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Reports


Inspection carried out on 11 December to 10 January 2019

During a routine inspection

  • We rated effective, caring, responsive and well-led at this hospital as good and safe as requires improvement.
  • We rated all services inspected at this hospital as good overall.
  • Staff worked together as a team to deliver effective, patient-centred care and improve patient outcomes. Treatment was planned and delivered in line with current evidence-based guidance and patients were supported by staff to take ownership of their own recovery.

  • Staff treated patients with kindness, dignity and respect. Patients were involved as partners in their care and were supported by staff to make decisions about their treatment. Feedback from patients confirmed that staff treated them well and with kindness.

  • There was a strong culture of openness, transparency and teamwork within the organisation. Staff felt well supported by managers and told us that they encouraged effective team working across the hospital. Senior staff were visible, approachable and supportive.

  • The needs and preferences of different people, including the local population, were taken into account when designing and delivering services. There was a proactive approach to delivering care in a way that met the needs of older people and people living with dementia.

  • The hospital had a vision for what it wanted to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community.

  • The service had suitable premises and equipment and looked after them well. Staff kept themselves, equipment and the premises clean. They used effective control measures to prevent the spread of infection.

  • The trust had implemented a number of innovative services and developed these to meet patient needs. The trust was committed to improving services by learning, promoting training and innovation.

However:

  • The trust needed to take action to ensure that patients were protected from the risk of avoidable harm. We were not assured that there were effective systems and processes in place to prevent avoidable patient safety incidents from reoccurring. For example evidence of completed actions in response to serious incidents, was not always robust.

  • Opportunities to share key safety information relating to patient risk were sometimes missed. For example, there was no system in place for staff to escalate to the safeguarding team and risk assesses patients that left the Urgent Care Centre before being assessed.

  • Staff told us they reported incidents infrequently and therefore opportunities to learn from near-misses were lost. We were not assured that there was a robust culture of incident reporting.

  • Although records were clear, up-to-date and easily available to all staff providing care, in the Urgent Care Centre, patient records were not always stored securely and appropriately.

  • Although the trust provided mandatory training in key skills to all staff, not all staff had completed it. Many staff told us they did not get time to complete training and had to do it in their own time.

  • Although the staff generally followed best practice when prescribing, giving and recording medicines, we found some medicines were not stored in line with trust policy.

  • Patients sometimes experienced delays in accessing care and treatment. Waiting times from referral to treatment was not in line with national standards for the endoscopy unit. Theatre lists often started late meaning patients sometimes had to wait a long time on the day of their surgical procedure. The service did not have oversight of the number of patients who left the Urgent Care Centre before being seen, including vulnerable children and adults.

Inspection carried out on 2 - 5 February 2016

During a routine inspection

This was the first inspection of Chase Farm Hospital under the new methodology. We have rated the hospital as Good overall with all core services rated as Good a few areas rated as Requires Improvement.

Chase Farm Hospital is a Good Hospital providing good levels of care and treatment across all of the five core services we inspected.

We carried out an announced inspection between 2 and 5 February 2016. We also undertook unannounced visits during  the following two weeks.

We inspected five core services: Urgent and Emergency Care, Medicine (including older people’s care, Surgery, End of life and Outpatients and diagnostic services.

Our key findings were as follows:

  • The UCC was a good nurse led service. We found that there was strong and effective clinical leadership. The UCC was well organised and consistently delivered safe and timely care and treatment. Patients outcomes were good.
  • The needs of older people and people living with dementia were at the forefront of service developments, including the refurbishment project and reviews of patient pathways.

  • There was effective multidisciplinary working, including liaison with community teams, to facilitate timely discharge planning.

  • Staff were able to speak openly about issues and serious incidents. However, staff told us they didn’t always report an incident as they were too busy and did not always receive feedback.
  • There was appropriate medical and nursing staff to cover the work although some medical staff were uncomfortable with the support they needed for more complex post-operative patients.
  • We saw the staff use the intranet to access evidence based protocols and care but there were a number of audits either not started or not completed that would demonstrate staff were reviewing their practice in line with national and local standards.
  • They was a dedicated team providing holistic care for patients with palliative and end of life care (EOLC) needs in line with national guidance.
  • The hospital provided mandatory EOLC training for staff which was attended, a current EOLC policy was evident and a steering group met regularly to ensure that a multidisciplinary approach was maintained.
  • The hospital and its staff recognised that provision of high quality, compassionate end of life care to its patients was the responsibility of all clinical staff that looked after patients at the end of life. They were supported by the palliative care team, end of life care guidelines and an education programme.
  • The outpatient and radiology departments followed best practice guidelines and there were regular audits taking place to maintain quality.

  • Staff contributed positively to patient care and worked hard to deliver improvements in their departments.

  • The trust had consistently not met the referral to treatment time standard or England average since April 2015.

  • The hospital cancelled 35% of outpatient appointments in the last year. From October to January, 34% of short notice cancellations were due to annual leave, which was not in line with trust policy.

We saw several areas of outstanding practice including:

  • The UCC at Chase Farm Hospital was an outstanding example of a nurse led multi-disciplinary team providing excellent outcomes for patients. Patients were seen promptly and obtained good clinical outcomes. The close working relationship with the Paediatric Assessment Unit significantly enhanced the service provided to children and young people.
  • The Matrons in surgery were dynamic, supportive and visible in clinical areas and they inspired others to work together.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

  • Remove the inconsistencies that existed in patient’s assessments for DNACPR and the recording of Mental Capacity Act assessments.
  • The hospital must reduce the number of outpatients appointments it is cancelling.
  • The trust must ensure the 62 day cancer wait times are met in accordance with national standards.

  • The trust must ensure all staff interacting with children have the appropriate level of safeguarding training.

In addition the trust should:

  • Risk assessment documentation must completed in areas such as falls risk assessments, nutrition charts and fluid balance charts.

  • The trust should ensure grading of surgical referrals occurs within acceptable timescales.

  • The trust should ensure that RTT is improved in accordance with national standards and England averages.

  • The trust should ensure security of prescriptions forms is in line with NHS Protect guidance.

  • The trust should ensure the safer surgery policy is implemented and staff awareness on the policy should be enforced.
  • The trust should continue with its work around implanting the 5 steps of safer surgery until embedded and audited to ensure full compliance.

Professor Sir Mike Richards

Chief Inspector of Hospitals