You are here

St Mary's Hospital Requires improvement

This service was previously managed by a different provider - see old profile

Inspection Summary


Overall summary & rating

Requires improvement

Updated 4 September 2019

Our rating of services improved. We rated it them as requires improvement because:

  • There were many areas still to develop for patient care and delivery, especially in medical, gynaecology and surgical services.

  • There had been ongoing issues with patient flow through St Mary’s Hospital and over occupancy for admissions. At time some patients were nursed in non-patient bed spaces, which risked patient safety as well as had compromised privacy and dignity of patients impacted upon.

  • There were delays for patients to receive care and treatment including for stroke care.

  • Policies and procedures were in place for recognising the deteriorating patient and the patient nearing end of life; however, the staff did not always apply these guidelines in a timely way.

  • Patient records were not always completed in full or in a timely way to promote optimum care as treatment.

  • The trust recognised and reported in 2018/2019 that key issues and risks had included a failure to deliver some national access targets including in the emergency department.

  • There was limited development of seven day working.

  • The frailty pathway was under development and therefore remained a risk until established.

  • The trust mandatory training uptake had been low in some wards and departments including for resuscitation and safeguarding.

  • There was insufficient support and supervision of junior doctors and this was reflected in the status of the General Medical Council enhanced surveillance.

  • Complaints were not responded to in a timely manner the themes were noted as communication, values and behaviours of staff and waiting times.

However:

  • Since our last comprehensive inspection in January 2018 the trust had formed new divisional teams with experienced leaders.

  • Ten week improvement plans had been applied to the areas of highest concern to drive improvement and changes had been made.

  • End of life care services had much improved from the new strategy to the care delivery.

  • There were new structures, processes and some systems of accountability to operate a governance system designed to monitor the service and provide assurance.

  • The estates department had a plan for improvement to the emergency department design to become in line with expectation of the service.

Inspection areas

Safe

Requires improvement

Updated 4 September 2019

Effective

Requires improvement

Updated 4 September 2019

Caring

Good

Updated 4 September 2019

Responsive

Requires improvement

Updated 4 September 2019

Well-led

Requires improvement

Updated 4 September 2019

Checks on specific services

Medical care (including older people’s care)

Inadequate

Updated 4 September 2019

Our rating of this service stayed the same. We rated it as inadequate.

We rated safe, effective, well led as inadequate, caring and responsive as requires improvement because:

  • Patients were at risk of avoidable harm, as at the last inspection. Fully completed care records were not always kept for patients. Staff did not always assess risks to patients and act on them. The number of nurses was impacting on care given to patients. The shortage of medical staff was putting patients at risk of unsafe care. Staff were not compliant with some mandatory training modules including safeguarding training, placing patients at risk of harm. There was a lack of assurance that nurses and medical staff had the knowledge to recognise abuse. Staff did not always recognise incidents, the trust were slow to report them and there were delays with feedback from incidents and lessons learned.
  • Staff did not always provide care and treatment that reflected current evidence based guidance or best practice standards, as at the last inspection. Some patient outcomes were persistently worse than expected. There was evidence that staff did not give patients enough to eat and drink. There was not a standardised tool in place for people unable to communicate verbally. There were some gaps in management and support arrangements for staff, to ensure their competence. Staff did not always show an understanding of how to apply the Mental Capacity Act (2005) to support patients who lacked capacity to make their own decisions or were experiencing mental ill health.
  • Staff did not always treat patients with compassion and kindness, respect their privacy and dignity, take account of individual needs.
  • Services had not always been planned or delivered in a way that met patients’ needs, as at the last inspection. The service was slow to plan care in a way that met the needs of people. Referral to treatment times were inconsistent, which prevented people from being able to access services when they needed them. Some patients experienced a higher average length of stay than the England average. A significant number of patients experienced a delayed discharge. Two initiatives to support people living with a dementia needed to be embedded into practice. The service did identify learning from complaints, but these had had been slow to change staff practice.
  • The following issues were highlighted at the last inspection that the delivery of high quality care was not assured by the leadership, governance or culture. The leaders had not developed a detailed vision and strategy for the medical care service. Staff did not always feel supported and listened to. Risk registers did not include all risks, to enable there management. The service did not always have the data in meetings to understand performance, make decisions and improvements. The trust did not show us evidence of innovation or research.

