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Inspection Summary


Overall summary & rating

Good

Updated 15 December 2016

This was the first comprehensive inspection of The New Victoria Hospital, which was part of the CQC’s ongoing programme of comprehensive, independent healthcare acute hospital inspections. We carried out an announced inspection of The New Victoria Hospital on 19-20 July 2016. We did not undertake an unannounced inspection, because we obtained the required evidence to make a judgement during the announced visit.

The inspection team inspected the core services of surgery and outpatients and diagnostic imaging services.

Complex diagnostic investigations such as magnetic resonance imaging (MRI) and computerised tomography (CT) scans were provided by the hospital.

Overall, we have rated The New Victoria Hospital as ‘Good’. We found surgery good in all of the key questions we always ask of every service and provider relating to safe, effective, caring, responsive and well led. Outpatients and diagnostic imaging services was rated good in the four key questions relating to safe, caring, responsive and well led. We inspected, but did not rate the key question of effective.

Are services safe at this hospital/service

By safe, we mean that people are protected from abuse and avoidable harm.

  • Patients were protected from avoidable harm and abuse. Incidents were reported, investigated and lessons were learned and improvements had been made when needed.
  • Patients were appropriately risk assessed and monitored throughout their stay.
  • There were appropriate levels of both consultant and nursing staff to meet the needs of patients.
  • Cleanliness and infection control procedures were adhered to by all staff.
  • Clinical staff had appropriate safeguarding awareness training and people were safeguarded from abuse.
  • Outcomes of incident reviews were not shared widely with junior staff.
  • Knowledge of and adherence to low level infection control measures were lacking.
  • Records of when equipment was cleaned were not kept.
  • Consultants used their own notes to record the patient’s outpatient consultation and not all of those notes were retained within the hospital medical records.
  • The hospital did not use the situation, background, assessment, recommendation (SBAR) tool for their RMO handover, however there were arrangements for comprehensive daily RMO to RMO handover, the RMO daily handover sheet contained name, age, consultant and concerns.
  • Children were seen by adult consultants and without a children's nurse present. The management was aware that this was an issue and had begun to address it by having a bank children's nurse cover when a child is being seen at the hospital.

Are services effective at this hospital/service

By effective, we mean that people’s care, treatment and support achieves good outcomes, promotes a good quality of life and is based on the best available evidence.

  • Patient care and treatment reflected relevant research and guidance, including the Royal Colleges and National Institute for Health and Care Excellence (NICE) guidance.
  • Staff had access to further training and were supported in developing.
  • Regular and meaningful clinical audits were carried out.
  • There was shared responsibility for care and treatment delivery and multidisciplinary team approach was evident across services provided.
  • The hospital provided evening appointments and diagnostic imaging was available seven days a week.
  • Knowledge and awareness of the Mental Capacity Act and Deprivation of Liberty Safeguards was lacking amongst some surgical staff.

Are services caring at this hospital/service

By caring, we mean that staff involve and treat patients with compassion, dignity and respect.

  • People were treated with kindness, dignity, respect and compassion whilst they received care and treatment.
  • Patients understood the care and treatment choices available to them and were given appropriate information and support regarding their care or treatment.
  • The patient feedback about the hospital was very positive and the way staff treated patients was rated very highly.

Are services responsive at this hospital/service

By responsive we mean that services are organised so they meet people’s needs.

  • Services were planned and delivered to meet the individual needs of most patients, including arranging and re-arranging appointments that met their individual needs.
  • Patients were seen in a timely manner for all appointments by their chosen consultant and clinics were rarely cancelled at short notice.
  • The service was easy to access and flow through the hospital was smooth and rarely impeded.
  • Provision had been made to meet the needs of people from different cultures and backgrounds.
  • People’s concerns and complaints were listened and responded to and feedback was used to improve the quality of care.

Are services well led at this hospital/service

By well-led, we mean that the leadership, management and governance of the organisation, assure the delivery of high-quality person-centred care, supports learning and innovation, and promotes an open and fair culture.

