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Inspection Summary


Overall summary & rating

Inadequate

Updated 24 July 2018

Our rating of services went down. We rated them as inadequate because:

  • There was a deterioration in infection prevention and control since the time of the last inspection. We found inconsistencies in hand hygiene practice amongst staff, during ward rounds.
  • Medicines were not always appropriately stored or checked in emergency department (ED).
  • There was poor recognition of sepsis.
  • There had been an improvement in safe levels of staffing although the trust needed to continue to work to increase substantive staff in post and reduce reliance on temporary staffing. Some services within the trust did not have enough permanent nursing and medical staff to ensure the provision of safe care and treatment. However, they used bank and agency staff to cover gaps in the staff provision.
  • We found out of date copies of the major incident plan on some wards and this was against the trust’s own policy.
  • The trust had not improved in relation to the testing of portable electrical equipment. We found that not all portable appliances had been tested.
  • We were not assured that high-risk patient groups were screened for MRSA at pre-admission.
  • Staff did not always maintain appropriate records of patients’ care and treatment. Records were not always clear, up-to-date and available to all staff providing care.
  • We were not assured that the laser service met the Medicines and Healthcare Products Regulatory Agency safety standards.
  • There was low participation in clinical audits and the trust performed poorly in some.
  • Appraisal rates were low in some areas.
  • Staff did not always understand their roles and responsibilities in relation to the Mental Capacity Act 2005, in particular in relation to Deprivation of Liberty Safeguards (DoLS).
  • The trust did not audit the World Health Organisation (WHO) five steps to safer surgery in 2017.
  • There were no pre-operative fasting audits for patients fasting before surgery.
  • The trust did not always actively monitor the effectiveness of care and treatment and use this information to improve services.
  • The trust did not meet the target to admit, discharge, or transfer and did not meet the standard that patients should wait no more than one hour for initial treatment.
  • The A&E waiting area for patients who attended by their own means was very crowded with insufficient seating.
  • We found that staff had poor awareness of the needs of people with learning disabilities.
  • Translation services were not always offered to patients.
  • The trust provided a range of information leaflets including support groups. However, similarly to the last inspection we did not see any information printed in any other language.
  • Spaces within the were surgery division was not suitable for inpatients due to the lack of essential equipment and washing facilities.
  • The trust’s investigation and closure of complaints was not in line with their complaints policy which states complaints should be completed in 30 days.
  • Since the last inspection, there had been limited improvement in the facilities on the ITU for relatives and visitors.
  • There were limited examples of departments supporting patients to manage their own health.
  • The bereavement service had limited opening hours and inappropriate waiting areas for bereaved family members
  • There was a large backlog of estates maintenance.
  • Local risk registers did not always reflect risks described by staff in some areas.
  • Matrons and managers within the trust did not have the capacity to effectively lead their teams due to pressures faced operationally.
  • The senior management team had not taken note of all of the concerns raised at the previous inspection.
  • We found that divisional and executive team were not visible in some areas and rarely some visited departments.
  • Staff struggled to locate clinical guidelines quickly as the trust intranet search engine was not user friendly.
  • The department had managers with the right skills to run the service; however senior nurses felt that their managerial duties were at times excessive of their role.
  • We were not assured that there were adequate governance procedures for the laser service as set by the Medicines and Healthcare Products Regulatory Agency safety standards.
Inspection areas

Safe

Inadequate

Updated 24 July 2018

Effective

Requires improvement

Updated 24 July 2018

Caring

Good

Updated 24 July 2018

Responsive

Requires improvement

Updated 24 July 2018

Well-led

Inadequate

Updated 24 July 2018

Checks on specific services

Outpatients and diagnostic imaging

Requires improvement

Updated 11 February 2015

We found that letters to general practitioners (GPs) were not being sent within the five-day period in line with trust policy. On the day of our inspection, the majority of medical secretaries were not typing letters within this timeframe.

The renal outpatients department (OPD) was unable to provide patients with follow-up appointments in a timely manner.

The ophthalmology clinic was not an ideal environment, as it was too small to meet with the demands of the service. Although the trust had attempted to mitigate the issue by running extra clinics within the community, this issue was still evident at the Hillingdon Hospital site.

