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Weston Park Hospital Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 14 November 2018

Our rating of the hospital stayed the same. We rated the hospital as requires improvement because we rated the domains of effective and well-led as requires improvement. However, we rated caring and responsive as outstanding and we rated safe as good.

Inspection areas

Safe

Good

Updated 14 November 2018

Effective

Requires improvement

Updated 14 November 2018

Caring

Outstanding

Updated 14 November 2018

Responsive

Outstanding

Updated 14 November 2018

Well-led

Requires improvement

Updated 14 November 2018

Checks on specific services

Outpatients and diagnostic imaging

Outstanding

Updated 9 June 2016

The services had a positive safety culture; there were clear management responsibilities and accountability for safety and governance. The services promoted continuous quality improvement.

There were enough qualified, skilled and experienced staff to meet people’s needs. Staff received good support; they told us their appraisals, and mandatory training was up to date. Radiology services provided well-established, highly regarded training programmes for medical staff at every stage of their five-year programme and for student radiographers from local universities.

All of the staff were passionate about their work and staff teams worked well together to provide an excellent experience for their patients. All of the patients and relatives we spoke with gave positive feedback about the staff and the services.

Staff were aware of the trust values; there was good staff engagement and an open culture. Staff participated in research activities and there were numerous examples of innovation and improvement.

Medical care (including older people’s care)

Good

Updated 14 November 2018

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

  • The service was safe because staff compliance with mandatory training, and safeguarding, had improved. Infection rates were low, and the wards had benefited from a recent refurbishment. This created a clutter free, wheelchair accessible environment with enough equipment for staff to perform their role. Nurse staffing was much better compared to when we inspected last time and there were no vacancies. Staff had access to records which were stored securely. Medicines including intravenous fluids were stored and managed safely. Staff knew how to report incidents and tools such as, the safety thermometer, were used to keep patients safe.
  • The service was effective because it had processes in place to ensure that guidance used by staff complied with national guidance, such as that issued by National Institute for Health and Care Excellence (NICE). Patients food, hydration and pain management needs were met. The service had actioned several initiatives to improve patient outcomes such as starting construction of a sky bridge to link the site to an adjacent trust hospital. Practice development nurses oversaw a programme to ensure staff remained competent. Staff worked effectively as a multi-disciplinary team and had good knowledge about consent and mental capacity.
  • The service was caring, with response rates in the friends and family test better than the England average. The inpatient score for friends and family in March 2018 was 97% which was above the trust’s internal target of 95%. Staff supported the emotional needs of patients and could signpost patients to a local charity for further support. Staff tried to understand and involve patients and their carers where it was safe to do so.
  • The service was responsive, making changes to its service to benefit patients with life changing conditions, such as changes to its pathways. It was compliant with all referral to treatment standards apart from the GP 62-day pathway: but it had plans to improve compliance in this area. The service was responsive to complaints and had made changes to its service, such as the improvements to the telephone service, in response to feedback received.
  • The senior leadership team running the service were visible, approachable, and responsive and worked as a cohesive team to promote a positive culture. The service had clear governance processes in place to drive patient safety forward. Staff and the public were engaged through meetings, clinics and focus groups. The service was working with partners to improve the service provision for the region.

However:

  • Junior doctors told us that securing physical presence of consultant oncologists on site was challenging. We raised this with the senior leadership team who said they were working on plans to address this, such as consultant of the week.
  • There were not clear systems and processes in place to manage, mitigate and escalate risk.

End of life care

Good

Updated 14 November 2018

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

  • We rated safe, caring, responsive and well-led as good. We rated effective as requires improvement.
  • Staff caring for patients at the end of their life were aware of how and when to report incidents, including safeguarding concerns. We saw that staff received feedback and lessons learned were shared.
  • All areas we visited were clean and well maintained. The environment had been updated resulting in improved facilities for patients and their relatives. Staff practiced safe infection control techniques.
  • Staff caring for patients at the end of their life assessed patients and escalated their care to the specialist team when necessary.
  • Guidelines, pathways and policies were produced in line with national best practice guidelines and recommendations.
  • We saw many good examples of multidisciplinary working.
  • The service participated in national audit and undertook local audits, such as an audit of compliance on the completion of do not attempt cardiopulmonary resuscitation (DNACPR) forms and assessment of the use of intravenous and subcutaneous fluids in patients in the last days of life The trust had a robust action plan to address the outcomes of national end of life care – dying in hospital audit 2016 and was making progress on the actions needed.
  • There were sufficient numbers of highly skilled specialist palliative care medical and nursing staff to care for patients at the end of their life. Specialist medical staff were available seven days a week, 24 hours a day.
  • We saw staff seeking patient consent before providing care and treatment. Do not attempt cardiopulmonary resuscitation orders were fully completed and showed evidence of discussion with patients and their families.
  • Patients, relatives and carers we spoke with gave consistently positive feedback: patients told us they felt safe on the wards and that staff were caring and compassionate.
  • Patients and their relatives told us that they were involved in planning their care and that communication with staff was good.
  • Staff provided emotional support to patients and their loved ones.
  • Services were planned in conjunction with external partners, across the whole of the health system to meet the needs of local people and the wider population.
  • We saw numerous positive examples of initiatives to meet the individual needs of patients at the end of their life.
  • There was a clear leadership structure and strategy for end of life care. Staff told us that their line managers were visible, approachable and supportive.
  • Local governance arrangements were robust, and the team was aware of the risks to their service.
  • We saw numerous examples of engagement, improvements and innovation.

However:

  • Whilst mandatory training compliance had improved we found low compliance amongst some staff groups for some subjects. Staff reported delays obtaining pressure relieving equipment.
  • The trust had processes in place to ensure patients care preferences at the end of their life were documented. However, they were unable to evidence improvements for patient outcomes because they were not auditing outcomes.
  • The trust did not have gold standards framework accreditation and did not provide any indication this was planned.
  • We saw printed copies of out of date end of life care guidelines on the oncology wards at Weston Park Hospital. This meant staff might not be using the most up to date guidance which had been recently updated and was available on the trust intranet.
  • The trust performance in the national End of life care Audit: Dying in Hospital 2016 was worse than the England average for three of the five agreed clinical indicators and the trust answered no for five of the eight organisational indicators.
  • The trust had made some improvements to the ward environments however we found more could have been done to support people living with dementia. Following our inspection, the trust provided evidence that further improvements had been identified and were being implemented.