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Croydon University Hospital Requires improvement

We are carrying out a review of quality at Croydon University Hospital. We will publish a report when our review is complete. Find out more about our inspection reports.

Inspection Summary


Overall summary & rating

Requires improvement

Updated 21 February 2018

A summary of services at this hospital appears in the overall summary above.

Inspection areas

Safe

Requires improvement

Updated 21 February 2018

Effective

Requires improvement

Updated 21 February 2018

Caring

Good

Updated 21 February 2018

Responsive

Good

Updated 21 February 2018

Well-led

Requires improvement

Updated 21 February 2018

Checks on specific services

Medical care (including older people’s care)

Updated 2 October 2019

We have not rated this service as we only focused on specific areas of concern.

Services for children & young people

Good

Updated 7 October 2015

Children’s services at Croydon University Hospital provided effective, caring and responsive support to premature babies, sick children and their families. Patient safety was assured though vigilant monitoring and responding to any deteriorating child.

Staff were required to complete safety related subjects but targets were not always met, particularly within the paediatric medical staff. There were some discrepancies in staffing levels of doctors and nurses due to vacancies, which were managed to ensure patient safety was not compromised.

There was an open and transparent approach to reporting and learning from incidents. Infection prevention and control measures were in place to minimise risks to those who used the service.

Effectiveness of services were geared to reducing emergency readmission rates and delivering the best treatment and care outcomes for children and young people, in accordance with best practice. A multidisciplinary team approach to patient care prevailed, and our observations and feedback from people using the services demonstrated that care was delivered in a kind, compassionate, respectful and friendly manner.

Responsiveness of the service was achieved through close working arrangements with community-based services, which ensured that children could expect to be cared for at home via community nursing services.

The service was well-led and staff spoke positively about providing high quality care that was aligned to the trust-wide vision of ensuring that patients received safe, clean and personal care. Whilst the overall care environment and ambiance of the Rupert Bear Ward and Special Care Baby Unit were tired and in need of refurbishment especially with regard to parent accommodation, the trust had acknowledged this was an area of concern and had developed action plans to improve facilities for babies and sick children.

Critical care

Requires improvement

Updated 21 February 2018

Our rating of this service stayed the same. We rated it as requires improvement because:

  • There were significant risks associated with the environment, which did not meet Department of Health Health Building Notes. Although the building was in place before these regulations, risks in relation to the environment were often poorly and inconsistently managed.
  • We observed variable levels of adherence to infection prevention and control policies and best practice that placed staff and patients at increased risk.
  • Staff did not effectively or consistently manage fire safety risks.
  • Although staff delivered care and treatment in accordance with national policies and best practice, there was a lack of auditing to monitor outcomes and deliver improvements.
  • Some staff did not demonstrate appropriate knowledge of the Mental Capacity Act (2005), capacity assessments or the implementation of the Deprivation of Liberty Safeguards. This meant patients who experienced fluctuating or reduced capacity to make decisions may not have always received appropriate care.
  • Although there was evidence of multidisciplinary team (MDT) working, this took place on an individual as-needed basis. There were no coordinated MDT meetings even for patients with the most complex needs and members of the MDT team were not included in ward rounds. However, where staff referred a patient we saw the MDT response was timely.
  • Pharmacist cover did not meet the minimum standards of the Intensive Care Society (ICS) and there were gaps in medicines management as a result.
  • There were limited resources available to staff on the unit for patients with needs relating to learning disabilities and dementia and for speakers of languages other than English. Although there was a learning disability lead nurse was in post, staff did not always proactively access resources that were available.
  • Governance and risk management systems were in place but were not always used effectively. There was limited evidence leadership was consistently effective or that it contributed to a sustainable work and care environment.

However:

  • The unit met the requirements of the Faculty of Intensive Care Medicine (FICM) and the (ICS) core standards for intensive care units in relation to staffing levels and competencies.
  • There was an effective system in place for reporting and investigating incidents and evidence that learning was shared in the team.
  • Staff delivered compassionate and attentive care and adapted this to a challenging environment.
  • Staff avoided overnight discharges whenever possible and where these were unavoidable completed an incident report to identify areas for improvement with patient flow.
  • Although we have noted the limited physical resources for staff to help them support patients with a learning disability, a learning disability lead nurse was in post. During our inspection we observed this member of staff provide a high standard of care when a patient was referred to them.

