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We are carrying out checks at St Michael's Hospital. We will publish a report when our check is complete.

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

Outpatients and diagnostic imaging

Good

Updated 5 October 2017

We rated this service as good because:

  • Staff reported incidents and demonstrated knowledge of how to do this.

  • The environments we visited were clean and tidy. Staff adhered to infection control policies and procedures.

  • Equipment was in working order and had been serviced/calibrated as required. Resuscitation equipment was checked regularly.

  • Medicines and prescription pads, where in use, were stored appropriately.

  • People’s individual care records were stored securely in the outpatient’s and X-ray service. The main reception area used computer records to book patients in when they arrived for their appointment the screen was not visible to patients and the paper clinic lists kept by the receptionist were kept covered so they could not be seen by patients.

  • There were arrangements in place to safeguard adults and children from abuse that reflected the relevant legislation and local requirements.

  • Staff were 100% compliant with their mandatory training.

  • Staff received training to look after people in an emergency.

  • The outpatient and X-ray services used relevant evidence based best practice guidance and standards to develop how services, care and treatment were delivered.

  • The outpatient services and X-ray department participated in local and national audits, benchmarking and peer review.

  • All outpatient staff were competent to carry out their roles. Learning needs were identified during their annual appraisal and the trust encouraged and supported continued professional development.

  • All staff we spoke with reported good multidisciplinary working between different departments and other Royal Cornwall Hospital Trust (RCHT) hospital sites.

  • The outpatient services at St Michael’s hospital ran Monday to Friday between 9am and 5 pm. There were no weekend or out of hours services.

  • Staff in all outpatient services were able to access relevant information to ensure they provided the appropriate care and support to patients.

  • Staff understood and respected patient’s personal, cultural, social and religious needs.

  • Staff showed a supportive attitude to patients. When patients experienced physical pain, discomfort or emotional distress, staff responded in a compassionate, timely and appropriate way.

  • We saw did everything possible to ensure that people’s privacy and dignity was respected

  • We heard staff ensuring patients understood the information they had been given during a consultation.

  • Staff considered the psychological needs of patients using their services and were able to provide support and signpost people to external services who may be able to provide ongoing support

  • Information about the needs of the local population was used to inform how services were planned and delivered.

  • Patients individual needs were taken into account for example for people with dementia, mobility problems, hearing difficulties and visual impairment may be given longer appointment times.

  • There was and pay and display parking, with disabled spaces. There was a drop off area at the main reception as the car park was a short walk away.

  • Information sent to patients prior to their appointments and information leaflets were available in different formats for example large print or alternative languages. Translation services were available via a telephone service.

  • Patients could be reminded via an automated telephone call a week before their appointment and by a text message two days before their appointment. Patients had an option to change their appointments at this time.

  • Referral to treatment times were overall better than the England average. Once in the outpatient departments patients did not have to wait long before they were called in to see their clinician.

  • There was information displayed and available about how to make a complaint or raise a concern.

  • The local management team were well respected. They supported their teams and promoted good quality care. The departments we visited were well organised and had a calm feel.

  • There was a very positive culture in all of the outpatient departments we visited.

  • There was a clear vision for the general outpatient and physiotherapy areas which were being redesigned and refurbished.

  • Staff felt informed about activity across the trust as a whole.

  • Through a programme of audit and work streams areas for improvement were identified and changes implemented.

  • Public engagement was ongoing and the hospital had a very active League of Friends.

However:

  • Individual records of each prescription issued were not kept. This meant that prescriptions might not be traceable if a problem arose in the future.

  • There was a potential for a breach of confidentiality in the pre-operative assessment clinic. It was accessible to the general public who may be able to access patient records if they were left unattended in the clinic.

  • In the pre-operative clinic waiting room tiles had fallen from the roof on at least two occasions and as recently as four weeks prior to the inspection. Staff told us the tiles have been replaced but no investigation had been carried out as to why they had fallen and there was no risk assessment in place

There were no call bells in the general outpatient consulting rooms.

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.

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.

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.