Diana Princess of Wales Hospital

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

At our last assessment we rated this key question Requires Improvement. At this assessment the rating remains Requires Improvement. This meant people did not always feel well-supported, cared for or treated with dignity and respect.

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

The evidence shows a good standard in ensuring that people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs.

Information provided following the inspection confirmed issues with the consistent completion of risk assessments. This was identified as an area for improvement. Audit compliance fluctuated between 50% and 100%. We saw up to date action plans that had been created to address this.

We reviewed 10 sets of patient notes and found that all were completed fully without error or omission. This included all appropriate risk assessments and evidence of safety checklists.

Staff developed care plans to meet needs identified during assessment. We saw some omissions in documentation; however, we also observed examples of care plans being used to guide care.

Care plans were personalised and holistic. We observed staff completing care plans with patients and their families.

The evidence shows some shortfalls. The service did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

During inspection, we saw staff assess patients needs for food, drink, and specialist nutrition or hydration. Local audit data provided following the inspection showed inconsistency in recording nutrition and hydration, with compliance over the previous 6 months ranging from 50% to 100%. Senior staff were sighted on this issue and plans for improvement were in place.

Local audit data provided following the inspection showed inconsistency in recording completed 2-hourly safety checklists, with compliance over the previous 6 months ranging from 50% to 100%. Senior staff were sighted on this issue and plans for improvement were in place.

The team included or had access to the full range of specialists required to meet the needs of patients in the service. As well as doctors and nurses, we spoke with specialist staff who would work collaboratively within the department, for example the frailty team consisted of specialist therapists. Staff told us that they could access specialist input when required for their patients.

Staff were experienced, qualified and had the opportunity to gain and consolidate the right skills and knowledge to meet the needs of the patient group. We did observe gaps in training compliance but noted that this featured in department action plans as an area for improvement.

Managers provided new staff with appropriate induction, all staff we spoke with had received a full induction when joining the department.

Managers provided staff with supervision (meetings to discuss care management, to reflect on and learn from practice, and for personal support and professional development) and appraisal of their work performance. All nursing staff reported that they were supported by their senior leaders.

Managers ensured that staff had access to regular team meetings. If staff were not available to attend, then senior leaders would ensure that all staff received meeting minutes by email.

The percentage of nursing staff who had had an appraisal in the last 12 months was 87% at the time of inspection.

Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge. Senior staff would regularly work with staff to help them develop and improve.

Managers ensured that staff received the necessary specialist training for their roles.

Managers dealt with poor staff performance promptly and effectively. We were given examples of how poor staff performance was identified and the steps taken to support that member of staff and help them improve.

The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Doctors, nurses and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide safe care. Staff held regular and effective multidisciplinary meetings to review patients and improve their care. We saw multidisciplinary working with services, such as occupational therapy, psychiatric liaison, and diagnostics to identify the most appropriate care and treatment for patients.

We observed effective communication between staff when handing over patient care at the beginning and end of shifts. We also observed staff huddles throughout the day when patients were discussed, and any concerns were raised as appropriate. We also noted the use of a flow navigator who linked all areas of the department effectively.

Multidisciplinary working was evident and effective within the department; however, we were given examples of communication between the department and other specialities within the hospital, being less effective which impacted the patient journey and reduced access to timely specialist services.

The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff supported patients to live healthier lives, we saw multiple posters and patient information leaflets throughout the department. Staff told us that they would discuss health promotion with patients when possible.

The evidence showed some shortfalls. The service did not always consistently monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

Staff used recognised tools, including National Early Warning System 2 (NEWS2), to detect and respond to clinical deterioration.

During inspection, we observed NEWS2 being undertaken appropriately, but information provided following inspection indicated issues with correct documentation and escalation. We noted that local action plans had been implemented to address this.

We were provided with a comprehensive audit schedule covering a wide range of topics. While local audits, such as ward managers’ compliance checks, covered the required areas, we identified inconsistencies and omissions in the completion and documentation in some of the other audits that were reviewed.

Staff used technology to support patients effectively (for example, for prompt access to blood test results).

The evidence shows some shortfalls. The service did not ensure all staff completed the training required.

Learning disability training for both medical and nursing staff was below trust targets. Medical staff training was 21% and nursing staff at 44%.

Staff were observed supporting patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent. Staff understood how and when to assess whether a patient had the capacity to make decisions about their care.

Dementia training had been completed by 92% of nursing staff and 81% of medical staff. Mental Capacity Act training had been completed by 96% of nursing staff and 86% of medical staff.

Staff gained consent from patients for their care and treatment during triage in line with legislation and guidance and this was clearly recorded in the patients’ records.

When patients could not give consent, staff made decisions in their best interest, taking into account patients’ wishes, culture and traditions. The service had effective systems to ensure staff assessed the mental capacity of patients and recorded decisions made in service users’ best interest when applying to deprive the service user of their liberty.