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The Walton Centre Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 19 August 2019

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

  • We rated effective and caring for the Walton Centre as outstanding.
  • We rated safe, responsive and well led as good.
  • Three of the five core services were rated as good and two as outstanding overall.
  • We rated well-led for the trust as good.
  • The trust had taken the appropriate actions relating to the requirements of the previous inspection and had developed an action plan relating to the core service inspection by the time we inspected well-led.
  • We inspected critical care services and found that they had overall maintained their rating from the previous inspection. The rating for effective went down to good and the rating for caring improved to outstanding.
  • We inspected surgery and found that they had improved their overall rating to outstanding.
Inspection areas

Safe

Good

Updated 19 August 2019

Effective

Outstanding

Updated 19 August 2019

Caring

Outstanding

Updated 19 August 2019

Responsive

Good

Updated 19 August 2019

Well-led

Good

Updated 19 August 2019

Checks on specific services

Medical care (including older people’s care)

Good

Updated 21 October 2016

Overall we rated the service as being ‘good’ with the caring domain as ‘outstanding’. There were robust systems in place to keep people safe. Incidents were reported and investigated with evidence of the outcomes being disseminated to staff and lessons being learned. People were protected against hospital acquired infections and when these did occur investigations took place and learning was shared. The trust had implemented the ‘stop, think, sink,’ initiative to encourage patients, families, and visitors to wash their hands and had invested in ultra-violet technology to decontaminate ward areas. There were nursing staff vacancies and the trust had an ongoing recruitment plan in place. The nursing staff ratio to patients on the wards we visited at the time of our inspection and prior to the inspection, on the whole, maintained safe staffing levels for patients. Patient risks were assessed, planned and managed with processes in place to identify and escalate the deteriorating patient. Due to the specialism of the trust they did not meet the criteria for a number of national audits. The trust had a range of policies and clinical guidelines that had been developed using evidence-based care and practice standards. We saw evidence of adherence to the Association of British Neurologists Quality Standards for Unscheduled Care including: rapid bed access, urgent scanning availability for diagnostics, and daily review of all patients by a consultant. There was a strong ethos of multi-disciplinary working across the trust and we observed medical, nursing and allied health professionals working well together. We saw evidence of multi-disciplinary review and care planning in patient records. We were given examples of outstanding care, where staff had gone ‘the extra mile’. One example shared involved supporting a patient who remained on Chavasse ward for nine months, to return home to their family instead of being admitted to a secure unit. The team received an award from the Encephalitis Society for an exceptional service award for their care to the patient. There was a clear vision which staff were aware of and a positive culture where staff felt supported by their leaders. The leadership team were visible to the staff on the wards on a daily basis.

Critical care

Good

Updated 19 August 2019

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

  • We rated safe, effective, responsive and well led as good and caring as outstanding.
  • The service ensured that there were enough staff in the right areas to keep people safe. Staff had received mandatory training, knew what to do to protect patients from abuse and how to report an incident if things went wrong.
  • The service had suitable premises and equipment and looked after them well. Wards were visibly clean and tidy, and staff had access to equipment they needed. Medicines were stored securely, and controlled drugs were well managed.
  • The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers monitored the effectiveness of care and treatment and used the findings to improve them. The Intensive Care National Audit and Research centre outcomes were good.
  • The service assessed and monitored patients’ nutritional and pain needs effectively. Staff of different kinds worked together as a team to benefit patients and were competent for their roles.
  • There was a strong, visible person-centred culture and staff cared for patients with compassion. Patients emotional and social needs were seen as being as important as their physical needs and staff provided emotional support to patients to minimise their distress.
  • The service planned and provided services in a way that met the needs of the people who used it and it took account of patients’ individual needs. There was an innovative use of communication aids for patients.
  • Managers at all levels in the service had the right skills and abilities to run a service providing high-quality sustainable care. There was a vision for what it wanted to achieve and workable plans to turn it into action with a focus on staff support and development.
  • Managers across the service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values. All staff were proud to work for the service.
  • The service had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected. Staff were empowered to develop, influence change and be involved in research.

However,

  • The service had identified a risk with pseudomonas in the water. The service did not follow the policy to mitigate the risk and we found gaps in the recording of water flush records.
  • Pharmacist provision did not meet the critical care core standards of 1.8 wholetime equivalents and weekend provision. This was an issue at the last inspection.
  • Medication expiry date checks were not undertaken consistently for stock medication and we found a number of out of date medicines stored on the unit.
  • The service did not provide a full seven-day service to patients which included dietetics, speech and language therapy, occupational therapy and pharmacy. This did not meet with the national core standards for critical care.
  • We saw that the time from the decision to admit a patient to the time of admission was not consistently recorded. This had been raised at the last inspection.
  • The service had identified that they were not consistently meeting the trusts targets for patient discharges and they were often delayed more than four hours.
  • Improvements identified from the Critical Care network peer review were not identified on the divisional risk register or as part of the strategy for the service.

