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The rating for ‘Medical Care’ shown on this page does not reflect our latest judgement of services at Peterborough City Hospital. At our latest inspection, in October 2018, we rated the Medical Care (Including older people's care) as Good. We did not inspect the ‘Medical Care’.

Inspection Summary


Overall summary & rating

Good

Updated 24 October 2018

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

A summary of this hospital appears in the overall summary above.

Inspection areas

Safe

Good

Updated 27 July 2015

Effective

Good

Updated 27 July 2015

Caring

Good

Updated 27 July 2015

Responsive

Good

Updated 27 July 2015

Well-led

Good

Updated 27 July 2015

Checks on specific services

Critical care

Good

Updated 16 May 2014

Critical care patients received safe, responsive and effective care services. The service was provided by sufficient specialist staff in a spacious and clean environment. Admissions to the unit were organised so that they were appropriate and took place without delay.

We saw that people received care and treatment according to national guidelines. There were always sufficient staffing numbers to meet patient needs. Consultant-led one-to-one nursing, or two-to-one nursing, was provided according to each patient’s assessed level of need. The staffing ratio was planned so that it was sufficient to meet the needs of critical care patients.

Staff training and appraisals were carried out to ensure that staff were competent, were aware of best practice, and were effective in caring for and treating patients. Care delivered within the unit and to patients on other wards by the outreach team was observed to be person-centred and compassionate.

Patients were supported to make decisions about their care where possible, and relatives were included in their family member’s care planning. There was an unacceptable level of delayed discharges from the critical care unit. There was effective leadership at all levels within the critical care service.

Outpatients and diagnostic imaging

Good

Updated 16 May 2014

Outpatients services were safe, and staff were well trained and knowledgeable. All staff understood the principles of safeguarding for children and adults and knew how to refer concerns.

The trust had responded positively to concerns about the booking office and call centre. A review of these departments had resulted in more staff being employed and systems refined; this has led to a more effective service. The trust has had 12 patients wait longer than the 13 week target, however this is in proportion to 103,152 new attendances in the year to date. Some outpatient clinics run over but ‘did not attend’ rates have dramatically decreased as a result of the appointment ‘chase and alert’ system.

Urgent and emergency services

Requires improvement

Updated 24 October 2018

Our rating of this service went down. We rated it as requires improvement because:

  • The newly implemented patient safety checklist was not routinely completed. Risk assessments were not always carried out when they should have been, for example, we saw that pressure ulcer assessments were not always carried out in our review of medical records.
  • The department was not meeting the trust’s target for compliance with mandatory training. Training compliance for paediatric basic life support was just below trust target at 86.2%, and paediatric intermediate life support was significantly below at 46.5% compliance against a target of 90%. Safeguarding training compliance for medical staff fell short of the trust’s 90% target in four out of five areas.
  • Staff were not consistently monitoring and recording medication fridge temperatures to ensure medicines were stored in a safe manner to protect their integrity.
  • Reception staff had not received training in the identification of red flag signs and symptoms. This meant that critically unwell patients may not have been recognised or escalated in a timely manner.
  • We were not assured, that self-presenting patients received an initial assessment in order to establish their degree of clinical acuity during hours when the streaming nurse was not present at the reception desk. The department did not hold records to monitor and ensure that patients had been seen in order of clinical priority. This had not been recognised as a risk by departmental leaders.
  • The emergency department was failing to achieve the Department of Health’s standard for emergency departments, that 95% of patients should be admitted, transferred or discharged within four hours. The department had consistently failed to meet this standard from April 2017 to March 2018.
  • From April 2017 to March 2018, the median total time in the emergency department, for all patients, was higher than the England average.
  • The Royal College of Emergency Medicine (RCEM) recommends that the time patients should wait from time of arrival to receiving treatment should be no more than one hour. The trust did not meet this standard for any of the 12 months from April 2017 to March 2018.
  • Senior staff were not effectively overseeing the completion of medical records including the use of patient safety checklists. In addition, medical records did not always contain all pertinent risk assessments. This meant that risks posed to patients was not always effectively identified.
  • Medical equipment, such as resuscitation trolleys lacked regular checks.
  • We were not assured that checking processes were embedded, or effectively overseen.
  • Data showing arrival time to initial assessment was not routinely collected or used for quality oversight and service improvement.

However:

  • Staff maintained oversight of the ambulance waiting area. Patients were cared for by dedicated staff, to ensure that clinical deterioration was identified in a timely manner.
  • Equipment was clean and well maintained.
  • The environment was clean. Effective processes were in place to prevent and control the spread of infection.
  • Staff understood their responsibilities to identify and report incidents and safeguarding concerns.
  • The service provided care which was evidence based and in line with national guidance.
  • Staff from various teams worked well together as a team to monitor and improve patient care and outcomes.
  • Patient feedback was positive, describing staff as ‘kind and caring’.
  • Despite being in it’s infancy, there were clear management structures in place both locally and at divisional level.
  • Staff spoke highly of the culture within the emergency department, telling us they felt supported and developed in their role.

Medical care (including older people’s care)

Requires improvement

Updated 27 July 2015

Maternity and gynaecology

Good

Updated 16 May 2014

Women we spoke with were generally positive about their experiences. Each person said that they had been very well informed throughout their pregnancy and that staff had been attentive to their needs and demonstrated a caring attitude. There was, however, a small number of negative comments about how quickly staff responded to queries or questions people may have had. Staff we spoke with were positive about the running of the service and there were clear lines of responsibility.