The trust was very responsive when planning the service to meet the needs of local people. Effective consultation allowed the service design to meet the needs of local communities and staff groups. We saw good ownership of the care and treatment they delivered by staff of all grades.

A proactive stance was taken in addressing issues that impacted on care delivery, such as developing a policy to monitor and reduce non-attendance at hospital appointments. In general, resources and facilities were good and met the needs of people attending the department.

We found that the OPD was accurately monitoring patient pathways. The central booking service was consistently able to give patient appointments within the NHS England and Clinical Commissioning Groups 2012 regulations about 18-week referral-to-treatment targets. We were able to see evidence of clear strategies to monitor and maintain systems to ensure that the trust met with these targets. The trust was consistently meeting with the two-week wait timescale for patients with urgent conditions, such as cancer and heart disease. We were able to see evidence of clear strategies to monitor and maintain systems to ensure that the trust met with these targets.

We found good local leadership within the OPD departments. The OPD matron was praised highly by staff who felt that they were proactive and supportive.

Maternity

Good

Updated 24 July 2018

We previously inspected maternity jointly with gynaecology so we cannot compare our new ratings directly with previous ratings. We rated the service as good because:

  • The trust had taken note of all concerns raised at the previous inspection and made improvements in the areas of staffing, cleanliness, reconfiguring the triage and day assessment area, and defects in security and theatre ventilation had been rectified.
  • The service had responded effectively to accommodate the locally agreed increase in births at the hospital which had taken place earlier than anticipated and the transition had been smooth.
  • Risks to women were well-identified and well-managed in antenatal care, intrapartum and postnatal care.
  • There were clearly defined and embedded systems and processes in place to keep people safe and safeguard them from abuse. Safeguarding was well managed and the new midwife service to women with social or mental health concerns had been strengthened to provide 24 hour telephone support for vulnerable women.
  • There was an open culture of incident reporting and a willingness to learn from incidents.
  • The governance arrangements were systematic and well understood. There was a responsive audit programme clearly focused on improving outcomes for women and prompt response to findings.
  • Staff engagement was strong and midwives and doctors worked closely and without hierarchy. All staff shared the same aims and vision for the service.
  • Women we spoke with were happy with their care and praised staff for being welcoming and supportive.
  • The service’s engagement with the local maternity network was proactive in coordinating care, and they were involved as early adopters of improved methods of care in many areas.
  • Trainee doctors were very positive about the support and teaching they received from senior clinicians, and obstetric training posts at the trust were sought after.
  • The service met expected patient outcomes for women in most areas, and in some areas exceeded these, for example in having a low rate of planned caesarean sections. The service assessed themselves against external standards in published reports and sought continuous improvement.

Outpatients

Requires improvement

Updated 24 July 2018

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

  • We rated safe and well-led as requires improvement, and responsive and caring as good. We do not rate effective for this core service.

  • The rating for responsive improved since the last inspection; the rating for safe went down and the rating for each of the other key questions remained the same.
  • We were not assured that the laser service met the Medicines and Healthcare Products Regulatory Agency safety standards
  • The laser service did not have a laser protection advisor in place since the start of the laser service in 2012, although the trust was making suitable arrangements at the time of the inspection there still was no one officially in post.
  • We were not assured the department had adequate governance procedures for the laser service as set by the Medicines and Healthcare Products Regulatory Agency safety standards. Risks associated with laser practice were not present on any trust risk register.
  • Staff did not always maintain appropriate records of patients’ care and treatment. Records were not always clear, up-to-date and available to all staff providing care.
  • The service did not have suitable premises and there was a large backlog of estates maintenance.
  • The service provided mandatory training in key skills to all staff.
  • The service did not actively monitor the effectiveness of care and treatment and use this information to improve the service.
  • The department had managers with the right skills to run the service; however senior nurses felt that their managerial duties were at times excessive of their role.
  • The service had a vision for what it wanted to achieve, however we were not assured it had workable plans to turn it into action.
  • The service had limited engagement with patients and staff to plan and manage appropriate services.
  • The service had systems for identifying risks and planning to eliminate them, however the services active risks were of an excessive age.

