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Queen's Hospital, Burton Upon Trent Requires improvement

Reports


Inspection carried out on 7 - 9 July 2015

During an inspection to make sure that the improvements required had been made

Queen’s Hospital is part of Burton Hospitals NHS Foundation Trust. The hospital provides a full range of district general hospital services and also has a treatment centre which provides day case ophthalmology, outreach and community-based clinics to the population.

We inspected this hospital in July 2015 as part of the comprehensive inspection programme. We inspected all core services provided by the trust.

We visited the hospital on 7, 8 and 9 July 2015 as part of our announced inspection. We also visited unannounced to the hospital on Friday 24 July 2015.

Overall we have rated this hospital as requires improvement. We saw that services were caring and compassionate. We also saw that people have good outcomes because they receive effective care and treatment that met their needs. We saw a number of areas that required improvement for them to be assessed as safe and responsive. We saw that leadership of services in some areas also required improvement.

Our key findings were as follows:

  • The hospital had made significant progress since our last inspection in April 2014. Improvements in safety and leadership were evident, but there was still more work to be done.
  • Staff were caring and compassionate towards patients and their relatives. Patients’ dignity and privacy was ensured and we saw many examples of good care right across the trust for staff at all levels.
  • There was a strong open culture and staff were encouraged and supported to report incidents. There were clears systems in place to ensure lessons were learnt and services developed as a result.
  • The pathway for patients requiring emergency gynaecology care was ineffective.
  • End of life care services had improved and there were clear plans in place to develop the service further.
  • Nurse staffing was a challenge in some areas of the trust. There was heavy reliance on agency staff to ensure staffing levels were kept safe. The trust was working hard to address this.

We saw several areas of outstanding practice

  • Critical care had developed an organ donation group to improve and promote organ donation within the hospital and the local community.
  • The maternity service was awarded the Excellence in Maternity Care award by CHKS in 2014. The quality of care at Burton Hospitals NHS Foundation Trust was judged to be the best out of 148 NHS maternity providers in England, Wales and Northern Ireland.
  • Innovative practice to increase hand hygiene, using the latest technology monitoring the use of alcohol sanitising gel.

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

Importantly the trust must:

  • The trust must ensure that ward assurance targets, such as hand hygiene practice and recording of patient observations, is achieved at a consistent level in the emergency department.
  • The trust must review the use of agency staff on surgical wards to ensure staffing levels and skills mix are maintain and all staff have access to the relevant records.
  • The trust must develop a clear vision and strategy for critical care services which is shared with staff and clinical leaders and demonstrates how the service will develop in the medium and long term.
  • The trust must ensure that all identified learning points from the investigations into recent Never Events are fully implemented and signed off to ensure that learning and changes to practice have been put in place.
  • The trust must develop a strategy and long term vision for gynaecology services at the trust to ensure that patient services can improve and develop.
  • The trust must ensure that a rapid discharge pathway for end of life patients is formalised to ensure that people can leave hospital in an effective way that meets their wishes.
  • The trust must review policies and procedures for planning and booking outpatient clinics to ensure that waiting times for appointments are minimise and patients are not subject to long delays in waiting for appointments. Waiting times in outpatient clinics should be re routinely monitored.

 

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection carried out on 24-25 April and 6-7 May 2014

During a routine inspection

Queen’s Hospital is part of Burton Hospitals NHS Foundation Trust. The hospital provides a full range of district general hospital services and also has a treatment centre which provides day case ophthalmology, outreach and community-based clinics to the population.

We inspected this hospital in July 2015 as part of the comprehensive inspection programme. We inspected all core services provided by the trust.

We visited the hospital on 7, 8 and 9 July 2015 as part of our announced inspection. We also visited unannounced to the hospital on Friday 24 July 2015.

Overall we have rated this hospital as requires improvement. We saw that services were caring and compassionate. We also saw that people have good outcomes because they receive effective care and treatment that met their needs. We saw a number of areas that required improvement for them to be assessed as safe and responsive. We saw that leadership of services in some areas also required improvement.

