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Diana Princess of Wales Hospital Requires improvement

We are carrying out checks at Diana Princess of Wales Hospital. We will publish a report when our check is complete.

Inspection Summary


Overall summary & rating

Requires improvement

Updated 12 September 2018

Our rating of services stayed the same. We rated them as requires improvement because:

  • We rated safe, effective, responsive and well led as requires improvement and caring and as good.
  • At this inspection we saw improvements in some of the hospital’s services, but some services had deteriorated since our previous inspection.
  • We rated two of the hospital’s nine services as good, six as requires improvement and one as inadequate.
  • The hospital did not always have appropriate numbers of staff to ensure patients received safe care and treatment. The trust had introduced some additional staff and roles and used agency staff to provide cover and mitigate some of the risk to patients.
  • There was limited evidence that services staff had the skills, training and experience to provide the right care and treatment. For example, appraisal rates for a number of staff groups were worse than the trust target and mandatory training rates in eight of the nine services at the hospital were below the trust target of 85%.
  • Services at the hospital did not all manage medicines in line with trust policy or national and professional guidance.
  • Not all services provided care and treatment based on national guidance. There was variable participation and outcomes in local audit and national audit and we found action plans did not always address the effectiveness of the care and treatment patients received.
  • Staff did not always understand their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. Training compliance in relation to the Mental Capacity Act did not meet the trust target in some services.
  • People could not always access services when they needed it. The total number of patients on outpatient waiting lists had increased since the previous inspection. Delayed transfers of care, outlying patients, bed moves at night remained a concern in medical care.
  • Services did not always manage and investigate concerns and complaints in line with the trust’s policy.
  • We had some concerns about the ability of staff at all levels in the hospital to recognise where and when improvements were required in their own services.
  • Services at the hospital did not all have a vision, strategy or business plan. There was limited evidence of effective engagement with patients, staff, and the public to plan and manage services.

However:

  • The trust had acted on most of the concerns in the Section 29A warning notice that was issued after the inspection in November 2016.
  • Staff used appropriate tools for identifying deteriorating patients and patients with sepsis and audits showed good compliance with these tools and escalation processes. Nurses told us that medical response to patients they escalated was prompt.
  • Staff worked together as a team to benefit patients. Doctors, nurses, porters, other healthcare professionals and non-clinical staff supported each other to provide good care.
  • Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness. Staff involved patients and those close to them in decisions about their care and treatment.
  • Staff morale appeared to be improving and most staff reported feeling well-supported by their immediate line managers.
Inspection areas

Safe

Requires improvement

Updated 12 September 2018

Effective

Requires improvement

Updated 12 September 2018

Caring

Good

Updated 12 September 2018

Responsive

Requires improvement

Updated 12 September 2018

Well-led

Requires improvement

Updated 12 September 2018

Checks on specific services

Outpatients and diagnostic imaging

Inadequate

Updated 6 April 2017

In the previous CQC inspection in October 2015, we rated this service as inadequate. At this inspection we rated this service as inadequate because:

  • In January 2016 the trust told us that the concerns raised at the October 2015 inspection had been addressed. However, prior to the inspection and following the inspection further cohorts of patients were identified which were not being effectively managed. The trust had failed to address a number of actions, from the October 2015 inspection, in a timely manner.

  • The trust had been slow to implement clinical validation and assessment of risk within waiting lists, across all specialities.
  • The trust had been slow to get to the bottom of waiting list issues and was still discovering patients in unmonitored systems in August 2016.
  • Referral to treatment times were worsening and the trust told us they were unlikely to recover a good position until March 2018.
  • There continued to be large numbers of patients’ overdue follow up appointments or with no due date on the patient administration system.
  • The trust had a continuing high number of cancelled clinics.
  • Effective oversight, monitoring and management of booking patient appointments and waiting list was not evident in all specialities.
  • There was evidence of actual harm and ongoing significant risk of potential harm to patients waiting long periods of time for first and follow up appointments.
  • Safeguarding training compliance for the outpatient staff was below the trust target.
  • There was mixed feedback from staff in a number of roles regarding leadership and an expressed reluctance to raise concerns regarding management or services, for fear of negative repercussions.