However:

  • The service mostly controlled infection risk well. Equipment and the premises were clean. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean. The service used monitoring results well to improve patient safety. Staff collected safety information and shared it with staff, patients and visitors.
  • Staff monitored the effectiveness of care and treatment. They used the findings to make improvements, to work towards achieving good outcomes for patients. Staff gave patients practical advice and support to lead healthier lives. Patients we spoke with us told us their pain was controlled well.
  • Staff usually provided emotional support to patients, families and carers to minimise their distress.

  • The service took into account patients’ needs and preferences.
  • Leaders were visible and approachable in the service for patients and staff. Staff we spoke with told us they were aware of the freedom to speak up guardian role. The service was using a safer staffing electronic tool, to support safe staffing.

Services for children & young people

Requires improvement

Updated 6 June 2018

Our rating of this service went down. We rated it as requires improvement because:

  • There was not enough nursing and medical staff with the right skill mix to provide safe care. The trust had reviewed staffing levels, and identified a shortage of medical and nursing staff. Recruitment to vacant posts was ongoing at the time of inspection. Nursing and medical staffing levels on the neonatal unit did not conform to the British Association of Perinatal Medicine (BAPM) standards and the overall medical staffing did not conform to the Royal College of Children’s and Child health (RCPCH).
  • Mandatory training rates for both medical and nursing staff were well below the trusts target of 85% in paediatric resuscitation, medicines management, new-born life support, Prevent training 1&2 and the mental capacity act.
  • Governance arrangements, to identify shortfalls in performance, were not robust. The systems to report and monitor the quality and safety of care and treatment were not applied accurately and opportunities for learning from audits and incidents were sometimes missed. The service did not appear to use a systematic approach to continually improving the quality of its services.
  • Policies on the intranet were not all up to date and in line with current National institute of clinical excellence (NICE) guidelines.
  • There were no available children’s development clinics on the Isle of Wight for the diagnosis and support of children requiring diagnosis of autistic spectrum disorders.
  • The Children and Adolescent mental health service (CAMHS) did not cover weekend and evenings, therefore children requiring a review before discharge would have extended stays in hospital.
  • Children could be exposed to inappropriate conversations in the outpatient departments, as there were no facilities for children and young people to wait separately from adults except in the ophthalmology department
  • Staff and managers had not developed and implemented a strong vision and strategy for the service.
  • There was a risk of unauthorised access to the neonatal unit due to the lack of reception staff and there was no system to record visitors to the unit.
  • There were not adequate age appropriate facilities across the trust for babies, children, young people and their families.

However:

  • Staff were clear about their safeguarding responsibilities and if there was a concern about a child’s wellbeing staff understood and followed safeguarding procedures. All staff we spoke with had completed the appropriate level of training in safeguarding.
  • Most staff we observed controlled infection risks well.
  • Staff planned and delivered care in line with evidence-based guidance, standards and best practice and met the individual needs of the child and family through the careful care planning. Staff followed care pathways on electronic, multidisciplinary patient records to support practice.
  • Staff received annual appraisals and new staff were supported when completing their competency assessments, helping to maintain and further develop their skills and experience.
  • Parents and children gave feedback about the care and kindness received from staff, which was positive. All the children and their carers we spoke with were happy with the care and support provided by staff. We observed staff treated children, young people and their families with compassion, kindness, dignity and respect. Staff worked in partnership with children, young people and families in their care.
  • Guidance on how to make a complaint was readily available across the CYP service and was on the trust’s website.

Critical care

Good

Updated 6 June 2018

Our rating of this service stayed the same. We rated it as good because:

  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
  • The service controlled infection risk well.
  • Staff completed and updated risk assessments for each patient. They kept clear records and asked for support when necessary.
  • The service had enough nursing and medical staff, with the right mix of qualification and skills, to keep patients safe and provide the right care and treatment.
  • The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately.
  • The service followed best practice when prescribing, giving, recording and storing medicines. Patients received the right medication at the right dose at the right time.
  • Staff gave patients enough food and drink to meet their needs and improve their health.
  • Managers monitored the effectiveness of care and treatment and used findings to improve them. They compared local results with those of other services to learn from them.
  • Staff of different kinds worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.
  • Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. They followed the trust policy and procedures when a patient could not give consent.
  • Staff cared for patients with compassion and provided emotional support to minimise their distress.
  • The service took account of patients’ individual needs.
  • People could access the service when they needed it.
  • Service leaders had the right skills and abilities to run a service providing high-quality sustainable care.
  • Managers across the trust promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.

