) guidance. The environment and equipment were clean and ready for use.

  • Medicines, including arrangements for storage and administration, were effectively managed across the hospital. Regular audits were undertaken to ensure standards were met.

  • We found suitable medical cover at all times from a resident medical officer (RMO) and on-call consultants and noted arrangements for consultants to provide cover for absent colleagues. Appropriate escalation occurred in the case of deteriorating patients.

  • There were sufficient numbers of nursing and support staff to meet patients’ needs, even where this had to be supplemented by non-permanent staff.

  • We saw there were efficient and effective methods for the handover of care between clinical staff.

  • There was a designated lead for safeguarding and staff were trained appropriately to recognise and report suspected abuse in vulnerable adults.

  • The security and safety of patients was of high importance and the children and young people’s (CYP) service put in additional measures to ensure that children in their service were protected from harm.

However:

  • There was no integrated record keeping system, which meant that resident medical officers (RMOs) and agency staff did not have access to patient notes. There was poor documentation from consultants regarding a common surgical procedure in six of the 12 sets of maternity notes we looked at.

  • Compliance rates of pre-assessment before surgery were low, ranging between 50% and 78% in the two months prior to out inspection. To improve this, the hospital recruited a dedicated pre-assessment nurse, but they were not yet in post.

  • The rate of ward and theatre staff turnover was above the average of other similar hospitals (July 2015 to June 2016). The surgical ward had two vacant posts since early 2016. Staff recruitment for these posts had started recently.

  • There was no second on-call theatre team out-of-hours. This meant there was no theatre team available for gynaecology emergencies. This was on the hospital’s risk register and most surgical patients were day cases with low pre-operative risk profiles.

  • We found that changes in working practices arising from incident learning in the outpatient department were not embedded into written policies or procedures in a timely manner.

  • Mandatory training rates for some hospital staff did not meet the hospital target of 90% compliance. Not all maternity staff were trained in the appropriate level of safeguarding.

Services we do not rate

We do not currently have a legal duty to rate termination of pregnancy services.

We found the following areas of good practice:

  • There were effective hospital-wide systems to ensure incidents were reported and lessons from these were shared across the hospital. No adverse incidents had been reported in relation to TOPS.

  • Infection prevention and control (IPC) measures ensured that both the wards and theatres were clean and suitable for purpose.

  • Staff we spoke with were knowledgeable about safeguarding and knew how to recognise if a woman was at risk or had been exposed to abuse, and how to escalate concerns.

  • There were enough nurses in the wards and theatres for staff to perform their roles safely. There was 24 hour, seven-days a week, RMO cover for the wards.

However, we also found the following issues that the service provider needs to improve:

  • Not all women having surgical terminations had a pre-operative assessment. The hospital had recruited a nurse into a post to perform these, but this was not yet in place at the time of inspection.

Effective

Good

Updated 19 June 2017

Are services effective?

We rated effective as good because:

  • We found there were arrangements to review guidance from national bodies such as the National Institute for Health and Care Excellence (NICE) and that care was delivered in line with best practice. Information about patient care, treatment and outcomes was routinely collected, monitored and used to improve care.

  • There was a system for reviewing policies and these were discussed at the medical advisory committee (MAC) and other governance forums at the hospital.

  • Patient outcomes were good when benchmarked against national standards. There were no concerns regarding rates of unplanned admissions, return to theatres or transfers to another hospital.

  • Pain was effectively managed, with high patient satisfaction in this area.

  • The multidisciplinary input was highly effective, well-coordinated and considered the patients holistic needs as well as clinical care. There was evidence of collaborative working and positive relationships across all departments within the hospital.

  • Staff were competent in their roles and undertook regular appraisals and supervision. There was a high degree of staff participation in additional training.

  • We found arrangements that ensured that doctors and nurses were compliant with the revalidation requirements of their professional bodies. All consultants had clear practising privileges agreements which set out the hospitals expectations of them, and ensured they were competent to carry out the treatments they provided.

Services we do not rate

We do not currently have a legal duty to rate termination of pregnancy services.

We found the following areas of good practice:

  • Hospital policies were current and appropriately referenced relevant national guidance. The TOPS policy had recently been reviewed and updated.

  • Records of all TOP procedures were maintained on a spreadsheet to monitor that all Department of Health (DH) Required Standard Operating Procedures (RSOPs) were met.

  • Pain relief and antibiotic medications were given to women post-procedure to manage their symptoms.

  • Consent and capacity were considered by nurses when a women was admitted for a TOP procedure. All staff demonstrated a working knowledge of the Mental Capacity Act (MCA) and its implications.

Caring

Good

Updated 19 June 2017

We rated caring as good because:

  • Patients were treated with dignity and respect and their privacy was maintained.

