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Peterborough City Hospital Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 20 December 2019

Inspection areas

Safe

Requires improvement

Updated 20 December 2019

Effective

Requires improvement

Updated 20 December 2019

Caring

Good

Updated 20 December 2019

Responsive

Requires improvement

Updated 20 December 2019

Well-led

Requires improvement

Updated 20 December 2019

Checks on specific services

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.

Services for children & young people

Good

Updated 20 December 2019

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

  • The service had enough staff to care for children and young people and keep them safe. Staff had training in key skills, understood how to protect children and young people from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to children and young people, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
  • Staff provided good care and treatment, gave children and young people enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of children and young people, advised them and their families on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
  • Staff treated children and young people with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to children and young people, families and carers.
  • The service planned care to meet the needs of local people, took account of children and young people’s individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of children and young people receiving care. Staff were clear about their roles and accountabilities. The service engaged well with children, young people and the community to plan and manage services and all staff were committed to improving services continually.

Critical care

Requires improvement

Updated 20 December 2019

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

  • Not all medical staff had completed mandatory training. The service did not have enough medical staff with the right qualifications, skills, training and experience. There were several vacant posts and rota gaps were filled by staff at short notice. Managers did not regularly review staffing levels to ensure an appropriate skill mix of medical staff.The systems and processes for the storage of medicines was not in line with national guidance. Medicines could be accessed by staff who were not authorised to access them.
  • The service did not use monitoring results well to improve safety. Staff collected safety information and displayed it in staff areas. However, monitoring results were not always used to improve safety. Managers did not check to make sure staff followed guidance. For example, the medicines management policy. Some policies were significantly out of date including the critical care operational policy.
  • It was unclear if people could access the service when they needed it. The service did not always admit, treat and discharge patients in line with national standards. For example, waiting times to be admitted were not monitored, and patients stayed in the department for longer than they needed to.
  • Not all leaders had the capacity to run the service. They did not understand and manage all the priorities and issues the service faced. The service had a vision for what it wanted to achieve but there was no clear strategy to turn it into action, and therefore progress could not be monitored. The draft clinical strategy was in its infancy and had not been developed with senior leaders from the service, relevant stakeholders or staff. Not all staff felt respected, supported or valued. The service had an open culture where patients, and their families could raise concerns however not all staff felt they could do so without fear of retribution.
  • Leaders did not operate a consistent governance process, throughout the service and with due to lack of senior staff and time constraints of leaders. Not all staff at all levels were clear about their roles and accountabilities. Staff did not have regular opportunities to meet, discuss, understand and learn from performance. Not all staff were committed to continually learning and improving services. They did not have an understanding of quality improvement methods and had not been equipped with the skills to improve quality. Leaders did not encourage innovation and participation in research.

End of life care

Good

Updated 20 December 2019

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

  • The service had enough nursing staff to care for patients and keep them safe. Staff had training in key skills and understood how to protect patients from abuse. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. Staff managed medicines well. Managers investigated incidents and shared lessons learnt with staff.
  • Staff provided care and treatment in line with national guidance. Staff gave patients enough to eat and drink and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients and supported them to make decisions about their care. The specialist palliative care team was available seven days a week.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
  • The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. Most people could access the service when they needed it.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However:

  • There was not an effective system to ensure syringe drivers were always available.
  • Medical staffing levels did not meet national guidelines. A business case to extend consultant hours has been developed by the service but was rejected by the trust due to lack of funding.
  • The specialist palliative care team were unable to access the records system used by local GPs. This had an impact on continuity of care within the community.
  • Staff documentation around cardiopulmonary resuscitation was poorly completed and not in line with national guidance.
  • Discussions around preferred place of care (PPC) and preferred place of death (PPD) did not always take place.

Surgery

Good

Updated 20 December 2019

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

  • Staff provided good care and treatment. Staff understood how to keep patients safe, recognise abuse and report incidents. Learning from incidents was shared to make improvements. Managers monitored the effectiveness of the service, ensured staff were competent within their roles and participated in local national audits to improve patient outcomes.

  • Staff of all types worked together in for the benefit of patients. Patients accessed up to date advice on how to lead healthier lives, staff supported them to make decisions about their care, and key services were available seven days a week.

  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their treatment and care. Patients we spoke with told us the care they received was appropriate to their needs. Staff provided emotional support to patients, families and carers to promote their wellbeing whilst in hospital and following discharge.

  • The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. Patients could access the service when they needed it and care staff planned and delivered individualised care.

  • Leaders, managers and staff focused on the needs of patients receiving care and used innovative treatment and technology to improve patient lives. Staff were clear about their roles and accountabilities. The service engaged with stakeholders to plan and manage services and all staff were committed to continuously improving services.

