Mount Vernon Hospital

Updated 11 February 2015

Mount Vernon Hospital is located in Northwood in the London borough of Hillingdon and is one of two hospitals managed by The Hillingdon Hospitals NHS Foundation Trust.

The trust was awarded foundation trust status in April 2011. The trust employs over 2,500 staff.

The trust provides services to the residents of the London Borough of Hillingdon, and increasingly to those living in the surrounding areas of Ealing, Harrow, Buckinghamshire and Hertfordshire giving them a total catchment population of over 300,000 people.

Hillingdon is a diverse suburban borough, with a large young population and an increasing proportion of older people. 25% of the population is under 18 years of age, while the proportion aged over 85 is set to rise by 22% by 2020. The proportion of the population from an ethnic background has risen to 28% of the total, and is projected to rise to 37% in 2020.

Updated 11 February 2015

We carried out this inspection as part of our comprehensive inspection programme of all NHS acute providers.

Overall, this hospital was rated as requires improvement and we found that each of the four core services we inspected at Mount Vernon Hospital require improvement.

Our key findings were as follows:

• Data from April to September 2014 showed that over 99% of patients were seen within the national target of 95% of patients being admitted, transferred or discharged within four hours of attending the Minor Injuries Unit.

• Staff training records showed low compliance with some areas of mandatory training including safeguarding children and management of medicines.

• Two thirds of nursing staff on the elderly care ward were agency staff.

• The trust performed better than expected in the number of patients acquiring clostridium difficile, however, they performed worse than expected for patients acquiring MRSA bacteraemia.

• Letters to GPs were not being sent within the five-day period in line with trust policy.

• System and processes did not make sure that staff checked the child protection register when necessary.

We saw several areas of good practice including:

• The nurse practitioners in the Minor Injuries Unit made direct referrals to specialities both internally and externally to the hospital; this included tertiary referrals to specialists such as plastic surgery.
• The effective management of 18 week referral to treatment times for patients.
• Good access to physiotherapy and occupational therapy and good multidisciplinary team working for surgical patients at the hospital.
• Good multidisciplinary team working to support one stop outpatient clinics.
• The trust had a proactive specialist nurse for organ donation.

However, there were also areas of poor practice where the trust needs to make improvements:

The trust MUST

• Make sure of the effective operation of systems to enable the trust to identify, assess and manage risks relating to the health, welfare and safety of patients.
• Manage the risks associated with the numerous staffing establishment shortages across the trust.
• Make sure that all staff receive the full suite of mandatory training that is required to manage risks to patient safety.
• Make sure that all staff understand their responsibilities in relation to the trust’s systems and processes that exist to safeguard children.
• Make sure agency staff receive an appropriate local induction on to wards.
• Complete venous thromboembolism assessments as appropriate.

The trust should:

• Review the resourcing of medical secretaries to make sure they can meet patient need and the trust’s own targets for sending GP letters.
• Consider implementing the Friends and Family Test for all wards at the hospital.
• Consider whether patient outcomes could be improved through dedicated consultant cover and / or consultant oversight for the Minor Injuries Unit.
• Consider auditing pre-operative starvation to make sure patients are not starved for significantly longer than required.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Updated 11 February 2015

Although patient feedback and outcomes were mainly positive, there were concerns with staffing skill-mix and staffing levels for both nursing and medical staff. Staff were not trained appropriately in most areas and the environment presented risks to patient safety.

Patients’ individual needs were not always met. However, the leadership was aware of the risks on the wards and the risks were being managed and mitigated.

There was a positive staff culture and vision on wards that had not been open for very long.

Updated 11 February 2015

Staff consistently reported incidents using the trust’s incident reporting system. We saw evidence that staff learned from trends in incident reporting and learning was fed back to all staff groups within the department.

We found that letters to GPs were not being sent within the five-day period in line with trust policy.

Follow-up appointments were not being given to patients in a timely manner in the renal service.

Staff adhered to policies and procedures on infection prevention and control. Equipment was maintained and available where needed. Medicines had been stored and prescribed in a way that complied with relevant legislation.

Records were stored securely and were mostly available when required. There had been an issue with the availability of health records for a short while during the relocation of medical record storage, these incidents had decreased. Staff had received mandatory training in line with the trust’s policy.

Staff were able to demonstrate a good understanding of safeguarding procedures.

Clinics were adequately staffed through staff goodwill and willingness to work extra hours.

Updated 11 February 2015

We found that the hospital was mostly clean and equipment used on wards was appropriately serviced. Staff knew how to report safeguarding concerns and patients were consented appropriately before procedures were carried out.

The hospital was unable to cover all shifts with nurses and healthcare assistants as planned. Some staff had not completed their mandatory training. Venous thromboembolism assessments to minimise risk of deep vein thrombosis and pulmonary embolism were not completed. No audit of pre-operative starvation was undertaken to make sure patients were not starved for significantly longer than required. The observed emergency readmissions rate for trauma and orthopaedics was worse than expected. Dementia screening was not routinely undertaken for patients aged over 75. Patients had to wait up to eight hours before their day surgery took place. There was no clear vision and strategy for the surgery services provided at the hospital.

The hospital met referral to treatment targets and patients had good access to physiotherapy and occupational therapy. We saw good examples of multidisciplinary working and staff told us they were able to share ideas and concerns openly.

Surgical wards scored better than the England average in the Friends and Family Test.

Updated 11 February 2015

The Minor Injuries Unit (MIU) had extended its opening hours to help with the increased demand for emergency care in the local area and to reduce pressure on the emergency department at Hillingdon Hospital.

Waiting times at the MIU were within national targets and patients we spoke with were happy with the care they received. However, safety standards were not always being met. This related to staff attendance at mandatory training such as safeguarding children.

We found 50% of Patient Group Directions (written instructions for the supply or administration of medicines to groups of patients who may not be individually identified before presentation for treatment) were out of date. Infection control and prevention practices were followed and there was some evidence of learning from incidents.

A safeguarding audit in July 2014 identified that records could not confirm whether the child protection register had been checked when necessary. Two months after the audit had taken place, the action plan had not been created and no mitigation of the risks had been implemented.

Apart from these instances, policies and procedures were followed by staff. We found the services provided for patients were timely and caring, and staff were respectful. We saw evidence that patients knew how to raise concerns.

There were some processes in place relating to governance, and key performance indicators were monitored regularly. However, there was an absence of medical oversight support provided to the unit by the main emergency department at Hillingdon Hospital, although there was medical cover on-site if there was a medical emergency.