However,

  • The trust had taken action to stop cancellation of clinics by non-clinical staff, to improve sharing of lessons from incidents, to ensure safe storage of refrigerated drugs and had improved the facilities and premises in outpatient areas.
  • All radiology staff had received training regarding the ionising radiation (medical exposure) regulations (IR(ME)R 2000).
  • The staff working in outpatients and diagnostic imaging departments were competent and there was evidence of multidisciplinary working across teams and local networks.
  • Nursing, imaging and medical staff understood their roles and responsibilities regarding consent and the application of the Mental Capacity Act.
  • We observed staff in all areas treating patients with kindness and respect and patients were very happy with their care.
  • Concerns and complaints were taken seriously and staff and managers responded positively to patient feedback. There were low levels of complaints for imaging services.
  • The trust performed well against cancer waiting time operational standards.
  • The diagnostic imaging department had a five-year strategy in place to ensure that the department was future proof and had governance processes in place to ensure that risks were mitigated.

Maternity

Good

Updated 12 September 2018

We previously inspected maternity jointly with gynaecology so we could not compare our new ratings directly with previous ratings. We rated it as good because:

  • Good governance processes were in place and good systems for risk management. A risk management and patient safety strategy were in place, and the maternity services risk register was monitored and updated.
  • The management structure had clear lines of responsibility and accountability and there was a strategic vision for maternity services.
  • The group clinical director had recently come into post prior to our inspection. Staff reported they were confident in this person to lead the clinical team.
  • The interim head of midwifery had a positive impact on the culture within maternity services.
  • The service had established an ‘NLaG Outstanding Midwife’ award and had developed local events to celebrate midwifery staff.
  • We observed good team working, with midwives working collaboratively and with respect for each other’s roles. All staff spoke positively and were proud of the progress the service had made since our inspection in 2016.
  • There was a Maternity Voices Partnership in place at the trust. Parents who had a child at the trust in the last three years were invited to join and share their experiences of care.
  • Procedures were in place to refer and safeguard adults and children from abuse. Staff felt confident making referrals and received safeguarding supervision.
  • Record keeping was of a good standard. Staff used ‘fresh eyes’ reviews of cardiotocography (CTG) for all women during labour, risk assessments were taking place and escalated appropriately.
  • Staff were encouraged to report incidents and systems were in place following investigation for monitoring and sharing lessons learned with staff.

However:

  • Not all medical and nursing/midwifery staff were up to date with mandatory training. This included Mental Capacity Act and Deprivation of Liberty Safeguarding training. They were not meeting the 85% training compliance target set by the trust.
  • The consultant medical staffing hours on labour ward were not in line with the Royal College of Gynaecologist (RCOG) guidelines, and the trust’s Policy for safe Staffing Levels for Obstetricians, Midwifery and Support Staff.
  • Women told us they all received 1:1 care during established labour. However, from March 2017 to February 2018, data provided by the trust showed that 84.8% of women received 1:1 care in labour cross the trust. Following the inspection the trust told us that the figures provided for 1:1 care, did not include women whose babies were delivered by caesarean section. However, the trust did not provide updated figures which included these births.
  • From April 2017 to March 2018, the community caseload staffing levels was 135 women per midwife. The current recommended Birth-rate plus ratio, allowing for some changes in the NICE Guidance since 2009, is 96 cases per WTE midwife.
  • Medical and nursing/midwifery staff were not up to date with their appraisals. They were not meeting the trust compliance target of 95%.
  • Several policies were past their date of review and the trust was aware of this. However, each out of date policy was allocated to a member of staff to review and update; within a specific timeframe. A policy review group was also in place. We were assured by the management team that the out of date policies would be updated quickly.

Outpatients

Inadequate

Updated 12 September 2018

We previously inspected outpatients jointly with diagnostic imaging so we cannot compare our

new ratings directly with previous ratings. We rated the service as inadequate because:

  • There were 31,295 patients overdue their follow up appointment as at March 2018. This was worse than the previous inspection.
  • The trust had started to clinically validate and administratively validate some waiting lists; however, this was not complete across all waiting lists.
  • Referral to treatment indicators were not met across all specialities. This had not improved since the previous inspection.
  • There were 320 patients waiting over 52 weeks at the trust as at March 2018. This was worse than the previous inspection.
  • The trust was performing worse than the 85% operational standard for patients receiving their first treatment within 62 days of an urgent GP referral.
  • At our last inspection we reported medical records were not stored securely. At this inspection we found three separate areas in outpatient clinics where medical records were left uncovered, unsupervised and in open areas.
  • From November 2016 to October 2017; the ‘did not attend’ rate for Diana, Princess of Wales Hospital was higher than the England average.
  • The trust did not investigate and close complaints in line with its own target.
  • There was no formal strategy for outpatients at the trust and staff were not always aware of the trust vision and values.

