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Kings Mill Hospital Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 14 May 2020

Our rating of services improved. We rated it them as outstanding because:

  • The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
  • Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
  • The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.
Inspection areas

Safe

Good

Updated 14 May 2020

Effective

Good

Updated 14 May 2020

Caring

Outstanding

Updated 14 May 2020

Responsive

Good

Updated 14 May 2020

Well-led

Outstanding

Updated 14 May 2020

Checks on specific services

Medical care (including older people’s care)

Good

Updated 15 August 2018

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

  • The service had improved in relation to sharing learning from incidents. We found a culture which encouraged the sharing of learning from incidents.
  • The service had improved in relation to staffing levels for level two patients in ward 43. There was increased staffing provision in comparison to the staffing arrangements at the time of our 2015 inspection.
  • Patient risk assessments were routinely completed and nursing records were clear and comprehensive.
  • The service monitored the effectiveness of care and treatment by participating in national and local audits and used the findings to drive improvements.
  • There was an effective multidisciplinary team (MDT) working environment within medical services with the involvement of external partners (such as mental health service providers) to support patients’ health and wellbeing.
  • Consent was well managed and staff understood their responsibilities in relation to the Mental Capacity Act and associated Deprivation of Liberties Safeguards (DoLs).
  • Staff demonstrated a kind and caring approach towards patients and their families. It was obvious that staff had positive relationships with patients and we saw them spend time talking to patients and their families and friends.
  • Staff took their time to respond to the individual needs of patients, including those living with a cognitive impairment such as dementia and those living with a learning disability.
  • Services were in place to support patients with spiritual and cultural needs.
  • All staff we spoke with were enthusiastic and passionate about the work they did.
  • There was evidence of clinical governance procedures and quality measurement processes. It was evident that risks were identified, mitigated (where possible), reviewed and escalated through different committees.

However;

  • Patients’ medical records were not always stored safely to maintain the privacy of patients.
  • Some risks on the risk register were past their review date and some didn’t have a review date at all.

Services for children & young people

Good

Updated 14 May 2020

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

  • The service provided mandatory training in key skills to all staff and made sure everyone completed it.
  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.
  • The service used systems and processes to safely prescribe, administer, record and store medicines.
  • The service managed patient safety incidents well. Staff recognised incidents and near misses and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave children, young people and their families honest information and suitable support. Managers ensured that actions from patient safety alerts were implemented and monitored.
  • Staff monitored the effectiveness of care and treatment. They used the findings to make improvements and achieved good outcomes for patients. The service had been accredited under relevant clinical accreditation schemes.
  • Staff gave children, young people and their families practical support and advice to lead healthier lives.
  • Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients consent. They knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health. They used measures that limit patients' liberty appropriately.
  • Staff provided emotional support to children, young people and their families to minimise their distress. They understood children and young people’s personal, cultural and religious needs.
  • Staff supported and involved children, young people and their families to understand their condition and make decisions about their care and treatment. They ensured a family centred approach.
  • The service was inclusive and took account of children, young people and their family’s individual needs and preferences. Staff made reasonable adjustments to help patients access services. They coordinated care with other services and providers.
  • People could access the service when they needed it and received the right care promptly. Waiting times from referral to treatment and arrangements to admit, treat and discharge children and young people were in line with national standards.
  • Leaders had the integrity, skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff. They supported staff to develop their skills and take on more senior roles.
  • Leaders and staff actively and openly engaged with patients, staff, equality groups, the public and local organisations to plan and manage services. They collaborated with partner organisations to help improve services for patients.
  • All staff were committed to continually learning and improving services. They had a good understanding of quality improvement methods and the skills to use them. Leaders encouraged innovation and participation in research.

Critical care

Good

Updated 14 May 2020

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

  • The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
  • Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.
  • Staff treated patients with compassion and kindness, they truly respected their privacy and dignity, took a holistic approach to meeting their individual needs, with a strong, visible patient centred culture. Staff helped them understand their conditions and provided information tailored to the individual. They provided emotional support to patients, families and carers. Feedback was consistently positive about the way they had been treated.
  • The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

End of life care

Good

Updated 15 August 2018

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

  • Staff understood their roles and responsibilities regarding the safeguarding of vulnerable adults and children. All staff we spoke with had received appropriate levels of safeguarding and could describe what safeguarding was and the process to refer alerts.
  • There were comprehensive risk assessments completed in the medical and nursing notes. These were commenced on admission and there was evidence that risk assessments continued throughout the patient’s stay in hospital.
  • We saw good examples of multidisciplinary working and involvement of other agencies and support services.
  • There was good team working between the specialist palliative care team, the bereavement service and the chaplaincy service. The chaplaincy team was an integrated part of the overall delivery of care to the dying patient.
  • Patients and their relatives told us they were fully included in discussions around their plan of care.
  • Data provided by the trust showed that there were no complaints related to end of life care between January 2017 and December 2017.
  • There was a newly appointed non-executive director for end of life care at board level.

However;

  • Some of the Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders known as Allow a natural death forms (AND) we viewed were not completed properly and did not reflect the information included in the patient’s mental capacity assessment.

Surgery

Good

Updated 14 May 2020

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

  • The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
  • Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
  • The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

Urgent and emergency services

Good

Updated 15 August 2018

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

  • Improvements in meeting the four-hour waiting time target had been made and sustained with the department performing better than the national average.