However:

  • 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 controlled infection risk well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection.
  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so; however some compliance with some training failed to meet trust targets.
  • The service had enough 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.
  • The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.
  • The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and monitor the effectiveness of the service.
  • 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 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 the 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 close to them in decisions about their care and treatment.
  • The trust planned and provided services in a way that met the needs of local people.
  • People could access the service when they needed it. Waiting times from referral to treatment were in line with good practice.
  • The service took account of patients’ individual needs.
  • Managers across the service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
  • The service used a systematic approach to continually improving the quality of its services and safeguarding high standards of care by creating an environment in which excellence in clinical care would flourish.
  • The service collected, analysed, managed and used information well to support all its activities, using secure electronic systems with security safeguards.

Maternity and gynaecology

Requires improvement

Updated 11 February 2015

The trust had recognised the risk to safe and responsive care because of inadequate midwifery staffing. The staffing establishment had been increased and newly appointed midwives were expected to join the trust before the end of the year. At times of high activity current risk was mitigated by the use of the escalation policy to prioritise the needs of women in labour. This meant that other areas were sometimes short staffed.

Women were able to access antenatal and postnatal services near their home and high risk women were seen at antenatal clinics at the hospital. These clinics were sometimes crowded and women had to wait for appointments. There had been no evaluation of the reconfiguration of the community midwifery service to assess its effectiveness and staff told us they were under pressure. The business case to increase staffing had been agreed; the appointments had not been made at the time of our inspection.

The wards were kept clean, but infection-control procedures were not always followed. The storage of medicines did not comply with nationally recognised good practice.

There had been improvements to the effective use of the World Health Organization (WHO) surgical safety checklist in obstetric procedures. There was a high level of awareness about the importance of safeguarding women and babies.

Trainee doctors said the teaching and support from consultants was of a high standard. Midwifery staff took part in a well-established appraisal process and had opportunities for training and development. Staff were confident about the quality of care they provided, and this was reflected in the positive comments of women who used the service. Bereaved parents were well supported.

There was a systematic approach to clinical governance, which included a process for reviewing and investigating incidents, an audit programme and clear allocation of responsibility for reviewing guidelines.

Medical care

Requires improvement

Updated 7 August 2015

Medical care (including older people’s care)

Requires improvement

Updated 24 July 2018

  • The service had systems and processes to keep people safe and safeguard them from abuse and staff understood these processes.
  • The service managed patient safety incidents well. Staff recognised incidents and near misses and reported them appropriately. Senior staff investigated incidents and shared lessons learnt with staff.
  • There had been an improvement in relation to safety monitoring and the collection and display of safety information on the wards.
  • There was consistent and effective use of National Early Warning Scores (NEWS) including appropriate escalation.
  • Overall, there had been an improvement in medicines management on the medical wards.
  • There had been an improvement in systems and processes around cleanliness, infection control and hygiene.
  • The service provided care and treatment based on national guidance and evidence of its effectiveness.
  • Overall, the service made sure staff working on the various wards were competent for their roles.
  • The service monitored the effectiveness of care and treatment and used the findings to improve them with notable performance improvements in some national audits.
  • Staff from different staff groups and teams worked together to deliver care and treatment.
  • Staff cared for patients with compassion, dignity, kindness and respect and involved patients and those close to them in decisions about their care and treatment.
  • The service had improved its discharge processes in order to improve flow within the hospital.
  • The service had taken action to minimise the length of time people waited for care and treatment using initiatives such ‘Discharge to Assess’ and ‘Home Safe’.
  • From December 2016 to November 2017 the trust’s referral to treatment time (RTT) for open or incomplete pathways for medicine ranged from 88-98% and was better than the England average for nine out of the 12 months.
  • The values of the trust were embedded and staff at all levels were able to tell us what the trust values were and how they applied to their roles.
  • There was alignment between what leadership said the risks were and what we found during the inspection.
  • Leaders promoted a positive culture that supported and valued staff.
  • Quality and safety received sufficient coverage in board meetings, and in other relevant meetings below board level. There was a culture of honesty, openness and transparency. We saw evidence of senior staff carrying out duty of candour responsibilities.