Urgent and emergency services

Requires improvement

Updated 20 December 2019

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

  • The number of staff who completed mandatory training in key skills did not always meet trust targets. Safeguarding training for medical staff did not always meet trust targets. Not all staff were aware of appropriate isolation procedures should they treat an infectious patient. The design, maintenance and use of facilities, premises and equipment did not always keep people safe. Staff did not always complete risk assessments for each patient swiftly and did not always remove or minimise risks and update the assessments. Staff did not always identify or quickly act upon patients at risk of deterioration. Staff did not always keep detailed records of patients’ care and treatment. Records were not always clear and up-to-date. Systems used for storing medicines were not in line with national guidance.
  • The service did not always make sure all staff in the main emergency department had sufficient skills and competencies to assess and treat children. Managers did not always appraise staff’s work performance and hold supervision meetings with them to provide support and development.
  • People could access emergency services when they needed it, however did not always receive treatment within agreed timeframes and national targets.
  • There was a lack of clarity in leadership at a local level. Senior leaders were new in post and some positions remained interim at the time of our inspection. Not all leaders were visible and approachable in the service for patients and staff. There was no formalised local strategy to turn it the service’s vision into action. Governance processes were not always fully effective. Staff did not always have regular opportunities to meet, discuss and learn from the performance of the service. Risks and issues were not always escalated promptly. Action was not always taken quickly to reduce their impact. There were no clear quality improvement methods in place.

However:

  • The service provided mandatory training to all staff. Staff understood how to protect patients from abuse. Staff used equipment and control measures to protect patients, themselves and others from infection. Staff were trained to use facilities, premises and equipment and managed clinical waste well. The service had enough nursing and medical staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Records were stored securely and were easily available to all staff providing care. Staff followed processes when storing medication documentation, and when prescribing and recording medicines. The service managed patient safety incidents well. The service used monitoring results well to improve safety. Staff collected safety information and shared it with staff, patients and visitors.
  • The service provided care and treatment based on national guidance and evidence-based practice. Staff gave patients enough food and drink to meet their needs and improve their health. Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way. Staff monitored the effectiveness of care and treatment and used the findings to make improvements and achieve good outcomes for patients. Doctors, nurses and other healthcare professionals worked together as a team to benefit patients. Key services were available seven days a week to support timely patient care. Staff gave patients practical support and advice to lead healthier lives. Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
  • The service planned and provided care in a way that met the needs of local people and the communities served. The service was inclusive and took account of patients’ individual needs and preferences. Staff made reasonable adjustments to help patients access services. They coordinated care with other services and providers. It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff. The service included patients in the investigation of their complaint.
  • Staff and leaders had a vision for what they wanted to achieve. Staff felt respected, supported and valued. The service had a governance structure in place. Leaders and teams identified relevant risks and issues. The service collected reliable data and analysed it. Leaders and staff actively and openly engaged with patients, staff, equality groups, the public and local organisations to plan and manage services. Some staff were committed to continually learning and developing.

Diagnostic imaging

Good

Updated 20 December 2019

We previously inspected diagnostic imaging jointly with outpatients in 2014, so we cannot compare our new ratings directly with previous ratings.

We rated it as good because:

  • The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.
  • The service used safety monitoring results well. Staff collected safety information and shared it with staff, patients and visitors. The service used information to improve the service.
  • The service provided mandatory training in key skills to all staff and made sure everyone completed it.
  • The service planned for emergencies and staff understood their roles if one should happen.
  • The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.
  • The service monitored the effectiveness of care and treatment and used the findings to improve them. They compared local results with those of other services to learn from them.
  • The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and monitor the effectiveness of the service.
  • Staff of different kinds worked together as a team to benefit patients. Healthcare professionals supported each other to provide good care.
  • Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.
  • Staff involved patients and those close to them in decisions about their care and treatment.
  • Staff provided emotional support to patients to minimise their distress.
  • The trust planned and provided services in a way that met the needs of local people.
  • The service took account of patients’ individual needs.
  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, which were shared with all staff.
  • The trust had managers at all levels with the right skills and abilities to run a service providing high-quality sustainable care.
  • Managers across the trust promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values. All staff we spoke with were invested in the department and spoke passionately about the service and care they gave to patients. All staff told us that they felt empowered to look for ways to continually improve the service provided.
  • The trust used a systematic approach to continually improve the quality of its services and safeguarding high standards of care by creating an environment in which excellence in clinical care would flourish. Governance arrangements were proactively reviewed and reflected best practice.
  • The trust had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected. There was a commitment to best practice performance. Staff at all levels had the skills and knowledge to use the risk management systems and processes in place. Any problems were identified and addressed quickly and openly.
  • The trust was committed to improving services by learning from when things go well and when they go wrong, promoting training, research and innovation. There was a fully embedded and systematic approach to improvement. There was a clear, systematic and proactive approach to seeking out and embedding new and more sustainable models care and service delivery.

