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Southend University Hospital Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 24 April 2018

All the information for this location appears in the overall summary above.

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Inspection areas

Safe

Requires improvement

Updated 24 April 2018

Effective

Good

Updated 24 April 2018

Caring

Good

Updated 24 April 2018

Responsive

Good

Updated 24 April 2018

Well-led

Requires improvement

Updated 24 April 2018

Checks on specific services

Outpatients and diagnostic imaging

Requires improvement

Updated 2 August 2016

We have rated this service as requires improvement for safe. This is because incident learning at directorate level was not well embedded; there were delays in patient follow up which had resulted in patient harm. The WHO check list was not embedded within diagnostic imaging and several pieces of diagnostic imagining equipment were listed as past their replacement dates. However we also saw that departments were clean, sufficient equipment was available to the staff and patient records were well maintained.

Effective was inspected but not rated; we found that multidisciplinary working was evident throughout the departments with excellent interaction from therapies staff. Staff training and re-validation were effective, as were supervision and appraisal systems. There was a good understanding of consent, Mental Capacity Act and Deprivation of Liberty Safeguards. Sonographers were becoming deskilled in anomaly scans which in turn were adversely affecting recruitment.

We have rated this service as good for caring. Feedback from patients and relatives was positive about the way staff treated people. Interactions between staff and patients were kind and friendly. Patients and their carers’ were involved and informed and complimentary about their experiences with staff at all levels, they felt staff took time to explain complex information in a way they could understand.

Responsive required improvement; there were significant access and flow issues in ophthalmology and respiratory services and there were no paediatric facilities within diagnostic imaging. However we also saw that the trust had good partnership working and excellent multidisciplinary team working. Learning from complaints was evident and the trust supported individuals with learning disabilities and dementia.

Well led required improvement; there were significant delays in follow up patient appointments in two specialities, these delays due to miss management had resulted in patient harm.  Joint meetings across all outpatients department and diagnostic imaging were not held therefore shared learning was lost.  Many items of diagnostic imaging equipment were significantly out of date; there was not a robust plan in place to address this. However we also saw that staff we spoke to were aware of the trusts vision statement and understood their role within the organisation.  There was good staff moral despite staff shortages in diagnostic imaging and staff felt valued and innovation was evident.

Outpatients

Good

Updated 24 April 2018

We previously inspected outpatients jointly with diagnostic imaging so we cannot compare our new ratings directly with previous ratings. We rated it as good because:

  • Medicines and prescriptions were stored safely and records were accessible, clear and up to date.
  • Staff understood how to protect patients from abuse and had training on how to recognise and report abuse and they knew how to apply it.
  • Staff cared for patients with compassion and empathy.
  • Staff involved patients and those close to them in decisions about their treatment and provided emotional support.
  • The service provided care and treatment based on national guidance and monitored evidence of its effectiveness to improve outcomes.
  • There was enough nursing staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and abuse and to provide the right care and treatment. Staff were able to access training to develop their skills and were supported to do so.
  • The trust planned and provided services in a way that met the needs of local people and of individuals who required additional support.
  • Staff of different kinds worked together as a team to benefit patients.
  • The trust performed better than the England average for people being seen within two weeks of an urgent GP referral, and receiving treatment within 31 days for a suspected cancer.
  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, which were shared with all staff.
  • The service had managers at all levels with the right skills and abilities to run the service providing high-quality sustainable care and had vision for what it wanted to achieve and workable plans to turn it into action.
  • Managers across the trust promoted a positive culture that supported and valued staff. There was good team work within the teams. Teams were proud of their service and this was evident in the good interpersonal relationships we witnessed.
  • The service engaged well with patients, staff, the public and local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively.
  • The trust was committed to improving services by learning from when things go well and when they go wrong.

However:

  • Only 71% of staff were up to date with safeguarding children level two which is below the trust target of 85%.
  • Not all areas controlled infection risk well. In one area the premises was visibly not clean and control measures were not in place to prevent the spread of infection. However this was resolved on our unannounced inspection.
  • The overall referral to treatment times for incomplete pathways at 83% were worse than the England average (93%) between September 2016 and August 2017.The trust had a group of patients on a backlog known as a patient tracking list (PTL) awaiting outpatient appointments. Some patients had been waiting more than 35 weeks for an appointment.
  • The eye unit did not use the World Health Organisation WHO Surgical Safety Checklist tool during invasive procedures. When we returned for the unannounced inspection its’ use had been implemented but had yet to be embedded.
  • Medical staff vacancies in certain specialities impacted the number of outpatient clinics that were able to run impacting the number of patients waiting for an outpatient appointment.

Maternity and gynaecology

Good

Updated 2 August 2016

Overall we rated the service as good but safety required improvement.

There were established local and divisional risk and governance arrangements. Staff felt the service had a profile on the trust board agenda. There were processes in place to share lessons learnt from incidents and investigations.

The trust promoted breastfeeding and women were supported in their chosen method of feeding. Women were positive about the care they had received. We observed staff interacting with women and their partners in a respectful compassionate way.

Women and their partners felt involved with their care and were happy with explanations given to them. Partners had the choice to stay to support women throughout the night.

