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Archived: Shepton Mallet Health Partnership Outstanding

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Inspection Summary


Overall summary & rating

Outstanding

Updated 9 May 2017

Shepton Mallet NHS Treatment Centre is operated by Care UK. The hospital has 34 beds. Facilites include four theatres, one daycase and endoscopy theatre, sterile services department, and outpatient and diagnostic facilities.

The hospital provides surgery, and outpatients and diagnostic imaging. We inspected the core services using our comprehensive inspection methodology. We carried out the announced part of the inspection on 11 to 13 October 2016 and an unannounced visit on 26 October 2016.

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.

The main service provided by this hospital was surgery. Where our findings on surgery, for example, governance arrangements, also apply to other services, we do not repeat the information but cross-refer to the surgery core service.

We rated this hospital as outstanding overall.

We found areas of outstanding practice in both surgery and outpatients and diagnostic imaging:

  • There were strong, comprehensive and embedded systems, processes and standard operating procedures to keep people safe and safeguarded from abuse.
  • Staffing levels and skill mix were planned, implemented and reviewed to keep people safe at all times.
  • A proactive approach to anticipating and managing risks was embedded and was recognised as being the responsibility of all staff.
  • Patients had excellent outcomes and their care and treatment was planned and delivered in line with evidence-based guidance, standards and best practice.
  • An extensive audit programme allowed early identification of areas for improvement and action plans were put in place as a result of any non-compliance.
  • The continuing development of staff skills, competence and knowledge was recognised as being integral to ensuring high quality care. Staff had the skills required to carry out their roles effectively and were proactively supported to maintain and develop their professional skills and experience.
  • There was outstanding care provided to the patients. Patients were respected and valued as individuals and were empowered as partners in their care. Patients were highly satisfied with the care they received and we observed this in practice.
  • Services were planned and delivered in a way that met the needs of the local population. Flexibility, choice and continuity of care were reflected in both services.

  • The hospital had robust policies and processes in place to effectively investigate, monitor and evaluate patient’s complaints.
  • Managers and staff were extremely proud of the organisation and the contribution they made to the healthcare of local people. Patient care was at the centre of everything they did.
  • All departments had developed detailed objectives which outlined the quality and business plans for the next year in line with the hospital’s strategic objectives.
  • There were comprehensive governance arrangements in place which allowed the hospital to work in line with best practice and deliver high quality care.
  • Frontline staff and senior managers were passionate about providing a high quality service for patients with a continual drive to improve the delivery of care.
  • There was excellent local leadership of the services. The senior management team had an inspiring shared purpose and were committed to the patients who used the services, and also to their staff and each other.

However, we also found areas of practice that required improvement:

  • The store room in theatre required reorganising to ensure the efficient management of supplies.
  • The average waiting time for patients attending their first outpatient appointment with a consultant required improvement. The average waiting time was 25 minutes and data showed 9% of patients had waited for longer than an hour.
  • Staff in the outpatients department were not consistently aware of how to access information in different formats/languages, and did not follow best practice by using relatives to translate.

Professor Edward Baker

Deputy Chief Inspector of Hospitals (South West)

Inspection areas

Safe

Outstanding

Updated 9 May 2017

We rated safe as outstanding because:

  • There were systems in place for recording and learning lessons from incidents and staff told us they were encouraged to report incidents
  • Harm free care was monitored using the safety thermometer and the hospital assessed patients and monitored pressure ulcers, falls, venous thromboembolism and catheter associated urinary tract infections.
  • The ward and theatre departments were visibly clean and well organised. Staff adhered to infection prevention and control policies and protocols.
  • Equipment appeared fit for purpose and was well maintained.
  • Systems were in place for the safe storage and administration of medicines Records were complete, accurate, legible and up to date and reflected patient’s individual needs.
  • Staff were knowledgeable about the safeguarding processes and understood their responsibilities to report concerns.
  • Mandatory training was monitored each month and most staff were compliant with their training.
  • Surgical staff followed the World Health Organisation (WHO) safe surgery checklist.
  • Processes were in place to respond to a deteriorating patient, there was a competent resuscitation team and staff had knowledge of emergency transfer procedures.
  • Business continuity plans were in place in case of planned and unplanned events that could cause disruption to the normal running of the hospital.
  • There were robust systems in place for incident reporting, investigation and learning lessons. Staff received feedback on incidents raised.
  • All staff (100%) in outpatients, physiotherapy and diagnostic imaging had completed their mandatory training.
  • Staff had knowledge and awareness of safeguarding and despite not seeing or treating children had been trained to level two in children’s safeguarding.
  • The hospital had a visitor’s policy in place to know who was on site and what they were doing in order to protect patients.
  • The departments we visited were visibly clean and tidy. Patient satisfaction scores and feedback from patients during our inspection confirmed the high levels of cleanliness.
  • Robust systems where in place to make sure equipment was calibrated and serviced in line with manufacturer’s instructions so that it was safe to use.
  • Procedures were in place for the safe storage, prescribing and administration of medicines.
  • Every patient who attended the hospital had their medical notes readily accessible in paper and electronic form.
  • The hospital and staff had an excellent understanding of what posed a risk to patients, and plans were in place to mitigate that risk as much as possible.
  • Staffing within outpatients, physiotherapy and diagnostic imaging was sufficient to meet the needs of their patients.

