Broadgreen 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

We rated this key question good. Patients were involved in assessments of their needs. Staff reviewed assessments taking account of communication, personal and health needs. Care was based on latest evidence and good practice. Patients always had enough to eat and drink to stay healthy. Staff made sure patients understood their care and treatment to enable them to give informed consent. Staff worked within a multidisciplinary team which provided streamlined patient care.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing, and communication needs with them.

People we spoke with told us their needs were met, and they spoke highly of the staff. They knew their care plans, saw appropriate medical teams daily and were involved in conversations about their care.

Staff knew and understood how to assess patient needs and used appropriate risk assessments to ensure safe care, including nutrition, hydration and falls risk assessments were regularly assessed in line with guidance. Staff were aware of how to monitor skin for pressure ulcers and use body maps when repositioning recording skin integrity. Staff told us they could access medical staff when needed and that they participated in daily ward rounds, as well as morning handovers.

We reviewed a sample of patient records. We saw that patient events were documented and kept up to date. Records reflected individual care needs and end goals of care were documented highlighting progress towards discharge to an appropriate environment. We saw a good standard of multidisciplinary team (MDT) working throughout the documentation. Patient boards in MDT rooms were thorough and detailed with good levels of detail noted.

Patients were observed to have equipment they needed to mobilise readily available and to hand.

The evidence showed a good standard. 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. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well.

During our onsite visit, the senior leaders told us about changes they had implemented including driving the ‘gloves off’ campaign following a rise in hospital acquired infections. A refocus on hand hygiene was underway with staff. Ward managers told us policies were regularly reviewed and updated and were accessible to all staff. Staff were able to tell us how to access medical staff during out of hours and emergencies protocols to follow.

Clinical audits were logged and monitored through the trust electronic system overseen by the clinical audit department. Following the completion of an audit, findings and action plans were documented electronically and reviewed by the specialty audit lead (SAIL) and then by a (deputy) divisional medical director. A RAG (red, amber, green) rating for the outcomes and action plan was then applied and any new risks identified. A quarterly clinical audit improvement group meeting was held and attended by audit leads and learning shared with all staff through a newsletter and email.

The trust used clinical audits to benchmark against standards including national guidelines. Participation in national audits allowed comparison with peers across the country.

Specialties also utilised GIRFT (Getting it right first time) for improvement and service re-design such as the collaborative renal service where they referred to acute kidney injury (AKI). In addition to AKI metrics include community and hospital acquired pneumonia, sepsis and liver disease.

The trust also benchmarked against and participated in Advancing Quality (aqua) programme. This measured some key indicators and reports compliance against other aqua members.

The trust was awarded Joint Advisory Group on Gastrointestinal Endoscopy (JAG) status when it was assessed in May 2024

The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Patients we spoke with gave positive feedback about all staff working together, with one person telling us they couldn’t fault a single doctor or nurse.

Staff described good working relationships with colleagues in the division with medical staff being accessible when needed. Staff told us on the medical day unit they had access to primarily advanced nurse practitioners, and this worked well as all patients were reviewed for their prescriptions in advance. Patients were assessed on arrival and reviews carried out, as necessary. This was said to improve the patient journey and reduced the time spent in the department.

Consultant led ward rounds took place daily and all staff were a part of this. Multidisciplinary meetings followed this, and staff were positive about these meetings but felt input from social care and the local authority on a regular basis would aid discharge planning.

We observed staff working well together in practice and in how they shared and communicated information both verbally and through documentation. Ward round and MDTs were attended by relevant specialisms.

The division could access physiotherapy, SaLT (Speech and Language Therapy) teams, discharge teams and specialist care teams to support patients. Whole ward handovers were completed in the morning with an individual handover of patients in a bay/area of care. The trust provided a policy 'supporting patient choice’ to avoid delays in discharge out of hospital. This framework considered the discharge policy, Mental Capacity Act, Choice and Equality policies and legislative documents to provide a guide to help support patients in choosing where to access care and when. Guidance was available for staff to follow for both patients with and without capacity to support their choices and evidenced the giving of essential information to make those choices.

The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice, and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff were observed spending time with patients, participating in activities and providing mental stimulation as well as supporting with walking and independent bathroom use.

