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Nuffield Health Shrewsbury Hospital Good

Inspection Summary


Overall summary & rating

Good

Updated 30 October 2018

Nuffield Health Hospital Shrewsbury is operated by Nuffield Health. The hospital has a 30 bedded ward. Facilities include three operating theatres, X-ray and outpatient and diagnostic facilities. The hospital provides surgery, and outpatients and diagnostic imaging.

During our inspection we inspected surgery only. We inspected this service using our focussed inspection methodology. We carried out the unannounced visit to the hospital on 19 July 2018.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

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 main service provided by this hospital was surgery. The hospital provided an outpatient service but we did not inspect it on this occasion.

This was a focussed follow up inspection looking particularly at surgery.

Throughout this inspection, we also followed up on concerns raised at the previous CQC inspection conducted in November 2016. We found:

  • On the last inspection we told the hospital they must ensure that the World Health Organisation (WHO) Five Steps to Safer Surgery checklist is consistently completed and adhered to at the hospital.

  • During this inspection we saw live examples of the WHO checklist being carried out, however, some of the paperwork in a record we reviewed had incomplete WHO checklist paperwork.

  • On the last inspection we told the hospital they must ensure steps are taken to improve the infection rates for surgical procedures.

  • During this inspection we saw the hospital had greatly improved the level of audit around infection prevention control and audit results were much better. They had also bought in an infection prevention control lead.

  • On the last inspection we told the hospital they must ensure all policies are complied with, specifically the antimicrobial policy, fasting arrangements and ensuring patients had sufficient information and time to provide informed consent about their operation.

  • During this inspection found that the hospital complied with the antimicrobial policy, fasting arrangements and ensuring patients had sufficient information and time to provide informed consent about their operation.

We rated this hospital as good overall.

We found good practice in relation to surgery:

  • Infection prevention and control was well managed; and was regularly audited to ensure staff compliance. This had been an big improvement from the last inspection.

  • We found incidents were managed appropriately. Staff were aware of how to report incidents; and supported to do so. Learning was shared to all staff; including learning from incidents which had occurred within other Nuffield Health locations.

  • Staff undertook a range of mandatory training subjects, including appropriate safeguarding training for their grade. We saw that staff training compliance was above target.

  • Staff were assessed for their competency to undertake their roles. Staff received yearly appraisals.

  • Patient outcomes for certain surgical procedures were measured using the Patient Reported Outcome Measures Tool (PROMs).

  • Staff were consistently caring and respectful towards patients. We observed direct patient care whereby staff were compassionate and engaged with patient needs and treated patients with dignity.

  • The hospital provides dementia friendly treatment and being a dementia friendly environment. The hospitals dementia toolkit was provided along with a ‘This is Me’ form, dignity audit and the dementia letter they shared within the hospital. They were also engaging with Dementia Friends and had pledged to train all hospital staff by the end of 2018.

  • Staff worked to meet patients’ individual needs including dietary requirements; spiritual needs and helped them access support.

  • The culture of the service was centred on the needs and experience of their patients which also promoted openness and honesty. Leaders encouraged staff to be open and honest with patients when things did go wrong. Staff were proud of the care they provided.

  • Senior management had a good understanding of the challenges that the service faced. We found the senior management of the hospital were proactive and sought to rectify concerns quickly.

We found areas of practice that require improvement in surgery:

  • WHO checklist paperwork was not always completed in records we reviewed.

  • The level of night staffing meant that when one nurse was pulled from the ward then only one staff member would be left to provide patient care on the ward.

  • On one occasion we saw the nurse’s office door was left unlocked when no nurse’s were present and anyone on site could have accessed patient records.

  • The latest audit results for records were at 67% for the records on the wards and at 68% for theatres.

  • One staff member we spoke to was not aware of the translation service and used a family member to translate.

Heidi Smoult

Deputy Chief Inspector of Hospitals (Central Region)

Inspection areas

Safe

Good

Updated 30 October 2018

We rated safe as good because:

  • The overall average compliance rate for mandatory training is 91% which is above the mandatory training target of 85%.

  • Safeguarding policies and procedures were in place at the hospital and staff were able to explain what they would do if they identified safeguarding abuse, safeguarding adults training was at 92%.

  • There were systems and processes in place to prevent and protect people from a healthcare-associated infection and staff were compliant with them. Hospital infection prevention audit results were good.

  • The design, maintenance and use of facilities and premises kept people safe. Appropriate equipment such as resuscitation equipment was available and well maintained.

  • A registered medical officer (RMO) was on site 24 hours a day, seven days a week to provide medical support to the nursing staff.

  • Medicines and medicines related stationery were managed safely and securely. Prescription charts were complete, fridge temperatures were measured and controlled drugs were stored securely.