However:

  • There had been no improvement in relation to safe levels of staffing. The service did not have enough permanent nursing and medical staff to ensure the provision of safe care and treatment. However, they used bank and agency staff to cover gaps in the staff provision. Although the service had taken action to address staff shortages, those actions had to date not resulted in improvements in staff numbers.
  • Staff did not always keep appropriate records of patients’ care and treatment, for example dementia, bed rails and mental capacity assessments.
  • We found out of date copies of the major incident plan on some wards and this was against the trust’s own policy.
  • Six out of 13 mandatory training modules failed to meet the target completion rate.
  • The service had not improved in relation to the testing of portable electrical equipment. We found that not all portable appliances had been tested.
  • Staff did not always understand their roles and responsibilities in relation to the Mental Capacity Act 2005, in particular in relation to Deprivation of Liberty Safeguards (DoLS).
  • Despite various actions and initiatives to improve access and flow, the hospital still experienced a high demand for beds with bed occupancy rates of between 97% and 98% during the three days of our announced inspection.
  • Matrons and managers within the service did not have the capacity to effectively lead their teams due to pressures faced operationally. Although the trust had systems for identifying risks and plans to mitigate risks, this did not always translate to improvements within the service.

Urgent and emergency services (A&E)

Inadequate

Updated 24 July 2018

Our rating of this service went down. We rated it as inadequate because:

  • There was deterioration in infection prevention and control since the time of the last inspection.
  • Medicines were not always appropriately stored or checked.
  • The mental health interview room was not safe.
  • Regular observations of patients were not carried out.
  • There was poor recognition of sepsis.
  • There was low participation in clinical audits and the trust performed poorly in some.
  • There was poor assessment of patients’ pain.
  • The appraisal rate for doctors was 13%, which was below the trust standard of 90%.
  • We observed some negative staff behaviour towards patients.
  • There was poor communication with patients.
  • The department did not meet the target to admit, discharge, or transfer 95% of patients within four hours between February 2017 and February 2018.
  • The service did not meet the standard that patients should wait no more than one hour for initial treatment during this same time period.
  • The waiting area for patients who attended by their own means was very crowded with insufficient seating.
  • We found that staff had poor awareness of the needs of people with learning disabilities.
  • Translation services were not always offered to patients.
  • There were differences between the recorded risks on the risk register and what staff expressed was on their ‘worry list’.
  • There had been no significant improvement in the storage and checking of medicines since the last inspection.
  • Junior doctors told us there were differences in consultant leadership and some were more supportive than others.
  • Many staff told us they did not feel able to escalate their concerns about pressures of work and how this impacted on poor patient safety and experience.

However:

  • The environment in paediatric ED was well maintained.
  • Staff were confident about how to record incidents.
  • Multidisciplinary working was evident in most areas of the department.
  • Patients and carers in the paediatric ED and the CDU spoke very positively of their experiences.
  • The department had a frailty pathway, supported by specialists, to safely reduce admissions and length of stay for elderly patients and ambulatory care pathways.
  • There was a mental health matron seconded from a local trust who supported staff to offer a better patient experience to those with mental health issues.
  • The trust was working alongside the NHS Improvement Emergency Care Improvement Programme Team (ECIP) to drive up standards and improve patient experience.
  • Many staff told us that members of the operational team were visible and they could tell us who they were.
  • Staff told us they enjoyed good local teamwork.

Surgery

Inadequate

Updated 24 July 2018

Our rating of this service went down. We rated it as inadequate because:

