St Luke's Hospital

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We looked for evidence that the service met people’s needs.

At our last assessment we rated this key question as good. At this assessment the rating has remained good.

This meant people’s needs were met through good organisation and delivery.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

Staff told us they considered individual patient needs and took into account adjustments required for those with protected characteristics. Vulnerable In-Patient (VIP) passports were used within the departments for sharing important information about how people wanted to be communicated with and the support they might need. The information could be used in outpatient or inpatient settings.

We saw examples of care planning that had taken into account peoples’ social circumstances, for example, children requiring time away from school were provided with supporting information for the school.

Clinics that involved deliverance of cancer diagnosis were set up to ensure patients were central to the care planning process. Additional time was allowed for each patient. Holistic needs assessments were carried out and support with onward referrals was available.

Some clinics allowed additional time to give health promotion and education surrounding specific medical conditions. For example, the colorectal nurse specialist had a care coordinator working alongside to support with onwards referrals and appointments allowing additional patient contact time.

People were fully informed and involved in making shared decisions, for example, some patients chose to follow a symptom management care plan rather than a more invasive treatment option.

The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

Peoples care and treatment was delivered in a way that met their needs. Appointments were offered via face to face or telemedicine where appropriate. Telemedicine allowed people to attend appointments virtually from, for example, their own homes. This enhanced accessibility for patients, reduced DNA rates and reduced the risks of people attending late for appointments as parking was frequently reported as a concern.

Additional weekend clinics were provided to support clinical demands and to meet fast track referral pathways.

Where appropriate some clinics offered short notice appointments for patients who identified a deterioration to their health condition.

The patient booking team used data to identify any themes and trends within patient attendance to support reducing barriers to attendance.

The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Information was provided in an accessible manner. Staff told us that there would usually be an interpreter booked and available if and when required. There were also staff in the teams who could speak the most commonly used languages for the patient population.

Posters providing information was displayed on walls within the departments. The posters included a range of the most popular local languages. There were also QR codes available to scan. For example, we saw QR codes relating to ‘understanding high blood pressure’. These could be scanned in seven different languages.

We observed staff updating people on waiting times in the departments. We saw one doctor came out to let a patient know the clinic was running late and explained how long the person would be waiting. However, some people told us that the boards for wait times were not always updated. We also observed not all boards were consistently kept up to date during the inspection.

We saw feedback and heard from people using the service that signage was confusing. We saw that a review of all signage had been commissioned as a result of feedback received. The reception team and volunteers at the front entrance were responsive to people’s needs and provided appropriate directions.

The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result.

Information regarding making complaints and raising concerns was not visible in all departments. We asked four patients in the adult outpatient department if they knew how to make a complaint. They could not identify any information in the area that advised on this or recall being given any information. However, families within paediatrics were able to identify ‘how to complain’ details on the wall.

We reviewed recent complaints and saw people received feedback. We saw action plans for improvements following complaints. For example, collaboration with family members to make changes to the way blood was taken from children with needle phobias.

Staff received feedback from complaints and were made aware of any changes to practice as required.

Staff knew how to handle complaints.

We saw examples of proactive engagement with people regarding service development. For example, the children’s diabetes team had worked closely with young people and families to identify how they might like to receive support. A community venue was identified to hold group sessions with full MDT involvement.

The paediatric outpatient department used an innovative method of obtaining real time feedback from children. This was a trust wide initiative using arts and crafts with positive and negative feedback being reported on ‘pants and tops’ shapes. Pants was negative and tops was positive feedback.

Friends and family test feedback cards were available in all areas and text messaging was used, however, feedback rates were often low and the trust recognised that a range of tools were needed to hear people’s voices. We did not see evidence of formal alternatives at the time of inspection, however, staff took into account peoples concerns on a day to day basis through conversation and engagement with them.

The service made sure that people could access the care, support and treatment they needed when they needed it.

We reviewed referral to treatment time data. At the time of inspection the trust was achieving 63.78% for 52 week waits (people waiting less than 52 weeks for planned treatments). The trust had performed better than the national average of 60.03% for the previous 12 month period. Waiting lists had also decreased.

The outpatient teams had a system in place to support equity in access. The central booking team used an application that determined people more at risk of not attending appointments. For example, people living with dementia or living in more disadvantaged areas within the community. This was supported by ‘Improving patient attendance guidance’ in the Elective Care Access policy’.

There were clear processes for ‘did not attend patients’ and ‘child not brought’ situations. Policy guidance supported equity in access.

Staff made reasonable adjustments for people on accessing the hospital, for example, people with mobility issues were able to access wheelchairs. In some areas we saw posters advising people to inform the receptionists if they had preferred alternatives to verbal communication. There were also posters advising people to raise awareness if they had or cared for someone with a learning disability. Following a patient safety incident investigation the trust was promoting greater awareness of consideration of the needs of people with a learning disability, including considering whether people had passports in place describing their care needs. We saw this information displayed in areas as prompts for staff.

There was an individual treatment room set up in adult outpatients for patients requiring bariatric equipment. For these patients accessing the service the multi-disciplinary team members would go to the patient rather than the patient moving between clinic rooms to see differing members of the team. Paediatric outpatients also ensured that children with cystic fibrosis were seen within the same room to support additional equipment requirements and minimise movement between rooms.

The service had carried out Patient-Led Assessments of the Care Environment (PLACE) audits. We saw that improvements to accessibility had been made following this, for example, blue handrails were installed throughout the outpatient areas, there was dementia friendly doors and art work. Hearing loops had been installed.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

We heard examples where barriers to receiving treatment had been identified and removed. For example, a patient with specific childcare needs impacting on the patient’s ability to attend appointments had been taken into consideration and alternative arrangements made to ensure the patient was able to attend in a timely way for assessment.

Appointments for children were managed around school times and consideration was given to timing of appointments, for example, for mothers with caring responsibilities.

Making every contact count (MECC) demographics were collected by the trust. This supported the trust in identifying when MECC conversations had happened, if onwards referrals had been completed and to which services.

Clinics were set up to meet the needs of the local population, for example, the paediatric team recognized incontinence was high in the local population. Partnership working was set up across the area to support equity in experiences and outcomes.

Staff within the service and the wider trust promoted a culture in which the people using the service felt empowered to give their views.

The trust had undertaken equality impact assessments of their policies and procedures to ensure they did not place vulnerable people or people with protected characteristics at a disadvantage.

Staff were trained in equality, diversity, inclusion and human rights.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Staff supported patients to make decisions about their care and treatment and their future.

Staff created personalised care plans including actions to take when things changed where this was appropriate. We saw one example of a care coordinator working alongside a cancer nurse specialist. This supported the patient pathway and ensured all onwards referrals were made and allowed the nurse to spend longer with the patient ensuring a full understanding of needs to then plan for important life changes.

Conversations regarding bad news were managed and communicated in a sensitive and dignified way.

Staff ensured all relevant healthcare professionals and other relevant agencies were involved in planning the care and treatment of people with complex needs.