Bedford Hospital NHS Trust provides a range of hospital care services to over 270,000 people living predominantly in north and mid Bedfordshire and is the vascular hub for Bedfordshire, Luton and Dunstable, and Milton Keynes. The trust provides a full range of district general hospital services to its local population, with some links to hospitals in Luton and Dunstable, Milton Keynes and Cambridge.
There are approximately 425 inpatient beds and 28 day case beds within the hospital.
We carried out an announced comprehensive inspection of the trust from 15 to 17 December 2015. We undertook two unannounced inspections on 6 and 7 January 2016. We held focus groups with a range of staff in the hospital, including nurses, junior doctors, consultants, midwives, student nurses, administrative and clerical staff, allied health professionals, domestic staff and porters. We also spoke with staff individually.
Overall, we rated Bedford Hospital as requires improvement. We found improvements were needed to ensure that services were safe, effective, responsive to patient’s needs and well-led. We found that caring was good. Patients were treated with dignity and respect and were provided with appropriate emotional support.
Four of the eight core services at Bedford Hospital were rated requires improvement (surgery, maternity and gynecology, children and young people and outpatient and diagnostics). Four services were rated as good (urgent and emergency care, medical care, critical care and end of life care).
Our key findings were as follows:
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Staff were kind and caring and treated people with dignity and respect.
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Overall the hospital was clean, hygienic and well maintained.
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Equipment was not always appropriately checked and maintained.
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Vacancy rates had improved in November 2015 to 6.1% but remained worse than the trust target of 5%. Nursing vacancies averaged 9.1%. The trust had identified this as a risk and a recruitment programme was underway.
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Temporary staff were used to fill vacant shifts. An induction process was followed for temporary staff.
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Not all staff had completed mandatory training and not all relevant staff had not completed other recommended training for example, Advanced Paediatric Life Support.
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Between June 2014 and June 2015 the trust had reported one case of Methicillin-resistant Staphylococcus Aureus (MRSA), this was in May 2015. There were 13 reported Clostridium difficile cases and four reported Methicillin Sensitive Staphylococcus Aureus (MSSA) cases. Incidences were similar to or better than the England average.
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Most patients were complimentary about the hospital food and women told us that they received support to feed their babies. We saw that the initiation of breast feeding rate was 85% in May 2015 which was better than the national average of 75%.
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Patient’s pain was well managed and none of the patients we spoke with reported being in pain.
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Patients at the end of life were given adequate pain relief and anticipatory prescribing was used to manage symptoms.
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The trust were generally meeting the national targets set regarding patients access to treatment in surgical and outpatient settings.
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The trust were meeting the standard for patients admitted, referred or discharged from the emergency department within four hours.
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There were governance processes in place to provide oversight of incident reporting and management, including categorisation of risk and harm. However, we were not assured demonstrated a sufficient depth of analysis or learningand therefore we were not assured that improvements in practice to prevent reoccurrence had been achieved.
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We saw evidence of learning from some incidents but were not assured of the ongoing monitoring of changes made and therefore their sustainability.
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Staff generally felt they were well supported at their ward or department level.
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Staff reported on the whole executive directors were visible.
We saw several areas of outstanding practice including:
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The hospital offered Endovascular stent-grafts for popliteal aneurysms, which is an alternative method to open surgery, early indication suggest it is safer and more effective for the patients.
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Image guidance for endoscopic sinus and skull base surgery is used for sino-nasal tumours, revision sinus surgery and disease abutting the optic nerve, carotid artery and skull base. For patients it means safe surgery, closer to home.
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One stop neck lump clinic. This speeds up the diagnosis of head and neck cancer by Tru-Cut biopsy solid tumours and avoids general anaesthetics in most cases, with the potential to speed up treatment.
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The critical care complex had designed and built an attachable portable unit for the end of a patient’s bed, to prevent disruption to the patient’s care and welfare. The unit was used when patients needed to go for a computerised tomography (CT) scan or a magnetic resonance imaging (MRI).
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A high risk birthing pool pathway was developed and implemented at the beginning of 2015. This meant that women with high risk pregnancies had the opportunity to experience the benefits of water whilst in labour. Midwives who were involved with the development of this project were selected as finalists in the Royal College of Midwives Innovation Awards 2015.
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Dementia facilities met the needs of patients living with dementia. Facilities included a cinema area, activity tables, coloured and picture coded bays and the inclusion of the wanderguard system. Under bed lighting assisted patients to differentiate between beds and flooring at night, and reported falls had decreased since the lighting was implemented.
However, there were also areas of poor practice where the trust needs to make improvements.
Importantly, the trust must:
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The trust must ensure patients privacy and dignity is always maintained at all times.
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The trust must ensure all reasonable efforts are made to make sure that discussions about care and treatment only take place where they cannot be overheard.
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The trust must ensure patients always have privacy when they receive treatment or when they used washing facilities.
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The trust must ensure that where a person lacks capacity to make an informed decision or give consent, staff must act in accordance with the requirements of the Mental Capacity Act 2005 and associated code of practice.
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The trust must improve the incident reporting process to ensure all incidents are reported, including those associated with staffing levels.
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The trust must ensure lessons learnt and actions taken from never events, incidents and complaints are shared across all staff.
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The trust must ensure risk registers reflect the risks within the trust.
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The trust must ensure effective and timely governance oversight of incident management, that actions agreed correlate to the concerns identified, are acted on and lessons learned are shared accordingly; including categorisation of risk and harm, particularly in maternity services.
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The trust must ensure patient records are accurate, complete and fit for purpose, including ‘do not attempt cardio-pulmonary resuscitation’ forms.
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The trust must ensure that systems and processes are in place to ensure the documentation and monitoring of the cleanliness of equipment.
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The trust must ensure that policies are comprehensive.
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The trust must ensure there are the appropriate numbers of qualified paediatric staff in the emergency department and paediatric unit to meet standards set by the Royal College of Paediatrics and Child Health 2012 or the Royal College of Nursing.
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The trust should ensure that where staffing fill rates do not meet trust target, associated risks are identified and mitigated.
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There must be sufficient numbers of staff trained to the expected standard to give life support to paediatric patients.
Professor Sir Mike Richards
Chief Inspector of Hospitals