However:

  • The service did not have enough staff in all areas. There was a concern about the vacancy rate for consultant radiologists. This was in part due to a national shortage of radiologists. The service was exploring different ways of working to attract staff to the trust. They had also invested in post graduate training for radiographers to enable them to extend their roles. All staff in post had the right qualifications, skills, training and experience to keep people safe from avoidable harm and abuse and to provide the right care and treatment.

Maternity

Requires improvement

Updated 20 December 2019

We previously inspected maternity jointly with gynaecology so we cannot compare our new ratings directly with previous ratings.

We rated it as requires improvement because:

We rated it as requires improvement overall. We rated safe as requires improvement, effective, caring and responsive as good and well led as inadequate because:

  • Staff did not complete all risks assessments fully. The service collected safety information but did not share it with staff, women and visitors. The service did not control infection risk well. Not all equipment was safety tested. The service did not always store medicines safely. The ward exits were not secure. Documentation in women’s records was in line with national guidance. Staff had training in key skills, required by the trust. Staff understood how to protect patients from abuse. The service managed safety incidents well and learned lessons from them.
  • Staff provided evidenced based care and treatment to women and gave them pain relief when they needed it. Managers monitored the outcomes of the service and made sure staff were competent. Staff worked well together for the benefit of women and babies. There were a number of guidelines that were out of date.
  • Staff cared for women and babies in a compassionate manner and ensured their privacy and dignity. Women and partners gave extremely positive feedback. Staff ensured women received emotional support when required.
  • The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. Although there were areas when women were not assessed by a midwife in a timely manner.
  • Leaders did have an awareness that not all risk assessments were not being completed by staff. There was not a specific maternity strategy for the service. Not all staff understood the trust’s vision and values, and how to apply them in their work. There were no long term plans to resolve long term risks. Governance processes in place were not fully effective, there remained a lack of oversight of performance from managers and the senior leadership team. Leaders were visible, all staff felt respected, supported and valued. The service engaged well with women, external agencies and the community to plan and manage services. The service supported initiatives and research projects.

Outpatients

Good

Updated 20 December 2019

We previously inspected outpatients jointly with diagnostic imaging in 2014, so we cannot compare our new ratings directly with previous ratings.

We rated it as good because:

  • The outpatient areas had enough staff who had completed safeguarding and mandatory training. Staff were trained in the necessary skills to protect patients from abuse and keep them safe. The service controlled infection risk well and used control measures to prevent the spread of infection. The service generally managed medicines well and kept good care records. Staff managed safety incidents well and learned lessons from them.
  • The service provided care and treatment based on national guidance and evidence-based practice. Staff ensured patients had enough food and drink to meet their needs and gave pain relief when needed. Staff worked together as a team to benefit patients supported each other to provide good care. Staff advised patients how to lead healthier lives, and supported them to make decisions about their care.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. Staff provided emotional support to patients, families and carers to minimise their distress. Staff supported patients, families and carers to understand their condition and make decisions about their care and treatment.
  • The service provided care that met the needs of local people and the communities served. Staff took account of patients’ individual needs and preferences and made adjustments to help patients access services. Access was available to those who needed it and waiting times from referral to treatment and arrangements to admit, treat and discharge patients were in line with national standards. It was easy for people to give feedback and raise concerns about care received.
  • Leaders were visible and approachable and had the skills and abilities to run the service. They supported staff to develop and junior staff felt respected, supported and valued. The service had a vision and a strategy to turn it into action. The service operated effective governance processes with all levels clear about their roles and accountabilities. Leaders monitored performance and the service collected reliable data and submitted to external organisations as required. All staff were committed to continually learning and improving services. They had a good understanding of quality improvement methods and the skills to use them.

However:

  • Leaders did not always identify and escalate relevant risks and issues and take action to reduce their impact. There was a lack of safety risk assessment for the pharmacy located in the oncology outpatient waiting area. World Health Organisation (WHO) five steps to safer surgery checklists were not correctly completed in main outpatients and audits were not made available for review.
  • The service did not always use systems and processes to safely prescribe, administer, record and store medicines. Medicines were not stored securely in the oncology and haematology outpatient pharmacy and hospital outpatient prescription pads were not stored securely or tracked to ensure they were not misused or missing.