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Hospital of St John & St Elizabeth Good

Inspection Summary


Overall summary & rating

Good

Updated 12 July 2019

The Hospital of St John and St Elizabeth is one of the UK's largest independent charitable hospitals, with any profits used to fund the on-site hospice, St John's, which offers free care to more than 4000 patients and their families every year. The hospital was founded in 1856 with a Roman Catholic affiliation and is a registered charity.

The hospital has 73 beds and facilities, which include; four operating theatres, diagnostic imaging, a three-bed level two-care high dependency unit (HDU), outpatient department, and a walk-in urgent care centre, Casualty First. There is also a hospice of St John and St Elizabeth.

The hospital provides surgery, medical care, and outpatient and diagnostic services for children, young people, and adults.

We carried out this unannounced focussed inspection on 21 March 2019. The purpose of the inspection was to review patient safety and governance processes, in response to two separate concerns raised with the Care Quality Commission (CQC).

The planning of the inspection included a review of information held in our electronic database, including notifications.

During the inspection we visited the urgent care centre (UCC), Casualty First, the high dependency unit (HDU) and St Francis and St Elizabeth wards. We reviewed two historical patient incidents, and the associated records. We looked at the hospital’s practices and processes at the time of the incidents and the changes made following the providers internal investigations.

We interviewed the management team. We spoke with 12 staff including nurses, medical staff, housekeeping and support staff staff.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

The Hospital of St John and St Elizabeth is registered to provide maternity and midwifery services, treatment of disease, disorder or injury, surgical procedures, diagnostic and screening procedures, and management of supply of blood and blood derived products.

We have provided guidance for services that we rate and do not rate. This was a focussed inspection we do not currently have a legal duty to rate them. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

We found the following areas of good practice:

  • All staff were required to complete infection prevention and control training as part of their mandatory training.

  • Staff kept themselves, equipment and the hospital premises clean. The hospital had improved control measures to prevent the spread of infection.

  • We saw staff demonstrated appropriate hand washing technique. Hand hygiene audits for the urgent care centre, Casualty First, met the hospital’s standards.

  • The hospital was in the process of refurbishing wards and departments. There was building work in progress on a new urgent care centre, a new high dependency unit (HDU), new imaging department and seven new theatres.

  • The hospital had introduced an online digital auditing tool to monitor the environment in the wards and departments. Results we viewed indicated the urgent care centre and HDU were meeting the hospital’s environmental audit standards.

  • Staff used the national early warning score (NEWS 2) to monitor patients for deterioration. If a patient’s condition deteriorated and they could not be safely treated on site, a consultant used an unplanned transfer protocol to transfer the patient to a hospital they could be safely cared for.

  • A team of resident medical officers (RMOs) provided medical cover 24-hours, seven days a week.

  • There was a clear management structure which staff were aware of. This meant that leadership and management responsibilities and accountabilities were explicit and clearly understood.

  • Staff spoke highly about their departmental managers. All staff said managers supported them to report concerns and said managers would act on them.

However, we also found the following issues that the service provider needs to improve:

  • Staff in the urgent care centre, Casualty First, and housekeeping staff were not clear about their specific areas of responsibility in regards to the cleaning of bodily fluids.

  • We found there had been a four day time period following an incident before house keeping staff had deep cleaned following an infection control risk in the urgent care centre.

  • We found patient care records did not always clearly detail patients care and treatment. We also found patients records had not been updated in a timely way.

  • We found delays in the reporting of an incident involving a patient on the electronic patient records system.

  • Root cause analysis (RCA) investigation following an incident did not adhere to the hospital’s policies and procedures for the investigation of incidents. As a result, there were gaps in the review of evidence and missed opportunities for learning.

  • We found learning from incidents was not always shared with team’s and staff across the hospital.

Following this inspection, we told the provider that that it should make improvements, even though a regulation had not been breached, to help the service improve.

Nigel Acheson

Deputy Chief Inspector of Hospitals

Inspection areas

Safe

Good

Updated 12 July 2019

Effective

Good

Updated 12 July 2019

Caring

Good

Updated 12 July 2019

Responsive

Good

Updated 12 July 2019

Well-led

Good

Updated 12 July 2019

Checks on specific services

Medical care (including older people’s care)

Good

Updated 7 June 2017

We rated this service as good because it was safe, effective, caring, responsive and well-led.

Staffing was managed jointly with surgery.

End of life care

Good

Updated 7 June 2017

We rated this service as good as it was safe, effective, caring and responsive to people’s needs, and was well-led.

Outpatients and diagnostic imaging

Good

Updated 7 June 2017

We rated this service as requires improvement for well-led. For safe, caring, and responsive we found this service was good. We did not rate the effectiveness of the service.

Surgery

Good

Updated 7 June 2017

Staffing was managed jointly with medical care.

We rated this service as requires improvement for safety and good for effective, caring, responsive, and well-led.

Urgent and emergency services

Updated 12 July 2019