  • We saw that staff offered appropriate emotional support. Additional psychological support was available where needed. Ongoing support was offered to women and children post-discharge to ensure their emotional needs were met.

  • Patients who shared their views said they felt well-informed and involved in their care. They reported staff were kind and compassionate at all times.

  • We saw that results of the friends and family test (FFT) and other patients satisfaction surveys demonstrated that patients would recommend the hospital to others.

Services we do not rate

We do not currently have a legal duty to rate termination of pregnancy services.

We found the following areas of good practice:

  • Patient’s privacy was maintained throughout their stay, as they were admitted to single occupancy rooms.

  • Feedback from women about the gynaecology wards was consistently positive, although it was not possible to identify women undergoing TOP from returns.

  • Consultants gave women verbal and written information on what to expect during and following a procedure. Women were able to contact the ward 24/7 after discharge for support or advice.

  • Counselling was available to all women before, during and after they had received treatment, as required. This was from an external provider.

Responsive

Outstanding

Updated 19 June 2017

We rated responsive as outstanding because:

  • Services were planned to fit the needs of patients. The environment was tailored for the needs of different patients and clinics were scheduled outside of normal hours.

  • International patients were provided with tailored care and were supervised throughout their care pathway. Translators were available 24 hours a day. The international team had good links to each embassy, in the event that the translators were not able to assist.

  • There were arrangements in place to support people with particular complex needs. We saw many examples of tailored packages of care to suit the needs of women and children with different backgrounds and circumstances.

  • The hospital had implemented a specialist, sensitive birthmark screening and treatment program for paediatric outpatients.

  • Patients were assessed prior to admission to ensure that hospital could safely meet their needs.

  • Patients were often seen on the same day if presenting as an outpatient. Elective procedures were scheduled to meet the needs of patients.

  • There was evidence of effective handovers of care to community agencies when patients were discharged.

  • There was a clear complaints procedure in place and we saw evidence of learning from complaints and incidents. Staff were able to give examples about things that had changed as a result.

However:

  • There was lack of space in some clinical areas in the main hospital building. Some staff were concerned that this may impede the care being provided to the patients. Equipment in theatres was not ideally stored.

Services we do not rate

We do not currently have a legal duty to rate termination of pregnancy services.

We found the following areas of good practice:

  • All women referred to the service received timely treatment, often beginning the same day they had their initial appointment.

  • Women were given enough information to make an informed choice about the sensitive disposal of pregnancy remains and time to consider this. Appropriate storage arrangements were in place.

  • Hospital-wide processes ensured that any complaints would be reviewed and were responded to appropriately.

Well-led

Good

Updated 19 June 2017

We rated well-led as good because:

  • Both senior and junior nurses, as well as doctors working in the service, embedded the vision and strategy for the service into their clinical practice.

  • There were clearly defined and visible local leadership roles.  Managers provided visible leadership and motivation to their teams. It was clear that the vast majority of staff felt supported by management.

  • There was an appropriate system of governance and managers knew the key risks and challenges to the hospital. They were taking steps to mitigate the impact of these.

  • Practising privileges were received, authorised and granted in conjunction with the medical advisory committee (MAC) and kept under review.

  • Staff across the hospital were encouraged to put forward ideas to improve patient experience and this was evident in the celebration of new ideas from staff at all levels.

  • We were provided with a number of positive examples of staff development, which all included staff members from support services identified by the CEO and mother managers as wanting to join clinical services. The staff members was supported and provided with funding to complete qualifications, allowing them to join as clinical staff.

  • We saw examples of initiatives that were introduced to improve patient experience and to ensure the safety and quality of care kept pace with new developments and growing expectations.

  • However:

  • While the hospital collected some data around equality and diversity, it did not include the four specific workforce metrics identified in the NHS Workforce Race Equality Standards (WRES) to demonstrate progress against a number of indicators of workforce equality.

Services we do not rate

We do not currently have a legal duty to rate termination of pregnancy services.

We found the following areas of good practice:

  • We saw evidence that legislation relating to the termination of pregnancy (TOP) was followed in all the cases we examined.

However, we also found the following issues that the service provider needs to improve:

  • The hospital could not be assured that consultants were all returning the HSA4 forms were to the Department of Health within 14 days, because consultants did not always copy the form to the ward.
Checks on specific services

Maternity

Good

Updated 19 June 2017

We rated this service as good because:

  • The elective caesarean section rate at the hospital was 34%, which was higher than the national average of 10.7%. This meant that the overall caesarean section rate was 52%, which was also higher than the national average of 25%. This was because more women chose to have an elective caesarean section at the hospital. Women were offered an informed choice on all types of birth, from normal deliveries to caesarean sections.