There was an effective multidisciplinary approach to care and treatment, which involved a range of staff in order to enable services to respond to the needs of women. All staff told us that that working relationships between the professional groups was excellent.

Staff wanted to continue to develop the service and demonstrated this through implementing new ideas. For example the development of a range of specialist clinics to meet women’s needs.

Women using the maternity service received evidenced based care on the maternity service’s guidelines and national guidance.

However, medical staffing and the numbers of supervisors of midwives were not in line with national guidance.

There were no displays of information for people using the services about how to make a complaint if they were dissatisfied. The majority of women and their families we spoke with did not know how to make a complaint.

Medical care (including older people’s care)

Good

Updated 24 April 2018

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

  • The service managed patient safety incidents well and staff apologised and gave patients honest information and suitable support if things went wrong.
  • The service controlled infection risk well and staff kept appropriate records of patients’ care and treatment.
  • The service prescribed, gave, recorded and stored medicines well and patient records were clear, up-to-date and available to all staff providing care.
  • The service planned for emergencies and staff understood their roles if one should happen.
  • The service provided care and treatment based on national guidance and staff gave patients enough food and drink to meet their needs and improve their health.
  • The service monitored the effectiveness of care and treatment and made sure staff were competent for their roles.
  • 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 and always had access to up-to-date, accurate and comprehensive information on patients’ care and treatment.
  • Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
  • Staff cared for patients with compassion, involved them and those close to them in decisions about their care and provided emotional support to ease any distress. Feedback from patients confirmed that staff treated them well and with kindness.
  • The trust planned and provided services in a way that met the needs of local people and took account of patients’ individual needs ensuring people could access the service when they needed it.
  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, which were shared with all staff.
  • The trust had managers at all levels with the right skills and abilities to run a service and had a vision for what it wanted to achieve.
  • The trust had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected.
  • The trust collected, analysed, managed and used information well to support all its activities, using secure electronic systems with security safeguards.
  • The trust engaged well with patients, staff, the public and local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively.

However:

  • The service did not have enough nursing staff to keep people safe from avoidable harm and to provide the right care and treatment. This was a potential breach of the Health and Social Care Act 2008 regulated activities regulations 2014 regulation 18: Staffing.
  • Nursing and medical staff compliance with trust mandatory training and safeguarding mandatory training was below target as was appraisal rates for nursing staff.
  • Not all services were available seven days per week. For example, occupational therapy, physio therapy and speech and language therapy were not routinely available at weekends.
  • Response rates for the friends and family test (FFT) were consistently low across all medicine wards.
  • There were a high number of medical outliers.
  • Nurses and doctors felt the executive team lacked visibility on the wards and consultants felt the communication from the executive team was poor.

Urgent and emergency services (A&E)

Good

Updated 24 April 2018

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

  • Urgent and emergency care stayed as good overall. The question of safety improved to good. Effective, caring, responsive and well-led remained good. Service performances against national standards were variable but had improved. The department had a cohesive team and had governance processes in place for the oversight of risk, safety and quality.

  • The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.
  • The service used safety-monitoring results well. Staff collected safety information and shared it with staff, patients and visitors. The service used information to improve the service.
  • The service controlled infection risk well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection.
  • The service prescribed, gave and recorded medicines well. Patients received the right medications at the right dose at the right time.
  • The service planned for emergencies and staff understood their roles if one should happen.
  • The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.
  • Staff gave patients enough food and drink to meet their needs and improve their health.
  • The service monitored the effectiveness of care and treatment and used the 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 always had up-to-date, accurate and comprehensive information on patients’ care and treatment. All staff had access to a records system that they could all update.
  • Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. They knew how to support patients experiencing mental ill health and those who lacked capacity to make decisions about their care.
  • Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.
  • Staff involved patients and those closed to them in the decisions about their care and treatment.
  • Staff provided emotional support to patients to minimise their distress.
  • The trust planned and provided services in a way that met the needs of the local people.
  • The service took account of patients’ individual needs.
  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, which were shared with staff.
  • The trust had managers at all levels with the right skills and abilities to run a service providing high quality sustainable care.
  • The trust had a vision enough for what it wanted to achieve and workable plans to turn it into action developed ways involvement from staff, patients and key groups representing the local community.
  • Managers across the trust promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
  • The trust used a systematic approach to continually improve the quality of its services and safeguarding high standards of care by creating an environment in which excellence in clinical care could flourish.
  • The trust has systems for identifying risks, planning to eliminate or reduce them, and is coping with both the expected and expected.
  • The trust collected, analysed, managed and used information well to support all its activities, using secure electronic systems with security safeguards.
  • The trust engaged well with patients, staff, the public and local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively.
  • The trust was committed to improving services by learning from when things go well and when they go wrong, promoting training, research and innovation.

