Wexham 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 inspection we rated this key question Good. At this inspection the rating has remained the same. We assessed four quality statements. We looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

Staff comprehensively assessed people, so the care and treatment provided met their needs. This included both their mental and physical health and any personal circumstances that needed to be considered. Staff worked in a strong culture of evidence-based practice. Staff worked together and with others when assessing people’s needs and shared information to maintain continuity of care.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

We did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

Staff gave people clear information about their care and treatment needed to support both their physical and mental health. Staff met people's nutrition and hydration needs. We saw that ward staff ensured that patients had access to fluids. They used effective tools for screening malnutrition and dehydration and acted on any indicators of concern.

Staff used the trust's systems to follow the latest guidance and evidence-based practice. E-referral on the patient records system was used to highlight patients requiring a speciality consult. Speciality teams provided an in-reach service to the Acute Ambulatory Unit (AAU) and Medical Short Stay Unit (MSSU) to identify patients who require their input. The trust kept its database of guidance up to date. Staff used information given regularly in safety briefings and newsletters to implement new guidance or changes to existing procedures.

The trust's intranet contained a comprehensive range of up-to-date policies and standard operating procedures which reflected best practice. It had guidance for staff around collaboration with multi-agency teams and for delegation of clinical tasks to ensure the right people delivered evidence-based care and treatment.

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. Systems were in place to ensure staff were up to date with evidence-based guidance and legislation. Clinical records we saw demonstrated care was provided in line with current guidance.

The Fundamental and Better Care Audit (FAB) was developed to drive continuous improvement for safe, quality care to promote a better patient centred experience. The audit is conducted once a month in accordance with a published schedule by either a matron, ward sister or nurse in charge. The results are published on the intranet so that teams can see where they are doing well, and which ward may be able to assist them to improve a score in another area. We discussed the results of this audit with a ward manager who was very aware and had plans to address the perceived deficits in the teams' performance.

The service worked well across teams and services to support people. Staff worked effectively across different disciplines to ensure all staff involved in assessing patients' needs to maintain the continuity of care. We observed effective board rounds where staff from multidisciplinary teams reviewed and discussed patients to ensure they received the correct treatment and care. We observed good compassionate multidisciplinary working to ensure that the patient received appropriate care and discharge. This in some cases meant working with external organisations to secure the appropriate accommodation for patients who had had amputations. Effective team working between external organisations, physiotherapists, occupational therapists, nursing and medical staff enabled patients to maintain their independence at home.

Staff effectively handed over people's assessment of needs when people moved between different services both within in the hospital or for transfer or discharge. The site team had a good understanding of the levels of care provided on each ward so that should medical outliers be needed this was managed with the agreement of all involved. Specialty review was prompt due to positive culture and working arrangements with colleagues across the hospital.

Staff had access to the information they needed to appropriately assess, plan, and deliver people's care, treatment, and support. Relevant staff had access to electronic patient records which they could access using secure log-ins. The service worked with other services to ensure continuity of care, including where clinical tasks were delegated to other services. For example, staff in the discharge lounge and on the wards spoke of how they worked effectively with each other, the pharmacy and transport liaison personnel to facilitate timely discharges. The hospital and service monitored the number of patients for whom treatment had been completed but they were unable to be discharged.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

The service routinely monitored people's care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

We found that people who used the service experienced positive outcomes as set out in legislation, standards, and evidence-based clinical guidance. The service had access to seven days a week diagnostic and support services. Medical staff we spoke with said that there was good access to services to support patient treatment and care. The AAU has dedicated medical cover during the working week, medical cover at weekends is provided by the on call medical team. The unit was staffed by advanced practitioners and the level of acuity of patients was lower at the weekends. This meant that patients with more complex needs had to remain in the emergency department.

Staff had access to and followed a wide range of policies and treatment guidelines which were stored electronically. Policies and procedures were based on best practice from National Institute Clinical Excellence (NICE). Outcomes for patients were monitored and action plans developed to improve the services. Staff told us that sometimes patients returned to hospital immediately after discharge. When this happened, staff reported this as a clinical incident and leaders investigated the reasons for the failed discharge.

We reviewed stroke, cardiology and respiratory audits which demonstrated that even when the hospital was performing well an action plan had been drawn up to further improve services. The hospital was performing at or above many national indicators. The latest publicised Summary Hospital level Mortality Indicator (SHMI) was 0.96 which is as expected for the level of care provided at the Wexham Park site.

The Sentinel Stroke National Audit Programme (SSNAP) scores units between A to E with A being the best. The stroke service scored an overall C at this unit. However, quarter on quarter data showed an improving picture in most areas. There were some issues with patients being admitted to the Hyper Acute Stroke Unit (HASU) immediately. The team had undertaken some investigation as to why this had occurred and the potential outcome for patients. A standard operating procedure had been implemented by clinical teams. This included the transfer of patient to a different unit as Wexham Park does not have a dedicated stroke unit.

The national asthma audit showed the trust performing at 44% for best practice tariff elements in quarter 2 of 2024/2025 which was better than the national performance of 35%. The national respiratory audit showed significant improvement between Quarter 1 and Quarter 2 in 2024. The hospital monitored the compliance with the sepsis bundle. In the last quarter of 2024 inpatient wards were 100% complaint with sepsis screening and giving antibiotics in line with National Institute for Health and Care Excellence (NICE) guidance.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment. Where consent could not be gained, staff understood their role in delivering care in the best interest of the patient. We observed staff obtained verbal consent from patients before interactions. Staff knew how to gain support if required.

Staff understood and applied legislation relating to consent. Capacity and consent were clearly recorded. Do not attempt cardiopulmonary resuscitation (DNACPR) and ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) decisions were appropriate and were made in line with relevant legislation. Completed forms were emailed to other appropriate service providers to ensure continuity of care.

Staff could describe the processes to assess and identify patients at risk and how they assessed and documented mental capacity. A checklist was completed on the electronic patient system which then produced alerts on the electronic patient record enabled staff to be aware of specific risks. For example, if a patient was assessed as having a high risk of fluctuating capacity or were living with dementia. Staff had a person-centred approach and involved patients, where possible when completing risk assessments. Staff had access to mental health support to gain consent and to enable care planning.