  • Systems were in place for assessing all patients arriving in the emergency department to determine how quickly they should be reviewed: this included a clear streaming/triage process. Criteria were in place for staff to determine which patients could be signposted to the co-located primary care centre.
  • Patients waiting longer than the recommended time to be handed over from the care of ambulance staff to hospital staff had generally improved.
  • When concerns were raised or things went wrong, the approach to reviewing and investigating causes had improved. We saw evidence of wider learning from events or action taken to improve safety.
  • The leadership, management and governance of the department assured the delivery of high quality person-centred care. Risks and quality measures were regularly reviewed, responsibilities were clear and risks were understood and managed.
  • Clinical leadership had improved and was now consistent. There was compassionate, inclusive and effective leadership at all levels in the department. Leaders had the capacity and capability needed to deliver excellent care.
  • A divisional wide urgent and emergency care improvement plan was in place which included medical leadership. Significant issues that threatened the delivery of safe and effective care had been identified and appropriate action was taken to manage them.

Diagnostic imaging

Good

Updated 15 August 2018

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

  • The radiology department was well supported through a service level agreement by a team of medical physics experts who monitored radiation levels received by staff and patients as well as auditing of compliance against national radiation regulations.
  • The radiology department conducted audits of clinical practise as well as operational performance against national standards where available and benchmarked themselves against other trusts locally and nationally.
  • Role development of radiographers and sonographers was actively encouraged and well supported by radiologists.
  • The management team in radiology was effectively managing staffing vacancies, and had managed to attract staff despite the national occupational shortages.
  • Performance and operations were well monitored in the radiology department. Senior staff were aware of up to date statistics via regular meetings, scorecards and weekly emails.

However:

  • Radiographers did not consistently check pregnancy status of women of child bearing age as per local procedures.
  • Inpatients attending the radiology department for examinations did not always have their notes transported with them. This meant that staff would not be aware of Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) order or falls risk assessment.
  • The MRI department was only seeing up to 40% of suspected cancer patients within the trust’s target of seven days.
  • X-ray images were having to be outsourced to a tele-radiology company as the department was struggling to meet their key performance indicators.
  • Document control in the x-ray departments was poor, and we found outdated or old versions of documents which staff were referring to. This was because the shared computer drive which held the most up to date policies and procedures was difficult to navigate.

Maternity

Good

Updated 15 August 2018

We previously inspected maternity jointly with gynaecology so we cannot compare our new ratings directly with previous ratings

We rated it as good because:

  • The service collected safety information, which was compared to national data. Staff used the information to improve the service.
  • Staff understood their roles and responsibilities regarding safeguarding vulnerable adults and children. Although consultants’ compliance with safeguarding training was lower than the trust target, most staff had received appropriate levels of safeguarding training and could tell us about examples of where they had identified and raised concerns.
  • Staff demonstrated good practice with regards to hand hygiene and infection control. We saw hand gel available in clinical areas and the environment and equipment were visibly clean. Equipment was regularly serviced and cleaned. Surgical site infections were below the national average.
  • There were effective processes for the reporting and management of incidents, Staff were aware of their responsibilities to report incidents and we saw learning from incidents was shared.
  • The service managed incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave women and families honest information and suitable support.
  • Staff kept appropriate records of women’s care and treatment. Handheld and inpatient records were clear, up-to-date and available to all staff providing care. Safeguarding records were up to date and easily accessible. Completion of cardiotography trace records was in line with trust policy.
  • The service provided care and treatment based on latest evidence and national guidance and maintained a quality dashboard to monitor outcomes. The normal birth rate was higher (better) than the national average and the total caesarean section rate was lower (better) than the national average.
  • Staff with different roles worked together as a team to benefit women. Midwives, doctors, nurses and other healthcare professionals supported each other to provide good care. Multidisciplinary teamwork was continuous and evident throughout the unit.
  • Staff gave patients enough food and drink to meet their needs and improve their health. Women had access to snacks and light meals as they required. Enhanced recovery programme supported early hydration and improved recovery.
  • Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. They knew how to support patients experiencing mental ill health and those who lacked the capacity to make decisions about their care. Staff documented when consent for procedures and ensure records had been gained.
  • Staff actively promoted improving women’s health by encouraging women to stop smoking, and increasing skin to skin and breastfeeding.
  • Staff understood and respected the personal, cultural, social and religious needs of women and those important to them. Women and their relatives we spoke with told us without exception they were treated with dignity, kindness and respect.
  • Feedback from people who used the service, those who are close to them and stakeholders was positive about the way staff treated people. The trust performed amongst the best performing trusts for three out of 15 questions in the CQC maternity survey 2017.
  • Staff provided emotional support to patients to minimise their distress. Women, families and staff particularly valued the bereavement service. Excellent bereavement care was a priority for the service. Bereavement services and staff knowledge on supporting bereaved families ensured people received the physical and emotional care required.
  • People’s individual needs and preferences were central to the delivery of tailored services. Staff routinely involved women who used the services and those close to them in planning and making shared decisions about their care and treatment. Birthing partners were included and involved in the care of their partner and new-born baby.
  • We saw specific examples of innovative approaches to care particularly for women with complex needs. Staff from the multidisciplinary team worked collaboratively to provide care for women. Staff had a proactive approach to understanding the needs and preferences of different groups of people and delivered care in a way that met these needs. We saw staff going above and beyond to plan care for a woman with complex physical needs.
  • The trust planned and provided services in a way that met the needs of local people. There were a range of clinics for both high and low risk women.
  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, which were shared with all staff. Complaints were investigated and closed within the trust target timescales.
  • Service leads had the right skills and abilities to run a service providing high-quality sustainable care. The middle manager structure had just been implemented.
  • Managers across the trust promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values. