Mount Vernon Hospital

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work. At our last assessment this key question was not rated. At this assessment the rating has changed to good. This meant people’s outcomes were good, and people’s feedback confirmed this.

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.

People were involved in the assessment of their needs, and support was provided where needed to maximise their involvement. People were confident that their individual needs had been appropriately assessed and were fully understood. Assessments considered the person’s health, care, wellbeing, and communication needs, to enable them to receive care or treatment that had the best possible outcomes.

Tools for assessing individual people’s needs included:

• Current and past medical history.
• Use of London care Record
• Health passports such as autism health passport
• Interpretation and translation policy
• Catheter passport
• Communication booklet
• Privacy and dignity policy
• Accessibility and communication needs.

People’s needs were assessed using a range of assessment tools to ensure their needs were reflected and understood. Staff assessed patients' needs and injuries in line with national guidance. Staff were able to access a patient's suitability for the service at the point of triage and redirect patients to other healthcare providers when necessary.

There had been no blue light transfer incidents reported between September 2023 and August 2024.

Assessments were up-to-date and staff understood people’s current needs. Upon discharge patients were given advice and told what to do if condition was worsening. Diagnostic images were reviewed by radiologists.

People received care, treatment and support that was evidence-based and in line with good practice standards. For example, staff used Ottawa ankle and foot inclusion criteria which was used by radiology staff to justify medication exposures of radiation to people using the service where applicable.

The trust had a process for updating clinical services on updates and changes to key national guidance and/or alerts and these were shared via governance networks, weekly comms and where appropriate daily meetings with IPC leads.

The provider’s systems ensured that staff were up-to-date with national legislation, evidence-based good practice and required standards. Staff accessed guidelines on electronic systems.

Appropriate polices were in place regarding sepsis management such as the 'recognition and early management of paediatric sepsis' that was in date and next due for review in January 2025.

People were told about current good practice that was relevant to their care and were involved in how this was reflected in their care plan.

Staff and leaders were encouraged to learn about new and innovative approaches that evidence shows can improve the way their service delivers care.

Staff had access to the information they needed to appropriately assess, plan and deliver people’s care, treatment and support. Plans for transition, referral and discharge considered people’s individual needs, circumstances, ongoing care arrangements and expected outcomes. When people were due to move between services, all necessary staff, teams and services were involved in assessing their needs to maintain continuity of care. Staff informed us they worked well with other staff within the unit and wider staff across other services to care for patients. Staff were able to make referrals to services such as:

• Virtual fracture clinic
• Direct referral pathways to acute specialty teams within THH and external tertiary referral services.
• Referral to outpatients clinics, such as fracture clinics, plastics trauma clinics.
• Referral to orthopaedics, maxillofacial, surgical, medical and plastic surgery at another London NHS provider.

Information was shared between teams and services to ensure continuity of care, for example when clinical tasks were delegated or when people were referred between services. A ‘call before send’ process was implemented where 111 called the service and handed over the patient. This was because the Emergency Department Digital Immigration module had been decommissioned by North West London Integrated Care Board. There was a need to find a solution for Mount Vernon UCNPs to ensure that they could continue to triage patients before they attended, to ensure that the patient’s presenting complaint was suitable for their service

When people received care from a range of different staff, teams or services, it was co-ordinated effectively. All relevant staff, teams and services were involved in assessing, planning and delivering people's care and treatment and staff worked collaboratively to understand and meet people's needs. The ENPs were able to make referrals both internal and external to the trust including:

• Support from a named ED Consultant
• Redirection flow to Hillingdon or Mount Vernon
• Direct referral pathways to acute specialty teams and external tertiary referral services.
• On site clinical site practitioner teams and access to estates and facilities and IT should any support be required.
• Referring patients to outpatient clinics, such as Fracture Clinics, plastics trauma clinics and burns trauma clinics.
• Referral to Orthopedics.
• In the event of severe injury or illness, contact will be made with LAS and the patient transferred to the Emergency Department at Hillingdon hospital, or other NHS provider.
• An emergency response team onsite if required.

People were empowered and supported to manage their own health, care and wellbeing needs by staff who understood their needs and preferences. Quick response codes known as QR codes were provided for patients to access information electronically about specific ailments and conditions such as animal bites, broken leg, colic and fevers.

People were encouraged and supported to make healthier choices to help promote and maintain their health and wellbeing. People were provided relevant information to live healthier lives. Posters were displayed on the walls providing advice on smoking cessation. Clinical staff had access to leaflets for a broad range of health-related issues. These were available via a QR code (which could be changed to the patient’s own language) or hard copies were available. During consultation, clinicians offered support and counselling relevant to the patients presenting complaint. For patients that only have telephone contact safety netting and simple first aid was given.

People who used the service consistently experienced positive outcomes. These met agreed expectations as set out in legislation, standards and evidence-based clinical guidance. Reattendance rates within 7 days of the initial UCC visit for adults and children were low. The average reattendance rate from January 2024 to August 2024 was 7.7%. Patients were encouraged to use primary care settings for follow up care such as dressing care.

Temperature Check Audits: Temperature checks were introduced across the Trust in 2021. The purpose of these audits was to ensure all areas in the Trust were adhering to fundamental standards of quality and safety for delivering care, including Health and Safety, IPC and medicines safety guidance and have preventative measures in place. A total of 18 checks were carried out between April 24- September 24 for Urgent Care Nurse Practitioner Service.

However, it had been identified that there was an issue with the way audits have been recorded at the service. Training had now been provided, and the service was now reporting in line with Trust expectations.

Patients who present with minor injuries and require an Xray were seen by ENPs who will request and interpret the Xray, to make a diagnosis and treat appropriately i.e. splint, plaster etc. All X rays were reviewed within the UCNPS to ensure the following failsafe:

• Interpretation of Xray i.e. Diagnosis demonstrating consistency with radiology report.
• Appropriate treatment commenced
• If variation from the diagnosis – follow up call to check patients' current concerns, recall to the service or referral to other services such as virtual fracture clinic.

In addition, there was also a requirement to complete an annual audit of imaging referrals applicable to all Non-Medical Referrers (NMR) as ENP were non-medical referrals. The results of this audit were not shared with CQC.

People understood their rights around consent to the care and treatment they were offered. People told us staff explained care and treatment options and gained verbal consent before carrying out physical assessment of their injuries.

People’s views and wishes were taken into account when their care was planned.

There were systems and practices to ensure that people understood the care and treatment being offered or recommended. This helped them make an informed decision.

People received information about care and treatment in a way they could understand and had appropriate support and time to make decisions.

Staff understood the importance of ensuring that people fully understood what they were consenting to and the importance of obtaining consent before they delivered care or treatment.

Where necessary, people with legal authority or responsibility could make decisions within the requirements of the Mental Capacity Act 2005. This included the duty to consult others such as carers, families and/or advocates, where appropriate.

People's capacity and ability to consent was taken into account, and they, or a person lawfully acting on their behalf, were involved in planning, managing and reviewing their care and treatment. Staff told us they understood their responsibilities regarding the Mental Capacity Act 2005. Most staff had worked on the sister acute hospital site, they knew how best interest meetings were held and decisions were made for people who lacked mental capacity in any particular area of their care.