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Inspection Summary


Overall summary & rating

Good

Updated 23 July 2019

Our rating of services stayed the same. We rated it them as good because:

  • Patients reported staff as kind, caring and responsive to their needs. The individual physical, spiritual and emotional needs of people were considered when discussing and agreeing their care. Staff were respectful and ensured patients dignity, decisions and choices were respected as far as possible.
  • The services inspected had enough staff with the right skills and experience to keep people safe and to enable the required treatment and care to be delivered. Staff had access to training and development opportunities, received supervision and support and had their performance reviewed.
  • Staff understood their responsibilities to protect people from avoidable harm. The Mental Health Act 1983 and the Mental Capacity Act 2005 was understood by staff. They knew how to support patients experiencing mental ill health and those who lacked the capacity to make decisions about their care.
  • Staff worked in cooperative way across the multidisciplinary team, ensuring patients received the right treatment and care from appropriately skilled staff.
  • Risk assessment and monitoring tools were available to help staff recognise and responded to patients whose needs changed. There was access to staff with additional skills and technical equipment in emergency situations.
  • Infection prevention and control practices followed by staff helped to minimise the risk of people getting a hospital acquired infection. The environment in which people received care was visibly clean and equipment was cleaned before patient use.
  • There was a well-established system to report, investigate and learn from incidents, which all staff understood and felt confident to use.
  • The services inspected were planned around the needs of the local population. There was a strong focus on ensuring patients had access to the right care at the right time.
  • Feedback from people who used the services was used to make improvements. The complaints process was overseen by a skilled team. Duty of candour was understood by staff and followed when it applied.
  • Leaders at service level were suitably skilled and experienced to lead their teams and to ensure the trust’s vision and strategic aims were being delivered. A culture which focused on the patient was very evident. Staff enjoyed working at the trust, where they felt valued and empowered to make improvements, be that on a personal or service level.

However:

  • Mandatory training was not achieving the trust’s expected rates in some areas.
  • Early Warning Observational Risk scores in maternity services were not always completed consistently.
  • Access and treatment targets were not being met for several reasons. This included referral to treatment and the operational standard for patients receiving their first treatment within 62 days of an urgent GP referral in relation to cancer waiting times. Did not attend rates were higher than the England average for the previous year.
Inspection areas

Safe

Requires improvement

Updated 23 July 2019

Effective

Good

Updated 23 July 2019

Caring

Outstanding

Updated 23 July 2019

Responsive

Good

Updated 23 July 2019

Well-led

Outstanding

Updated 23 July 2019

Checks on specific services

Maternity

Good

Updated 23 July 2019

We rated it as good because:

  • Women were encouraged to discuss their choices and decision-making about the birth of their baby with the midwife. A range of options for birth, including a midwifery-led home from home birth centre and a community midwife-led home birth option.

  • The service had made marked improvements in the antenatal day assessment unit which had been renamed the maternity assessment unit. Women were now seen and treated in a timely manner.

  • The service had improved the completion and recording of venous thromboembolism (VTE) risk assessments for women.

  • Policies and treatment protocols were informed by evidence based national guidance.

  • Staff of all disciplines reported good team and line manager support and had opportunities for continuing professional development.

  • Staff told us management encouraged openness. Incident reporting was embedded in practice. There were clear systems for reviewing, investigating and learning from incidents and complaints.

  • There was effective multidisciplinary working with other services in the trust and with external organisations.

  • There was bereavement support for women, their partners and loved ones.

    Midwives provided care and support for vulnerable women and women with medical conditions.

  • The service was well-led with a clear vision and strategy. Staff felt supported, they enjoyed working for the service and morale was high.

Outpatients

Requires improvement

Updated 23 July 2019

We visited the outpatients services at St Thomas’ Hospital for three unannounced inspection days from Tuesday 2 April to Thursday 4 April 2019. During our inspection we inspected clinics in the Gassiot House Outpatient Centre, the diabetes, cardiology, pain, pelvic floor, ears nose and throat, ophthalmology, colorectal, emergency vascular and chest clinics. We spoke with 45 members of staff including doctors, nurses, allied health professionals and ancillary staff. We also spoke with the outpatients leadership team, and 17 patients and relatives. We reviewed seven patient records and checked many items of clinical and non-clinical equipment.

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

We rated it as requires improvement because:

  • The trust had many patients with overdue follow up appointments and it was unclear how the trust was managing the risks to these patients.

  • The trust’s ‘did not attend’ rate was higher than the England average.

  • The service was not meeting the referral to treatment (RTT) targets for certain specialities.

  • The trust wide data showed a backlog of patients waiting longer than 18 weeks was 9810 in

February 2019 and in March 2019, the backlog was 10048. In January and February 2019, there were 32 patients waiting over 52 weeks for both months.

  • The service provided mandatory training in key skills to all staff and but not all staff completed it to meet the trust targets.

  • The trust was not auditing their patient waiting times from the time of first appointment from when they first checked into the appointment and the time when the patient was seen by the clinician.

However:

  • The service provided care and treatment based on national guidance and evidence of its effectiveness.

  • Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.

  • Staff felt supported and motivated and there was a positive culture within the workplace.