  • Staff understood their responsibilities to raise concerns, record and report safety incidents, concerns and near misses, and to report them internally. Dissemination of learning from incidents took place after incidents.

However;

  • World Health Organisation checklist paperwork was not always completed in records we reviewed.

  • The level of night staffing meant that if one nurse was pulled from the ward then only one staff member would be left to provide patient care on the ward.

  • On one occasion we saw the nurse’s office door was left unlocked when no nurse’s were present and anyone on site could have accessed patient records.

Effective

Good

Updated 30 October 2018

We rated effective as good because:

  • We saw that the hospital had systems in place to provide care and treatment in line with national guidance and staff were able to give examples of following best practice.

  • Patient’s nutrition and hydration needs were assessed and met. All patients we spoke with were happy with the quality of food they received.

  • Staff managed pain effectively and in a timely manner.

  • The hospital recorded Patient Reported Outcome Measures (PROM) and Q-PROM data and audit data then used this information in various governance meetings.

  • Staff at the hospital were competent. All consultants were up to date with practising privileges and permanent staffhad regular appraisals. Staff told us learning and development was encouraged by the hospital.

  • The staff demonstrated good multidisciplinary working with informative, effective handovers. All staff reported that medical and nursing staff, therapists and pharmacist staff worked in partnership on the ward.

  • Staff promoted health and wellbeing to patients. If staff members identified potential health issues with patients they would signpost to appropriate agencies.

However;

  • Staff were not always aware of where they could access certain policies.

Caring

Good

Updated 30 October 2018

We rated caring as good because:

  • Staff treated patients compassionately throughout their stay at the hospital. All patients we spoke with reported that staff treated them with kindness, dignity and respect.

  • Staff gave patients emotional support throughout their stay at the hospital. Staff could refer patients for psychiatric or psychological support if required.

  • Staff provided patients with appropriate information in a way they could understand. All patients had a named nurse.

Responsive

Good

Updated 30 October 2018

We rated responsive as good because:

  • Services were planned and delivered in a way that took people’s needs and preferences into account.

  • The hospital met the individual needs of its patients. Patients could access information in the format they needed. Staff catered to patients dietary, religious and special needs.

  • The hospitals admission process, care pathways and treatment plans were the same for private and NHS patients. Discharge packs which included a letter to the GP were provided to patients.

  • The hospital dealt with and learnt from complaints. They responded to complainants in a timely and compassionate manner and explained any changes that had taken place as a result of the complaint.

However;

  • One staff member we spoke to was not aware of the translation service and used a family member to translate. Which is an improvement since the last report, but is not fully embedded.

Well-led

Good

Updated 30 October 2018

We rated well-led as good because:

  • The leadership team had the skills, knowledge and experience to manage the service. Managers demonstrated the ability to understand the challenges and were visible to staff on the wards.

  • The hospital had a clear vision and strategy for the hospital.

  • The culture of the service was centred on the needs and experience of their patients which also promoted openness and honesty. Staff said the culture of the service was positive and a learning culture was promoted.

  • There were robust quality measurement system in place, which were managed by the senior leadership team. The matron captured clinical data and presented this to various governance groups and used it to inform service decisions.

  • The hospital engaged with both patients and staff and used the feedback to inform service decisions. They held quarterly patient forum meetings.

  • The hospital provided dementia friendly treatment and being a dementia friendly environment.

Checks on specific services

Outpatients and diagnostic imaging

Good

Updated 11 January 2017

Outpatients and diagnostic imaging services at this hospital had systems and processes in place to promote practices that protected patients from the risk of harm.

There were sufficient numbers of trained staff to meet the needs of patients. We saw that equipment in all areas was well maintained and kept clean to minimise the risk of infection. Records were available and well maintained.

There was an open culture where staff were encouraged to report incidents and lessons learned were shared within teams.

The radiology department had recently introduced the use of the World Health Organisation (WHO) Five Steps to Safer Surgery checklist to ensure patient safety.

Treatment and care was provided in line with national guidance. We saw there was good multi-disciplinary working and patient’s needs were responded to.

Staff were polite, courteous, friendly and responsive to patients’ individual needs.

Staff felt supported and proud to work within the hospital. They were very positive about the Matron who had been in post for 12 months and made positive changes to the hospital.

However, we also saw that flooring and hand washing sinks did not meet current guidelines but the hospital was in the process of replacing them. Not all staff we spoke with demonstrated full understanding of the Mental Capacity Act.

Surgery

Good

Updated 30 October 2018

Surgery was the main activity of the hospital. The hospital provided and outpatient service but we did not inspect it on this occasion. The service carried out general surgery and orthopaedics.

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