  • We saw examples of safety incident reporting systems, audits concerning safe practice, and compliance with best practice in relation to care and treatment. Staff planned and delivered care to patients in line with current evidence-based guidance and standards.  Information about patient care, treatment and outcomes was routinely collected, monitored and used to improve care.

  • Patient care was consultant led. Medical staffing across the department was sufficient to provide women with good quality care. Access to consultant medical support was available seven days per week. The hospital provided evidence of one-to-one care during labour, which is recommended by the Department of Health.

  • Women told us they felt well- informed and were able to ask staff if they were not sure about something. Feedback from patients and those close to them was positive. Staff helped patients and those close to them to cope emotionally with their care and treatment. Women we spoke with felt that their pain and analgesia administration had been well-managed.

  • Staff were competent in their roles and undertook regular appraisals and supervision. Midwives rotated throughout the service, which meant that they were competent to work in all areas in times of escalation. Staff worked collaboratively to serve the interests of women across the service. There was evidence of effective handovers of care to community agencies when women were discharged.

  • Patients’ individual needs and preferences were considered when planning and delivering services. The maternity service was flexible and provided choice and continuity of care. The individual care needs of women at each stage of their pregnancy were acknowledged and acted on, as far as possible. There were arrangements in place to support people with particular complex needs.

However:

  • There was poor documentation from consultants regarding a common surgical procedure in six of the 12 sets of notes we looked at.

  • Medical gases were stored in an area which did not have appropriate signage on the door.

Termination of pregnancy

Updated 19 June 2017

We do not currently have a legal duty to rate this service but we highlight good practice and issues that service providers need to improve and take regulatory action as necessary. We found that the TOP service was providing safe, effective, caring, responsive and well-led care to women. This was because:

  • Medicines were managed and stored appropriately. Pain relief and antibiotic medications were given to women post-procedure to manage their symptoms.

  • Documentation was concise and clear. We saw evidence that legislation relating to the termination of pregnancy (TOP) was followed in all the cases we examined.

  • Staff we spoke with were knowledgeable about safeguarding and knew how to recognise if a woman was at risk or had been exposed to abuse, and how to escalate concerns. They were up-to-date with appropriate levels of training.

  • Hospital policies were current and appropriately referenced relevant national guidance. The TOPS policy had recently been reviewed and updated.

  • Consultants gave women verbal and written information on what to expect during and following a TOP procedure. Nurses on the ward also provided information about what women may experience. Women were able to contact the ward 24/7 after discharge for support or advice. Counselling was available to all women before, during and after they had received treatment, as required. This was from an external provider.

  • Nurses shared responsibility for completing audits to monitor compliance and improvement. Records of all TOP procedures were maintained on a spreadsheet to monitor that all Department of Health (DH) Required Standard Operating Procedures (RSOPs) were met.

  • Consent and capacity were considered by nurses when a women was admitted for a TOP procedure. All staff demonstrated a working knowledge of the Mental Capacity Act (MCA) and its implications.

  • All women referred to the service received timely treatment, often beginning the same day they had their initial appointment.

  • Women were given enough information to make an informed choice about the sensitive disposal of pregnancy remains and time to consider this. Appropriate storage arrangements were in place.

However:

  • Not all women having surgical terminations had a pre-operative assessment. The hospital had recruited a nurse into a post to perform these, but this was not yet in place.

  • The hospital could not be assured that consultants were all returning the HSA4 forms to the Department of Health within 14 days because consultants did not always copy the form to the ward.

Surgery

Good

Updated 19 June 2017

We rated this service as good because:

  • Staff we spoke with felt confident and encouraged to report incidents and we saw evidence of learning from incidents. There was a clear complaints procedure in place and we saw evidence of learning from complaints and incidents. Effective governance structures supported quality improvement through this learning.

  • Staff followed infection prevention control(IPC) guidance. We observed staff wash their hands between seeing patients and use personal protective equipment (PPE) effectively. The environment and equipment were clean and ready for use.

  • The rate of surgical site infection was below that of other similar hospitals that we hold this type of data for. Compliance with the Safer Steps to Surgery, including the World Health Organisation (WHO) checklist, was closely monitored. Monthly audits showed 100% compliance since April 2016. Unplanned readmission and transfer rates were also lower than other comparable services.

  • Patient care was delivered in line with current standards of best practice and guidelines. Regular audits took place that monitored the quality of care and drove improvement across the service.

  • There was appropriate medical cover for the surgical wards, 24 hours a day, seven days a week. There was access to relevant consultants where required. Appropriate escalation occurred in the case of deteriorating patients.

  • We observed staff treating patients with dignity, kindness and respect. Patient feedback surveys were positive about the care that they received. Post-operative pain was effectively managed, with high patient satisfaction in this area. We saw staff responding promptly to call bells.

  • Flexible services were provided to accommodate patients’ individual needs and patients were able to access services in a way and time that suited them. The hospital had a dedicated international patient centre staffed by liaison officers, who assisted and met the needs of the large demographic of international patients.