However:

  • Patients stayed longer on this critical care unit than was always necessary meaning mixed sex accommodation requirements were not always met.
  • Seven day services were not fully established across all of the multi-disciplinary teams, although action had been taken which would develop the service to meet the seven day standard.
  • Not all GPIC standards had been met in full however there were mitigations and plans in place to address the shortfall.

End of life care

Good

Updated 4 September 2019

Our rating of this service improved. We rated it as good because:

  • There was strong, clear and visible clinical leadership that enabled the service to improve at pace. The end of life care and the specialist palliative care services were under one leadership of the integrated palliative and end of life care team. There was joined up working across the trust with a single point of referral and contact.
  • Staff cared for patients with compassion and kindness and their dignity was respected and maintained. Staff were passionate about their vision and the improvements they wanted to make to benefit patients, their care and support.
  • There were appropriate governance arrangements to monitor the service provision for all patients. There were action plans to address the shortfalls and monitoring systems to ensure continuous compliance to regulation.
  • The trust assessed, monitored and improved the quality and safety of the services it provided. It undertook audits to assure staff consistently completed and reviewed evidence-based and end of life documentation. Data was collected from bereaved relatives and reported every six months and as a result, service improvements were identified.
  • The trust had implemented safety systems. Staff completed and updated risk assessments for each patient. They kept clear records and escalated concerns when necessary.
  • Staff were trained in safe administration of medicines via syringe drivers. There was now a structured training for their use and only staff who had completed their competencies could use the equipment.
  • The lead clinician regularly checked and monitored that best practice was used to inform decisions about patient’s treatment and care. Wards were now monitored through unannounced inspection of their areas and were given feedback on their performance against the services strategy and vision.
  • The trust planned and provided services in a way that met the needs of local people.
  • Staff were aware of what constituted end of life incidents. The trust reported incidents relating to end of life care. There was a risk register to provide oversight of risks relating to end of life care that was monitored.

However:

  • Key services were not available seven days a week.
  • Staff did not always start patients who were known as end of life care onto the end of life care pathway, especially those in the last few days of their life, in a timely manner.
  • There were delays in the transfer of deceased from wards to the mortuary.

Surgery

Requires improvement

Updated 4 September 2019

Our rating of this service stayed the same. We rated it as requires improvement because:

  • The service provided mandatory training in key skills to all staff, however they did not make sure all staff completed it. Improvements had been made to overall training completion rates, however medical and theatre staff completion of mandatory training remained low, in particular in relation to resuscitation.
  • Medical staff compliance with hand hygiene training and practice was not consistent and infection rates in some areas of surgery were higher than average.
  • Not all patients showing signs of infection were on the sepsis pathway.
  • The service did not have enough nursing staff in all areas with the right qualifications, skills and training to keep people safe from avoidable harm and to provide the right care and treatment, although there was evidence of improvements since the January 2018 inspection.
  • There were ongoing concerns with medical cover out of hours and junior doctors reported some issues with obtaining input from senior colleagues when they needed it.
  • The provider had systems in place for the safe storage, administration, prescribing and disposal of medicines. We observed some improvements in the recording of controlled drugs in theatres, although there continued to be some gaps and we observed an incident where a controlled drug had been left unlocked and prepared in an anaesthetic room.
  • Some medical staff told us there was a reluctance to report incidents, particularly amongst junior doctors due to a belief that issues would not be addressed.
  • Actions from mortality and morbidity meetings were not clearly recorded and some medical staff reported outcomes from incident investigations not being shared.
  • The service provided some treatment that reflected current evidence-based guidance or best practice standards, however standards around enhanced recovery after surgery and emergency surgery lists were not embedded.
  • There was evidence of improved appraisal completion although appraisals were below the trust target of 85% for five staff groups including nursing staff.
  • Permanent night staff in theatres had not all had their competencies assessed and agency staff working in theatres had only partially completed their inductions.
  • Key services were not available seven days a week to support timely patient care.
  • Staff did not consistently show an understanding of how to support patients who lacked capacity to make their own decisions or were experiencing poor mental health.
  • On St Helens ward arrangements for the pre-operative care of patients in the day room meant that staff were not always able to protect their privacy and dignity.
  • Feedback from patients and relatives included that care for patients at night was not of the same standard as during the day.
  • Friends and family test survey completion rates were low, meaning that services were not always aware of patient feedback in order to improve.
  • The service provided did not always reflect the needs of the population served. Facilities and premises were not always appropriate for the services delivered, however there were clear plans in place to address this.
  • Patients could not always access the service when they needed it to receive the right care promptly. Patients stayed in hospital longer than average following non-elective surgery and in some specialities for elective surgery.
  • Waiting times from referral to treatment had deteriorated and were significantly below average in some specialities. Urgent treatment delays led to compromised patient care in some cases.
  • The process to review and update individual care plans for patients on longer term admissions needed to improve.
  • The service investigated concerns and complaints. The service identified lessons learned and shared these with staff and there was evidence of improved practice as a result of this. However, the responses to complaints were not always completed in a timely manner.
  • Leaders had an understanding of the challenges facing the service but, there were some areas of risk that were not being sufficiently identified, prioritised and managed.
  • Ward leaders were visible and approachable but, there were some concerns from junior medical staff about the approachability of their senior colleagues.
  • Interim management posts were evident within the service and staff reported a lack of visibility of some senior care group staff.
  • There were acute service, nursing and quality strategies in place and staff were aware of these, however there was no surgery specific strategy in operation.
  • There was evidence of an improved culture in theatres and the culture on the wards was centred on the needs of patients. However, junior medical staff did not always feel supported and listened to and we were told that issues and concerns were not being escalated because of this.
  • There were governance systems, however actions to reduce the impact of risks relating to bed management issues were not managed in a way that clearly mitigated the risks and not all risks were recorded on the service risk register. Minutes from mortality and morbidity meetings were not in line with the Royal College of Surgeons recommendations.