Our key findings were as follows:

  • The hospital had made significant progress since our last inspection in April 2014. Improvements in safety and leadership were evident, but there was still more work to be done.
  • Staff were caring and compassionate towards patients and their relatives. Patients’ dignity and privacy was ensured and we saw many examples of good care right across the trust for staff at all levels.
  • There was a strong open culture and staff were encouraged and supported to report incidents. There were clears systems in place to ensure lessons were learnt and services developed as a result.
  • The pathway for patients requiring emergency gynaecology care was ineffective.
  • End of life care services had improved and there were clear plans in place to develop the service further.
  • Nurse staffing was a challenge in some areas of the trust. There was heavy reliance on agency staff to ensure staffing levels were kept safe. The trust was working hard to address this.

We saw several areas of outstanding practice

  • Critical care had developed an organ donation group to improve and promote organ donation within the hospital and the local community.
  • The maternity service was awarded the Excellence in Maternity Care award by CHKS in 2014. The quality of care at Burton Hospitals NHS Foundation Trust was judged to be the best out of 148 NHS maternity providers in England, Wales and Northern Ireland.
  • Innovative practice to increase hand hygiene, using the latest technology monitoring the use of alcohol sanitising gel.

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

Importantly the trust must:

  • The trust must ensure that ward assurance targets, such as hand hygiene practice and recording of patient observations, is achieved at a consistent level in the emergency department.
  • The trust must review the use of agency staff on surgical wards to ensure staffing levels and skills mix are maintain and all staff have access to the relevant records.
  • The trust must develop a clear vision and strategy for critical care services which is shared with staff and clinical leaders and demonstrates how the service will develop in the medium and long term.
  • The trust must ensure that all identified learning points from the investigations into recent Never Events are fully implemented and signed off to ensure that learning and changes to practice have been put in place.
  • The trust must develop a strategy and long term vision for gynaecology services at the trust to ensure that patient services can improve and develop.
  • The trust must ensure that a rapid discharge pathway for end of life patients is formalised to ensure that people can leave hospital in an effective way that meets their wishes.
  • The trust must review policies and procedures for planning and booking outpatient clinics to ensure that waiting times for appointments are minimise and patients are not subject to long delays in waiting for appointments. Waiting times in outpatient clinics should be re routinely monitored.

 

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection carried out on 31 May 2013

During an inspection in response to concerns

We carried out this inspection because we received information of concern from the Rapid Responsive Review team (RRR). The RRR was being completed as part of the Professor Sir Bruce Keogh review into the quality of care and treatment provided by those NHS trusts and NHS foundation trusts that are persistent mortality indicators. This trust is one of 14 hospital trusts being reviewed on the basis that they have been outliers for the last two consecutive years on either the Summary Hospital Mortality Indicator or the Hospital Standardised Mortality Ratio.

We were told that some staff responsible for completing patients’ death certificates had been asked to alter patients’ death certificates and in some cases complete death certificates for patients they had not recently seen or treated.

We spent time during our inspection speaking with staff, looking at deceased patients’ care records and reviewing completed death certificates. We found that in each case we looked at death certificates were completed correctly.

Inspection carried out on 18 December 2012

During an inspection to make sure that the improvements required had been made

We inspected this service in September 2012 and we found they were not compliant in relation to medication practices. This meant the registered provider had to make improvements to deliver good outcomes for the people when they required support with their medication. The inspection was unannounced, which meant the registered provider and the staff did not know we were coming.

This inspection was to look at the evidence available following the action plan we had received from the registered provider, and to speak with people using the service and the staff, to see if improvements had been made in relation to medication practices.

We inspected three wards, Ward 3, 5 and 11, and the treatment centre, which had not been inspected previously. This is a separate building, but part of the hospital.

We spoke with five people and asked them about the staff and how their medication had been managed during their stay. One person said, “The approach of the staff has been brilliant, they are courteous and listen. They have explained everything about the medication I am taking and have ensured I know what to do when I go home.” Another person said, “They are better now than they have ever been, the staff are fantastic. They have written everything in my notes and I know why they are giving me my tablets.”

We saw the registered provider had put right what was required. This meant they were managing medicines as required for the people using their service.

Inspection carried out on 10 September 2012

During an inspection to make sure that the improvements required had been made

We carried out an unannounced scheduled inspection in June 2012. During the inspection we made one compliance action about the management of medicines. This meant the trust had to make improvements and deliver good outcomes for the people who used their service when they required support with their medication.

This unannounced inspection was to look at the evidence available following the action plan we received from the trust, and to speak with people who used the service to see if improvements had been made in relation to medication practices. We visited two wards, Ward 11 which we had visited on our last inspection and Ward 3, which we chose at random and had not inspected previously.

