You are here

Kings Mill Hospital Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 9 November 2016

Inspection areas

Safe

Requires improvement

Updated 9 November 2016

Effective

Requires improvement

Updated 9 November 2016

Caring

Good

Updated 9 November 2016

Responsive

Requires improvement

Updated 9 November 2016

Well-led

Requires improvement

Updated 9 November 2016

Checks on specific services

Maternity and gynaecology

Requires improvement

Updated 9 November 2016

Medical care (including older people’s care)

Requires improvement

Updated 9 November 2016

Urgent and emergency services (A&E)

Requires improvement

Updated 9 November 2016

Surgery

Good

Updated 20 October 2015

We rated the surgical services as good.

Arrangements to minimise risks to patients were in place with a full range of risk assessments on admission, and the early identification of patient deterioration following a surgical procedure. However, in the 12 months April 2014 to March 2015, two thirds of patients with sepsis, a potentially life-threatening condition triggered by infection, did not receive safe and timely treatment.

Care and treatment was planned and delivered in line with national guidance and NICE (National Institute of Clinical Excellence) quality standards. Patient outcomes were generally in line with or better than the England average, although some standards were not being met. Some allied health professional support was only available four days a week, which resulted in delays in patients receiving assessments and treatment.

People’s individual needs and preferences were considered when planning care. The service achieved the required referral to treatment time (RTT) of 18 weeks and cancellation rates had been improved by 50% over the last twelve months.

There was good leadership at departmental level. Staff were enthusiastic and supportive of each other. There was a good governance structure with regular, well attended meetings, with sharing and learning from incidents and complaints. However, there was a lack of clear vision and strategy for the future development of surgical services.

Intensive/critical care

Requires improvement

Updated 20 October 2015

We rated the critical care service as requires improvement.

Patients were at risk of increased harm and not receiving effective care and treatment. Current evidence based guidance and standards were not always followed. Patients were not routinely assessed for delirium. Daily ward rounds did not always support or promote effective multidisciplinary working. Physiotherapy was not available for all patients at weekends. The critical outreach team was not available 24 hours a day, despite a demonstrated need for this.

The proportion of nursing staff attending mandatory training was well below the target of 90% for most of the required topics. Staff lacked awareness of the requirements of the Duty of Candour regulation. There was a lack of strategic overview and planning of critical care services Risks were not always identified and issues were not always dealt with in a timely way.

Patients were treated with kindness, dignity and respect. Patients and relatives were positive about how they were cared for and supported. Staff spent time with patients and relatives to ensure they understood the care and treatment and were involved in making decisions. Staff understood and fulfilled their responsibilities to report concerns and safety incidents. Lessons were learned and action was taken to improve safety. Cleanliness and infection control measures were generally appropriate and effective. The environment and equipment were mostly properly checked and maintained. Staffing levels in the critical care unit were in line with national standards.

Services for children & young people

Good

Updated 20 October 2015

We rated the children and young peoples service as good.

Although risks to patients were assessed and managed, staff had not consistently monitored the emergency resuscitation equipment. Medication monitoring practices were not effective as we found some out of date medications.

Patients received evidenced based care and there was good multi-disciplinary working between the children’s services and the child and adolescent mental health team. However, there was no written guidance on how to manage risks for children and young people who presented with mental health concerns.

In adult outpatient clinics staff tried to accommodate children’s needs, but the clinic environments were not child friendly, and some patients had excessive waiting times. Staff in adult outpatient areas where children and young people were seen had not received adequate child safeguarding training.

Staff were caring, compassionate and respectful. Staff were positive about working in the service and there was a culture of openness, flexibility and commitment. Arrangements were in place to minimise risks to children and young people receiving care, and there was effective monitoring of quality and outcomes.

End of life care

Requires improvement

Updated 20 October 2015

We rated the end of life care services as requires improvement.

Staff knew how to report incidents but there was little evidence that learning from incidents and near misses was shared throughout the organisation. We were not assured that all incidents were reported as they should be. There were few audits and quality measures in place to monitor the effectiveness of end of life care throughout the trust and to benchmark against end of life care services nationally.

An executive lead had been identified at board level, but there was a lack of engagement and commitment on behalf of the trust to invest in adequate resources so that a quality end of life care service could be sustained. There was no service level agreement for the specialist palliative care team from a local hospice who were commissioned to provide specialist support within the trust. This meant the trust had no protection from this service being withdrawn.

The end of life care team acknowledged there was a lot of work that needed to be done and improvements were underway. The operational lead nurse had worked hard to improve the quality of end of life care.

Outpatients

Requires improvement

Updated 9 November 2016