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Royal Berkshire Hospital Good

Inspection Summary


Overall summary & rating

Good

Updated 7 January 2020

Our rating of services went down. We rated it them as good because:

  • We rated three of the trust’s services at Royal Berkshire Hospital as good. Overall, we rated this location as good.

  • We rated safe, effective, caring, responsive and well led as good at the Royal Berkshire Hospital. Safe was rated as requires improvement in two of the three core services we inspected, and good in the other core service. All three core services were rated good for effective, caring, responsive and well led.
  • Gynaecology services had previously been rated with maternity services, at this inspection we rated the service separately to maternity in line with our new approach to inspection of this core service. We rated safe, effective, caring, responsive and well led as good,
  • Medical care service at Royal Berkshire Hospital had dropped its ratings from outstanding to good in caring and responsive, from good to requires improvement for safe, but stayed the same for effective and well led, which were rated as good.

  • Maternity services had previously been rated with gynaecology services, at this inspection we rated the service separately to gynaecology in line with our new approach to inspection of this core service. We rated safe as requires improvement. Effective, caring, responsive and well led were rated as good.

Inspection areas

Safe

Good

Updated 7 January 2020

Effective

Good

Updated 7 January 2020

Caring

Good

Updated 7 January 2020

Responsive

Good

Updated 7 January 2020

Well-led

Good

Updated 7 January 2020

Checks on specific services

Medical care (including older people’s care)

Good

Updated 7 January 2020

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

  • Patients were protected by a strong comprehensive safety system and there was a focus on openness, transparency and learning when things went wrong.
  • Staffing levels and skill mix were planned, implemented and reviewed to keep patients safe at all times. Any staff shortages were responded to.
  • Outcomes for patients who used the service were mostly better than expected when compared with other services.
  • Staff’s skills, competence and knowledge were continuing being developed as integral to ensure high-quality care.
  • Staff were proactively supported and encouraged to acquire new skills, use transferable skills and share best practice. Volunteers were proactively recruited, trained and supported in their roles.
  • There was excellent, effective multidisciplinary working within the medical care services.
  • Feedback from people who used the service, friends and family was consistently positive about the way staff treated people and provided care. Staff were highly motivated in delivering patient-centred care in a respectful and dignified way.
  • Patients told us they felt involved in decisions about their or their loved ones care and treatment.
  • Clear governance structures were in place and we saw effective management of risks. Senior managers were visible and highly regarded.
  • Staff were proud of the organisation as a place to work and spoke highly of the culture.

However:

  • Not all staff were up-to-date with their mandatory and safeguarding training.
  • There were lapses in infection and prevention control practices.
  • Storage of equipment did not always follow best practice or was kept in inappropriate areas of the wards.

Services for children & young people

Good

Updated 24 June 2014

Babies, children and young people were cared for in wards and departments that were clean. Infection control practices were adhered to. There were sufficient nursing and medical staff across all areas. Staff used recognised early warning systems for both neonates and paediatric patients. Staff reported incidents, and learning was shared across the area to prevent the likelihood of a reoccurrence. Security for patients and staff in the neonatal and paediatric areas was good. Access to mandatory and additional training was available to staff, to allow them to develop additional skills.

Care and treatment was delivered in line with national guidelines. Outcomes were reviewed, and there was active participation in research and audit. Care plans and pathways were in use. Multidisciplinary team working was good in all areas.

Staff provided care in a kind and compassionate manner. Parents were involved in both decision-making and the delivery of care and were given appropriate emotional support. There was a highly visible leadership team and an open and supportive culture.

Critical care

Good

Updated 11 January 2018

Our rating of this service improved. We rated it as Good.

End of life care

Good

Updated 24 June 2014

The palliative care team was available seven days a week, with the hospice providing out-of-hours cover. Medicines were provided in line with guidelines for end of life care. DNACPR forms were not consistently completed in accordance with policy and there were no standardised processes for completing mental capacity assessments.