However the following area required improvement:

  • The theatre equipment store was not efficiently maintained and required reorganising.

Effective

Outstanding

Updated 9 May 2017

We rated effective as outstanding because:

  • Patients had good outcomes as they received effective care and treatment to meet their needs.
  • Treatment by all staff was delivered in accordance with best practice and recognised national guidelines.
  • Patients were at the centre of the service and the priority for staff. High quality performance and care were encouraged and acknowledged and all staff were engaged in monitoring and improving outcomes for patients.
  • Staff skills and competence were examined and staff were supported to obtain new skills and share best practice.
  • There was a comprehensive learning management system in place that was fully auditable and up to date.
  • Multidisciplinary team working was excellent throughout the surgery service.
  • Information was readily available to staff to deliver effective care and treatment, and appropriate communication and relationships were maintained externally.
  • Patients’ pain relief was effectively reviewed and managed.
  • The nutritional and hydration needs of patients was assessed and met.

The effectiveness of outpatients and diagnostic services was not rated due to insufficient data being available to rate these departments’ effectiveness nationally.

We found:

  • The hospital had provided a teledermatology service since 2014 and had reduced the number of referrals to acute hospital dermatology services.
  • The physiotherapy team had established a falls programme which had seen a reduction in the number of falls suffered by patients following joint replacement surgery.
  • The physiotherapy tracked their patients and were able to demonstrate improved outcomes because treatment could be tailored to suit that individual patient.
  • The staff were well trained and had the knowledge and skills to do their job.

Caring

Outstanding

Updated 9 May 2017

We rated caring as outstanding because:

  • Patients were treated as individuals. Feedback from patients and their relatives had been exceptionally positive. They praised the way the staff really understood their needs.
  • Patients said staff were caring and compassionate, treated them with dignity and respect, and made them feel safe. Staff went above and beyond their usual duties to ensure patients experienced high quality care.
  • Staff were skilled to be able to communicate well with patients to reduce their anxieties and keep them informed of what was happening and involved in their care. They were able to ask questions and raise anxieties and concerns and receive answers and information they could understand
  • We observed outstanding care. and observed staff treating patients with kindness and warmth.
  • The theatres and ward were busy and professionally run, but staff always had time to provide individualised care.
  • All staff including clinical staff and supporting teams were highly motivated to provide person centred care which was dignified, kind, compassionate, respectful and professional.
  • The patient satisfaction scores showed consistently high rates of patient satisfaction.
  • Staff were aware of the needs of their individual patients and did everything they could to make the patients stay as good as it could be.

Responsive

Outstanding

Updated 9 May 2017

We rated responsive as outstanding because:

  • The service was committed to delivering care in a manner that recognised, respected, and responded to the diversity of the people to whom they provided clinical services.
  • Services were tailored to meet the needs of individual patients and were delivered in a flexible way.
  • The outpatients department ran ‘one-stop’ clinics for patients to see the consultant and then have the necessary tests if deemed suitable for surgery Individual patient needs were identified at their pre-operative assessment and where possible staff accommodated patient needs during their time in hospital.
  • A computer application (pocket physio) for use on mobile phones had been developed with extensive clinical input from members of the physiotherapy department.
  • The hospital achieved all its waiting time targets.
  • There were good facilities for patients.
  • Complaints were handled appropriately and learning from complaints was shared.
  • There were no barriers for those making a complaint. Staff actively invited feedback from patients and were very open to learning and improvement. There were, however, few complaints made to the unit. Those that had been made were fully investigated and responded to with compassion.

However the following areas required improvement:

  • The average waiting time for patients attending their first outpatient appointment with a consultant required improvement. The average waiting time was 25 minutes and data showed 9% of patients had waited for longer than an hour.
  • Staff were not consistently aware of how to access information in different formats/languages, and did not follow best practice by using relatives to translate.

