You are here

Inspection Summary


Overall summary & rating

Good

Updated 25 May 2018

The trust has 432 inpatient beds, 62 maternity beds, 14 intensive care unit beds and 6 coronary care unit beds. It also has 23 trollies within the day surgery Unit and eight in the medical day unit It has 16 operating theatres including two within a day surgery unit and one obstetric theatre. Diagnostic imaging resources include two MRI and three CT scanners.

Outpatient activity encompasses specialist, general and oncology clinics and the hospital runs outpatient services at Cranleigh, Haslemere and Cobham hospitals with outreach clinics in a number of local GP surgeries. The trust also provides specialist support services to HMP Cordingly and HMP Send.

As the regional cancer network hub, it operates an outreach radiotherapy service from the hospital as well as another local trust. Oncology facilities include five linear accelerators (LINACs) at Guildford and two LINACs at Redhill. Chemotherapy services are provided in partnership with local trusts.

Co-located services operated by other providers are:

  • Out of hours GP service
  • Dermatology outpatients
  • Discharge hub
  • MRI scanner
  • New-born hearing screening
Inspection areas

Safe

Good

Updated 25 May 2018

Effective

Good

Updated 25 May 2018

Caring

Good

Updated 25 May 2018

Responsive

Outstanding

Updated 25 May 2018

Well-led

Good

Updated 25 May 2018

Checks on specific services

Critical care

Good

Updated 18 December 2013

Over all we found intensive/critical care  to be safe, caring, effective, responsive and well-led.  Staff assessed patients’ needs and planned care to meet those needs. There were sufficient numbers of suitably qualified nursing staff to meet patients’ needs and provide safe care. Intensive Care National Audit & Research Centre (ICNARC) data shows that the trust were performing well within expectations nationally, though there were significant delays in discharging their medically well to the wards.  The department recognised that the number of beds in the unit was not adequate. It had plans for expansion for an additional 12 beds. However, we are concerned that the trust has not clearly thought through the requirement for additional nursing,other staff and beds in other wards to accommodate the increased amount of patients requiring discharge from ICU, or how it will manage discharge of medically well patients.

Staff respected patients’ privacy and dignity. Family members told us that the care in the  ICU was “first class”. The department had carried out a survey of the views of patients’ families. Responding to the feedback, it was going to put in place accommodation for relatives. We found there was a multi-professional team working across the unit and with other hospital providers in the area. This meant the service was well-led.

Outpatients and diagnostic imaging

Requires improvement

Updated 18 December 2013

Over all we found outpatients to be safe and caring.  Improvements are needed in effective, responsive and well-led domains. We found out-patient departments that did not always have the capacity to meet demand.

The eye outpatient service was especially overcrowded. Patients said they had been waiting for up to four hours, and data that we received before and during the inspection confirmed that this was a regular occurrence. The trust was aware of this and had plans to expand the service to address its capacity issue. However, it had not taken sufficient action to minimise the impact of this issue on patients while the service was expanded.

Problems in accessing medical records also made delays worse and put extra demands on the nursing staff to cope with the capacity levels. We had concerns that eye testing was being performed in a busy corridor and that there were significant delays in communicating with patients’ GPs, which had the potential to disrupt patients’ treatment.

The hospital made arrangements for people to attend appointments at a time that was convenient for them. However, the long waiting meant that appointments did not take place at the time planned, and patients expressed concern about that a lack of available parking spaces made it difficult to be on time for appointments.

We observed that staff were kind, caring and courteous in their dealings with patients. Staff were familiar with and understood the hospital’s vision and strategy.

Urgent and emergency services

Good

Updated 18 December 2013

The A&E department was safe, caring,responsive and well-led. However, we found that the department’s effectiveness could be improved. Some clinical pathways were not being followed, (for example management of Neutropenic sepsis) and the management of people’s pain needed improvement as patients presenting with pain were not always given or offered pain relief in a timely manner.

