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Arrowe Park Hospital Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 31 March 2020

Our rating of services stayed the same. We rated it them as requires improvement because:

Inspection areas

Safe

Requires improvement

Updated 31 March 2020

Effective

Requires improvement

Updated 31 March 2020

Caring

Good

Updated 31 March 2020

Responsive

Requires improvement

Updated 31 March 2020

Well-led

Requires improvement

Updated 31 March 2020

Checks on specific services

Medical care (including older people’s care)

Requires improvement

Updated 31 March 2020

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

  • At our last inspection we rated the service as inadequate in safe and well-led. We rated effective, caring and responsive as requires improvement. At this inspection we rated safe, effective, responsive and well-led as requires improvement and caring as good.
  • The service did not have enough allied health professional staff to always care for patients. Not all staff completed training in key skills and compliance with intermediate life support training was low. The service did not always control infection risk well. Staff did not consistently assess risks to patients, or act on them or keep good care records.
  • The service did not always control infection risk well. The service had an outbreak of clostridium difficile in 2019. Not all equipment and areas of the premises were kept visibly clean.
  • The service did not consistently provide good care and treatment. Patient outcomes did not meet all national standards and expectations. Staff did not always work well together for the benefit of patients.
  • Care did not always meet the needs of local people. It did not take account of patients’ individual needs, People could not always access the service when they needed it and referral to treatment times were consistently below the national average. The service did not discharge patients in a timely way and did not minimise the number of patient moves between wards at night. There were not effective arrangements for medical staff to review any medical patients who were not on medical wards.
  • The leadership team and structure had changed following our previous inspection. This meant leaders had not been able to fully implement and embed all necessary changes and improvements. Not all staff felt respected, supported and valued. Local governance and systems to manage performance were not always effective. Not all staff had opportunities to engage well with the service and influence service development.

However,

  • Staff understood how to protect patients from abuse, and managed safety well. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
  • Staff gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure the majority of staff were competent. Staff advised patients on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
  • The service made it easy for people to give feedback.
  • Staff were supported to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. They were focused on the needs of patients receiving care.

Services for children & young people

Requires improvement

Updated 31 March 2020

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

  • The service had not provided training in key skills to staff, had not assessed risks to patients, was not compliant with key information sharing standards and had failed to control infection risk. There were not enough medical staff within the neonatal department and the design, use and maintenance of premises and equipment did not keep people safe.
  • Staff did not monitor patients pain regularly and the service did not ensure staff had the knowledge, skills or ability to care for patients with mental health needs or patients who lacked capacity.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
  • The service planned care to meet the needs of local people and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
  • The strategy for the service did not align to significant challenges faced within it such as the care and treatment of children and young people suffering from mental health symptoms and gaps within governance processes such as local audits meant a lack of assurance.

Critical care

Requires improvement

Updated 13 July 2018

A summary of our findings about this service appears in the Overall summary

End of life care

Good

Updated 13 July 2018

A summary of our findings about this service appears in the Overall summary

Surgery

Requires improvement

Updated 31 March 2020

  • The service did not always control infection risk well. Staff did not always asses the risks to patients. However, staff kept good care records. The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
  • Staff did not always monitor whether they gave patients enough to eat and drink. Patient outcomes did not always positive, consistent or met expectations. However, staff gave patients pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
  • People could not access the service when they needed it and had to wait too long for treatment. However, the service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback.
  • Leaders did not use systems to manage performance effectively. However, they supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

Urgent and emergency services

Requires improvement

Updated 31 March 2020

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

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

  • There were not enough middle grade doctors to keep people safe and there was a lack of privacy and dignity for patients being cared for in the emergency department corridors. Patients were accommodated in these areas for extended periods of time and staff carried out examinations without access to privacy screens.
  • Patients were cared for in corridors during times of high demand. Although a qualified nurse and care support workers were assigned to care for these patients, the environment did not ensure they could deliver safe care.
  • ED doctors did not have the authority to make a decision to admit to medical or surgical specialties. which led to lengthy delays to patient care. All of the staff we spoke with in ED said they felt that care delivered in corridors was unsafe.
  • The service had a vision for what it wanted to achieve and a strategy. However, we did see any evidence how this strategy was going to be turned into action or how this was going to be monitored.
  • Leaders did not always operate effective governance and performances processes, throughout the service and with partner organisations. These included the management of the environment and additional systems to help improve flow through the department. There were a number of key performance indicators that were not being met or improvement sustained as well as action plans and audits to improve and failure in performance still occurring.

However

  • The service had enough nursing staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. Induction processes were robust. Staff assessed risks to patients and acted on them. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
  • Staff provided evidence based care and treatment. They gave pain relief when patients needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients. Key services were available seven days a week.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs They provided emotional support to patients, families and carers to minimise their distress. Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.
  • The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The culture of the department was open.

Diagnostic imaging

Good

Updated 31 March 2020

We have not previously rated diagnostic imaging as a distinct service at this hospital. We rated it as good because:

  • The diagnostic imaging service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them.
  • Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients and supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
  • The diagnostic imaging service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
  • Leaders ran services well using reliable information systems. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued, and they were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service planned and managed services and all staff were committed to improving services continually.

However,

  • The diagnostic imaging services did not always provide care and treatment, or manage facilities, in line with good governance principles around evidence based practice.

Outpatients

Requires improvement

Updated 31 March 2020

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

  • The service did not always control infection risk well. Staff used some control measures to protect patients, themselves and others from infection. The design, maintenance and use of facilities, premises and equipment did not always keep people safe. Nursing staff in ophthalmology did not use a tool to identify deteriorating patients.
  • People requiring routine treatment could not always access the service when they needed it. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were not always in line with national expectations.

However:

  • There were enough nursing staff to safely care for patients and mandatory training levels had been achieved. Safeguarding processes were in place and staff knew how to recognise and report abuse. They kept the premises visibly clean. The service used systems and processes to safely prescribe, administer, record and store medicines. The service managed patient safety incidents well.
  • Staff provided good care and treatment. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
  • The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. The service had a vision for what it wanted to achieve and a strategy to turn it into action. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with staff and the community to plan and manage services and all staff were committed to improving services continually.

Maternity

Good

Updated 13 July 2018

A summary of our findings about this service appears in the Overall summary