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We are carrying out checks at Peterborough City Hospital. We will publish a report when our check is complete.

Reports


Inspection carried out on 18 and 19 May 2015

During an inspection to make sure that the improvements required had been made

Peterborough and Stamford Hospitals NHS Foundation Trust was one of the first wave of NHS trusts to be authorised as a foundation trust in April 2004. The trust has approximately 633 beds and over 3,500 staff spread across two sites, Peterborough City Hospital (611 beds) and Stamford Hospital (22 beds). Peterborough City Hospital is a new building funded under the private finance initiative (PFI); it became fully operational only in December 2010, combining services previously supported on three separate sites. It provides acute health services to patients in Peterborough, Cambridgeshire and Lincolnshire.

In addition, the trust provides a range of community services including community midwifery and Macmillan nursing as well as domiciliary visits undertaken by consultants. The trust provides rheumatology and neurology services at the City Care Centre and services in support of Sue Ryder in Peterborough, at HMP Peterborough and in local GP practices. We did not inspect these services during this inspection.

This was a follow up inspection to the comprehensive inspection of March 2014. This inspection was focused and specifically considered  the core services of urgent care and medicine and looked at all key questions and considered the responsiveness of children’s services as well as the effectiveness in end of life services. The inspection took place on the 18th and 19th May 2015.

Overall we found a trust that is improving and had addressed most of the issues we noted during our inspection in March 2014.

Our key findings were as follows:

  • There had been a recent improvement in the performance of the emergency department against the four hour wait and treatment target.
  • A new medical admissions unit had improved patient access and flow through the emergency department and the rest of the hospital whilst also reducing the numbers of outliers.
  • Safeguarding procedures in the emergency department were more robust with appropriate checks made by staff regarding children’s attendance in the department.
  • Medical and nursing staffing had improved across the clinical areas we inspected since our last inspection in 2014 but there remained shortfalls in some areas and there had been an acuity review during this period with an uplift in staff in some areas.
  • There were some concerns about storage of medicines in medical wards, specifically the monitoring of temperatures.
  • Whilst there was evidence of a learning culture, this was not embedded across the whole of the medical directorate.
  • Leadership was visible at trust and directorate level. Most staff felt valued and supported by their managers.
  • The majority of staff were caring and compassionate when providing care and treatment but we observed a small number of interactions that were not caring.
  • The service had made significant improvements in relation to the provision of same sex accommodation and services for adolescents. The service had engaged adolescents in service development and improvement. We saw a number of patient feedback stories from adolescents giving their opinions on the service, one of these had even been presented to the trust board.
  • The Amber Care Bundle had been successfully rolled out to all areas and there was a more consistent approach to managing pain relief in end of life care patients.

We saw several areas of outstanding practice including:

  • The trust had thoughtfully engaged with children and young people in the service development and improvement of children’s services.
  • A new transition projected had been agreed and was being supported by a CQUIN target for this year called “Ready Steady Go”. This project aimed to build confidence and the understanding of children, younger people and their families’ when transitioning into adult services.

  • The trust was now meeting face to face increasing numbers of patients to discuss concerns or complaints.
  • The Quality Assurance Committee was open to some external stakeholders including Healthwatch.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

  • Ensure records are accurate and updated to reflect the needs of patients and that care is given in line with records.

In addition the trust should:

  • Ensure that learning from incidents is disseminated consistently across the medical directorate.
  • Ensure that patients are adequately supported with nutritional needs on medical wards.
  • Ensure that medicines are stored correctly in all areas.
  • Ensure that call bells are answered in a timely way.

    • The trust should ensure that there are appropriate measures in place to further reduce falls and pressure ulcers.
    • The trust should ensure effective admission to the stroke unit for patients requiring specialist care.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection carried out on 4-5 March and 10 March 2014

During a routine inspection

Peterborough City Hospital has 611 beds and is a new building funded under the private finance initiative. It became fully operational only from December 2010, combining services previously supported on three separate sites. It is managed by and is the main site for Peterborough and Stamford Hospitals NHS Foundation Trust. It provides acute health services to patients from Peterborough, Cambridgeshire South Lincolnshire, North-East Northamptonshire and Rutland.

We found that the services at the Peterborough City Hospital site met the needs of most of the patients attending. The accident and emergency (A&E) department was a busy unit as road links to the hospital were good and patients from surrounding counties used this unit. The hospital had good links with its five surrounding local authorities and patients were sent to the most appropriate hospital for treatment if this could not be provided by Peterborough City Hospital. The hospital provided medical and surgical services to the expanding population of Peterborough and the surrounding area. The increases in house building meant that the population was expanding and at times of increased demand the hospital struggled to cope with these pressures.

Staffing

The hospital was in the process of reviewing the number of staff on every ward and was using the Safer Nursing Tool recommended by the NHS Institute for Innovation and Improvement. The initial review found that most wards were already functioning at the required level of staffing but a few wards needed further assessment of patient acuity. At our announced inspection we found that most wards were appropriately staffed but we heard that night times were a particular problem with regard to reduced staffing. We returned for our unannounced inspection during the late evening and found that the staffing was appropriate to meet the needs of the patients on all but one of the medical wards, where a member of staff had called in unwell. This was mitigated as a student nurse was on duty. While this meant that staff were busy, patients remained safe during this night visit.

Cleanliness and infection control.