However:

  • We found nursing staff had exceeded the mandatory training completion.
  • Nursing staffing levels were generally as planned in outpatients.
  • Staff had access to trust policies. Audits were completed within specialities.
  • Staff we spoke with were friendly and provided compassionate care to patients and ensured privacy and dignity was maintained. Patient feedback regarding services was generally positive.
  • Staff told us morale was generally good across the services.

Maternity and gynaecology

Updated 12 October 2017

  • Emergency equipment was checked in line with trust policies.
  • Patient records were completed to a high standard and had evidence of appropriate risk assessment and escalation when required.
  • Risk registers were displayed in clinical areas and were visible to staff on the unit.
  • The service had completed a review of staffing levels using the Birthrate Plus® midwifery workforce-planning tool.
  • The trust had developed a maternity services escalation policy.
  • The service had developed a pathway to outline how to contact an anaesthetist if women required an epidural.

However;

  • Actual midwifery staffing levels did not always match the planned midwifery staffing levels.
  • Staff told us that sharing information and learning from incidents had improved on the unit. We were not assured that changes in practice had been fully embedded following a further never event relating to a retained swab.

Medical care (including older people’s care)

Requires improvement

Updated 12 September 2018

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

  • We had concerns about the safety of medical care services with regard to; the number of serious incidents, some issues with medicines management, compliance with mandatory training among medical staff and the number of medical staffing vacancies which was impacting on cover arrangements and support and training of junior doctors.
  • The trust’s referral to treatment time (RTT) for admitted pathways for medical services was worse than the England average and RTT performance had steadily deteriorated since 2015.
  • Patients were not reviewed daily by a senior clinician and were not always reviewed by their specialty consultant/team in a timely manner.
  • There continued to be issues with delayed transfers of care, outlying patients, bed moves at night and mixed sex-accommodation breaches, although the trust was working on these and there had been some signs of improvement.
  • There was no overarching, fully developed strategy or business plan for the medical service for 2018/2019. We were not assured that risks on the risk register were being actively managed or effectively overseen and there were still areas where junior nursing staff felt bullied and intimidated by middle managers.

However:

  • Nurse staffing had improved since the last inspection and there were escalation processes in place to move staff to where they were needed most, based on ongoing risk assessments. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Levels of safeguarding training were around the trust target.
  • The endoscopy unit had reapplied for JAG (Joint Advisory Group on Gastrointestinal endoscopy) accreditation in April 2018 and at the time of the inspection were waiting for final confirmation that this had been re-instated. There was a good system in place to ensure two week wait targets were met and urgent patients were seen quickly and there was now a 24-hour GI bleed rota in place.
  • Staff cared for patients with compassion and involved them in decisions about their care. Feedback from patients confirmed that staff treated them well and with kindness.
  • There had been changes to the senior management team and they had clear ideas and early plans for how the services needed to be developed. They were aware of the issues regarding pockets of bullying and had started to act to improve this situation. Staff spoke highly of the new Associate Chief Nurse and staff morale appeared to have improved since the last inspection and their appointments.

 

Diagnostic imaging

Requires improvement

Updated 12 September 2018

We previously inspected diagnostic imaging jointly with outpatients so we cannot compare our new ratings directly with previous ratings. We rated it as requires improvement because:

  • Medical staffing was low across the trust with significant vacancies and those medical staff in place were not up to date with mandatory training.
  • The department did not have sufficient MRI and CT scanning equipment to meet increasing demand.
  • MRI and CT scanning equipment and other radiological equipment was not reliable and had suffered multiple break downs. Some equipment was classed as end of life and when it broke down, new parts were not always available meaning reconditioned parts had to be used. There were a number of equipment risks recorded on the risk register.
  • Patients had long waits to undergo scans, waiting lists were increasing and there was a risk of patient harm because of these long waits.
  • Once treated, patients had long waits to receive the results of their tests. This was a trust wide problem compounded by low medical staffing numbers.
  • Waiting times for patients on urgent treatment pathways were difficult to meet at DPoW.
  • At the time of the inspection we did not see evidence that the department was participating in local clinical audit and was therefore unable to provide evidence that policies and procedures were being adhered to. However, after the initial report was written, the trust sent us evidence to show some clinical audit was being carried out by radiologists.
  • There was no evidence of patient engagement in the department.
  • Staff did not always feel valued or have their contributions recognised by the senior management team.
  • Implementation of the trust wide five year strategy for diagnostics and radiology was behind schedule and this was having an impact on the trust’s ability to meet demand across all sites.