  • The senior leadership team was visible and approachable. Staff felt supported, listened to and valued. They were encouraged to voice concerns or new ideas and to attend additional training suitable to their post.

However:

  • Electronic patient records were often incomplete. The lack of an integrated records system meant that regularly used agency staff did not have access to electronic patient records.

  • Lack of storage space in theatres was identified as an issue. This meant that equipment was not ideally stored, in corridors and in large cupboards in corridors.

  • Compliance rates of pre-assessment before surgery were low, ranging between 50% and 78% in the two months prior to out inspection. To improve this, the hospital recruited a dedicated pre-assessment nurse, scheduled to start in January 2017.

  • The last staff survey showed a decline in staff satisfaction and staff commitment. The rate of ward and theatre staff turnover was above the average of other similar hospitals (July 2015 to June 2016).

  • There was a resident on-call theatre team available out-of-hours for primarily obstetric patients. The same team covered gynaecology emergencies. The absence of a second theatre team on-call was on the hospital’s risk register and most surgical patients were day cases with low pre-operative risk profiles.

Services for children & young people

Good

Updated 19 June 2017

We rated this service as good because:

  • Services were planned to fit the needs of patients. There was a dedicated family room on both inpatient ward floors. The children’s outpatients department had tailored their environment for children and scheduled clinics outside of normal hours to accommodate patients and their families.

  • International patients were provided with tailored care and were supervised throughout their care pathway. Multidisciplinary teams (MDTs) worked together to ensure the smooth and efficient discharge of international patients to their home countries. Translators were available 24 hours a day. Meal plans and medications were tailored to the individual, to ensure that cultural and religious needs were met and maintained.

  • All staff spoke highly of their Chief Executive Officer (CEO) and Chief Nursing Officer (CNO). Both senior and junior nurses, as well as doctors, working in the service embedded the vision and strategy for the service into practice. Ward managers and senior staff had a shared purpose and strived to deliver the highest quality of care. They motivated junior staff to succeed and encouraged them to attend training to develop their careers. There was a high degree of staff participation in additional training.

  • We saw examples of innovation. Staff across the service were encouraged to put forward ideas to improve patient experience and this was evident in the celebration of new ideas from staff at all levels.

  • All staff were proud to work within the service and members of staff spoke very highly of one another.

  • The security and safety of patients was important and the service had put in additional measures to ensure that children in their service were protected from harm.

  • The multidisciplinary input was highly effective, well-coordinated and considered the patients holistic needs as well as clinical care. MDT meetings were well attended by a wide variety of specialities. Parents were also invited along to these meetings and had a high degree of involvement in the care planning of their child.

However:

  • There was lack of space in some clinical areas and staff were concerned that this may impede the care being provided to the patients.

  • There was no integrated record keeping system, which meant that resident medical officers (RMOs) attending for an emergency wouldn’t always have access to up-to-date medical records.

  • We identified risks in the resuscitation trolleys as they contained equipment and medicines for both adults and children. We observed a copy of the risk assessment and found

    they were in accordance with the UK Resuscitation Council guidelines to ensure appropriate use for both patient types.

Outpatients

Outstanding

Updated 19 June 2017

We rated this service as outstanding because:

  • Staff were encouraged to develop within their roles and seek out opportunities for progression. We were provided of numerous examples of support staff being provided support, training and funding to progress to a clinical role.

  • There was an active culture of innovation and improvement. We were provided examples of staff members and also whole department efforts that changed working practice across the hospital and other organisations.  

  • There was cohesive multidisciplinary team (MDT) working. There was evidence of collaborative working and positive relationships with other departments within the hospital.

  • Outpatient and diagnostic services were delivered by caring, committed and compassionate staff. We observed staff interaction with patients and found them to be polite, friendly and helpful. Patient satisfaction results were consistently positive in all areas of the outpatients and imaging departments, with 99% of patients in the most recent survey saying they would recommend the hospital to friends and family based on the care and support they received.

  • On inspection we observed numerous examples of the service proactively responding to patient needs and wishes.  

  • Complaints were handled in a professional and timely manner within the hospital timeframe.

  • We observed that there were minimal waiting times for outpatient clinics and diagnostic imaging. Patients we spoke with confirmed this.

  • All departments we visited had clear vision and strategy for future goals and expansion projects. Staff we spoke with were aware of this.

  • We saw evidence of positive public and staff engagement. Staff felt highly supported by their managers. All departments we visited demonstrated patient experience was key factor for their service.

However:

  • We found that changes in working practices arising from incident learning were not embedded into written policies or procedures in a timely manner.

  • Mandatory training rates for staff in the outpatient department did not meet the hospital target of 90% compliance.