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The Queen Elizabeth Hospital Inadequate

We are carrying out checks at The Queen Elizabeth Hospital. We will publish a report when our check is complete.

Inspection Summary


Overall summary & rating

Inadequate

Updated 13 September 2018

  • Staff in the cardiorespiratory department and the ultrasound department did not routinely offer chaperones or observe consultants during intimate patient imaging procedures.
  • Consulting staff in the breast unit did not secure patient identifiable information on computer screens when they left the room. This was a breach of the Health and Social Care Act 2008 regulated activities regulations 2014 regulation 17: Governance.
  • Radiology staff did not meet the trust wide target of 95% compliance for adults and children safeguarding training. Radiology medical staff achieved 64% and allied health professional staff achieved 66%.
  • Breast care staff achieved 75% compliance for children safeguarding training, this did not meet the trust wide target of 95%.
  • Radiology medical staff did not meet the trust wide target for mandatory training compliance (95%) in nine out of ten modules Including resuscitation training where only 50% of staff had completed the training.
  • Allied health professional staff did not meet the trust wide target for mandatory training compliance (95%) in six out of ten modules including resuscitation training where only 67% of staff had received the training.
  • Allied health professional staff did not meet the trust wide target for appraisal (90%) with only 61% of staff receiving an appraisal.
  • Staff In the computerised tomography (CT) department referred to out of date protocols and protocols which applied to a decommissioned piece of equipment.

  • Staff members in the radiology department did not consistently complete cleaning records. This meant that cleaning procedures were not followed appropriately and there was a potential infection prevention control risk.

  • Waiting times from referral to treatment were worse than the England average and the trust was reporting 47% of images within 24 hours. This was not meeting the reporting turnaround time target of 90% of images within 24 hours.

  • We had some concerns around the secure storage, prescription and administration of medicines. In the breast care unit staff stored personal medicines in the secure medicines cupboard. Staff in the magnetic resonance imaging unit (MRI) administered saline without the presence of a patient group directive (PGD) for its administration.

  • There was no evidence of sharing the learning from complaints with staff.

  • We were not assured the service had robust structures, processes and systems in place to support the delivery of high quality person centred care especially in the radiology department.

However,

  • The service managed patient safety incidents well. There had been no reported never events in the service between April 2017 and March 2018.
  • Staff could access appropriate records of patients’ care at the point of providing care and treatment. Staff provided care based on national guidance and monitored the effectiveness through audit.
  • Staff of different specialisms worked together as a team to benefit patients and always had access to up-to-date, accurate and comprehensive information on patients’ care and treatment.
  • Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005 and involved patients and those close to them in decisions about their care and treatment where appropriate.
  • Staff cared for patients with compassion and kindness and provided emotional support to patients when required. Staff greeted patients by their name, asked patients what they prefer to be called, enquired after their comfort and protected their dignity.
  • The service took account of patients’ individual needs and staff knew how to access a wide range of services to improve patient experience. For example, interpreters for those patients whose first language was not English, hearing loops, bariatric equipment, play specialists and dementia champions to meet the needs of patients.
  • The service had a vision for what it wanted to achieve and workable strategy to turn it into action along with effective systems for identifying risks, planning to eliminate them or reduce them. Local leaders were visible, approachable and supportive to staff.
  • The radiology department had a comprehensive audit programme to improve performance and safety and managers across the trust promoted a positive culture that supported and valued staff.

Inspection areas

Safe

Inadequate

Updated 13 September 2018

Effective

Requires improvement

Updated 13 September 2018

Caring

Good

Updated 13 September 2018

Responsive

Requires improvement

Updated 13 September 2018

Well-led

Inadequate

Updated 13 September 2018

Checks on specific services

Outpatients and diagnostic imaging

Requires improvement

Updated 30 July 2015

Safety and responsiveness in the outpatient service required improvement. Infection prevention and control had greatly improved since our last inspection in 2014 with a clear audit process in place to ensure that care and treatment was delivered in line with current national standards and legislation.

However there were concerns around the safe storage of medicines which was not consistently in line with trust policy and national guidelines. Patient records were not always stored securely. Access to services was inconsistent with significant delays in some specialties with a large number of patients waiting too long for their appointments. Staff demonstrated a commitment to patient–centred care. Patients were treated with dignity and respect and spoke highly of the staff. The staff were friendly, helpful and approachable. There were good links with other community services.

