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Royal Surrey County Hospital Good

Reports


Inspection carried out on 04 March to 05 March 2020

During a routine inspection

We conducted an inspection of: Emergency and urgent care, medical care and end of life care. During our inspection, we spoke with 74 staff and 24 patients and relatives.

Our rating of services stayed the same. We rated it them as good because:

  • The trust controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. The design, maintenance and use of facilities, premises and equipment kept people safe.
  • The trust had enough staff with training in key skills to care for patients and keep them safe. Staff understood how to protect patients from abuse, and managed safety well. Staff assessed risks to patients, acted on them and, in most areas, kept good care records. The service collected safety information, managed safety incidents, learned lessons from them and used this to improve the service.
  • The trust generally managed medicines effectively. There was ready access to expert prescribers, oversight by the pharmacy team and innovative support for non-specialist prescribers. The level of medicine errors was low.
  • Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them and their families 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.
  • Throughout the trust staff treated patients with compassion and kindness, mostly respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided high quality emotional support to patients, families and carers.
  • There were innovative approaches to providing integrated person-centred pathways of care that involved other service providers, particularly for people with multiple and complex needs.
  • Across the trust there were some innovative approaches to providing integrated person-centred pathways of care that involved other service providers, particularly for people with multiple and complex needs. People’s individual needs and preferences were central to the delivery of tailored services. The services were flexible, provide informed choice and ensured continuity of care. The design of facilities and premises in areas of the trust were innovative and met the needs of a range of people who used the services.
  • There was a proactive approach to understanding the needs and preferences of different groups of people and to delivering care in a way that meets these needs, which was accessible and promotes equality. People could access the service when they needed it and did not have to wait too long for treatment.
  • It was easy for people to give feedback and raise concerns about care received at the trust. The trust treated concerns and complaints seriously, investigated them and shared lessons learned with all staff.
  • Throughout the trust leaders were highly visible and approachable for patients and staff. The leadership, governance and culture were used to drive and improve the delivery of high-quality person-centred care. Staff understood the trust vision and values, and how to apply them in their departments and 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 trust engaged well with patients and the community to plan and manage services. All staff were committed to continually learning and improving services. They had a good understanding of quality improvement methods and the skills to use them. Leaders encouraged innovation and participation in research.

However:

  • In some areas across the trust, mandatory safeguarding and Mental Capacity Act training compliance for both nursing and medical staff was low compared to the trust target.
  • In some areas we saw records of patients’ care and treatment were not always clear or stored securely.
  • We found regular checks of emergency medicines and equipment in the emergency department were not always carried out by staff in line with trust policy.
  • The trust had not always met some national audits standards in line with the England average but had action plans to deliver improvements.
  • Across the trust most people were encouraged to dress in their own clothes and had support to maintain their dignity, there were two occasions when we noticed that individual staff members had not paid enough attention to ensuring patients were appropriately covered.
  • Data captured and provided by the emergency department showed they did not meet the Department of Health’s standard for emergency departments which states that 95% of patients should be admitted, transferred or discharged within four hours of arrival in the emergency department.
  • The trust was unable to provide emergency department data in the format as required by the national emergency care dataset. However, they had agreed plans to improve data capture and reporting systems to comply with requirements.

Inspection carried out on 24 January to 22 February 2018

During a routine inspection

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 carried out on 17-18 and 23 October 2013

During a routine inspection

The ratings in this report were awarded as part of a pilot scheme to test CQC’s new approach to rating NHS hospitals and services.

The Royal Surrey County Hospitals NHS Foundation Trust is based at the Royal Surrey County Hospital. It is a leading general hospital and specialist tertiary centre for cancer, oral and maxillofacial surgery and pathology. The trust also has a very strong reputation for minimally invasive and laparoscopic surgery, which are used widely across the surgical specialties. It runs outpatient clinics at Cranleigh, Haslemere and Woking hospitals.

