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Archived: The Raphael Hospital Requires improvement

All reports

Inspection report

Date of Inspection: 19, 20 September 2013
Date of Publication: 6 November 2013
Inspection Report published 06 November 2013 PDF

People should get safe and coordinated care when they move between different services (outcome 6)

Meeting this standard

We checked that people who use this service

  • Receive safe and coordinated care, treatment and support where more than one provider is involved, or they are moved between services.

How this check was done

We looked at the personal care or treatment records of people who use the service, carried out a visit on 19 September 2013 and 20 September 2013, observed how people were being cared for and checked how people were cared for at each stage of their treatment and care. We talked with people who use the service, talked with carers and / or family members, talked with staff and were accompanied by a specialist advisor.

We were supported on this inspection by an expert-by-experience. This is a person who has personal experience of using or caring for someone who uses this type of care service.

Our judgement

People’s health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in co-operation with others.

Reasons for our judgement

We talked with patients and relatives about their experiences of co-ordinated care. One patient had been transferred from another hospital. The patient said that there had been a discharge meeting where staff from the hospital and the Raphael Medical Centre (RMC) had been present. The discharge process had been explained to the patient and the relative. The patient said they felt informed and involved, “the cooperation was good … I felt confident because what they said would happen did happen … and it happened when they said it would”

We saw there was close cooperation with the Lane Fox respiratory unit, which is a national referral centre for chronic (long term) respiratory failure. Staff from the unit came to the RMC and helped to settle the patients and set up the equipment, which was required to be tailored to the individual. Once the equipment was set up by staff from the unit it was locked so that it could not accidently be altered. Staff from the Fox Lane unit made random visits to the RMC to ensure that the equipment was working correctly. Staff from the Fox Lane Unit provided training on respiratory issues to staff from the RMC.

The RMC was a founding member of the Kent Acquired Brain Injury Forum (KABIF). This group brought together partners from NHS, the education department, the local authorities and both the private and voluntary sector. The achievements of the group included constructing a county wide strategic plan for commissioning of services for acquired brain injury. Kent was the first county in England to have done so. The RMC was actively involved in the forum. On the day of our visit the nominated individual for mental health services at the RMC was chairing a meeting of the forum.

We saw from patients’ records that the RMC cooperated with, and made referrals to, other providers. We looked at a recent referral to an acute hospital for medical reasons, not directly related to the patient’s brain injury. This had happened at a weekend. The on call doctor had attended the patient. There were comprehensive notes of the doctor’s conversation with the hospital. The hospital had been informed of the care needs of the patient, in respect of the brain injury as well the more immediate problem. When the hospital wished to discharge the patient the RMC had been unwilling to accept the patient’s return until they were satisfied that the patient was medically stable.

The RMC made routine referrals for patients’ physical needs. We saw letters of referral for dermatology, surgery and nuero-surgery. We saw that these had been followed up and in one case how the outcome of surgery had impacted positively on a patient’s care plan.

There were discharge meetings involving other providers. We looked at a selection of notes of these. There were representatives from other health providers, local social services departments, families and voluntary agencies. We saw that discussions focused on finding the most appropriate placement for the individual and mapping out a care pathway. We also looked at the records of a 'best interest' meeting held prior to a patient’s discharge. People present included health professions, social workers and an independent advocate. The patient’s nearest relative had been invited but was unable to attend. There was however a letter from the relative which had set out their aspirations for the patient.