The hospital was found to be clean and infection was prevented and controlled through good use of cleaning schedules and monitoring systems. Each ward and department had audits displayed of the numbers of infections that had occurred and staff were aware of the need for good hand hygiene in preventing the spread of infections. However, we found that a number of hand gel dispensers were empty and that on occasion people had to walk through several sets of doors to find a dispenser that had antibacterial hand gel in it.

Inspection carried out on 4, 8, 20 February 2013

During an inspection to make sure that the improvements required had been made

Patients’ existing care needs were not always assessed and care was not always adequately planned to make sure they received the care they needed. Information about the need of people who could not communicate easily was not available and this meant that ward staff did not always know the best way to take care of patients.

Patients were provided with a choice of meals and staff members assisted them appropriately with eating and drinking if this was required.

There were enough staff members available to care for people properly.

There were systems in place to regularly check and monitor the way the service was run. However, this did not identify that existing care needs information was not available and actions put into place was not fast enough to reduce risk to patients.

Inspection carried out on 8 August 2012

During an inspection to make sure that the improvements required had been made

This inspection was completed to check improvements following a targeted review of the regulated activity of 'termination of pregnancies'. The focus of our visit was to assess the use of the forms that are used to certify the grounds under which a termination of pregnancy may lawfully take place.

Inspection carried out on 21 March 2012

During a themed inspection looking at Termination of Pregnancy Services

We did not speak to people who used this service as part of this review. We looked at a random sample of medical records. This was to check that current practice ensured that no treatment for the termination of pregnancy was commenced unless two certificated opinions from doctors had been obtained.

Inspection carried out on 6 October 2011

During a routine inspection

We were told that staff were polite, courteous and respectful and one person commented, “Staff are kind, gentle and move at my pace”. People were involved in decisions about their care and treatment and felt they were listened to by staff. They said staff members were good at explaining what they were going to do and told us that the results of tests were explained in a way that people understood. Tests and scans were carried out and results were provided quickly.

All of the people we spoke with who had suffered pain confirmed that they had received pain relief quickly and that staff monitored whether people were in pain. One person had pain relief that they could control and staff listened to what they wanted. Referrals were made to specialist teams for pain management and different types of pain relief were tried.

People had positive comments regarding meals and one person said that, “The food is very good indeed and a marvellous choice, better than home”.

People were seen quickly by the triage nurse but that they did not know how long they would have to wait following this.

Staff members washed their hands before and after attending to people and any used utensils and equipment were cleared away and not left in patient use areas.

Most people were able to find the emergency department easily, although they had difficulty finding disabled parking and in understanding where to park.

Most people we spoke with said staff responded quickly to their call bells and acknowledged them if they were not able to attend to the person straight away. All but one of the people we spoke with on different wards through the hospital said they felt there were enough staff available.

All of the people we spoke with regarding complaints confirmed that they had no concerns about their care and treatment. They stated they knew who to speak to if they were not happy with any aspect of their care but that they had not needed to do this.

Inspection carried out on 31 August 2011

During a routine inspection

All of the patients we spoke with during our visit to the Maternity Unit told us they had always been shown respect by the staff caring for them. Staff were polite, caring and attentive and they said that they were treated with respect and dignity. They also told us their partners and husbands were treated with respect and welcomed into the unit. One patient told us, "All the staff have been very nice, they’re all helpful. They spend time explaining things".

The care provided was of a good standard and one woman said, "Staff have all been really nice, supportive and have had the time to talk". Most patients said they received care and treatment quickly and did not have to wait. They told us that there were usually enough staff and that they had received one to one care from a midwife while in labour.

Inspection carried out on 30 March 2011

During a themed inspection looking at Dignity and Nutrition

Most people said their privacy and dignity was respected and they had not been embarrassed or made to feel uncomfortable in any way. Comments some patients made include staff being described as, “Very impressed, they really care”, “staff are lovely” and “very polite”. One patient commented when asked if they were happy with the care and treatment, “Yes very … 10/10!”

Most patients said they are involved in decisions about their care, although about half of the people we spoke with said they had not received enough information, especially about the hospital facilities. One patient said that the doctors were very good at explaining. However, a patient’s relative told us, “We ask for information, Mum is moved between wards, we are not informed”.

Patients told us that staff are caring towards them, most staff members ask them how they want to be addressed and treated, and explain what the staff member is going to do. However, some patients said they had to wait quite a long time to receive the care they required and staff members were always very busy.

Most people we spoke with were complimentary about meals provided at the hospital. They commented that there is enough to eat, often saying the amount was too much and most patients said they liked the food. One patient commented that there was a lot of choice and another patient said about meals, “I like my food hot and it always is”.

Patients said staff help them with their meals, but that sometimes they don’t get enough help with opening packets or obtaining drinks. Patients are not always helped to wash their hands before eating.

Inspection carried out on 21 December 2010

During an inspection in response to concerns

During our visit to the emergency department on 21 December 2010, we spoke with a large number of people who were using the service and also spoke with their relatives.

People told us that overall they felt that the facilities were better than those offered at the previous A&E department located at Peterborough District Hospital. However, a number of people felt that the parking arrangements were not adequate and that the emergency department’s waiting room was very cold.

The majority of people spoke highly of clinical staff and the treatment they received. People told us that they had been given specific information regarding their condition and details of discharge arrangements. People told us that their nutritional needs were met where applicable and that they were offered timely pain relief.

Although the emergency department was not excessively busy on the day of our visit, a number of people who had attended on previous days had experienced very long waits for treatment.

People told us that they found the booking in and triage arrangements confusing, and that signage in and around the department was not sufficient. People we spoke with also told us that they had been required to discuss private information in a public area.