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Inspection Summary


Overall summary & rating

Good

Updated 18 January 2018

A summary of our findings about Ipswich Hospital appears in the overall summary

Inspection areas

Safe

Requires improvement

Updated 18 January 2018

Effective

Good

Updated 18 January 2018

Caring

Good

Updated 18 January 2018

Responsive

Good

Updated 18 January 2018

Well-led

Good

Updated 18 January 2018

Checks on specific services

Maternity and gynaecology

Good

Updated 10 April 2015

Maternity and gynaecology services provided to women and babies by Ipswich Hospital overall was good, with some improvements required in respect of the responsiveness of the service. There was a strong focus on patient safety and risk management practices. Mandatory training, including safeguarding measures, were in place, and staff recognised and responded appropriately to changes in risks to people who use services.

Staff were appropriately qualified and competent, and safe staffing levels and skill mix encouraged proactive teamwork, to support a safe environment. Individual care and treatment was planned and delivered in line with current evidence-based guidance.

Patient outcomes for maternity and gynaecology were good, as was the counselling support for women undergoing termination of pregnancy and those women suffering a miscarriage. Care provided was good, and patients were treated with dignity, respect and kindness.

Service planning and delivery required improvement, as actions for service development in line with current clinical practices were not always in place or proactive, as there was a lack of specialist lead roles.

 The midwifery leadership model encouraged co-operative, supportive relationships among staff, and compassion towards people who use the service. An open, honest and transparent culture was evident, with staff confident in the support of their managers and the senior executive team.

Medical care (including older people’s care)

Good

Updated 18 January 2018

Our rating of this service stayed the same. We rated it as good because:

  • The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.
  • The service used safety-monitoring results well and provided care and treatment based on national guidance and evidence of its effectiveness.
  • The service took account of patients’ individual needs. Staff of different kinds worked together as a team to benefit patients. There was a strong culture of multidisciplinary staff working.
  • The trust had managers at all levels with the right skills and abilities to run a service providing high-quality sustainable care.

However:

  • Medical records were not always secure as these were stored in unlocked trolleys.
  • There was inconsistency between electronic and paper based records of venous thromboembolism (VTE) assessments.
  • There was limited access to the acute psychiatric pathway and therefore delays in psychiatric assessment were an issue on the inpatient wards.

Urgent and emergency services (A&E)

Good

Updated 18 January 2018

Our rating of this service went down. We rated it as good because:

  • The emergency department had processes in place to manage patient incidents. Staff identified incidents and reported them appropriately. Managers shared learning from the investigation of incidents and concerns with staff.
  • Staff from different specialities worked effectively as a team and they had the required skills to treat patients presenting to the emergency department from minor injuries to major trauma.
  • The department continually monitored performance both locally and nationally. These results were used to plan new services and improve existing services.
  • Staff provided compassionate care to their patients tailoring care to the patient’s individual needs.
  • The department had a positive staff culture and staff felt able to contribute ideas to improve the services provided.
  • There were processes in place to communicate information from the emergency department to the board.

However:

  • The trust did not have robust processes in place to ensure that equipment checking or testing was completed in a timely way.
  • The completion of mandatory training by staff within the emergency department did not meet the trust completion target.
  • There was no formalised assessment process to ensure that the area in majors used for mental health assessments was safe and suitable for use.
  • The structure of the paper records did not help staff in identifying and recording all types of abuse.
  • The department’s performance against national standards was variable.

Surgery

Good

Updated 10 April 2015

Surgery services at Ipswich Hospital were good; however, staff in East Theatre felt unable to report incidents due to time constraints, and believed the process to be too time consuming. Therefore, an open culture for raising safety concerns was not embedded throughout the division. This area require improvement.

Patients were monitored and reviewed promptly. Care and treatment given was evidence-based, and followed NICE guidelines. The surgical division had taken a robust approach to audit, and was benchmarking patient outcomes internationally by participating in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP). Best practice learnings was shared across the trust.

Surgical services were planned, and surgery cancellation rates were low. The service was responsive to the needs of patients; patients were treated with compassion, kindness, dignity and respect.

The arrangement of surgical services across the site made for logistical problems and management challenges, resulting in varying leadership across the division.

Intensive/critical care

Good

Updated 10 April 2015

Critical care services were safe, effective, caring and responsive to meet the needs of patients and relatives, and the service was well-led. Staff cared for patients with compassion, dignity and respect. Good quality outcomes were evident, and patients received treatment that was based on national guidelines. The overall capacity was adequate, and patients received timely care and admission to the unit; however, delayed transfers out of hours were high due to the unavailability of step down beds on the wards.

Medical and nursing staffing levels were planned, implemented and reviewed depending on patient acuity and turnover, and adhered to national guidance.

Staff competency and training arrangements were embedded, resulting in a supportive environment, and staff morale was good.