Well-led

Outstanding

Updated 9 May 2017

We rated well-led as outstanding because:

  • The leadership, management and governance of the services was outstanding and assured the delivery of high-quality person-centred care. The clinical managers were committed to the patients in their care, their staff and the service.
  • There were clear departmental objectives and staff were able to repeat this and understood their responsibilities to achieve the objectives for the service.
  • There was a strong local leadership, the senior management team were visible, approachable and supportive, and motivated and inspired all staff.
  • Frontline staff and managers were passionate about providing a high quality service for patients with a continual drive to improve the delivery of care.
  • The culture was one of openness and transparency. A culture where staff could learn from mistakes and not be blamed for them.
  • There was a high level of staff satisfaction with staff saying they were proud of the centre as a place to work. They showed commitment to the patients, their responsibilities and to one another. All staff were treated with respect and their views and opinions heard and valued.
  • Patients were able to give their feedback on the services they received; this was recorded and acted upon where necessary.
  • Managers understood the key risk management issues and risk registers were maintained and reviewed regularly
  • An extensive audit programme was used to monitor the hospital’s performance and quality of care, clear action plans were put in place if non-compliance was identified and learning was shared.
Checks on specific services

Outpatients and diagnostic imaging

Outstanding

Updated 9 May 2017

  • There were robust systems in place for incident reporting, investigation and learning lessons. Staff received feedback on incidents raised.
  • All staff (100%) in outpatients, physiotherapy and diagnostic imaging had completed their mandatory training.
  • Staff had knowledge and awareness of safeguarding and despite not seeing or treating children had been trained to level two in children’s safeguarding.
  • The departments were visibly clean and tidy. Patient satisfaction scores and feedback from patients during our inspection confirmed the high levels of cleanliness.
  • Robust systems were in place to make sure equipment was calibrated and serviced in line with manufacturer’s instructions so that it was safe to use.
  • Procedures were in place for the safe storage, prescribing and administration of medicines.
  • Every patient who attended the hospital had their medical notes readily accessible in paper and electronic form.
  • Staff had a good understanding of what posed a risk to patients and plans were in place to mitigate that risk as much as possible.
  • Staffing within outpatients, physiotherapy and diagnostic imaging was sufficient to meet the needs of their patients.
  • The staff were well trained and had the knowledge and skills to do their job.
  • The patient satisfaction scores showed consistently high rates of patient satisfaction. All the patients we spoke with during our inspection were very complimentary about the hospital, the staff and their care and treatment.
  • We observed staff communicating with patients in a way they could understand and in a friendly, respectful and caring manner.
  • Staff were aware of the needs of their individual patients and did everything they could to make the patients stay as good as it could be.
  • Leadership was effective, approachable and visible. Managers were proud of their teams and the staff we spoke with were proud to work at the hospital.

Surgery

Outstanding

Updated 9 May 2017

We rated this service as outstanding because:

  • There were clear processes in place to ensure the safety of patients. Incidents were reported and investigated acted upon with feedback and learning provided to staff.
  • All areas in theatre and on the ward were visibly clean to a high standard and staff demonstrated good infection control practice to reduce the risk of infection.
  • There were policies and procedures to be followed for the safe management of medicines.
  • Comprehensive risk assessments were carried out and regularly reviewed.
  • Nursing and surgical staffing were planned and reviewed regularly in line with best practice guidance to ensure patients received safe care and treatment. Staff were knowledgeable and experienced in their roles.
  • Treatment and care were effective and delivered in accordance with best practice and recognised national guidelines.
  • Patients were well supported with nutrition, hydration and pain relief.
  • Patients were at the centre of the service and the priority for staff.
  • Patients received excellent care from dedicated, caring and well trained staff who were skilled in working and communicating with patients.
  • Staff understood the individual needs of patients and designed and delivered services to meet them. Patients were kept involved with their care and staff ensured their full understanding.
  • Patients spoke highly of the approach and commitment of the staff who provided the service. Feedback from those who used the service had been exceptionally positive. Staff went above and beyond their usual duties to ensure patients received compassionate care.
  • There were clear lines of local management in place and structures for managing governance and measuring quality.
  • The leadership and culture of the service drove improvement and the delivery of high-quality individual care.
  • All staff were committed to patients and to their colleagues. There were high levels of staff satisfaction with staff saying they were proud of the hospital as a place to work. They spoke highly of the culture and levels of engagement from managers.
  • There was a good track record of lessons learnt and improvements when things went wrong. This was supported by staff working in an open and honest culture with a desire to get things right.
  • Innovation, high performance and the high quality of care were encouraged and acknowledged.