  • There were clear values for the service which staff were aware of and reflected on the care and treatment they provided.
  • The governance framework and risk management ensured staff responsibilities were clear and that quality, performance and risks were well understood and managed.
  • Staff morale was very high and all staff felt engaged and able to suggest improvements to the way care and treatment was provided.
  • There was an open and supportive culture.
  • Nursing staff were focused on providing the best service they could for all patients.
  • The risk register did not reflect the actual risks of the service, with no date, actions or responsible persons.

We saw one area of outstanding practice:

  • One surgeon uses the UroLift System which is ground-breaking prostate surgery.

However, there were also areas of where the provider needs to make improvements.

The provider should:

  • Ensure the risk register reflects the actual current risks of the service and includes date, actions and responsible person for each action.

  • Ensure children are not seen by adult consultants, unless a children's nurse is present at all times.
  • Widely share outcomes of incident reviews with junior staff.
  • Ensure staff knowledge of and adherence to low level infection control measures is improved.
  • Keep records of when equipment are cleaned.
  • Ensure all patient records are always available prior to outpatients appointments.
  • Ensure staff knowledge and awareness of the Mental Capacity Act, 2005 and Deprivation of Liberty Safeguards is improved.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection areas

Safe

Good

Updated 15 December 2016

Effective

Good

Updated 15 December 2016

Caring

Good

Updated 15 December 2016

Responsive

Good

Updated 15 December 2016

Well-led

Good

Updated 15 December 2016

Checks on specific services

Outpatients and diagnostic imaging

Good

Updated 15 December 2016

We rated outpatients and diagnostic imaging as good because:

  • Staff had a good understanding of how to report incidents and learning from incidents was shared at a departmental level.
  • Clinical areas and waiting rooms were all visibly clean and tidy. Infection prevention and control practices were followed and these were regularly monitored, to prevent the unnecessary spread of infection.
  • Appropriate equipment was available for patient procedures and tests. Equipment was well maintained and safety tested annually or in accordance with manufacturer’s guidelines.
  • Medicines were stored securely. There was evidence of multidisciplinary team working across all departments.
  • Care and treatment were based upon National Institute of Health and Care Excellence (NICE) guidance and recognised best practice, there was evidence that clinical audits were being undertaken in all outpatient areas, including recording of patient reported outcomes.
  • Nursing staff were supported in their role through appraisals and were encouraged to participate in training and development to enable them to deliver good quality care.
  • Staffing levels and the skill mix of staff was appropriate for both the outpatient department and diagnostic imaging.
  • Nursing staff undertook appropriate mandatory training for their role and they were supported to keep this up-to-date.
  • Patients were very positive about the care that they received and the information provided to them. Patients were treated with dignity and respect while they attended the hospital.
  • The consent process for patients was well structured and staff demonstrated a good understanding of the Mental Capacity Act and Deprivation of Liberty Safeguards.
  • Patients pain needs were met appropriately during a procedure or investigation.

However:

  • Children were seen by adult consultants and without a children's nurse present. The management was aware that this was an issue and had begun to address it by having a bank children's nurse available when a child is being seen.
  • Some patients we spoke with commented there was insufficient parking due the refurbishment and reconfiguration of the hospital.

Surgery

Good

Updated 15 December 2016

We rated this service as good because:

  • Patients were appropriately risk assessed and monitored throughout their stay.
  • There were appropriate levels of both consultant and nursing staff to meet the needs of patients.
  • Care and treatment were based upon recognised best practice and national guidelines.
  • Staff had access to further training and were supported in developing.
  • We observed staff providing people with treatment in a kind and considerate fashion.
  • Patients were given appropriate information about their care and treatment and involved in decisions about it.
  • The service was easy to access and flow through the hospital was smooth and rarely impeded.
  • Provision had been made to meet the needs of people from different cultures and backgrounds.
  • There were clear values for the service which staff were aware of and reflected in the care and treatment they provided.
  • Comprehensive governance arrangements were in place to monitor the quality of the service at the hospital and these were used to make improvements.

However:

  • The risk register did not reflect the actual risks of the service, with no date, actions or responsible persons.
  • Outcomes of incident reviews were not shared widely with junior staff.
  • Knowledge of and adherence to low level infection control measures were lacking.
  • Records of when equipment was cleaned were not kept.
  • There were gaps in staff knowledge and awareness of the Mental Capacity Act and Deprivation of Liberty Safeguards.