Service provision for children was primarily stabilisation prior to transfer; however, the unit treated approximately 20 children a year. There was no written policy for paediatrics in place, and no registered sick children’s nurse (RSCN) employed on the intensive care unit (ICU).

The management at service level on the nursing side were clear about their roles and vision for the service; however, this was not as embedded within the medical team. The governance and risk management within critical care was not embedded. During our inspection we identified a number of aspects of care where risks had been identified; however, there were no current risks on the risk register. An example of this was the paediatric patients on the ITU. Therefore, there was no assurance that timely actions were being taken to protect people from avoidable harm.

Services for children & young people

Good

Updated 18 January 2018

Our rating of this service improved. We rated it as good because:

  • The service now had enough trained staff and clear clinical leadership for the provision of high dependency care.
  • The critical care pathway for children was now more defined. There was clarity around patient flow and expectations of staff when a patient may require critical care provision.
  • Incident management was robust. Staff not only understood how and when to report incidents, but were now also informed regarding learning and improvement from incidents.
  • An annual audit plan was in place for the service which received management and monitoring from the audit department and had oversight by a named consultant. Whereas previously there had been a lack of initiatives to measure and monitor patient outcomes.
  • Both internal and external multidisciplinary (MDT) working was evident throughout the service.
  • Compassionate care was consistently observed and noted by patients and their families, and privacy and dignity were well highlighted throughout the service.
  • Several support groups were established offering specialist advice to patients and their families. The Voice4Change young people’s group was a finalist in the Patient Experience Network national awards.
  • There was a portable sensory suite available. This provided a range of programmes to stimulate and provide enjoyment for all children, including those with additional needs.
  • There was an improved governance system with increased staff awareness of identifying risks, and planning to reduce them. Staff were committed to improving services with innovation evident throughout the service.

However:

  • Not all mandatory training, including safeguarding children level three, met the Trust target.
  • Medication management and oversight of the temperature requirements for medication storage was inconsistent across the service.
  • There was poor completion of the ‘First hour of care’ documentation on the neonatal unit by medical staff.
  • There was no lead for the transition pathway for adolescents moving on to adult services. Transition was ad hoc. This was acknowledged by the trust however, plans to address this were in their infancy.
  • Involvement of parents in ward rounds on the neonatal unit was not wholly transparent. Babies would be seen without their parents, with parents being brought into discussions at the end of the medical review of their baby, and updated on their care.
  • There was no separate paediatric recovery area for children who had undergone day surgery and paediatric recovery nurses were not always available.

End of life care

Good

Updated 18 January 2018

Our rating of this service stayed the same. We rated it as good because:

  • The service had enough staff with the right qualifications, skills, training and experience. The nurse staffing for the specialist palliative care team (SPCT) was now in line with national guidance.
  • The service managed patient safety incidents well. Staff knew their responsibilities around reporting incidents and shared learning from incidents related to end of life care.
  • Staff kept appropriate records of patients’ care and treatment. The symptom assessment tool had been improved and there were now individualised care plans which were in line with national guidance.
  • Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) forms were mostly well completed. Records of discussions with patients and relatives, signed by a senior clinician, had improved.
  • Staff at the service treated patients with compassion, dignity and respect and involved them in their care. All patients we spoke to were positive about the care given by staff.
  • The trust had managers at all levels with the right skills and abilities to run a service providing high-quality sustainable care. The director of nursing was the executive lead for end of life care and there was now a named non-executive director with responsibility for end of life care.
  • The end of life care strategy included defined local priorities, outcomes and measures of success.

However:

  • Staff in the SPCT informally monitored their response times but did not formally audit this. The trust did not audit preferred place of death or preferred place of care so were unable to measure the efficacy of the service.
  • Patient’s mental capacity was not always clearly documented.
  • There were sometimes delays in completion of death certificates and cremation documentation.
  • Senior staff had limited oversight of incidents relating to end of life care across the trust and there was no risk register specific to end of life care.
  • The mortuary was still in need of refurbishment.

Outpatients

Good

Updated 10 April 2015

Outpatient and diagnostic imaging services required some improvement. Not all areas of the outpatient services were visibly clean. The outpatient ENT department decontamination room was not fully Hospital Technical Memorandum compliant. The equipment within the diagnostic centre was aged, and whilst it was noted on the vision for the service that equipment was aged, the plans for replacement had only recently been signed off by the trust board. Due to the age of the equipment, NICE guidelines were not being met due to out-of-date software and hardware. This meant that whilst they were safe they could not deliver treatment and diagnosis in line with current guidance. Seven day working did not take place in outpatients or in diagnostic imaging. The care provided by staff to patients in the outpatient and diagnostic imaging services was good. The service was responsive, and patients were able to access their outpatient and diagnostic appointments in a timely way, with the trust performing well on the outpatient and cancer pathways. The service was well-led locally, although the structure of the outpatients department meant that there was no overarching outpatients lead, and there was a disconnect between how each outpatient service was run, because it was run by each division. Staff were proud to work at Ipswich Hospital.