However:

  • There were processes in place to ensure patients and staff were not over exposed to radiation and sufficient staff had completed mandatory training to support patient needs.
  • The department was clean and tidy.
  • Patients were seen quickly on arrival and there were facilities to meet their individual needs.
  • Staff had access to policies and procedures based on best practice.
  • Staff were aware of their responsibilities relating to consent, mental capacity and safeguarding of vulnerable people.
  • Performance against national and local standards, targets and performance indicators was closely monitored and there was a governance process.
  • Staff felt well supported locally by their manager and colleagues and the culture of the department was patient centred. The wider trust had started to engage with staff although this was a work in progress.

Urgent and emergency services (A&E)

Requires improvement

Updated 12 September 2018

Our rating of this service stayed the same although we saw some improvements. We rated it as requires improvement because:

  • The number of registered sick children’s nurses (RSCN) had reduced and the department did not have enough to provide cover on each shift. Three staff had completed university accredited modules in paediatric care out of 71 staff. None of the emergency nurse practitioners (ENP) had completed any paediatric modules or courses. Paediatric and adult patients were cared for in the same areas and used the same facilities. A children’s waiting area could be used for only part of the day when the paediatric assessment unit was open.
  • The majority of mandatory training figures for both medical and nursing staff did not meet the trust’s target of 85%. Medical staff did not meet any of the ten mandatory training courses and nursing staff only met two out of ten mandatory training courses. For safeguarding training, four out of eight training figures met the trust target.
  • There were vacancies for medical staffing which meant that locums covered many shifts, however some gaps were left unfilled.
  • Medicines were not stored appropriately when required to be refrigerated and no mechanism was in place for monitoring out of range temperatures.
  • The designated mental health room was not ligature free.
  • Some patient pathways had not been reviewed and remained out of date, these included pathways that we raised at our inspection in November 2016. Patient group directions (PGD) that were due to be reviewed in 2017 had been extended to August 2018 before they would be reviewed.
  • Appraisal rates were not met for any of the staff groups.
  • Royal College of Emergency Medicine (RCEM) audits showed that the trust failed to meet the 100% national standard set. We reviewed six RCEM audits and found out of 32 standards: - the trust was in the lower UK quartile for six standards.
  • Mental capacity was not always recorded in patient records we reviewed. Out of 21 records, 15 had completed information about mental capacity. We saw that two patients who were living with dementia did not have their mental capacity recorded. The trust’s unplanned re-attendance rate to A&E within seven days was between 9% and 10% and consistently worse than the national standard of 5% average in 11 out of 12 months.
  • Further work was required to embed strategies that would improve flow. These included adhering to the ED escalation process, introduction of frailty assessment team (FEAST) and improving ambulatory care.
  • There was no consistent method in reporting patients that had left the department without being seen.
  • Senior managers had identified that the trust needed to work more cohesively with other specialities and external providers to support ED staff and reduce the length of stay for patients, but the pace of arranging and changing practice was not embedded.
  • The trust was not meeting their targets to close complaints within the allocated timeframes. For example, 30% were closed within 30 days and 50% within 45 days. For complex complaints, 80% were closed within the time frame of 60 days.