End of life care

Good

Updated 21 February 2018

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

  • The SPCT were competent, knowledgeable and responded to patients and their loved ones’ needs. The team had completed mandatory training.
  • The SPCT worked as an integrated team with hospital and local hospice to promote continuity and consistency in patient care. The team also participated in local and national audits to share information.
  • Staff knew what incidents to report and how to report them and managers were involved in investigating incidents and shared any lessons learned.
  • The team held daily meetings, attended ward rounds and multidisciplinary team meetings across the hospital specialties, in order to provide knowledge, support and input into patients’ end of life care.
  • Medicines were managed and prescribed appropriately and equipment was available to patients at the end of their life and equipment was well maintained.
  • Palliative and end of life care was provided on many wards at the hospital and all staff were caring and committed to meeting patients’ needs.
  • Palliative and end of life care services was provided by dedicated, caring and compassionate staff across the hospital. We observed care was planned and delivered in a way which took account of people’s wishes.

However:

  • Whilst Do Not Attempt Resuscitation (DNACPR) were in place for patients and clearly identified on the electronic patient record (EPR), ward staff were not able to show us the completed forms. SPCT were able to access the forms easily.
  • The consultant cover was .5 whole time equivalent (WTE) which is 1.5 WTE short of national guidelines. A business case had been submitted for additional consultants.
  • Staff across the service understood how to protect patients from harm and abuse. However, they were not correctly assessing patients’ with regards to their capacity to make decisions about their care. Staff had training on safeguarding, the Mental Capacity Act, and Deprivation of Liberty Safeguards (DoLS), but we found areas of concern with regards to the Mental Capacity Act (2005) and the completion of DoLS application. The trust did not ensure that staff complied with its policy on Deprivation of Liberties Safeguards (DoLS).

Maternity and gynaecology

Good

Updated 7 October 2015

We found that maternity and gynaecology services were provided to a good standard. There had been continued and sustained improvements to maternity services. Women who had previously given birth at the hospital commented positively on the improvements to maternity services and told us staff were caring, responsive and knowledgeable.

We found an integrated clinical governance system in use and action was taken when non-compliance with standards was identified. The risk register was active and regularly updated and plans for mitigation put in place pending action to eliminate the risk. Information about performance and risk was communicated through the governance arrangements to the trust board. 

There were robust arrangements in place for recording adverse events and near misses, and investigating and learning from these. There was an expectation of openness and honesty. When outcomes were worse than expected, staff met women, and their families when appropriate, to provide a full explanation.

Staff did not always complete the required safety related mandatory training.

Agreed staffing levels were appropriate to meet current demand. However, improvements were needed in the use of the maternity services escalation policy at busy times. New staff were well supported, and there was a comprehensive mandatory training programme, with opportunities for development. The directorate had identified that appraisal rates for midwifery staff were low and action had been taken to improve this. Staff we spoke with said there was effective communication in maternity and gynaecology services.

There was easy access to services for women and there individualised care plans were developed for each woman.

There was adherence to good practice guidelines and outcomes for women met expectations.

Outpatients and diagnostic imaging

Good

Updated 21 February 2018

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

  • Staff had completed mandatory training and they were supported with their professional development.
  • There was good compliance with infection prevention and control practices.
  • There were sufficient staff to care for patients and a matron had been appointed since our last inspection.
  • Patients were positive about the care they received and told us they were involved in decisions about their care.
  • Clinics were well organised and waiting times were within national standards for many conditions including cancer.
  • A new dedicated cardiology department had been opened.

However:

  • Not all staff were aware and had access to the risk registers.
  • There was a backlog of some GP letters which the trust planned to clear by December 2017.
  • Some staff at Purley War Memorial Hospital had some concerns about security.

Surgery

Updated 2 October 2019

We have not rated this service as we only focused on specific areas of concern.

Urgent and emergency services

Good

Updated 7 October 2015

Overall, we have rated the Accident and Emergency Department also known as the Emergency Department (ED) at Croydon University Hospital as good. Staff who worked in the department demonstrated a multi-disciplinary approach to caring for their patients. They worked cohesively together, respecting each other’s skills, experience and competencies in a professional manner that benefited the patients they cared for.

Safety in the department required improvement. The environment did not always enhance patient safety and equipment was not always cleaned properly.

Patients arriving by ambulance were assessed and treated quickly but other patients were not always clinically assessed as soon as they arrived in the department. It was possible for their condition to deteriorate while they were waiting to be seen. This was partly caused by the fact that the Emergency Department shared reception facilities with the adjacent urgent care centre, which was run by another organisation. On arrival at the reception, some patients were sent in error to the urgent care centre, which had an adverse impact on some of their patients.

Staffing levels for both medical and nursing staff also needed to improve. Care and treatment was effective and delivered in line with current evidence based guidance and standards. The trust used national and local clinical audits to monitor the effectiveness of care and treatment.

The department was responsive to the needs of local people and had particularly good facilities for patients with dementia. The ED was better than many other hospitals in meeting the national target of admitting or discharging 95% of patients within four hours. The department itself was well-led. The leadership actively shaped the culture through effective engagement with staff and patients. They Demonstrated the skills, knowledge and experience needed for their roles.