However:

  • Staff understood how to protect patients from abuse and the service worked with other agencies to do so.
  • Appropriate equipment was available, checked and fit for purpose. The environment was not always suitable; however, risk management assessments and plans were in place to mitigate the associated risks.
  • Staff monitored and managed risks to patient safety and improvements with evidence of improved processes to help identify the risk of deterioration in patients.
  • Records were stored securely and easily available to all staff providing care. There were consistent improvements to the use of and completion of safer surgery checklists in theatres.
  • The service monitored patient harm in relation to falls, pressure ulcers and infections and communicated the results to patients, staff and visitors.
  • Staff working in theatres and on the wards recognised and reported incidents. Managers investigated incidents and there was evidence of learning from these. When things went wrong, staff apologised and gave patients honest information and suitable support.
  • Staff monitored patient’s nutrition and hydration needs and gave them enough food and drink to meet their needs and improve their health.
  • Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way.
  • Staff monitored the effectiveness of care and treatment. They used the findings to make improvements and work towards achieving good outcomes for patients. There was evidence of improved patient outcomes.
  • Staff worked well together as a team to benefit patients.
  • The trust had made some improvements against the priority clinical standards for seven-day services.
  • Staff gave patients support and advice to lead healthier lives.
  • There were improvements seen in checks of consent for patients undergoing surgery.
  • Staff provided emotional support to patients to improve their wellbeing and make their admission more comfortable.
  • Staff provided support and involved patients, families and carers to understand their condition and make decisions about their care and treatment.
  • Staff treated patients with compassion and kindness, taking account of their individual needs.
  • The service took account of patients’ individual needs. They had services in place to support patients with a learning disability on their journey through surgery.
  • The service used data to understand performance and make decisions about improvements.
  • Theatre staff reported improvements in the way managers and colleagues engaged with them.
  • There was a commitment to continually learn and improve services with evidence of improvements in some areas.

Urgent and emergency services

Requires improvement

Updated 4 September 2019

Our rating of this service improved. We rated it as requires improvement.

We rated safe, effective, responsive and well led as requires improvement, with caring as good.

  • Staff continued to put patients at risk as mandatory training was not completed by all staff.
  • Hand hygiene audits showed that staff were not always meticulous about washing their hands at every opportunity.
  • Staff completed patient clinical observations and risk assessments more rigorously most of the time but did not do this consistently and they did not fully complete the documentation.
  • The medical staff cover did not meet Royal College of Medicine standards for adults or children.
  • There were not enough children’s nurses in post to cover a 24 hour service seven days a week.
  • Medicines were managed well on the whole with the exception of high dose antipsychotic medicines prescribing.
  • The service did not consistently monitor the effectiveness of care and treatment. They did not consistently use the findings to make improvements and achieve good outcomes for patients and some patient outcomes were worse than expected.
  • The service was unable to meet national standards for patient waiting times and length of stay within the department.
  • People waited too long for a response when they raised a complaint.

