Arrowe Park Hospital

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• 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

At our last assessment we rated this key question was good. At this assessment the rating has remained to good.

Staff followed policies and guidelines to plan and deliver care. Doctors, nurses, and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide safe care. The service had relevant information promoting healthy lifestyles and support on the wards and units. However, we found example of duplication in paper and electronic records. We found inconsistencies and unnecessary variation in some record keeping processes, tools and templates between wards. The service did not always routinely monitor people’s care and treatment to continuously improve it.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

We reviewed a sample of paper and electronic records and found examples of duplication. We found inconsistencies and unnecessary variation in some record keeping processes, tools and templates between wards.

Staff received training on how to use the EPR system. However, refresher training was only provided to staff who had been absent from the trust for a minimum period of 6 months. A ward manager told us they had not completed any refresher training since the EPR system was implemented in 2016. The trust was in the process of developing an enhanced training delivery model to provide a more flexible, accessible and assessed learning opportunities in relation to significant system changes.

Patient handover notes were not printed from the EPR system between each shift. A paper handover form was used to collate the information from the EPR system.

Senior leaders acknowledged that improvements were required regarding the EPR system. The trust had recently implemented a one patient record programme with the aim of evaluating current clinical workflows and eliminating the use of paper records.

Patients we spoke with told us their needs were met, and they spoke highly of the staff. They knew their care plans, saw appropriate medical teams daily and were involved in conversations about their care.

Staff were aware of how to monitor skin for pressure ulcers and use body maps when repositioning and recording skin integrity. Staff told us they could access medical staff when needed and that they participated in daily ward rounds, as well as morning handovers.

The wards we visited had patient information boards for body mapping and pressure ulcer checks and nutrition and required staff updating these manually when patients moved wards or were discharged.

We scored the service as 3. The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Staff followed policies and guidelines to plan and deliver care. Staff could view policies on the trust’s intranet system and on the wards. Policies we reviewed during this assessment were in date and had a review date.

A sample of pathways and guidelines were reviewed during this assessment, including stroke and sepsis; these were found to be in line with national guidance.

Stroke coordinators had received training in the National Institute of Health Stroke Score (NIHSS). This assessment tool is used to evaluate and document neurological status in acute stroke patients.

Specialties including cardiology, respiratory and rheumatology utilised GIRFT (Getting it right first time) to improve the treatment and care of patients through in-depth reviews of services.

The endoscopy service was accredited by the Joint Advisory Group on gastrointestinal endoscopy.

At handover meetings, staff routinely referred to the psychological and emotional needs of patients, their relatives and carers.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Doctors, nurses, and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide safe care. Staff held regular and effective multidisciplinary meetings to review patients and improve their care. We saw multidisciplinary working with services, such as occupational therapy, psychiatric liaison, and diagnostics to identify the most appropriate care and treatment for patients.

Staff told us that when a patient required admission, sometimes admission to the appropriate ward or clinical area was not possible as the ward was full. Patients had to wait either in the emergency department or in a temporary escalation space on the ward. Staff reported good access to specialist teams of staff who would be contacted to review patients. Generally, patients were assessed on a risk basis and patients with a higher acuity were reviewed first.

The frailty team attended the emergency department and urgent medical assessment centre as required to review and assess patients who could be cared for in the acute frailty unit. Chronic pain teams, learning difficulties teams and dementia support were available.

Mental Health support was available to patients and the team visited patients regularly throughout their stay where it was identified they would benefit from this support.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

The service had relevant information promoting healthy lifestyles and support on the wards and units. Information leaflets were readily available for patients.

Staff assessed each patient’s health when admitted and provided support for any individual needs to live a healthier lifestyle.

We scored the service as 2. The evidence showed some shortfalls. The service did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

The service participated in relevant national clinical audits such as the national audit of myocardial ischaemia, diabetes, cancer, heart failure and end of life. We saw evidence of action plans to show that any identified concerns were being addressed appropriately.

The service also participated in local clinical audits such as improving frailty assessments in frail and older persons diagnosed with myeloid leukaemia, smoking cessation advice to patients in cariology and use of chemical sedation in elderly agitated patients.

The service submitted their audit data for the Sentinel Stroke National Audit Programme (SSNAP) (measures the quality and organisation of stroke care in the NHS). Between July and September 2024 inclusive, the overall patient centred SSNAP level was B out of a scale A to E, of which A is the best. The trust had submitted SSNAP data for quarter 4 2024/2025, however results were not yet available. We were told the overall patient centred SSNAP level reflected the challenges within the stroke consultant workforce and flow within the hospital, particularly around the 4-hour target in stroke care.

For patient centred and team centred indicators the trust scored a B. However, on both indicators the stroke unit was rated E which was the worst score available. There was an issue with patients receiving appropriate care through timely admission to the stroke unit. Trust data showed that only around 35% of stroke patients got to the stroke unit within four hours of arrival at the hospital between July and September 2024. In addition, the national aspirational thrombolysis target rate of 20% had not been achieved in the last 12 months.

In August 2024, the stroke service applied to participate in the NHS Elect Quality Improvement team as part of the Thrombolysis in Acute Stroke Collaborate (TASC) team. The Trust were one of 12 hospitals in the country to be accepted and had completed a number of Plan-Do study act (PDSA) cycles which had led to change in patient pathways. This included reinstating weekly Patient Journey Review meetings, switching from Alteplase to Tenecteplase, reviewing decision making alongside the National data and developing pathways to enable delivery of thrombolysis on the CT scanner.

The division used standardised electronic audits to measure the quality of nursing care delivered by services and specialties across the trust. The audits covered topics such as patient safety, nutrition and hydration, pressure ulcers, medicines management and infection control.

Managers shared and made sure staff understood information from the audits. Managers told us that information gathered from audits would be shared through staff meetings and group emails.

We scored the service as 2. The evidence showed some shortfalls. The service did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

The trust had Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) policies in place.

There were clear processes to guide staff when making a Deprivation of Liberty Safeguards (DoLS) when it is in the best intertest of the person. All clinicians were able to articulate how they would assess a patient with mental health issues including the appropriate risk assessment. However, data from the trust safeguarding oversight report for quarter 4 2024/2025 showed that 83% of DoLS were submitted to the trust safeguarding team within 3 days of admission or when a DoLS was identified, 81% of DoLS applications required further information and only 67% of patients received a relevant person’s representative booklet which them of their rights. The trust safeguarding team were notified of changes of restrictions or a regain in capacity for 12% of patients who were subject to a DoLS.

The trust recognised that monitoring of DoLS applications was an important component within the trust’s safeguarding governance processes. The compliance data was used to drive continuous quality improvement. Within the division of medicine, DoLS completion within 72 hours had increased from 77% to almost 88%. Improvement trajectories were monitored via the trust’s safeguarding governance to provide assurance around effective DoLS processes.

The trust had identified issues with recording when physical restraint had occurred and information sharing with the trust safeguarding team.

Results from the quarter 4 2024/2025 Mental Capacity Act (MCA) compliance audit identified 160 concerns. The most frequent themes of concern were lasting power of attorney processes not being followed and delay in DoLS applications.

Referral forms for Independent Mental Capacity Advocate (IMCAs) were located through the patient’s electronic records and guidance was located within the MCA policy. Referrals for IMCA were sent electronically to both Wirral Duty Advocacy and the Safeguarding Team generic inbox.