Bedford Hospital

Updated 16 December 2022

Updated 16 December 2022

Updated 20 April 2016

Updated 4 December 2018

• There was a strong, visible patient and family-centred culture. Staff were highly motivated and inspired to provide care and treatment that was kind, compassionate and promoted patients’ dignity, and respected people’s needs.
• Leadership was strong, supportive and visible. The leadership team understood the challenges to service provision and actions needed to address them. Staff were committed to providing the best possible care for children, young people and their families. Staff felt ownership for the service and were proud to be part of the children’s service.
• The service had a vision of what it wanted to achieve and clear objectives to ensure the vision was met. The vision was developed with involvement from staff.
• Staff understood their responsibilities to raise concerns and report patient safety incidents. There was an effective governance and risk management framework in place to ensure incidents were investigated and reviewed in a timely way. Learning from incidents was shared with staff and changes were made to delivery of care because of lessons learned.
• The service made sure staff were competent for their roles. Mandatory training in key skills was provided to all staff and the service made sure everyone completed it. Staff were encouraged to develop their knowledge, skills and practice.
• The service generally provided care and treatment based on national guidance and evidence of its effectiveness. Local and national audits were completed and actions were taken to improve care and treatment when indicated.
• The children’s unit was imaginatively decorated, and equipment and toys were used creatively to create a fun, warm and child-friendly environment. Play was seen as an essential part of children’s care. There was a wide range of age appropriate toys, games and books for children and young people, including an outside play area. Play therapists supported the care and treatment of children and young people and arranged a schedule of activities.

However:

• Medical staffing levels did not always meet planned levels or national recommendations. However, we found there was generally enough staff to keep people safe from avoidable harm and to provide the right care and treatment.
• Written records were not always legible and medical staff who made entries could not easily be identified. Patient medical records were not always stored securely.
• We found some policies and guidance had expired their review date. This meant there was a risk staff were referring to out-of-date guidance. At the time of our inspection, 26% of paediatric guidelines were out-of-date. The trust provided assurance that all out of date guidance had been risk assessed, prioritised and allocated.
• Prescriptions of medications, recording of administration or reason for not administrating were not consistently recorded in line with the trust policy. The review of antibiotic medication was not always recorded on prescription charts after three days in line with trust guidelines.
• Not all the environment was maintained in accordance with Department of Health guidance. Flooring in some rooms within the children’s outpatient department did not comply with relevant Health Building Note (HBN) requirements.

Updated 12 August 2021

Updated 16 December 2022

Updated 4 December 2018

• We rated safe, caring, responsive and well led as good. Effective was not rated, as we are not confident we are collecting enough information to rate this area.
• The service managed risk to patients well, this included infection control, having suitable premises and equipment, assessing and managing patients at risk of deteriorating, and understanding how to protect patients from abuse
• There were enough suitably qualified and experienced staff to keep patients safe.
• The service managed patient safety incidents well.
• The service worked in line with national guidance, monitoring the effectiveness of care and treatment and using the findings to improve.
• Patient were treated with compassion and respect.
• Patients could access the service when they needed it, with waiting times mostly better than the England average.
• The service took account of patients’ individual needs.
• Managers had the right skills and abilities to run the service in order to provide high quality sustainable care.
• Managers supported and valued staff through the promotion of a positive culture and engaged well with staff
• The service used a systematic approach to improve the quality if its services, recognising risks and developing plans to reduce to eliminate these.
• The service used feedback from patients to improve the service.

However,

• Not all staff completed the required mandatory training courses.
• Some clinics could become overcrowded and did not always have enough seating available.
• The stock room where drugs were stored in the oncology clinic was not locked when occupied by a member of staff.
• The service did not always manage complaints in a timely way.

Updated 4 December 2018

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

There were several breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This included:

• Poor mandatory training compliance.
• Poor infection control and prevention practice.
• Inconsistencies in the monitoring of equipment for ensuring safe use.
• Reduced nurse staffing levels.
• There were gaps in the provision of a qualified children’s registered nurse in the department.
• Department meetings were separated by staff grade: there were no whole team meetings and there were no joint handovers between medical and nursing staff.
• Staff appraisal rates were lower than the Trust target. Clinical supervision was not routinely provided or formally recorded for all relevant staff.
• The service did not ensure there was a dedicated mental health room that was free from hazard.
• Concerns raised during our inspection in 2015 had not been resolved.
• Unauthorised people could enter the department unchallenged.
• The environment in the majors’ area did not allow all the patients in each bay to be observed easily. The waiting room was too small to accommodate all the patients using it at sometimes. Patients were not observed in the waiting areas.
• There were limited facilities for patients with individual needs. There was no hearing loop and there was no information available in foreign languages. Staff did not always use translation services when necessary and used family members instead.
• Consent was rarely documented.
• Patients checking in at the ED desk could be observed and overheard by waiting patients.
• Patients were not always reviewed by a consultant within 14 hours of admission, in line with recommendations.
• Time of waiting for a specialty review was not recorded. This included time spent waiting for a psychiatric assessment and time waiting to see a specialty doctor.

However:

• Staff knew their responsibilities for escalating concerns and reporting incidents.
• Patient’s nutritional needs were met, with oral diet provided to patients who were in the department for long periods.
• Patients were prioritised according to the clinical condition.
• Patients were positive about the care received. They were included in discussions around care and kept informed of treatment plans.
• From April 2017 to March 2018 the monthly percentage of patients that left the trust’s ED before being seen for treatment was better than the England average in all but two months, and from November 2017 to March 2018, no patients left before being seen.
• Managers across the trust promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.