The reablement hub focused on improving outcomes for patients so they could go home. Stakeholders feedback was that staff had provided activities including visits from a pet as Therapy (PAT) dog, performances by singers, a hospital gardener offering patients the opportunity to observe or undertake light gardening, taking photos to share with relatives (with consent), and board games. We heard that a patient had been given access to a keyboard and was able to play to a very high standard entertaining staff and other patients, there was access to a hair and nail salon, and an annual D-Day event was held, amongst others.

Review of medical records show individual care needs were being considered holistically. Multidisciplinary discussions and subsequent plans were made to further understand cognitive impairment and related needs, dietary needs and when discharge home could be realistically achieved.

The trust supported patients with smoking cessation programmes. This service provided advice and prescribed nicotine replacement therapy. The trust identified that 18-20% of patients were smokers. The support identified to stop people smoking was identified as a national exemplar with a good 4 week quit rate outcome. This service was also available to staff. Patients scoring above a trigger for alcohol consumption could be referred to a specialist alcohol care team for assessment and treatment.

The division of medicine’s skin cancer community support service worked in partnership with a local football club in the community and skin cancer awareness and sun safety sessions were held for coaching staff. In addition, the skin cancer team held regular skin cancer clinics which were open to trust staff which provided skin cancer information, signposting, and mole checks.

Corporate initiatives included utilising public health initiatives to support the homeless, substance misuse and health literacy.

The evidence showed a good standard. 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.

The patients we spoke with told us staff worked very hard and were attentive and caring. They had equipment that met their needs.

Staff demonstrated good use of risk assessments to identify the needs of patients in relation to risk of fall and their nutritional needs. They identified patients preferred options and these were recorded for all staff to access as required. They encouraged patients to engage in the activities room and this was observed while on site. Processes ran smoothly on a day-to-day basis to ensure rapid daily assessment of patients by doctors and multidisciplinary teams on ward rounds and in daily meetings. Staff were encouraged to speak up and care plans were clearly identified and documented. Individual needs were clearly considered when discharges were being planned, and patients were able to remain for rehabilitation, even when medically fit for home, improving their overall standard of living. Physical therapy staff were accessible on the wards.

The trust had an audit programme which was extensive and responsive. Audits undertaken demonstrated a high level of compliance in areas including fire drills, mandatory training and tenable audits. Where areas of improvement were identified actions were identified and monitored and learning shared. Tenable audits identified no repeat issues raised all wards. Fire safety audits for the site were 90.19% compliant. Fire safety drill checks were carried out with written feedback being given to wards.

Further examples of audits undertaken included an audit of compliance with the British Society for Allergy and Clinical Immunology (BSACI) guidelines for the management of Hymenoptera, a tool for the management of hereditary angioedema patients, the use of artificial intelligence to support dermatology services streamline the referral process particularly to offer appointments within 2 weeks of being referred.

The reablement wards offered patients who required further intervention and support time to enable them to be discharged home safely. Patients who had been admitted to hospital due to illness or injury could be transferred to the reablement wards from across the sites where they would be encouraged to get dressed, get moving and engage in the hub activities with support from nurses and the therapy team. As a result, a quarter of patients who were admitted to the hub were discharged to home rather than to a community or care-based placement. Half of the patients discharged had a significantly reduced care level than was anticipated on admission and patients were able to be discharged home with a support package rather than onward admission to an intermediate care bed. Patients we spoke with in the hub told us staff enabled them to gain confidence and increase their independence following illness and injury.

The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

All patients we spoke with told us they had an opportunity to ask questions about their care and treatment and understood it. They felt listened to by staff. One service user told us about their visits to the medical day unit and how the staff were always friendly and happy to talk them through options.

Staff clearly understood the importance of consent and demonstrated an understanding of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff understood the process to follow, to make an application, obtain medical review, and how to get support if they needed it. Staff showed awareness of trust policies where they could access it, and the relevant online paperwork.

During our visit we spoke with staff who told us how they took time to build rapport with patients to help build their confidence in their decision making. We spoke with a patient who told us the MDT spent time with her over a week using occupational therapist and physiotherapists to support her and build her confidence in her mobility. The patient became confident and excited to be returning home.

Staff completed mandatory training in MCA, DoLs and Oliver McGowan mandatory training on Learning Disability and Autism. Staff training rates were above the trust compliance rate of 90% in these areas, with the Oliver McGowan compliance at 95.43% achieving the highest completion rate across all sites at the trust