However:

  • The trust had acted on the concerns and Section 29A warning notice that was issued after the inspection in November 2016. This included changes and improvements to patients’ record keeping. Risk assessments had been completed and monthly dashboards were completed to provide assurances that these were completed. There had been an increase in healthcare assistants to provide regular care rounds to patients to support them with their needs.
  • There were improvements in how patients were provided with nutrition and hydration and pain relief. A monthly dashboard provided the department with assurances that patients’ needs were being met.
  • There were improvements to the time patients waited from arrival to their initial assessment with the introduction with the department streaming and triaging patients. This had reduced from 30 minutes to 15 minutes to be assessed. There had also been a reduction with turnaround times over 30 minutes, since July 2017, for ambulance journeys.
  • We reviewed six RCEM audits and found out of 31 standards, the trust was in the upper UK quartile for six standards. The trust was similar to other hospitals (between upper and lower UK quartiles) for 20 standards
  • We observed that wards had effective approaches to multidisciplinary working. Staff described good working relationships between consultants, nurses and allied health professional staff.
  • Patients provided feedback and told us that staff were caring and provided compassionate care. They felt involved in making decisions with their care and treatment. Privacy and dignity was observed and patients were supported with the emotional needs.
  • The trust had applied measures to manage the access and flow in the department. These included regular meetings and escalation processes to support the department. There had been an introduction of streaming and triage staff that triaged patients. There had been reductions in the time to treat and patients waiting from the decision to admit until being admitted. There were improvements towards the four-hour target which was better than the England average from October 2017 to January 2018.
  • The department had invested in increasing the numbers of staff within leadership roles to provide an overview and to monitor and review ongoing care in the department. Various mechanisms had been implemented to provide assurances that there was an oversight of the issues in the department. These included walk rounds, board rounds, safety huddles and quality meetings.
  • The majority of staff enjoyed working in the department and felt listened to. The local leadership in the department was evident and had identified risks such as the lack of registered sick children’s nurses and had plans in place to mitigate the risk. These included further training and extended paediatric resuscitation skills. Staff within the department had initiatives to support and celebrate the success of their colleagues. The department was also working with vulnerable patient groups to improve the patients’ experience.

Surgery

Requires improvement

Updated 12 September 2018

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

  • The directorate did not have a stable management structure in place. The divisional clinical director was new in post, the divisional general manager was in an interim role. The divisional head of nursing was the only member of the team that remained in post since the last inspection. This had an impact on the decision making, governance and oversight of the issues within surgery.
  • We saw variable performance in national audits. Action plans we reviewed did not always address issues identified within the reports and actions had not had an impact on overall performance outcomes.
  • The trust was not meeting the national performance standards for treatment or cancer standards. The trust referral to treatment time was consistently worse than the England average, fluctuating around 65%. Four out of six surgical specialities were worse than the England average performance.
  • Overall mental capacity act training compliance for medical and dental staff was 55% and 77% for nursing staff which was worse than the trust target of 85%. We also saw one patient who lacked capacity was not supported to make decisions in line with relevant legislation and guidance. We also saw that DoLs applications were not available for all patients that required one.
  • From prescription charts we reviewed on ward B6 we saw that medicines were not always prescribed or administered in line with national guidance.
  • We had previously highlighted pre-assessment services required improvement in relation to clinical pathways, clinical cancellations of patients and competence of staff. At this inspection we did see some improvements in this service, however this needed more pace and a further period of embedding to provide assurance that the service was effective and responsive to clinical needs.
  • There were shortages of nursing and medical staff; these shortages were evidence in the majority of surgical areas. There was also high levels of bank and agency staff in use and some surgical areas had a low number of substantive permanent staff.
  • The trust was in the process of refreshing its strategy which covered the period 2016-2019 and there was no overarching, fully developed strategy or business plan for the surgical service for 2018/2019.
  • Appraisal rates for staff were worse than the trust target. Seventy one percent of nursing staff had received an appraisal which was worse than the target of 95%.
  • Policies, procedures and clinical decision making were not always based on guidance from the Royal College of Surgeons and the National Institute for Health and Care Excellence (NICE).

However:

  • From our observations it was apparent that the five steps to safer surgery checklist, was embedded as a routine part of the surgical pathway.
  • The majority of patients we spoke with were positive about the care and experience they had received.
  • The service had systems in place for reporting, monitoring and learning from incidents. Staff we spoke with knew how to report incidents.
  • We found wards and departments we visited clean and tidy, and we saw ward cleanliness scores displayed in public corridors.