We found that although improvements had been made in the areas we had identified there were new areas of concern. These included medication storage and current administration practices.

We spoke with people using the service on Ward 11 and asked them about the staff and about how their medication had been managed during their stay. Comments included, “The nurses here couldn't do enough for me.” Another person said, “They always ask me if I have any pain and offer me my paracetamol.”

We saw the trust had put right what was required following our last inspection, but needed to ensure their systems and structures across all areas of medicine management were suitable and safe.

Inspection carried out on 19 June 2012

During a routine inspection

We carried out this inspection to check on the care and welfare of people using this service. We visited Queens Hospital to ensure that the needs of people using the service were being met. The visit was unannounced which meant the hospital and the staff did not know we were coming. The visit consisted of a team of five inspectors, an expert by experience, a pharmacist inspector and a regional intelligence and evidence officer from the Care Quality Commission (CQC). We visited four wards providing adult inpatient care across the hospital. We spoke with 31 people who were receiving a service, four visitors, two volunteers and 36 staff from different disciplines.

We involve people who use services and family carers to help us improve the way we inspect. These people have experience of using health and social care services and we call them experts by experience. An expert by experience took part in this inspection and talked to the people who used the service. They took some notes and wrote a report about what they found. Their information is included within this report.

Everyone we spoke with told us that they were getting the care and support they needed. Comments included, “I feel I have been treated in a dignified manner. The care is absolutely fine, and the staff attitude was professional.” Another person told us; “I am very satisfied; they have looked after me very well.”

People said the staff supported them sensitively and discreetly. When we spoke with the staff they were able to provide good examples of how they promoted people’s privacy and dignity in their work. People who used the service felt they were treated with respect. One person said; “They closed the curtains during the doctor’s visit. The care so far has been 100%, very dignified; I am very satisfied with my treatment.”

Everyone we spoke with told us that they liked the meals. People said there was always a choice and that food arrived hot. One person told us, “I have been here a week, food is good, four lunch choices, so you cannot fault it.” The staff told us protected mealtimes had ensured people were not disturbed when eating their meals, and that staff were able to assist people who required support and supervision with eating and drinking. We evidenced this at lunchtime, and saw people received the support they required from the staff to eat and drink in a calm and relaxed manner.

We looked at medication management and found that medication was not stored securely and not always administered or recorded in a suitable manner. This meant people using the service were placed at risk because the management of medicines was not as safe as it needed to be.

We observed people being cared for in a clean environment. There was evidence available to confirm suitable practices were in place regarding infection control and its management.

Everyone we spoke with told us that the nurses were are always asking them if they were happy with everything. They said that they were able to express their wishes and share their views about how they were feeling and what could be done to make them feel more comfortable. One person said, “I have been in here three months, they have all been so kind and understanding, they have saved my life.”

We looked at ways in which the hospital assessed it own quality and safety and saw suitable systems were in place. However, when issues within the hospital had been identified there were not always records to support how these had been dealt with and/or improved upon. This meant the outcome of audits were not always available.

Inspection carried out on 20 March 2012

During a themed inspection looking at Termination of Pregnancy Services

We did not speak to people who used this service as part of this review. We looked at a random sample of medical records. This was to check that current practice ensured that no treatment for the termination of pregnancy was commenced unless two certificated opinions from doctors had been obtained.

Inspection carried out on 6 April 2011

During a themed inspection looking at Dignity and Nutrition

Most people who used the service (patients) told us all the staff involved them in their care, treatment and support. They confirmed their privacy and dignity was respected. Most people told us that staff responded to their needs quickly and verified the staff were kind and explained what was happening to them.

Comments included:

“I am more than happy with the staff; their treatment is superior.”

“I am treated well. They do come and check on me regularly.”

“Normally they discuss things with me but when they take blood they just say; ‘I have come to take your blood’, I am not given a choice about having it done.”

We talked to people about meals and mealtimes and observed the lunch being served on two wards. People said they were offered a good choice at mealtimes. All but one person we spoke with were happy with the food, choice, portion size and how their food was presented.

Comments included:

“The food is really nice, loads of choice and not repetitious.”

“They have talked to me about diet and food, I am quite happy with the menu.”

“I only eat breakfast here my family bring my other meals in. The food is awful I can’t eat it. I get plenty of drinks though, including hot drinks.”