Maternity

Outstanding

Updated 25 May 2018

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

  • Staff recognised and responded quickly to changes in the risks to people who use the maternity services, including community care. Risks to people who used the services were assessed, monitored and managed on a day to day basis. These included signs of deteriorating health, medical emergencies and behaviour that challenges.
  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
  • Openness and transparency about safety was encouraged. Staff felt able to raise concerns and report incidents, which were regularly reviewed to aid learning. We saw learning from incidents was widely shared and saw changes within the department as a result of incidents.
  • There were sufficient numbers of staff with the right qualifications, training and experience to meet the needs of patients. Staffing was reviewed regularly to ensure the correct skill mix and numbers of staff on the wards and throughout the department.
  • Staff adhered to trust policies and best practice with regards to the department’s environment and equipment. Premises and facilities were visibly clean and suitable. Infection control and equipment management were regularly monitored.
  • The service undertook a series of audits to ensure they regularly reviewed the effectiveness of care and treatment of patients. These showed that the care delivered was meeting national standards.
  • Patients received co-ordinated care from a range of different staff, teams and services. Staff worked collaboratively to meet patients’ individual needs, including their mental health and emotional wellbeing.
  • Staff responded compassionately when people needed help and supported them to make informed choices about the care they received. Women were supported to breastfeed.
  • Women had access to a range of pain relief methods including birthing pools. Epidurals were available 24 hours, seven days a week.
  • We saw several innovative approaches to providing integrated person centred pathways of care that involved other service providers. We found an energetic and ambitious workforce that took accountability and ownership for changes within the department.

  • Care and treatment was co-ordinated with other services and staff were responsive to patients’ requests, with reasonable adjustments being made where possible to remove barriers, for example patients with physical disabilities having the option of a water birth.
  • The leadership, governance and culture were used to drive and improve the delivery of high quality person-centred care.
  • Leaders at all levels demonstrated high levels of experience, capability and had the capacity to deliver sustainable care with compassion. Leaders understood the challenges to achieve quality and sustainability, and demonstrated they could identify the actions needed to address them.

  • Staff and managers demonstrated commitment to best practice performance and risk management. Risk and performance was reviewed and managed through a series of local and trust wide meetings.

Outpatients

Good

Updated 25 May 2018

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

  • Staff were encouraged to report incidents. Managers investigated incidents and shared lessons with the whole team and the wider trust. Continued learning and information sharing happened at daily huddles in the outpatient department.
  • There were clear performance trackers for the service providing information of the overall performance of the department, staffing levels and staff performance such as training. The trackers identified that the department was in line with trust’s targets for mandatory training, safeguarding, able to identify staffing levels and manage risks.
  • Staff working in outpatients were above trust targets for mandatory training and had achieved 100% completed for safeguarding training level two and three.
  • Patients received care that was of a high standard based on national guidelines and there was an audit programme to review the effectiveness of this care.
  • One stop clinics provided swift treatment and diagnosis for patients in several specialities. This meant that patients were seen by a team of health care professionals on the same day reducing the need for multiple hospital visits.
  • Patients received coordinated care because staff worked well and supportively together. Staff were passionate about the service and spoke enthusiastically about developing services, improving services and innovation.
  • Feedback from patients was overwhelmingly positive about care and the department was open to improving and changing the environment based on patient comments.
  • Staff responded compassionately when people needed help, and access to information for people with disabilities, impairments and sensory losses was available.
  • Procedures were in place to manage waiting times for patients being referred from their GPs and for treatment and there were improvement plans to meet overall referral to treatment times for all patients.
  • Staff worked hard to minimise delays and meet patient demand.
  • There was strong, clear leadership and staff said they felt well managed and well-led. Staff said the matron and senior nurses were visible and supportive within the department, they felt valued, listened to and respected and did not have concerns about addressing issues or concerns with their line managers.
  • We saw lots of innovation and enthusiasm when talking to staff within outpatients. The matron in outpatients was a finalist in; The Nursing Times award for innovation after developing a ‘safer staffing tool’ in use across the trust.

However:

  • The phlebotomy drop-in clinic had long waits and a small waiting area.
  • Some medicated eye drops in the ophthalmology department were found to be stored insecurely. Treatment rooms had not been locked when not in use and medicines were not locked away.
  • Confidentiality was not maintained in some areas where doors were left open during consultations and the use of curtained areas for height and weight measurements did not protect patient confidentiality.
  • The trust was in breach of cancer waiting time standards for patients receiving their first cancer treatment within 62 days of an urgent GP referral.

  • Car parking capacity was an issue for patients and the trust.

Maternity and gynaecology

Good

Updated 18 December 2013

Over all we found maternity services  to be safe, caring, effective,  responsive and well led. The maternity service had good and effective leadership, and an open and supportive culture. Positive leadership had led to high levels of staff morale and a service that met the needs and expectations of the people who used the maternity services.

Patients were mostly very complimentary about the care and dedication of the staff looking after them. They said that communication was good, staff referred to individual birth plans and women felt supported, listened to and had confidence in the quality and safety of their care.

