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The County Hospital Requires improvement

This service was previously managed by a different provider - see old profile

Inspection Summary


Overall summary & rating

Requires improvement

Updated 28 July 2015

The County Hospital is part of The University Hospitals of North Midlands NHS Trust. It was known as Stafford Hospital until 31 October 2014, when it was part of Mid Staffordshire NHS Foundation Trust. In 2013, the foundation trust was put into administration by Monitor. The new trust was created on 1 November 2014, following integration with University Hospital of North Staffordshire NHS Trust.

We inspected this hospital in April 2015 as part of the comprehensive inspection programme. We inspected all core services provided.

We visited the hospital on 23 April 2015 as part of our announced inspection. We also visited unannounced on the trust on Friday 1 May and Tuesday 5 May 2015. Our unannounced visit included A&E and Medical Care Services.

Overall we have rated this hospital as requiring improvement. We saw that services were caring and compassionate. We saw a number of areas that required improvement for them to be assessed as safe and effective. We saw that leadership of services at the trust also required improvement at both a local and an executive level.

Our key findings were as follows:

  • Staff were caring and compassionate towards patients and their relatives; we saw a number of outstanding examples of good care right across the trust.

    • There was a strong culture of incident reporting and staff were encouraged and supported by their managers to engage in this. This made staff feel empowered.

    • Achieving safe staffing levels was a constant challenge in medical services and there was a heavy reliance on agency and locum staff to support this.

    • Systems and processes did not support patients flow through the organisation.

We saw outstanding work being done on the Specialised Neurological Unit at the County Hospital to improve the outcomes for patients

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

Importantly, the trust must:

  • Review systems and processes to ensure patients flow through the organisation in a timely manner

  • Implement the end of life individualised care plan as soon as possible so that patients who are actively dying are supported holistically. This would also support the nursing staff to meet all the needs of the patients.

  • Review systems and processes to ensure staff are engaged with the plans for service integration and communication networks between senior management and front line staff are improved.

  • Review pathways between County Hospital and Royal Stoke to ensure patients transferred from the emergency department are kept safe and patients who transferred for treatments and procedures are done so efficiently and effectively.

  • The trust must review systems and processes to ensure staff are engaged with the plans for service integration and communication networks between senior management and front line staff are improved.

  • Arrangements regarding DNACPR and mental capacity assessments must be improved so that people are safeguarded against decisions being made without their input.

  • Improve the training opportunities for clinical staff with regard to Dying Matters

  • The discharge process for patients who wish to go home so that fast track discharges can be completed within 48hrs.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection areas

Safe

Requires improvement

Updated 28 July 2015

Effective

Requires improvement

Updated 28 July 2015

Caring

Good

Updated 28 July 2015

Responsive

Requires improvement

Updated 28 July 2015

Well-led

Requires improvement

Updated 28 July 2015

Checks on specific services

Maternity and gynaecology

Good

Updated 28 July 2015

Overall we found the service good with one area that required improvement.

There were many good examples of safe processes including incident reporting systems, audits concerning safe practice and compliance with best practice in relation to care and treatment plans.

Policies were based on National Institute of Clinical Excellence (NICE) and Royal College of Obstetrics and Gynaecology (RCOG) guidelines. People received care and treatment that was planned in line with current evidence-based guidance, standards and best practice.

The birth to midwife ratio was 1:29. The named midwife model was in place. Midwives told us that they provided one to one care in labour.

Medical care

Requires improvement

Updated 28 July 2015

Medical care (including older people’s care)

Updated 28 July 2015

Further improvements were required to protect patients across medical services from avoidable harm with medicines management, safe storage of patient records and a lack of continuity for patients due to the high reliance on agency and locum staff. Opportunities for disseminating and learning from incidents and improving the service, through audit and monitoring of the service could be improved.

Accessing information could be challenging for staff as neither hospital site could view the other’s electronically held records and test results. At times, this led to delays in delivery of care and treatment.

We saw that patients were affected by long delays when accessing these services and treatments that were provided at the Royal Stoke site.

Care was provided in line with national best practice guidelines and the trust participated in all national clinical audits they were eligible to take part in. Results of national audits for the newly formed trust were not yet available; however, results from the former Mid Staffordshire NHS Foundation Trust showed that outcomes for patients were good. The hospital achieved all the applicable targets in relation to referral to treatment times.