However:

  • The warning notice served following the inspection in January 2019 had been met in respect of patients were better cared for and treated in non-designated areas for clinical care in the emergency and accident department throughout this inspection. Patients were assessed by triage in a timely and safe manner.
  • Throughout this inspection there were insufficient numbers of staff on duty to deliver safe care and treatment to patients to the number of attending patients.
  • The service reported concerns, investigated them and shared learning.
  • The nursing staff numbers had increased, and the skill mix improved, which improved the care and management of patients.
  • Staff recognised and knew how to protect vulnerable adults and children.
  • All professional groups worked well together to keep patients safe and provide good care; they made sure patients had enough food and drink and ensured patients’ pain was alleviated.
  • Staff treated people with respect and patients appreciated the compassion and kindness shown to them.
  • The leadership team were visible and respected by staff. They had a vison for the service and had improved governance structures and processes to enable service improvements to happen, with plans to ensure improvements continued.

We reviewed the issues raised at the winter pressures inspection resulting in a warning notice. At this inspection we found that there had been significant improvement against all three concerns. There remains some unease that the improvements made by the department may not be sustainable during busy periods.

Gynaecology

Inadequate

Updated 4 September 2019

Our rating of this service went down. We rated it as inadequate because:

  • There were examples of medical staff showing wilful or routine disregard of standard operating or safety procedures.
  • Systems had not always ensured patient safety.
  • Some medical staff had not engaged in the service and had disregarded risk and safety processes to monitor the safety of the service.
  • Staff did not recognise concerns, incidents or near misses.
  • There was a lack of evidence of learning from events or action taken to improve safety.
  • Incidents had not been routinely reported on the trusts electronic reporting system. Therefore, investigations and learning had not taken place.
  • Staff had not always assessed risks to patients or kept good care records.
  • Although the trust provided mandatory training in key skills for staff, not all staff had attended, and the level of compliance remained below the trust’s target.

  • Managers had not made sure all staff were competent.
  • Not all staff treated women with compassion and kindness.
  • Women were frequently and consistently unable to access services in a timely way for an initial assessment, diagnosis or treatment.
  • Although the trust had regular daily bed management meetings there were also regular bed capacity issues.
  • Staff did not understand how their role contributes to achieving the strategy.
  • There were a number of strategies in place and on display on the wards however, not all staff could articulate them. The strategies had been included in meeting minutes did but not comprehensively cover all domains of the clinical quality strategy.
  • There continued to be difficult relationships with some members of staff that impacted on the wellbeing of their colleagues. The trust was aware of the issues and had implemented several strategies to improve working relationships. However, these were not seen to have improved the situation.
  • There is little attention to some staff development and there are low appraisal rates for some staff.

However:

  • Most staff understood how to protect women from abuse, and managed safety well.
  • The service managed infection risks well.
  • The service managed medicines well.
  • Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it.
  • Most staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
  • Nursing and support staff respected women’s privacy and dignity and took account their individual needs. These staff provided emotional support to women, 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.
  • Staff were clear about their roles and accountabilities. The outpatients service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

Diagnostic imaging

Requires improvement

Updated 6 June 2018

  • The service did not always provided care and treatment based on national guidance and evidence of its effectiveness. The service did not follow the guidelines issued by the Royal College of Radiology on non-radiology clinicians reviewing images.
  • Learning from serious incidents was not shared with the whole team to minimise the potential for repeat occurrence, risking harm to patients. Staff were not using the three point identification procedure in daily practice.
  • Duty of Candour was not appropriately applied when incidents of patient harm occurred.
  • Staff did not undertake sufficient audits to demonstrate compliance with Ionising Radiation (Medical Exposure) Regulations 2000 (IR(ME)R)
  • There was a shortage of consultant radiologists which impacted on the quality of image reporting.
  • Insufficient numbers of staff had completed mandatory training, safeguarding training at the correct level, annual appraisals of their work, and the Mental Capacity Act 2005.
  • The waiting area in the main department was cramped and provided insufficient accommodation for the number of people using it.
  • The service had not always monitored the effectiveness of care and treatment in order to use the findings to improve care. Appropriate audits had not been done to ensure quality of practice was maintained.
  • The service did not manage complaints according to agreed timescales.

