24-25 August & 8 September 2021
During an inspection looking at part of the service
Our rating of this location stayed the same. We rated it as good because:
- Staff understood how to protect patients from abuse and managed safety well. The service controlled infection risk well. Staff tried to minimise risks to patients and acted on them. They managed medicines well. The service managed safety incidents well. Staff collected safety information and used it to improve the service.
- Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers made sure staff were competent. Staff worked well together for the benefit of patients and supported them to make decisions about their care. Key services were available seven days a week.
- Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
- The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
- Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and all staff were committed to improving services continually.
However:
- Some staff across the service did not complete their mandatory training. Within the hospice community team, only 76% of staff has completed life support training at the time of inspection. Porters within the hospital were given some end of life care (EOLC) training at their induction but only 64% had completed this. Following our first site inspection, the hospital began to deliver further EOLC tailored training to the porters, which 81% of these staff had completed by the time of the second site visit. The remaining staff were booked to complete this training.
- Some minor issues were found with infection prevention control (IPC) within urgent care. There was no handwashing poster displayed by the handwashing sink in the treatment room. No record of cleaning toys was kept. The hospital policy for reception staff dress code within the urgent care centre was not in line with the best infection prevention control practice, as staff were not required to be ‘bare below the elbow’ (BBE).
- In the hospice day centre and basement areas, there were some environmental issues such as lack of air conditioning and poor wheelchair access. However, the hospital was aware of these issues and were in the process of redesigning the areas with staff input, with plans and concept designs being drawn up.
- In urgent care, we found some emergency medicines in the resuscitation trolleys were stored incorrectly and did not match the daily stock list. However, the service rectified this immediately on the day of inspection.
- Not all staff in surgical services completed and updated risk assessments accurately.
- In the end of life service, staff did not always receive feedback from investigation of incidents. Although staff were aware of incidents that had occurred, we were not always assured that planned actions or recommendations from incident investigations were taken forward. Action plans as a result of incidents were not always clear and responsible people were not always assigned to ensure that learning was fully implemented across the service.
- There was no safeguarding flagging system in the electronic health records to identify adult patients who may be vulnerable. Senior leaders told us that they were working with the IT software team to incorporate this.
- There had been a 43% increase in patient contacts to the social work team in the last year due to pressures from the pandemic, leaving the team feeling stretched. There was a feeling amongst staff we spoke with that whilst the team offered excellent support, they perhaps they did not have the capacity to support everyone. Senior staff told us that they were aware of the workload challenges of the team and another post focusing specifically on welfare benefits had been agreed.
- There were medical vacancies within the end of life care service. This reflected a national shortage of palliative care consultants, and the service had been trying to recruit into these vacancies for some time. The provider had identified insufficient consultant cover as a risk and was working with a local NHS trust to develop a joint consultant post to attract a greater number of applicants.
- The hospice community and hospice inpatient unit teams used different patient record systems, and IT systems and records across the hospital were not integrated. This led to some duplication, frustration and delays. Electronic patient records in urgent care were not integrated. The hospital was aware of these issues and were working to integrate systems and ultimately the creation of a hospital-wide patient record system.
- Staff monitored the effectiveness of some care and treatment, but not all audits were carried out in a systematic and meaningful way. They used the findings to make some improvements but action plans were not always clear.
- There was no separate multifaith room, although the service informed us that alternative quiet rooms were available on request. There were also no prayer mats available for patients.