Training relating to end of life care was provided at induction and study days were arranged for palliative care link nurses from wards. Leadership of the palliative care team was good and quality and patient experience was seen as a priority.

All patients requiring end of life care could access the palliative care team. Viewing times in the mortuary were limited, which impacted on patients’ families being able to view their relative. There was a multidisciplinary team (MDT) approach to facilitate the rapid discharge of patients to their preferred place of care.

Relatives of patients receiving end of life care were provided with meal vouchers and free car parking. Patients were cared for with dignity and respect and received compassionate care. The ‘End of Life Care Plan’ was the pathway patients were placed on in the last few days of life.

Outpatients and diagnostic imaging

Outstanding

Updated 11 January 2018

A summary of this service appears in the Overall summary.

Surgery

Good

Updated 11 January 2018

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

The wards, theatres and recovery areas were clean and well maintained.

  • Theatre staff followed the World Health Organisation (WHO) surgical safety checklist and five steps to safer surgery, and staff in theatre provided a safe environment for the patient.

However:

  • Each morning on Level 3, Main Entrance, there was a daily bed meeting which reviewed current and new environment and equipment issues that required attention.
  • Ward staff were using the National Early Warning Score (NEWS) system for the monitoring of patients on wards.
  • Clinical observations were logged on to the electronic patient record (EPR) in real time.
  • Staff were aware of the systems and processes for reporting safeguarding incidents, and staff on different wards demonstrated they knew how to use the electronic adverse incident reporting system.
  • The 90% target was not met for any of the safeguarding training modules by medical staff.
  • The 90% target was not met for any of the statutory and mandatory training modules by clinical staff. Completion was particularly low for clinical risk assessment and venous thromboembolism.

Urgent and emergency services

Good

Updated 11 January 2018

Our rating of this service stayed the same. We rated it as Good

Gynaecology

Good

Updated 7 January 2020

This inspection was the first time the gynaecology service had been inspected as a stand-alone service. Previously it had been inspected alongside Maternity. We rated it it as good because:

The trust has 15 inpatient gynaecology beds located on Sonning Ward at Royal Berkshire Hospital. The ward admits both emergency and elective gynaecology patients, and also admits breast surgery and early pregnancy patients. The ward hosts a gynaecology day unit.

The trust has a range of outpatient gynaecology clinics including the colposcopy clinic, gynaecology emergency clinic, hysteroscopy clinic, minor operations and implants clinic, pelvic floor and urodynamics, and post-menopausal bleeding clinic. The trust also provides a fertility service.

(Source: Trust Provider Information Request – Acute sites)

The trust’s gynaecology service is part of their urgent care division.

The gynaecology services provided by the trust included 15 inpatient beds, clinics and theatres to support women’s health conditions. These included diagnostic and treatment services for a range of health concerns including; abnormal bleeding, cancer services, pelvic pain, hysteroscopy services, endometriosis, colposcopy and urogynaecology services.

Termination of pregnancy is not routinely carried out at the Royal Berkshire Hospital. The termination of pregnancy service is provided by an external provider. The Royal Berkshire Hospital only performs the procedure for women with very complex medical needs who are referred to them.

During the period 1 March 2018 to 28 February 2019 the service carried out two surgical abortions and no medical abortions

We visited the following areas:

  • Early Pregnancy Unit (EPU). This is located in one room which has three curtained treatment areas.
  • Sonning ward, which is a gynaecology ward for women receiving gynaecological procedures or treatment, including surgical management of miscarriage, and, rarely, termination of pregnancy. It has 15 beds in the form of two four-bed bays, one five-bed bay and two side rooms.
  • Outpatient’s department, which is where all gynaecology clinics including the post-menopause bleeding service, endometriosis service, oncology clinics and termination of pregnancy clinics are provided.

  • Gynaecology theatres, which are dedicated theatres for gynaecological surgeries. There are two dedicated theatres for the gynaecology service.

