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Royal National Orthopaedic Hospital (Bolsover Street) Good

The provider of this service has requested a review of one or more of the ratings and they are currently under review. The ratings for this service could change further to completion of the review. This page will be updated in due course.

Inspection Summary


Overall summary & rating

Good

Updated 22 March 2019

Royal National Orthopaedic Hospital (Bolsover Street) is an outpatient only facility. This is the only core service we inspected.

We previously inspected outpatients jointly with diagnostic imaging so we cannot compare our new ratings directly with previous ratings.

We rated safe, caring, responsive and well led as good. We do not rate the effective domain for outpatients.

Inspection areas

Safe

Good

Updated 22 March 2019

Effective

Not sufficient evidence to rate

Updated 15 August 2014

Caring

Good

Updated 22 March 2019

Responsive

Good

Updated 22 March 2019

Well-led

Good

Updated 22 March 2019

Checks on specific services

Outpatients and diagnostic imaging

Requires improvement

Updated 15 August 2014

The service was safely managed caring and effective but it required improvement in being responsive and well-led. The building was purpose built for outpatients and accommodated a variety of patient needs.

Patient records were available for at least 99% of appointments; they were transported and stored securely.

21% of the clinics started late. There was no key performance indicator for sending out clinic letters following consultation to patients and their GPs. A significant proportion of letters were not sent out for over one month. There was an exception within the trust that letters regarding patients who had cancer would be sent out within 48 hours. The leadership team were aware of the issues but had not addressed them as they were not responsible for the clinical divisions who booked appointments.

Outpatients

Good

Updated 22 March 2019

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:

  • Staff at Bolsover Street achieved 100% for 5 out of 7 mandatory training modules.
  • The hospital operated fully staffed with no vacancies.
  • Hand hygiene audits were completed monthly and the results for September 2018 showed 95%.
  • There was a greater understanding from staff in their knowledge of safeguarding. Staff understood how to recognise and report abuse. There were clear safeguarding procedures in place.
  • Facilities were available to provide longer appointment times if required, and larger rooms to accommodate wheelchairs and equipment.
  • We examined seven sets of electronic notes and we saw that drug treatment charts were completed and we saw GP letters and copies that would have been sent to patients and other agencies were available within the patients’ files.
  • The medicines we looked at were all in date. Fridge temperature checks were completed daily, and we saw evidence of this.
  • The service managed patient incidents effectively. Staff recognised incidents when they occurred and knew how to report them. Staff apologised to patients when things went wrong and gave them information and support. Staff we spoke with understood the Duty of Candour.
  • The structure of the clinics and an interview with a doctor in training doctor showed evidence of an individualised management plan for patients. This was also reflected in the detailed letters following consultations seen in the seven electronic medical records that we looked at.
  • A pain clinic occurred every Friday, which was run by a pain consultant and specialist nurse team.
  • Staff were nominated and praised for good work completed. We saw emails where compliments from patients about nurses were fed back by their manager.

  • The Bolsover outpatient department reported that as at August 2018 Mental Capacity Act (MCA) training was completed by 100% staff in outpatient services compared to the trust target of 95%.
  • We saw episodes of good care with patients and carers being in full understanding of what was being explained to them.
  • All patients we spoke with confirmed that all staff from clinicians to receptionists were all  kind and polite.
  • Patients who had received distressing news such as a cancer diagnosis were seen with a nurse with specialist qualifications and skills in cancer care. The service also had these specialist nurses available for appointments with paediatric patients if needed. There were quiet rooms that patients could go into with the nurse to process the information following their consultation.

  • We observed that privacy and dignity of patients was respected at all times in the consulting rooms and care and consultation was provided in a compassionate way.
  • The service delivered services effectively to patients coming from all over the United Kingdom taking account of any logistical problems presented.
  • We observed attentive reception staff calling patients to remind them of their appointments, providing them with directions to the hospital, and advising patients as to which floor their appointment was on.
  • We observed that there were unisex toilets available, with foot-operated bins. Disabled toilets were available with large hand rails and emergency call bells and motion sensor operated bins. All disabled toilets were furnished with baby changing facilities.
  • The trust was performing better than the 93% operational standard for people being seen within two weeks of an urgent GP referral from July 2017 to June 2018.
  • From August 2017 to July 2018 the trust’s referral to treatment time (RTT) for incomplete pathways was consistently better than the England overall performance.
  • A senior sister described fostering a culture in which staff took ownership and responsibility of what they did, which would lead to better outcomes for the patient.
  • We observed that the hospital had six risks on their risk register. The senior nurse was sighted on these risks and provided us with mitigations for some of the risks that we identified that could compromise patient care.
  • A senior nurse told us that improvements had been made in the engagement between the hospital and a transport provider, with the relationship between the two being described as “good”.

However:

  • The follow-up to new rate for Royal National Orthopaedic Hospital (Bolsover Street) was higher than the England average.
  • The DNA rate at Bolsover Street was slightly higher than the England average. The reasons given were that it could have been due to the location of the hospital, which falls within the congestion charging zone, making it expensive and difficult for patients to find parking.
  • A senior nurse told us that it was sometimes difficult to engage staff to complete the staff survey because there was a perception amongst staff that they were identifiable through the barcode that was attached to the paper copy of the survey.