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Weston Park Hospital Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 9 June 2016

We inspected Weston Park Hospital as part of the inspection of Sheffield Teaching Hospitals NHS Foundation Trust from 7 to 11 December 2015. We undertook an unannounced inspection on 23 December 2015. We carried out this inspection as part of the Care Quality Commission (CQC) comprehensive inspection programme.

We did not inspect radiotherapy services during this inspection.

Overall, we rated Weston Park Hospital as requires improvement. We rated safe, effective and responsive as requires improvement. We rated well-led as good and caring as outstanding.

We rated outpatients and diagnostics as outstanding. Medical care and end of life care were rated as requires improvement.

Our key findings were as follows:

  • The environment at Weston Park Hospital was in need of updating. A planned refurbishment programme had commenced and staff and patients had been involved in developing these plans. This would improve the environment for patients.
  • There were no Methicillin Resistant Staphylococcus Aureus (MRSA) infections attributed to the medical wards in this service between March and September 2015. Two cases of Clostridium difficile (C.diff) reported by the trust between March and September 2015 were attributable to the medical wards.
  • The trust implemented an infection control accreditation programme which set standards for infection prevention and control practices. All the areas we inspected were part of the trust infection control accreditation programme and there was evidence of audits meeting the required standards for accreditation to be maintained.
  • There were appropriate levels of nursing in outpatient and diagnostic service. However, on the wards, nursing staffing levels were frequently below the planned level with many shifts having fewer registered nurses than required on duty.
  • Medical cover at night was provided by the Hospital at Night team based at the nearby Royal Hallamshire Hospital.
  • Patient’s nutritional needs were assessed. The service had worked closely with dietitians and the hospital catering team to ensure that meals were served at a time that suited the patients. Audits identified that fluid balance charts were not compliant and an action plan was in place to address this.
  • Patient’s pain was assessed and pain relief provided promptly.
  • The wards were not dementia friendly in layout or environment. No staff had been identified as dementia champions on the medical wards in accordance with the trust strategy.
  • There were some mixed gender facilities for toileting and bathing.
  • We were concerned about the use of the teenage and young adult unit for other patients who required an acute bed.
  • There was no clear strategy for end of life care and trust guidelines had not been implemented at Weston Park Hospital.
  • Patients preferred place of care was not monitored for patients at the end of life.
  • We found excellent examples of multidisciplinary team (MDT) working in both radiology and OP services. MDT working underpinned service development and effective care delivery.
  • We found that staff caring for patients and their families, treated them with compassion, kindness, dignity and respect.
  • A microsystems quality improvement project was being piloted on Ward 3 and staff were optimistic this would bring positive changes.

We saw several areas of outstanding practice including:

  • Within outpatients and diagnostic services, we saw numerous examples that showed staff respected and valued patients as individuals and empowered them as partners in their care.
  • The directorate hosted the ‘Devices for Dignity (D4D) Healthcare Co-operative’. This is a national initiative to drive forward innovative products processes and services to help people with long-term conditions’. The Devices for Dignity (D4D) Healthcare Co-operative’ had been recognised with a number of awards including 2012 Advancing Healthcare Awards and Allied Health Professionals and Healthcare Scientist and Leading Together on Health Award.
  • The development of the Sheffield 3D imaging lab was unique to the NHS and provided improved quality of scans and detail of brain tumour growth. Images were processed quicker, in seconds rather up to an hour, saving time and money. The 3D lab was a finalist in the Yorkshire and Humber Medipex NHS Innovation awards.
  • In addition to walk in services for general plain film imaging GP’s can refer patients directly for CT, MRI, ultrasound, fluoroscopy and other specialised imaging examinations.
  • There was a state of the art Medicines and Healthcare products Regulatory Agency (MHRA) Licenced Radiopharmacy, serving all of the trusts locations.
  • Nuclear medicine staff were finalists in the Medipex NHS innovation awards 2014 after developing a new system for diagnosing debilitating digestive disorder that freed up the gamma camera, so reducing patient waiting times.
  • Pet therapy had recently been introduced on Ward 3 and staff told us this was well received by patients.
  • There was a multidisciplinary malignant spinal cord compression project group in the service to improve the care of patients with this serious condition. The service informed us that the project had been reviewed through audit, service evaluation, staff and patient experience surveys. The team were shortlisted in the Patient Safety Awards Cancer Care Category in 2015.
  • The teenage cancer unit had a number of innovations which had been paid for out of charitable funds. These included a ‘couples retreat’ for end of life patients and their partners. They could spend time away from home and explore issues about coming to the end of life.
  • Art therapy had also been used as a way of communication on the teenage cancer unit for young people nearing the end of life.