The trust has over 520 beds, 14 operating theatres, two MRI scanners, four CT scanners, interventional radiology equipment and a gamma camera.

It serves a population of 320,000 for emergency and general hospital services and employs 3,100 staff, making it the second largest employer in Guildford. Every year, the trust sees 240,000 outpatients, 58,000 inpatients, and 72,000 patients in Accident and Emergency. It delivers more than 3,200 babies every year.

Overall, the trust was providing services that were safe, effective, responsive, caring and well-led. However, there were some areas for improvement.

The culture throughout the trust was very open, and staff were very enthusiastic, positive and knowledgeable about the trust’s overall vision and strategy.

The Board structure and portfolio structure is relatively new and there is still some embedding required. The CEO is well respected and popular with the staff and he and board members were visible throughout the trust. There was evidence of good leadership at the majority of department levels and a lot of innovation by staff to continually improve the patient’s experience. There are a number of processes for communication flow from and to the Board and departments. However, priorities at the departmental level had not been captured at trust level, and there is some lack of connection to the Board. This led to the executive team being unclear on its understanding ofsome of the  issues in departments, and there was a general perception throughout the trust that the executive team and local teams are progressing at different paces and priorities were not always aligned

The quality strategy focused on national targets and future developments without defining some key quality and safety priorities of the organisation. Thus members of the Board were not able to articulate all of the quality strategy for some basic quality issues specific to the trust.

Operational management was not fully connected from Board to departmental level and not all middle management had a clear understanding of the range of risks across the trust. There is a risk register that looks at risks highlighted by the specialist business units, but it was not evident that the Board reflect a trust wide perspective.

The trust was working to full capacity in most departments with cancellations of elective surgery on one of the days of the visit, and this was providing a challenge for them. The trust recognised this problem, and it had a number of plans to improve the capacity of the hospital in the long term. The full alignment of capacity issues and the impact of patient experience could not be fully articulated by the trust. Although capacity was being created within theatres and critical care to support cancer services, the impact of this in pressure on ward beds could not be evidenced within the business planning. The trust had paid less attention to how it would manage the current capacity issues, and the impact they were having on the experience of patients, until it implemented the long-term plans. These capacity issues included:

  • Staffing levels for support/administration staff.
  • Staffing on some wards, particularly care of the elderly.
  • Managing capacity issues in outpatients, particularly in ophthalmology.
  • Managing issues such as discharge letters and GP correspondence.

The trust had plans for the development of its cancer services to meet the needs of patients. This will inevitably put further challenges on capacity and staffing requirements. The trust will need to address these before it puts its plans to expand cancer services into action.

Patients were generally very positive about the care they received at the hospital. They were very supportive of the trust and keen to be involved in the improvement at the hospital. The vast majority of patients that contacted us and those we spoke with commended the care they received at the trust. However some patients we spoke to at the listening event and who had contacted us directly had not had good experiences and some reported delays in their complaints being dealt with a timely fashion. They had little opportunity to engage with the trust other than through the complaints system. The trust was developing more ways to engage with patients and the community, but it had not fully implemented its ideas. However, there was some innovative work taking place at departmental level.

Cancer services were safe, effective, responsive and well-led. They were at full capacity, and staffing in some areas left little allowance for contingency planning and unplanned absences. On occasions this did impact on the effectiveness of services and their ability to be caring. The staff themselves were caring, but not all patients had their expectations met, and the cancer patients experience survey identified a number of areas where the trust needs to make improvements.

Staff were positive and engaged, and nursing staff levels were being managed well at departmental level, despite staff shortages in some areas.

Inspection carried out on 15, 16, 17 April and 24 May 2013

During a routine inspection

During our four day visit we carried out interviews with 21 in-patients and some of their relatives across nine wards, and handed out questionnaires in outpatients. Specialisms on the wards included elderly and dementia care, children�s medicine and surgery, orthopaedics, urology, respiratory conditions, cancer care, and gastro-intestinal disorders. On the final day of our visit we visited operating theatres, the elective surgical unit and day surgery ward.