Maternity

Inadequate

Updated 13 September 2018

We previously inspected maternity jointly with gynaecology so we cannot compare our new ratings directly with previous ratings. We rated Maternity services as inadequate.

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

Outpatients

Requires improvement

Updated 13 September 2018

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

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

Maternity and gynaecology

Requires improvement

Updated 30 July 2015

Responsive and well led in maternity services required improvement. Many of the issues we identified in maternity services during our last inspection in 2014 report had not improved. Staffing both medical and nursing was a concern, specifically senior medical staffing, and midwifery staffing levels meant staff had to be transferred from other areas of the service to support the central delivery suite (CDS). At times the unit had to close due to insufficient numbers of staff with patients being diverted to other units.

Women were not offered the choice between a home birth or a birth in a midwifery led unit. The Trust had developed plans for a midwifery led unit and aimed to have the service in place by September 2015.

Planned elective caesarean sections were delayed on occasions because of theatre and medical staff availability. Patient assessments were not consistently recorded which meant there was a risk that a woman’s deteriorating condition may not be escalated appropriately. There were privacy and dignity concerns for women experiencing a miscarriage as they were seen in the main emergency department or the surgical assessment unit before being admitted to a surgical ward.

The trust had commissioned a review by the Royal College of Obstetricians to look at the leadership and management of the service. The review highlighted the lack of clinical outcome information and the absence of outcome reviews. There was a lack of clinical ownership for clinics, inpatients and theatre lists. The report had been submitted to the trust in April 2015 but it was not clear what the trust’s plan was for responding to the recommendations.

There had been a change in leadership within the service and a maternity transformation project was in the early stages of development but it was not clear whether consultant medical staff were fully engaged in the work. A strategy for quality improvement across the trust had been developed and strategic objectives had been identified at specialty level however a strategy for maternity services had not been developed.

Medical care

Good

Updated 30 July 2015

Medical care (including older people’s care)

Inadequate

Updated 13 September 2018

Our rating of this service went down. We rated it as inadequate.

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

Diagnostic imaging

Requires improvement

Updated 13 September 2018

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

Urgent and emergency services (A&E)

Inadequate

Updated 13 September 2018

Our rating of this service went down. We rated it as inadequate

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

Surgery

Requires improvement

Updated 13 September 2018

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

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

Intensive/critical care

Good

Updated 19 September 2014

Patients and their families said that staff were attentive and caring. Staff treated people with kindness, dignity, respect, compassion and empathy, while providing good care and evidence-based treatment. Staff worked well as a team, felt supported by their line managers, and were highly motivated to provide patients with the best care possible.

 

The service had a clear vision and credible strategy to deliver high-quality care and promote good outcomes. The service was actively involved in national and local research and audit projects, and demonstrated innovation through involvement in equipment design. The trust engaged with patients and visitors, and acted on their feedback.

 

The trust’s track record on safety was good. There were reliable systems, processes and practices in place to keep people safe and safeguarded from abuse. The trust learned when things went wrong, and improved safety standards as a result. We were concerned that there were no side room facilities for coronary care patients; however, we were reassured that this was already on the service risk register, and that senior managers were taking appropriate action by looking at ways to resolve this issue.

Some outcomes for people using the service were good compared to other services. There were periods in the past year where bed occupancy levels were above the England average. These capacity issues meant that patients were not always cared for in the most appropriate setting for their needs, and elective surgery got cancelled.

Services for children & young people

Good

Updated 30 July 2015

The safety of the children and young people service had improved since our last inspection and despite further improvement required we have rated this service as being good as action had been taken to mitigate the risks we identified. Nurse staffing levels remained an issue and did not comply with national guidelines. The number of beds had been reduced from 23 to 18 on Rudham children’s ward to ensure there was adequate staff for the number of beds. The trust planned to increase the beds flexibly in response to demand and there being sufficient staff available.

There was only one member of staff available to care for children attending the PAU. A business case had been developed to fund additional staff and opening hours but at the time of our inspection this had not been presented to the board and therefore approval and funding were not definite.

End of life care

Requires improvement

Updated 13 September 2018

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

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