However:

  • Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness, and they were well informed about the procedures staff were performing.
  • The service worked well to provide a service to meet the needs of the island residents with extended working days and some walk in appointments.
  • Staff felt well supported by managers and were offered opportunities for further training and development.
  • The service leads were working towards Imaging Services Accreditation Scheme (ISAS), which is a structured approach to providing a high quality service, and will highlight the areas where the service can improve services and focus attention appropriately.

Maternity

Requires improvement

Updated 6 June 2018

  • The mandatory training evidence supplied by the trust showed the staff had not completed all mandatory training. The uptake was low and this may put patients at risk of receiving outdated care and practices.
  • Emergency equipment was not regularly checked to ensure that these were safe, available and ready for use in an emergency.
  • The arrangement relating to the birthing pool had not been risk assessed and we were not assured that equipment, staff training and infection control processes were in line with guidelines to keep women safe.
  • Medicines were not checked regularly and this included control medicines.
  • Medical staff looking after babies had not completed the necessary safeguarding training and at the recommended level.
  • Infection control processes were not followed and system for identifying clean and dirty equipment was not adequate. Cleaning schedules were not available for the birthing pool and records of cleaning were not adequate to provide assurance.
  • There was not always adequately trained staff to provide care, guidance and support to other staff during the night and at the weekends.
  • There was a risk of unauthorised access to the maternity unit due to the lack of reception staff and there was no system to record visitors to the unit.
  • The five steps to safer surgery were used; however there was low compliance and this was not embedded in daily practice. This may pose risks of surgical errors as checks were not fully adhered to at each stage of procedures.
  • Nursing staff were confident in raising safeguarding concerns and had completed appropriate training to identify and report any safeguarding concerns. This was also considered as part of women’s assessment.
  • The environment was appropriate and there was a dedicated labour suite with level access to the operating theatre and the neonatal intensive care unit.
  • Staff did not receive regular supervision of their practice and the yearly appraisal rate was well below the trust’s target.

However:

  • Staff treated women with care, compassion and were respectful, ensuring their privacy and dignity was maintained at all times when receiving care.
  • Staff followed national guidelines and escalation tools were used for identifying deteriorating women and babies. This ensured that any changes in conditions are identified at an early stage and actions taken.
  • Policy and procedures for the management of sepsis were available to the staff and guidance was followed.
  • The unit had achieved baby friendly stage 1 for breastfeeding.
  • There was facility in the unit for bereaved women and they had support of a bereavement midwife based in the community.
  • Women received appropriate pain control of their choice during labour and they told us that their pain was well managed.
  • Women with low risk or uncomplicated pregnancies were offered midwife led care to have their babies at home or in hospital.
  • The governance arrangements were not well embedded and risks were not always identified in order for action plans to be developed and mitigate these.
  • The culture within the service was not supportive of staff to raise their concerns as staff felt they were not listened to.
  • There was no regular audit programme to identify trends in order to improve practices and the overall service delivery.
  • There was a lack of systematic approach to continually improve the service provision.
  • The unit was consultant led and midwives played an integral part in the management of women’s care. The unit had a consultant obstetrician as clinical lead.
  • There was a stable management team and staff were passionate about providing a service that met the needs of women.
  • Management team was working towards promoting home births and community based care and normalisation of childbirth.

Outpatients

Good

Updated 6 June 2018

We previously inspected outpatients jointly with diagnostic imaging so we cannot compare our new ratings directly with previous ratings.

On this inspection we rated the outpatients service as good because:

  • People who used the outpatient services were kept safe from avoidable harm because there were suitable arrangements to enable staff to identify and respond to risks.
  • There were sufficient numbers of staff, and they had been provided with safety training. Staff were further supported through service related policies and procedures in addition to evidence based professional guidance.
  • Feedback from people using outpatient services, and those close to them, was continually positive about the way staff treated them.
  • Services provided by the outpatient departments mostly reflected the needs of the local population.
  • Most patients were able to access the service in a timely way, with many specialties in line with or close to the national averages in waiting times.

However:

  • Outpatient services did not have clear, well-established and effective governance processes.
  • Outpatient services did not have clear and effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected.
Other CQC inspections of services

Community & mental health inspection reports for St Mary's Hospital can be found at Isle of Wight NHS Trust.