The majority of both in-patients and outpatients who responded to our question on consent told us their consent had been sought, and positive comments included �Staff always ask and explain.� Most patients also confirmed that staff had involved them in decisions about their care and treatment.

In relation to the care and treatment they had received, the vast majority said they had been treated with dignity and respect, and felt safe in the hands of staff at this trust.

We asked patients if there were enough staff to meet their needs and we received some mixed responses. Most people said they got the care they needed but staff seemed very busy; one person summed this up: �More staff would make the service smoother.�

Most patients were satisfied with the record keeping arrangements, and positive comments included �Yes, and records are frequently verified and checked.� They also commented positively on the overall quality of the service.

Inspection carried out on 16 August 2012

During a routine inspection

We carried out semi structured interviews with 25 in-patients and some of their relatives across six wards, including elderly care, the children�s ward, gynaecology, orthopaedics, the stroke ward, and the gastro-intestinal unit. We also had shorter discussions on specific topics such as cleanliness, and medication, with a number of other patients during this two day visit. We also visited and spoke with people in the accident and emergency department.

Discussions with in-patients showed that overall they were satisfied with the care they had received and those who needed assistance with personal care said they got it. The majority felt they had been included in discussions about their care, and had been kept informed about their progress. People told us they felt safe in the hands of staff at this hospital, and that staff appeared well trained for the work they were asked to do. Positive comments included �No worries about their skills or abilities - staff all try their best to meet my needs.� Overall, people commented positively on the quality of the care and service they received and complimentary remarks were made in relation to the staff, the level of cleanliness, and the food.

We also asked people using the general outpatients department, and St. Luke�s Cancer Centre, to fill in a self completion questionnaire and return it into a sealed box. We distributed 100 self completion questionnaires in total. We passed 70 to general outpatients, on 15 and 16 August 2012. A total of 39 were returned. We also distributed 30 questionnaires in St. Luke�s Cancer Centre on 15 August, and all 30 were returned.

The self completion questionnaires showed that patients were very satisfied with the service at this hospital. Questions relating to being treated with dignity and respect, being involved in discussions about their care, as well as the standard of cleanliness in the hospital scored the highest �Yes� responses. Patients were also asked if they felt safe in the hands of the people providing their care at this hospital, and 100% of respondents said that they did. Some added comments such as �Absolutely� and �Most certainly�.

The questionnaires also identified that patients thought staff appeared well trained for the work they were being asked to do, and the majority of patients said that there were staff available to speak to if they had any worries. Patients were asked about their opinion of the overall quality of the care provided at this hospital. A total of 72 people answered this question, and 68 positive comments were received. The majority of these respondents thought the service was either �very good� or �excellent�, with several people noting that they had been coming to the hospital for years, either as patients or visitors, and they had been satisfied with the service over a long period.

Overall, only around half the patients said they would know how to make a complaint, but the majority of those who said they would not know, noted that they would find out, or speak to a member of staff. One person, in answer to the question about whether they knew how to make a complaint, stated that they did, but had never had one in 37 years.

Inspection carried out on 22, 23 March 2012

During a themed inspection looking at Termination of Pregnancy Services

We did not speak to people who used this service as part of this review. We looked at a random sample of medical records. This was to check that current practice ensured that no treatment for the termination of pregnancy was commenced unless two certificated opinions from doctors had been obtained.

Inspection carried out on 24 March 2011

During a themed inspection looking at Dignity and Nutrition

Patients and families we spoke to were positive about their experiences of care and treatment. When asked if they were happy with the way staff cared for them, those who were able to answer, said they were happy, with staff being described as �caring�.

People we spoke to were complimentary about the arrangements for meals at this hospital, with comments such as �Plenty of food � good food� being typical. Patients said that staff checked if they had had enough to eat and drink, and that the food suited them.