However:

  • The service did not have suitable premises to ensure all patients remained safe. The children’s ED waiting room was not controlled access and the mental health assessment area had a door that led to the car park.
  • The department did not always protect patients from potential abuse. Children were not separated adequately from adult patients at night in the adults ED when the children’s ED was not staffed.
  • Staff mostly kept appropriate records of patients’ care and treatment. Records were clear, mostly up-to-date and available to all staff providing care.
  • Not all staff had completed mandatory training in key skills.
  • The service did not have enough staff with the right skills to keep people safe from avoidable harm and to provide the right care and treatment.
  • The service had not always made sure staff were competent in their roles. Managers had not appraised all staffs work performance and held supervision meetings with them to provide support and monitor the effective of the service.
  • People could not always access the service when they needed it. The children’s ED was not staffed from 9pm to 8am and there was not always a registered children’s nurse on duty in the adults ED during these times. However, after our inspection the trust approved a business case to increase capacity within the children’s ED.

Surgery

Good

Updated 24 April 2018

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

  • The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.
  • The service prescribed, gave, recorded and stored medicines well. Patients received the right medication at the right dose at the right time. Each ward we visited had a pharmacist. This was an improvement since our last inspection.
  • Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection.
  • Staff compliance with sepsis training had improved since our last inspection.
  • The service made sure staff were competent for their roles. Managers appraised staff’s work performance and staff had regular team meetings to monitor the effectiveness of the service and develop practice.
  • 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 cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.
  • The trust planned and provided services in a way that met the needs of local people. Consultants worked closely with senior leaders to improve the responsiveness of the service.
  • The service took account of patients’ individual needs.
  • The trust had managers at all levels with the right skills and abilities to run a service providing high-quality sustainable care.
  • The trust had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected.
  • The trust engaged well with patients, staff and other healthcare providers to plan and manage appropriate services. Staff in the out of hours team and theatres were involved in projects to share good practice and benchmark their services against other providers.
  • The trust was committed to improving services by learning from when things go well and when they go wrong, promoting training, research and innovation. Staff demonstrated learning from incidents and never events and used innovative training methods such as a simulation training room to develop practice.

However:

  • Staffing on Southbourne ward was not in line with guidance from the Royal College of Nursing. Senior staff knew about this and were taking action to keep patients safe.
  • Although the service provided mandatory training in key skills to all staff, compliance with mandatory training and safeguarding training was variable.
  • The trust’s referral to treatment time (RTT) for admitted pathways for surgery showed a decline in performance and was below the England average from August 2016 to July 2017. Senior staff were aware of this and were taking actions to improve performance.
  • Complaints were not always investigated in a timely way. From August 2016 to July 2017 there were 102 complaints about surgical care. The trust took an average of 75 days to investigate and close complaints, which was not in line with the trust’s complaints policy.

Intensive/critical care

Good

Updated 2 August 2016

Effective processes were in place to learn from incidents and staff used learning from incidents and complaints to improve their practice and deliver safer, more effective care. The environment was clean and staff followed infection control procedures. Medicines, including controlled drugs, were safely and securely stored.

Medical and nursing staffing numbers did not always follow guidelines laid down in the Core Standards for Intensive Care Units.

Patients received treatment and care according to national guidelines and best practice. We saw effective multi-disciplinary team working across the units, with good consultant input. Junior doctors were adequately supported to provide safe treatment and assessment. Physiotherapists, dieticians, microbiologists and pharmacists were highly spoken of by CCU staff and were available when needed.

Without exception, staff were complimentary about the leadership on the unit. Managers on CCU and ARCU demonstrated commitment to patient care, delivering a positive patient experience, developing and caring for their staff, robust governance and effective strategic planning.

Services for children & young people

Good

Updated 24 April 2018

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

  • Staff kept patients safe from harm and abuse. They understood and followed procedures to protect vulnerable children. Staff assessed and monitored patient risk.
  • Care was provided in line with national and best practice guidelines. The service participated in both local and national audits to improve patient outcomes.
  • Staff had the appropriate skills, knowledge and experience to deliver effective care and treatment.
  • Staff cared for patients with compassion, treating them with dignity and respect.
  • Staff planned and delivered services to meet individual needs.
  • The service had governance, risk management and quality measures to improve patient care, safety and outcomes.

However:

  • The department did not ensure medical staff completed mandatory training to trust target levels.
  • Staff did not consider the personal preferences of young people aged 16 and 17, specifically their preference to be nursed on either an adult or paediatric ward.
  • Paediatric waiting lists were long, particularly for autism spectrum disorder (ASD) and epilepsy assessments. The trust was not commissioned to provide this service to children over the age of five; however, they had continued to accept referrals. The trust was in communications with the local commissioners to reduce the waiting list.

End of life care

Good

Updated 24 April 2018

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

  • End of life care improved and has been rated as good overall. The questions of safe, effective, responsive and well-led improved to good. Caring remained the same and was rated as good. The service handled safety incidents well. The service had processes in place to measure their performance. Staff went the extra mile in caring for their patients. The service had a cohesive team and had governance processes in place for the oversight of risk, safety and quality.
  • The service managed patient safety well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.
  • The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.
  • Staff cared for patients with commitment, dignity and compassion. Feedback from patients confirmed that staff treated them well and with kindness.
  • The trust planned and provided services in a way that met the needs of local people.
  • The trust had managers at all levels with the right skills and abilities to run a service providing high-quality sustainable care.