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

Importantly, the trust must:

  • Ensure there are sufficient numbers of suitably qualified, competent, skilled and experienced staff on duty.
  • Ensure proper systems are in place to ensure the safe management of medications.
  • Ensure there is a clear strategy for the end of life care, which is implemented and monitored.
  • Ensure that staff implement individualised, evidence based care for patients at the end of life.
  • Person centred care and treatment must be appropriate, meet patient’s needs and reflect their preferences.
  • Ensure that DNACPR records are fully completed.

In addition the trust should:

  • The hospital should improve the environment and the skills of staff to ensure that the needs of people living with dementia are met.
  • The hospital should improve the completeness of patient records. In particular, the nursing care plans and review of patient risk.
  • Level of compliance with mandatory training need to be improved, in particular, basic life support for adults and paediatrics and safeguarding children and vulnerable adults.
  • The hospital should develop standard procedures for completing interventional radiology non-surgical safety checklists for all staff to follow.
  • The hospital should undertake regular audits of patient electronic records to ensure consistency in the completion of MRI safety checklist and pregnancy checks.
  • The trust should identify and monitor patients preferred place of care or death in order to meet the individual’s needs and to improve or develop services.
  • The trust should continue to implement IT systems to enable staff to access accurate and timely information.
  • The trust should review the Deprivation of Liberty Safeguards (DoLS) policy.
  • The trust should monitor access to records in the outpatient departments.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection areas

Safe

Requires improvement

Updated 9 June 2016

Effective

Requires improvement

Updated 9 June 2016

Caring

Outstanding

Updated 9 June 2016

Responsive

Requires improvement

Updated 9 June 2016

Well-led

Good

Updated 9 June 2016

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)

Requires improvement

Updated 9 June 2016

Overall, we rated this service as requires improvement. Nursing staffing levels were frequently below the planned level with many shifts having fewer registered nurses than planned on duty. We found evidence of patient records and documentation not being in line with national guidance, and not all staff were up to date with mandatory training. We also found there were gaps in documentation of checks of emergency equipment and had concern about the safety and storage of some medications and medical gases.

The environment required improvement as some patients were not given access to same sex accommodation such as showering and toileting facilities, there was insufficient storage space and tired decor in some areas. There was a major refurbishment plan underway which would address this. The wards were not dementia friendly in layout or environment and there were no identified dementia champions

Wards were visibly clean and equipment was available for staff to use. People’s care and treatment was planned and delivered in line with current evidence based guidance and there was participation in local and national audits.

Feedback from patients and carers was positive in relation to their experiences of the service and staff were proud of the service they provided.

There was an open culture in the service with senior managers being visible and approachable for staff.

End of life care

Requires improvement

Updated 9 June 2016

Out of nine ‘do not attempt cardiopulmonary resuscitation’ (DNACPR) forms we looked at, four were either incomplete or gave us concern.

The draft guidelines for end of life care and the last days of life had not yet been implemented at the hospital. The Deprivation of Liberty Safeguards (DoLS) policy expired in October 2013. The flowchart to guide staff in DoLS decisions was also out of date.

Patient choice around preferred place of care or death was not measured. There was no strategy in place for end of life care.

The environment had limited facilities for patients at the end of life, such as side room availability and showers. There was a refurbishment programme which had commenced.

There were delays in ‘Fast Track’ discharges. There was limited monitoring of quality of care for end of life care.

However, we also found that lessons were learned and learning was shared after things had gone wrong. The specialist palliative care team of nurses and doctors were skilled and knowledgeable. All the clinical nurse specialists were non-medical prescribers. This meant they could prescribe medications for patients when they were needed

In the year from April 2014 to 2015, over 97% patients were seen within 24 hours of referral to the specialist palliative care team. The specialist palliative care team provided seven day clinical support to the hospital. We found evidence of compassionate and understanding care on all the wards at the hospital. Staff we spoke with understood the impact of end of life care on the patients and family well-being.

The teenage cancer unit had a bright informal atmosphere; patient’s individual needs were met on the unit. There were positive examples of local leadership in the palliative care team, from both a nursing and medical perspective.