Urgent and emergency services (A&E)

Requires improvement

Updated 28 July 2015

There was no fast track pathway for patients who needed specialist follow-on care and treatment at Royal Stoke. Patients requiring transferred had to be admitted via the emergency department to Royal Stoke had further waiting in the emergency department there, before finally being transferred or in some instances discharged.

Although leaders were well respected and staff felt supported, recent organisational change had had an impact on staff morale, and staff felt uncertain about the future.

We saw that people were kept safe whilst they were in the department, Staff were well trained and knowledgeable, they followed policies and procedures which were designed to keep people safe and reduce risk.

Staff were compassionate and caring. Patients received treatment which followed recognised pathways. Outcomes were monitored locally in addition to engagement with national audits at trust level.

Surgery

Good

Updated 28 July 2015

Patients received compassionate care and staff were kind and caring. Patients’ privacy and dignity were respected and outcomes for patients were above the England national average. The standard of cleanliness was good and infection control procedures were followed. There were standardised protocols for elective surgery which were followed and included the five steps to safer surgery checklist. Incidents were reported and learning from these was shared with staff.

Access and flow was not well managed and resources at the County were not optimised. Beds and theatre were not being fully utilised.

Senior clinicians and nurses told us they had good multi- disciplinary working at the County and they felt supported in their roles. Staff did not feel part of the wider trust. They said senior trust management was not visible.

Intensive/critical care

Requires improvement

Updated 28 July 2015

The changes to critical care services had been in place for three weeks at the time of the inspection. As a result of this it was difficult to assess an accurate picture of the responsiveness of the service.

An intensive care consultant was on site Monday to Friday. Medical cover was mainly provided from early afternoon, evening and throughout the night by anaesthetic middle grade doctors with anaesthetic consultants on call from home. This does not meet intensive care core standards.

Staff morale was low and they were concerned about the future of the unit and their on-going employment.

Critical care staff were caring and compassionate. There were sufficient, highly experienced nursing staff available within the critical care unit and within the outreach team at the time of our inspection.

People received effective care, treatment and support that met their needs and achieved good outcomes, promoted a good quality of life and was based on the best available evidence.

Services for children & young people

Requires improvement

Updated 28 July 2015

Inpatient care for children transferred to the Royal Stoke site in May 2015. We saw robust plans in place to facilitate the move and staff were involved.

We found some parents were confused over the plans and did not know what services the hospital was planning to provide. Although, we noted there had been several efforts to engage with the public around the closure of the inpatient ward.

Care plans and risks assessments were not adequately maintained and contained insufficient detail to care for patients. Parents made comments that the medical staff did not always keep them informed but the nursing staff did. We saw there were a number of issues in maintaining patient and staff safety. There was a lack of correct storage of medicines and hazardous cleaning products were not safely stored.

We saw elements of compassionate care and were told staff had taken the children on days out. Parents told us they felt emotionally supported by staff. Staffing levels were found to be of a safe standard.

End of life care

Requires improvement

Updated 28 July 2015

Since the removal of the Liverpool Care Pathway, the hospital had failed to implement an individualised plan of care for the dying patient, with the trust still in the evaluation process for a new pathway.

The hospital did not have safe arrangements in place regarding Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR). The completion of the forms was not always done as per trust policy. In addition to this, if a person appeared to lack capacity no associated mental capacity assessment was undertaken to maintain their safeguards.

The local leadership was good; the specialist team were effective once they received a referral. Caring within the service was good; staff were committed, compassionate and emotionally supportive.

Outpatients

Requires improvement

Updated 28 July 2015

Services were safe; there were sufficient staff who were trained and understood their responsibilities. Any incidents were followed up appropriately.

Patients’ needs were assessed and their care and treatment was delivered following local and national guidance for best practice. Consent to care and treatment was obtained in line with legislation and guidance. They were treated with dignity and respect.

There was potential risk for patients who require treatment at both sites, where records may be unavailable and we also observed that records were not consistently stored securely.

There is a clear vision for the service following the integration with Royal Stoke. Although it is still early days, most staff appeared to understand the vision and their role within it. Radiology staff did not feel engaged with integration and are unclear why some services have been moved.