We saw how the service identified, responded to and acted upon things that had gone wrong to ensure that the service remained safe.

Effective practices were in place and these were continually monitored and reviewed to ensure that the service met the needs of the women it cared for. The service was staffed in line with recommended ratios; however, concerns were raised about the level of staffing within the antenatal clinic.

While overall the service was well led, we found that there was confusion within the senior team about how and where the staff should report quality issues. Also, there was no clear strategy or vision for the maternity service. We found that the service had not analysed information to determine how it could improve the running of the available maternity helpline.

Medical care (including older people’s care)

Good

Updated 24 October 2018

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

  • Medicines management and records management practices were implemented effectively.
  • Most staff had received an up to date appraisal and safeguarding and Mental Capacity Act (2005) training.
  • Staff reported and managers investigated incidents and shared lessons learned with the whole team and the wider service. Staff kept themselves, equipment and the premises clean.
  • Patients and their families were involved in developing care plans and given information to help them understand choices available to them. Feedback from patients was uniformly positive about the caring attitude of staff.
  • The service was responsive to people’s needs. Vulnerable people had their needs met and there was good access to specialist staff and support services.
  • Waiting times for referral to treatment were in line with national averages.
  • Senior managers promoted a positive and open culture amongst staff and managers had the necessary skills and experience to achieve the service objectives and vision.

However:

  • Mandatory and safeguarding training rates for medical staff were consistently below the trust target.

Surgery

Good

Updated 16 May 2014

Services in the surgical department were safe for patients. Services were provided in a clean and hygienic environment in line with recognised guidance, which helped protect patients from the risk of infection, including hospital-acquired infections.

We saw staff who were caring; the patients we spoke with complimented staff on their caring approach and professionalism.

Shortages of beds resulted in some patients being admitted to an inappropriate environment, particularly in the planned surgery orthopaedic ward. Patients’ operations were often cancelled or delayed due to lack of capacity. The operating theatre time available, due to cancelled elective surgery, was utilised by performing emergency surgery and thus minimising the need to attend to cases out of hours. Gaps in staffing were met using bank (overtime) and agency staff, but such staff were not always available. The trust has a recruitment programme; however, staff reported to us that there were delays recruiting and replacing staff.

Action plans were written as a result of reported incidents; however, there was no robust system in place to facilitate learning from incidents or complaints. We saw that appropriate equipment checks and maintenance were carried out. However, there was a lack of storage space throughout all the surgical wards.

Most of the staff we spoke with felt supported by their managers. A minority reported to us that they would be afraid to raise concerns and they feared being victimised. However, most staff we spoke with said that they would challenge a senior member of staff for wrongdoing, either directly or via a senior colleague. Staff training and appraisals were carried out to ensure that staff were competent and had knowledge of best practice to effectively care for and treat patients. A clinical governance framework was also in place.

We found that staff were responsive to people’s individual needs; however, staff told us that there were often delays in patients’ discharge from the hospital.

Services for children & young people

Good

Updated 27 July 2015

In 2014 we found that children’s and young people’s services were provided in a clean and hygienic environment in line with recognised guidance, which helped protect patients from the risk of infection, including hospital-acquired infections.Children’s care and treatment followed best practice guidance and monthly audits were carried out regarding patient safety, patient experience and the environment. Parents we spoke with told us that they felt that their child received good-quality care and that they were informed about any treatment required.

In 2014 we found that staff were responsive to people’s individual needs; however, staff were unaware of the trusts guidance for staff on the ward areas when they needed to make a decision concerning same-sex accommodation. There was also limited support from the child and adolescent mental health services out of hours. There was leadership at all levels within children’s and young people’s services and staff felt well supported well supported by their managers. A clinical governance frame was also in place.

In 2015 we returned to the service to assess whether or not improvements had been made in relation to the responsive domain where in 2014 the service was found to require improvement. This was specifically in relation adolescent service provision and the use of single sex accommodation. It was also identified that improvements were needed in relation to joint working with child and adolescent mental health services (CAMHS). We found that these improvements had been made and that the service had worked extremely hard to develop and progress projects and plans to meet the needs of the children and young people using this service.

End of life care

Good

Updated 27 July 2015

In 2014 we found that the trust had a strong focus on end of life care. The trust had used CQUINs (Commissioning for Quality and Innovation targets agreed with the local commissioning groups) to develop and improve the service provided to patients at the end of their life.

The trust was clear with regard to the actions required to review and replace the Liverpool Care Pathway. The Amber Care Bundle was being piloted on two wards. The action plan demonstrated that it would then be rolled out across the trust to meet the Department of Health’s guideline timeframe of July 2014.

The palliative care team was very committed and provided a service seven days a week. The team was alerted immediately to any admission of a terminally ill patient. There was very good multi-agency working and close working with both the community team and the local hospice.

Staff were clear about ‘do not resuscitate’ policies and documents viewed were appropriately signed. Equipment was available and clean, appropriate checks had been made and staff understood how to use the equipment.

The care provided to those who had died was excellent and led by a very passionate bereavement centre manager. In addition, the chaplaincy service and the faith centre provided support to both patients, their families and friends and staff of all faiths and cultural backgrounds.

The purpose of our follow up inspection in May 2015 was to check that the Amber Care Bundle had been rolled out throughout the trust, that pain management was being prescribed and administered effectively and communication over the preferred place of death had been improved. We found that a new lead for palliative care had been put in place and that they had supported and empowered the palliative care team to drive forward improvements and positive change. This meant that the effective domain had gone from requiring improvement to being rated as good.