We found clear lines of accountability in the department, and staff were confident about their roles and responsibilities. We were told that there was consistent and immediate access to specialist consultant paediatricians, obstetricians and anaesthetists. We saw how the trust had learned lessons from incidents, found solutions to problems and promoted risk reduction.

Gynaecology

Good

Updated 25 May 2018

  • Openness and transparency about safety was encouraged. Staff understood their responsibilities relating to the reporting of incidents. Incidents and concerns were addressed at team meetings and safety huddles. We saw evidence that incidents had been used to drive improvement within the service.
  • The gynaecology outpatient clinic, theatres, ward and equipment were visibly clean and staff adhered to infection control policies and protocols. This was consistent with the monthly hand hygiene, bare below the elbow audits where the service consistently achieved scores of 100%.
  • Staff understood the importance of collaborative working in order to improve patient outcomes. Throughout the service, staff from different professional backgrounds were observed consulting each other to ensure the patients were given care by the relevant practitioner in a timely manner.
  • Patients were very complimentary about the care they received. They said they were well informed about the treatments they were having and staff had time to answer any questions they had.
  • The trust proactively monitored staffing levels and patient acuity. The ward matron was able to maintain safe staffing levels at all times by deploying staff with the required skills from one area to another. There was always a nurse on each bay to attend to patients throughout the day.
  • Treatment and care was provided in accordance with the National Institute for Health and Care Excellence (NICE) guidance and quality standards. Divisional leads regularly monitored the publication of new guidelines ensuring local guidelines were up to date and reflected current practice.

However,

  • Staffed lacked training in key areas of care. We found that nursing staff on Compton ward did not have accredited gynaecology training for every shift. Staff had to contact the gynaecology specialist nurses or the on call doctor if a patient required urgent gynaecology care.
  • Patients’ names were visible to all visitors in the gynaecology outpatient clinic, which raised concerns about the lack of patient privacy.
  • Staff on the ward were using patient group directions which had expired in September 2017.

Medical care (including older people’s care)

Good

Updated 25 May 2018

Surgery

Good

Updated 18 December 2013

Over all we found Surgery to be safe, caring, effective, responsive and well led.  We found that staff assessed patients’ needs and planned care to meet those needs. Staffing levels were acceptable on all wards except Ewhurst, where there had been no senior sister for eight weeks. Since the recent appointment of a senior sister on this ward, we were told that things had improved.

Practices and procedures within theatres were safe. The trust had recently revised the World Health Organisation Surgical Safety Checklist. Most patients we spoke with told us that their treatment had been effective at each stage, from admission as an emergency or referral by the GP to successful surgery and recovery. The surgical wards had an ‘early warning score’ that detected deterioration of patients’ conditions and called for urgent medical help. We saw that all wards had safety performance heat maps.

Patients were satisfied with their care. Some patients said that they had quick personal care when they needed it, but a few said that staff did not answer call bells as quickly as possible. Overall, we found that staff kept patients informed about their treatment. However, there were a few instances when patients had not been kept adequately informed. This resulted in patients feeling isolated. Patients told us that the overall service was good and the wards were well run. They told us that members of staff worked well with each other. We found that staff had completed training in a number of areas including dementia awareness, infection control, and health and safety. 

Services for children & young people

Good

Updated 18 December 2013

Over all we found Childrens services to be safe, caring, effective,  responsive and well-led.  The children’s unit was modern and well equipped and reflects the ideas and contributions of children and young adults who use the service. The unit was a testament to how the organisation has used staff and patient suggestions to develop a state-of-the-art environment that provided high levels of care in a calm and relaxed atmosphere. Parents told us that the facilities were outstanding and that staff paid great care and attention to the needs of the children and their families.

The paediatric service had good and effective leadership within an open and supportive culture. The staff reported that there was a close and integrated team spirit in the unit that worked closely with maternity services.

There was a dedicated children’s outpatient department that provided a service within the children’s unit and offered a range of general paediatric and specialist clinics. A&E facilities were functional and provided a high level of care and support. However, the environment for children and young people attending the A&E department did not reflect the care and attention to detail of the design of the main paediatric area.

End of life care

Good

Updated 18 December 2013

Over all we found end of life care  to be safe, caring, effective, responsive and well-led. Patients and relatives were positive about the quality of end of life care. None of the people we spoke to had any concerns about the way staff maintained patients’ privacy and dignity. We found that staff were caring and services responded to patient’s needs. Services were well-led.