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Inspection Summary


Overall summary & rating

Good

Updated 14 December 2018

Our rating of services stayed the same. We rated them as good because:

  • Medicine was rated as good. Safe, effective, caring, responsive and well led were all rated as good.
  • Surgery remained good overall. Safe stayed the same since our last inspection and was rated good. Effective stayed the same and was rated good. Caring went down and was rated as good. Responsive and well led stayed the same since our last inspection and were rated good.
  • Outpatients was rated good overall. Safe, caring, responsive and well-led were rated good. Effective was not rated.
Inspection areas

Safe

Good

Updated 14 December 2018

Effective

Good

Updated 14 December 2018

Caring

Good

Updated 14 December 2018

Responsive

Good

Updated 14 December 2018

Well-led

Good

Updated 14 December 2018

Checks on specific services

Surgery

Good

Updated 14 December 2018

Our rating of this service stayed the same. We rated it as good because:

  • Nursing staff we spoke with understood and followed the process to report safeguarding concerns, and there was evidence of learning and sharing of good practice.
  • Staff followed safety guidelines and the five steps to safer surgery checklist was consistently followed.
  • Nurse staffing levels were as planned. This was reviewed using relevant tools to identify appropriate staffing numbers for theatre lists and the acuity of patients on the wards.
  • Staff recognised incidents and reported them appropriately. Learning was shared across sites within the trust.
  • Staff worked together to deliver effective care and treatment. The multidisciplinary approach ensured a greater proportion of patients were mobilising on the day of surgery when compared with our previous inspection in 2017.
  • The service made sure that staff had the skills, knowledge and experience to deliver effective care. Staff received enhanced training to develop their skills in the care of patients who were less medically stable as part of a programme to increase the proportion of patients with access to elective surgery at St Michael’s Hospital.
  • People were treated with kindness, dignity, respect and compassion. Patients spoken with were positive about the care and treatment they received.
  • People received personal care that was responsive to their needs. Staff were aware of the importance of learning about individual needs to provide personalised care.
  • The services were delivered, made accessible and coordinated to take account of the needs of different people, including those in vulnerable circumstances.
  • There was leadership capacity and capability to deliver high-quality and sustainable care. Staff reported that leaders were visible and approachable.
  • Information was used to monitor, manage and report on the quality and performance of the service.

However:

  • Mandatory training levels did not meet trust target. These were not met in six out of 11 training modules. Manual handling had particularly poor compliance.
  • Safeguarding training compliance level two, for both nursing and medical staff was below target.
  • The appraisal rates for medical and nursing staff at St Michael’s Hospital were lower than the trust average for the surgical division and below the trust target.
  • Patients did not always have access to care and treatment in a timely way. There were a high number of patients who had been waiting for 52 weeks or longer for their surgery for trauma and orthopaedics.
  • The timeliness of responding to complaints needed improvement.
  • The management and oversight of the risk register was not clear.

Medical care (including older people’s care)

Good

Updated 14 December 2018

We rated safe as good because:

  • Patients were protected from abuse and avoidable harm. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service.
  • The service monitored infection risks and took appropriate action to prevent cross infection. The environment, equipment and the premises were seen to be clean and well monitored.
  • Medicines were managed safely. The service prescribed, administered, recorded and stored medicines well. Patients received the right medication at the right dose at the right time. Stock rotation was not consistently well managed.

However:

  • Medical and nursing staff had not completed mandatory training as required in trust policy. The 95% target was not met by nursing staff for 11 mandatory training areas set by the trust.
  • The service had suitable premises and equipment, but they did not appear to be maintained effectively and there was a lack of storage for equipment.
  • Staff did not always keep appropriate records of patients’ care and treatment. Records were not always clear, up-to-date and available to all staff providing care. Trust nursing care plans were too generic, not personalised and lacked detail of how to care for patients.

Outpatients

Good

Updated 14 December 2018

  • The hospital provided a safe service to patients and made sure they were protected for avoidable harm and abuse. Staff had completed mandatory training to enable them to provide safe care, records were well maintained, medicines were managed safely, and infection prevention and control practices adhered to.
  • There was strong multidisciplinary working between staff in the department and in-house training was provided to ensure staff were competent in their role.
  • There was a strong patient centred culture. Staff were respectful and treated patients compassionately. Staff recognised when they need to provide emotional support and how to involve patients and those close to them in their care.
  • Services met the needs of the population and the individuals attending clinics. This included how patients could make a complaint.
  • The lead nurse had the knowledge and skills to lead the department and understood the challenges to provide good patient care at a local level. Risk was understood and managed, and staff spoke of a positive culture and felt valued.

However:

  • Patient outcomes were not collected to identify areas for service improvement.
  • Compliance against national guidance in the pre-assessment clinic was not always reviewed to ensure care and treatment was optimised for patients.
  • The governance framework for the hospital did not provide oversight of quality, safety or performance of the outpatient department. Some staff felt they worked in silo and were not part of the wider organisation.