Intensive/critical care

Requires improvement

Updated 12 September 2018

Our rating of this service went down. We rated it as requires improvement because:

  • The responsive domain improved and was rated as good. The caring domain remained good, however safe, effective and well led were rated as requires improvement.
  • Medical staffing was not in line with Guidelines for the Provision of Intensive Care Services 2015 (GPICS) standards and there were areas of training below the trust target.
  • Some concerns were identified in relation to unit acquired infection rates and the management of clinical waste.
  • Appraisal rates and mandatory training figures were below the trust target and the number of staff with a post registration award in critical care nursing was less than the recommended 50%.
  • Delirium screening was not taking place in HDU.
  • We received mixed feedback from staff about leadership and culture within the units and few staff were aware of the vision and strategy for critical care.

However:

  • The systems and processes in place for management of patient records and the assessment of patient risks were reliable and followed national guidance.
  • Care was evidence based and feedback from patients and relatives was positive. The privacy and dignity of patients was maintained and care was compassionate.
  • Access and flow through the units had improved and we found evidence of individualised patient care.

Services for children & young people

Good

Updated 12 September 2018

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

  • We rated effective, caring, responsive and well led as good. Safe was rated as requires improvement.
  • Staff had a good understanding of safeguarding and were aware of their responsibilities in relation to this.
  • Patient records were completed to a good standard.
  • The paediatric early warning score (PEWS) tool had been improved since our last inspection and we saw appropriate assessment and escalation of children and young people.
  • Staff understood their responsibility to report incidents and feedback from incidents was shared in a number of ways.
  • Staff provided care and treatment in line with national guidance. The service monitored the effectiveness of care and treatment through local and national audits.
  • Patient outcomes were in line with or better than the national average.
  • There was effective multidisciplinary team working, both internally and externally.
  • Staff understood their responsibilities when obtaining consent from young people and their parents/carers.
  • Staff treated patients and their families with kindness and compassion, encouraging family members to be involved in their child’s care.
  • The children’s services met the individual needs of children and provided a range of therapeutic interventions and specialist nurses.
  • Staff we spoke with told us leaders were visible, approachable and supportive. Leaders were aware of the risks to the service and had plans in place for the management of risks.
  • Effective governance processes were in place to manage risk and quality.

However:

  • Medical staff were still not meeting trust targets for mandatory training and safeguarding training.
  • There was no formal risk assessment tool for those patients with mental health concerns and staff had no specific training to deal with patients with mental health needs.
  • Medical staffing was not compliant with national guidance.
  • Children’s services were not meeting the Accessible Communication Standards (2017) concerning the communication needs of parents/carers.

End of life care

Requires improvement

Updated 12 September 2018

Our rating of this service went down. We rated it as requires improvement because:

  • Compliance with end of life mandatory training was below the trust target for nurses.
  • There was only one palliative care consultant with the right qualifications, skills, training and experience to keep people safe from avoidable harm and abuse and to provide the right care and treatment.
  • The service did not manage patient safety incidents. Staff did not recognise incidents as end of life and report them appropriately.
  • The service did not always monitor the effectiveness of care and treatment and used the findings to improve them.
  • The service was not available over seven days: it was Monday to Friday only, with out of hours telephone advice and discharge support outside of this
  • Staff did not always understand their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. We saw do not attempt cardio pulmonary resuscitation (DNACPR) documentation was not consistently or appropriately completed.
  • Patients, together with their families and carers, were not always included in discussions regarding capacity assessment or DNACPR decisions.
  • There was one complaint identified as end of life and this had not been managed in a timely manner.
  • The service did not have sufficient numbers of senior managers with the right skills and abilities to run a service providing high-quality sustainable care. There was one consultant to provide cover for both hospitals and the community palliative care services.
  • The service did not have a systematic approach to continually improving the quality of its services and safeguarding high standards of care by creating an environment in which excellence in clinical care would flourish. Whilst the end of life strategy group had identified areas for improvement, overall progress towards these was slow.
  • The service did not have effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected. Risk assessments for patients with mental health needs were not always identified.

However:

  • The service prescribed, gave, recorded and stored anticipatory medicines well. Patients received the right medication at the right dose at the right time.
  • The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.
  • Staff gave patients enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary. The service made adjustments for patients’ religious, cultural and other preferences.
  • Staff worked together as a team to benefit patients. Specialist palliative care staff and ward staff supported each other to provide good care.
  • Staff cared for patients and those close to them with compassion. Feedback from patients confirmed that staff treated them well and with kindness and provided emotional support.
  • Managers across the service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
  • The trust engaged well with patients, staff, the public and local organisations to plan and manage appropriate services and collaborated with partner organisations effectively.