Outpatients and diagnostic imaging

Good

Updated 21 October 2016

Incident reporting was good; staff knew how to report incidents and this was fed back to staff. Mandatory training levels were at 100% and the environment was visibly clean. There were procedures in place for the prevention and control of infection. The care and treatment delivered was evidence-based and followed national guidance. Staff were competent to perform their roles and worked together in a multi-disciplinary environment to meet patients’ needs. Throughout our inspection we witnessed exemplary patient centred care being given. Services were delivered by caring, committed, and compassionate staff who treated people with dignity and respect. Staff knew some of the patients who had been attending the trust for many years and there were caring interactions between them. Staff greeted patients like old friends. Patient satisfaction surveys were consistently positive and the results were used to improve. Staff were willing to be flexible with patients and recognised that patients regularly travel to the trust from far away. For example, one patient arrived at the hospital OPD at 6pm; staff rang the consultant who agreed to see them. There were good support services for patients, both from the trust and through engagement with the voluntary sector. Since April 2014 the percentage of people seen within two weeks for urgent cancer treatment was mainly at 100% and always above the England average. The management and leadership was good and the departments engaged with patients and staff. Risks were well managed and systems were in place to ensure quality.

Rehabilitation services

Outstanding

Updated 21 October 2016

There was a strong multidisciplinary team (MDT) approach to care for patients undergoing rehabilitation. There was a joined-up and thorough approach to assessing the range of people’s needs and a consistent approach to ensuring assessments were regularly reviewed by all team members and kept up to date. Outcomes throughout the service were above, or in line with, the expected national average. The service had a culture of learning and staff, including post graduates, had regular access to training for development to enhance their skills and knowledge. We found the service had worked within its commissioning arrangements to implement a complete service redesign of specialised rehabilitation services. It operated a hub and spoke model to make best use of resources and provide high quality responsive care for people requiring specialist rehabilitation. There were systems for reporting actual and near miss incidents across services. Staff were familiar with and encouraged to use the trust’s procedures for reporting incidents. We saw evidence where findings from incidents were discussed and learning was shared. Care was delivered that was kind, compassionate and ensured patient dignity was maintained. Patients were well informed and felt their input was valued when planning their care and treatment. People were supported to raise concerns or complaints. Complaints were investigated and lessons learnt were communicated to staff. There was a clear governance structure and learning was discussed and disseminated at key meetings. The majority of staff said they felt supported and well led. The service was proactive in promoting research and innovation and there was a culture of supporting post graduate education and striving to improve service delivery.

Surgery

Outstanding

Updated 19 August 2019

Our rating of this service improved. We rated it as outstanding because:

  • We previously rated this service in October 2016 when we rated it good in safe, effective, caring, responsive and well-led. At this inspection, we rate safe, caring and responsive as good and effective and well-led as outstanding.
  • The service had enough medical and nursing staff with the right skills, experience and qualifications to deliver safe care and treatment to patients. Staff were aware of how to raise and manage safeguarding issues and received support to do so.
  • Staff across different disciplines worked together well to meet patients’ care and treatment needs. Patients accessed timely consultant led care from a range of staff to meet their individual care needs.
  • The service ensured all staff received an annual appraisal. This was an improvement from our previous inspection. The service provided opportunities for staff to develop professional skills and provided additional role specific training.
  • Staff treated patients with compassion, dignity and respect. Feedback from patients and carers about staff was positive. We saw many examples of staff going above and beyond to support patients.
  • The service managed access and flow effectively. The time patients had to wait for referral to treatment was below the national average.
  • We found a positive, open, learning culture throughout the service, where the leadership, governance structures and culture were used to drive and improve the delivery of high-quality care. Staff were proud to work for the service. Leaders encouraged learning and innovation, with the service participating in national and international research and outcomes monitoring.
  • We saw several examples of outstanding practice such as innovative use of technology in theatres and the use of specialist practitioners and teams to provide additional support to staff and patients and ensure the service achieved effective patient outcomes.

However,

  • Compliance rates with trust targets for mandatory, safeguarding and Deprivation of Liberty Safeguards were low in some groups of staff and in some subject areas. This was the same as at our last inspection even though the trust had lowered its target for mandatory training compliance.
  • The service used a mix of paper based and electronic patient records. Not all systems were linked and some staff found it difficult to access some records in a timely manner. Staff could not adapt patient care plans within electronic records to address individual patient needs.
  • The service did not consistently manage medicines effectively. We found out of date medicines in some areas and the service had identified issues with the checking of controlled drugs.
  • Information was not readily available in different languages and formats, this was different from our previous inspection. We saw staff did not always have access to appropriate equipment to facilitate translation for patients who did not speak English.
  • The service did not investigate and close complaints in a timely manner. The average length of time the service took to investigated and close complaints was outside the time limit set by the trust complaints policy.