  • Hyperemesis day centre, which is located on the Day Assessment Unit. Staff treat women with rapid fluid and medication infusion through intravenous access on a day case basis. It has one room with two comfortable chairs for treating women.

  • Hysteroscopy and colposcopy suite, which has one treatment room for hysteroscopy and minor ops, and one treatment room for colposcopy.

  • Urogynaecology and urodynamics unit, which has two consultation and treatment rooms.
  • Pre-assessment unit, which is where women go to be assessed one or more days before they are due for a surgical procedure. The clinic appointment is where nurses check if women have any medical problems that might need to be treated before their operation, or if they will need special care during or after the surgery.
  • Our inspection was unannounced (staff did not know we were coming) to enable us to observe routine activity. We inspected all five key questions of the gynaecology service.
  • Before the inspection visit, we reviewed information that we held about these services and information requested from the trust.

Maternity

Good

Updated 7 January 2020

We previously inspected maternity jointly with gynaecology so we cannot compare our new ratings directly with previous ratings. We rated maternity as requires improvement because:

  • Staff told us the age of the maternity block the building could present challenges to staff. During our inspection we saw a leak in the antenatal unit reception area. Although the trust took timely action to address the leak, staff told us leaks were a regular occurrence.
  • We found an electrical cupboard unlocked on the antenatal unit. We drew this to staff attention and the cupboard was locked immediately. However, there was a risk that the electrical supply on the unit could be interfered with if the cupboard was unlocked.
  •  The Maternity Birthrate Plus and report 2018 submitted to the executive management committee in February 2019, showed that a freeze on vacancies on 2018-2019 meant that funding for an additional 62.2 midwives and 6.3 maternity support workers was necessary to meet their own assessed staffing level.
  • Training rates for the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards were not meeting the trust’s 90% standard. As a result the trust could not be assured that all staff followed the trust policy and procedures when a woman lacked capacity to consent.
  • The number of occasions the midwifery led unit was suspended for four hours or more had been ‘red flagged’ for nine out of 12 months from April 2018 to March 2019.
  • The risk register did not contain details of actions that had been taken to mitigate risks or identify timescales for when actions should be completed. This meant the risk register could not be used as a tool to monitor the progress of risks.
  • Staff told us that due to system changes as a result of the trust’s move to digitalisation they had been unable to pull some outcome data from the system. Staff said they were doing a ‘work around’ until the trust’s digital services team had resolved the issue. IT issues had also been identified by some staff when working remotely in the community or other work settings.

However:

  • The maternity service had completed actions to meet the requirements of the ‘saving babies lives’ care bundle, with the aim of reducing stillbirths, neonatal deaths, and intrapartum brain injuries.
  • There was a focus on innovation and research in maternity. Most staff we spoke with told us they were of the opinion that maternity services had improved and there was a culture of quality assurance being embedded in the service.
  • The antenatal unit was midwife led. We found staff were committed to providing and promoting normal birth. Women were assessed for any extra care needs they may require at booking with the community midwives. This included an assessment for postnatal anxiety and depression.
  • Maternity had introduced a triage area which provided triage, assessment, advice and a plan of care to women, 24 hours a day, seven days a week. There was a designated triage team allowing for better continuity of care and improved communication.
  • Maternity services had introduced a new model of midwifery supervision, the professional maternity advisor (PMA) role to roll out the new model of midwifery supervision ‘A-EQUIP’ (advocating for education and quality improvement).
  • The women and relatives we spoke with all reported that they received compassionate care and all staff were kind to them. Most women told us they felt involved in planning and making decisions about their care.
  • Maternity services had a clearly defined accountability structure. The midwifery lead and community matron were accountable to the director of midwifery.
  • There were a range of governance meetings to ensure information flowed from board to ward.

Outpatients

Outstanding

Updated 11 January 2018

We rated it as Outstanding.