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Arrowe Park Hospital Requires improvement

We are carrying out checks at Arrowe Park Hospital. We will publish a report when our check is complete.

Inspection Summary


Overall summary & rating

Requires improvement

Updated 13 July 2018

A summary of services at this hospital appears in the overall summary above.

Inspection areas

Safe

Requires improvement

Updated 13 July 2018

Effective

Requires improvement

Updated 13 July 2018

Caring

Good

Updated 13 July 2018

Responsive

Requires improvement

Updated 13 July 2018

Well-led

Inadequate

Updated 13 July 2018

Checks on specific services

Outpatients and diagnostic imaging

Requires improvement

Updated 10 March 2016

There were significant staff vacancies across the whole trust in diagnostic and imaging services. The service failed to meet the national target in July and August 2015 for referral to treatment times. In addition, the trust failed to meet their internal target for urgent reporting of plain x-rays between April 2015 and August 2015. The radiology department had equipment that exceeded the recommended ten year life span and regular equipment failures caused delays for patients. There were a large number of clinic appointments cancelled due to the process in place for rebooking appointments. Managers had plans to implement a partial booking system to reduce cancellation of appointments and to offer patients more choice. Some clinical governance measures were in place for radiology however, there had been no radiation safety committee meetings since September 2012. We saw that teams worked well locally but some staff were not formally made aware of key issues following complaints, incidents and audits. Staff felt supported by their local managers however Patients were treated in a dignified and respectful way by caring and committed staff. There was a clear process for reporting and investigating incidents and staff received feedback. Records were available for 99% of outpatient appointments. Mandatory Training was well attended and staff were aware of their role and responsibilities in relation to safeguarding. The leadership and governance arrangements did not always support the delivery of high quality care. Staff shortages had been identified and placed on the risk register. However, progress was slow to resolve the issue. Cleanliness and hygiene was of a good standard throughout areas we visited and staff followed good practice guidance in relation to the control and prevention of infection.

Maternity

Good

Updated 13 July 2018

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

Maternity and gynaecology

Requires improvement

Updated 10 March 2016

Staffing arrangements did not always ensure there were enough skilled and knowledgeable midwives on duty. There was inconsistency in the reporting and review of serious incidents including root cause analysis which lacked robustness in its approach and actions. The record keeping systems did not guarantee that accurate and up-to-date information about patients would be readily available. Patients received consultant and midwifery-led care depending on where they chose to have their babies, and received the support of specialist staff for advice and guidance. Patients were cared for with kindness, compassion and they were positive about the standard of care and treatment. Staff were supported to learn and develop. Only a minority of maternity and gynaecology staff felt there was effective communication between ward staff and senior managers. Best practice guidance in relation to care and treatment was followed and plans were in place to participate in national and local audits. However, many of the audits had been discussed but not commenced. Staff were not supported to be involved in the overall development of the service. There was limited involvement of stakeholders or the general public in the trusts long-term plans for the service. The management structure of the maternity services was relatively new and a system review was being completed. The gynaecology ward and clinics were well run by the gynaecology service and ward managers.

Medical care (including older people’s care)

Inadequate

Updated 13 July 2018

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

Urgent and emergency services (A&E)

Requires improvement

Updated 13 July 2018

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

Surgery

Requires improvement

Updated 13 July 2018

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

Intensive/critical care

Requires improvement

Updated 13 July 2018

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

Services for children & young people

Requires improvement

Updated 10 March 2016

The systems to devise staffing numbers on the paediatric ward were not robust. Staff knew how to report incidents but did not always know what constituted an incident. There were concerns about equipment on the paediatric ward as the resuscitation trolley was not locked and did not have a defibrillator on it. We found some controlled drugs which had expired. The safeguarding policy did not refer to current guidance. We identified gaps in safeguarding case notes such as incomplete MARS (Multi Agency Referral Service) forms. Hand hygiene was good, staff washed their hands between patients and used aprons to reduce the risk of infection spreading. The neonatal unit did not meet the British Association of Perinatal Medicine (BAPM) standards for cot space which sometimes impacted on the number of babies that could be admitted. The service participated in national and local audits and the results were within national averages. A transition policy wasn’t in place for children with long term health needs and nursing staff were unclear how to initiate a child’s transfer to adult services in line with guidance. The community paediatric service consistently failed to meet national referral to treatment targets and the waiting list was lengthy with some children waiting up to 47 weeks. However, services for children at Arrowe Park Hospital consistently met the national referral to treatment targets. Parents and young people felt safe and informed about their treatment. We observed patients been looked after with respect and dignity. Training and development of staff on the paediatric ward was not a priority and staff told us they were not supported to develop themselves. Care on the neonatal unit was well managed and local leadership on the unit was clear and directive. The unit constantly looked at ways to improve care. There were governance structures in place. However, some risks on the register had been there since 2012 with actions still being completed.

End of life care

Good

Updated 13 July 2018

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