  • Safeguarding Children (level 2) failed to meet the trust target.
  • The surgical assessment unit (SAU) was dividing singular bed spaces into two patient bed spaces, with the use of screens. This meant that only one patient had access to oxygen, call bells and suction.
  • Staff we spoke with were not aware of the sepsis six (bundle of medical therapies) and we could not locate a screening tool for sepsis.
  • We were not assured that high-risk patient groups were screened for MRSA at pre-admission.
  • The hospital did not audit the World Health Organisation (WHO) five steps to safer surgery in 2017.
  • Similarly to the last inspection we found five of the 13 mandatory training modules failed to meet the trust target, including manual handling which we observed to be very poor.
  • There were no pre-operative fasting audits for patients fasting before surgery.
  • DoLs (Deprivation of liberty) had been put in place for three patients without a DoL’s assessment.
  • The hospital provided a range of information leaflets including support groups. However, similarly to the last inspection we did not see any information printed in any other language.
  • Similarly to the last inspection many spaces within the surgery division were being used to house inpatients, this included the female day care unit, recovery and the day room in Kennedy. These facilities were not suitable for inpatients due to the lack of essential equipment, and washing facilities.
  • Staff in recovery were not trained to discharge patients, for example providing patients with ‘to take away’ medications which caused delays.
  • The trust took an average of 51 days to investigate and close complaints, this is not in line with their complaints policy, which states complaints should be completed in 30 days.
  • Executive staff told us that issues that arose out of hours were not always addressed with appropriately. Problems were dealt with in the moment with little forward planning.
  • Staff reported that staff retention was low and that this was linked to poor relationships with management.
  • Staff reported that they were often left without senior management and “no one in charge”.

Intensive/critical care

Requires improvement

Updated 24 July 2018

  • We rated safe, responsive and well-led as requires improvement, and effective and caring as good.

  • The rating for effective improved since the last inspection; the rating for each of the other key questions remained the same.

  • The senior management team had not taken note of all of the concerns raised at the previous inspection and only made improvements in the areas of 24 hours consultant cover, healthcare assistant recruitment, partial improvement of the ventilation system and submission of the Intensive Care National Audit and Research Centre (ICNARC) data.

  • There were no formal morbidity and mortality meetings. Learning from any clinical case presentations was not shared with the wider directorate, or fed back to the board through any identifiable governance structure.

  • At the time of inspection, the unit was unable to provide optimal care for patients requiring isolation facilities such as positive and negative air pressure management. There was increased risk of cross infection, as at the time of our inspection; the ITU environment was not compliant with recommended building (HBN04-02) standards and heating and ventilation for health sector building (HTM 03-01) standards. We found inconsistencies in hand hygiene practice amongst staff, in particular during ward rounds. There was dust on some equipment and high surfaces. This remained an area of concern from the time of the last inspection.

  • We found inconsistencies in the daily checks of the difficult airway/ intubation trolley in the located in the unit. Nursing staff equipment competencies for some key pieces of equipment had not been rechecked since 2015 and were now overdue.

  • In the ITU, oxygen was not prescribed on the patient prescription chart as per the trust policy on the prescribing and administration of oxygen in adults.

  • In February 2018, the nursing vacancy rate was 16%. Staff informed us that due to increased bed pressures recently, there had been many occasions when the supernumerary nurse would cover the short staffed/unfilled shifts. There was no 24-hour cover provided by the critical care outreach team (CCOT). This was an area of concern at the last inspection.

  • The unit did not use any sepsis screening tool and there was no separate policy for sepsis management in place. Although the outreach team told us that sepsis was part of the deteriorating patient policy. All junior staff we spoke with were not aware where to find information on sepsis management and if there was trust lead for sepsis.

  • The unit was not meeting the Core Standards for Intensive Care Units recommendation of having a practice nurse educator, who dedicated two-thirds of their time to this role. This was an area of concern at the last inspection and we found no improvement in regards to this provision.

  • The unit had made no progress in relation to the facilities for patients and relatives. There was only one patient toilet in the unit and no bath or shower facilities. Since the last inspection, there had been limited improvement in the facilities on the unit for relatives and visitors.

  • Capacity and flow was one of the key areas of concerns for the unit. According to ICNARC data covering April 2016 to March 2017, the percentage of bed days occupied by patients with discharge delayed more than 8 hours and 24 hour was higher compared to other similar unit.

  • We found that divisional and executive team were not visible and rarely visited the unit. The staff told us that there was little support for the critical care unit within the trust; they felt isolated and disjointed from the division. At the time of the last inspection, we found that there was no evidence of strong critical care leadership to challenge or influence the future direction of the service. At this inspection, we found there was still lack of any consensus regarding cohesive future direction of the service.

  • There was a lack of an effective governance structure driven by the unit leadership team. Not all the junior staff we spoke with could articulate the department governance arrangements and how it fed into the divisional governance structure. Not all risks identified by us during the inspection were reflected on the risk register. In addition to this, many risks identified at the last inspection were still outstanding.

