Diana Princess of Wales Hospital

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

At our last assessment we rated this key question Requires Improvement. At this assessment the rating remains Requires Improvement. This meant people’s needs were not always met.

We have not awarded this service a score for Responsive.

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

The evidence shows some shortfalls. The service did not always demonstrate that people were at the centre of their care and treatment choices.

We saw an inconsistent approach to the completion of risk assessments, during the inspection we saw staff completing all appropriate risk assessments and documenting appropriately but when we reviewed previously completed audits regarding patient notes we saw omissions.

We found an inconsistent approach to the recording within patient notes. We saw examples of care plans that lacked evidence of patient input or personalised goals and incomplete or generic records that didn’t reflect changing needs or preferences.

The evidence showed a good standard. The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

All staff could articulate how their local communities had diverse health and care needs. All staff could give examples of patients who had varying level of need and could describe how they would accommodate them. This included patients with chronic and long-standing conditions that required a different approach.

The evidence showed a good standard. The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

All staff were able to describe how they made notifications to external bodies such as the local authority for safeguarding issues and to the UK Health Security Agency for notifiable illnesses.

At this inspection we saw all computers locked when not in use and any other patient information was secured.

The service complied with the Accessible Information Standard. We saw the department consider varying levels of need to ensure equitable access across all patient groups.

Staff ensured that patients could obtain information on treatments, local services, patients’ rights, how to complain and so on. Information was readily available throughout all patient areas.

The information provided was in a form accessible to the patient groups ,such as easy-read form and other languages.

Staff made information leaflets available in languages spoken by patients.

Staff ensured carers and families were regularly updated about the patient’s progress. A recent patient survey reported that 90% of survey patients and carer’s felt able to speak with staff regarding their health and care.

The evidence showed a good standard. The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result.

All patients were given the opportunity by staff to give feedback and staff would assist any patient to make a complaint or raise a concern.

We saw examples of complaints being raised in monthly governance meetings. We saw timely responses and apologies when required.

Feedback was actively encouraged, and equal importance was given to both positive and negative feedback, as it was an opportunity to learn and to improve.

Staff were able to articulate the process and their role in how to handle complaints appropriately.

Staff received feedback on the outcome of investigation of complaints and acted on the findings. Any learning from complaints was discussed during safety huddles and was also disseminated by email to ensure all staff had access.

Evidence shows significant shortfalls. The service was unable to ensure that people could access the care, support and treatment they needed when they needed it.

The average time to triage for the 6 months preceding inspection was 56 minutes which was worse than the national target of 15 minutes.

In the 6 months preceding inspection the average handover time for ambulance patients was 51 minutes, which did not meet the national target of 15 minutes.

The percentage of patients admitted, transferred or discharged within four hours of arrival at the trust was 68% and consistently lower than the England average. The trust also didn’t meet the aspirational standard of 76% in the previous 6 months.

We saw that 55% of patients who required admission waited over 4 hours but less than 12 hours, and 30% of patients waited over 12 hours.

We did note that 4% of patients left the department without being seen, which was better than the national average of 5%.

The unplanned reattendance rate was at the national average of 9%.

The evidence showed a good standard. Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

Staff within the service and the wider organisation promoted a culture in which the people using the service felt empowered to give their views. We saw a proactive approach across all staff grades within the department to encourage feedback from all patients. They used a variety of tools to ensure all patients were given equal opportunity to raise concerns and for that information to be used.

All staff had the opportunity to undertake training in equality, diversity, inclusion and human rights.

The evidence showed a good standard. People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

We saw examples of staff supporting patients to make decisions about their care and treatment and their future. We saw the use of treatment escalation plans which were completed with patients.

Staff were able to articulate how they would care for people who are nearing the end of their life and how they would ensure that it was managed and communicated in a sensitive and dignified way.

We saw that 80% of all nursing staff had completed training in end of life care planning.

Staff ensured all relevant healthcare professionals and other relevant bodies were involved in planning the care and treatment of people with complex needs. We observed patients being referred to appropriate specialities.