  • Staff struggled to locate clinical guidelines quickly as the trust intranet search engine was not user friendly.

However:

  • Staff demonstrated an awareness of safeguarding procedures and how to recognise if someone was at risk, or had been exposed to abuse. There was a clear and effective process to ensure that potential safeguarding concerns were escalated.
  • The service used safety monitoring results well. The unit now monitored incidents of falls, pressure ulcers, venous thromboembolism (VTE), central venous catheter infections and catheter associated urinary tract infections (UTIs). This information was displayed in both the staff room and on noticeboards within the unit. This had improved since the last inspection.

  • The unit had made progress with regard to consultant cover and now had a separate on-call rota.

  • Since the last inspection, the unit had made improvement and was now contributing data to the Intensive Care National Audit and Research Centre (ICNARC).

  • Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.

  • At a local level, there was clear leadership for both medical and nursing staff. The lead consultant and unit manager worked closely together. They were both visible in the department and junior clinical staff described them as approachable and supportive.

  • We saw collaborative working between clinicians. Junior doctors and nurses felt supported, with regular supervision. We saw that the medical team worked well together, with consultants being available for junior doctors to discuss patients and to give advice where needed.

Services for children & young people

Good

Updated 24 July 2018

  • There was an open and constructive culture of sharing and learning from incidents.
  • Safeguarding knowledge and processes had improved. Staff understood their responsibilities and how to keep patients safe.
  • Medicines were stored and managed appropriately; patients received the correct doses at the right times.
  • The effectiveness of care and treatment was monitored and improvements were made as a result.
  • Nutrition and hydration needs were met as a result of effective monitoring.
  • Patients’ pain was managed and monitored well.
  • There was a multidisciplinary approach to patient care and staff worked well together to deliver an effective service.
  • Staff cared for patients with compassion and ensured that dignity and privacy were respected.
  • There was good emotional support for patients and their families and carers.
  • Patients and those close to them were supported to understand their care and treatment and were involved in making decisions.
  • The department delivered a broad range of services including speciality and one-stop clinics.
  • There was timely access to services and good flow through the department.
  • There was a positive, ‘can do’ culture in the department and staff were proud to work there.
  • There had been an improvement since the previous report in staff feeling listened to and supported by their managers.
  • There were processes for engaging staff in news and developments in the department including newsletters and meetings.

However:

  • The department had not implemented a seven day service.
  • There were limited examples of the department supporting patients to manage their own health.
  • Staff did not receive formal training provision for learning disabilities and the service relied on support from external partners or the trust’s learning disability link nurse.
  • Some areas where children were seen in adult outpatients were not child friendly.
  • Parents reported delays in seeing the dietitian.
  • There was limited engagement with patients and those close to them to gather their input in improving the service.

End of life care

Good

Updated 24 July 2018

  • We rated safe, effective, caring, responsive and well-led as good.
  • The ratings of safe, effective, responsive and well-led improved since the last inspection. The rating for caring remained the same.
  • Since our last inspection there had been a focus on the trust wide understanding and development of end of life acre. There was now a strategy and governance programme in end of life care with a clear structure of leadership and accountability.
  • Appropriate measures were in place to keep patients safe from avoidable harm. Record keeping had improved.
  • There were specialised end of life care advanced care plans in place and risk assessments had been adapted for patients at the end of their lives.
  • Team working was strong and the development of staff within the specialist palliative care team had strengthened governance structures. There was a non-executive director in place that sat on the board and had end of life care oversight.
  • Patients were provided with compassionate and person-centred care, which took account of their individual differences and needs. There was multi-disciplinary input to ensure that patients received a holistic and individualised care plan.
  • The specialist palliative care team had developed end of end training within the trust and worked well with external agencies in order to coordinate care for each patient.

However:

  • There was not always evidence that the appropriate mental capacity assessments had been carried out where this was noted in the patients DNACPR form.
  • There was no end of life champion on each ward and the SPCT team did not take oversight for the training of staff in syringe pumps.
  • The bereavement service had limited opening hours and inappropriate waiting areas for bereaved family members.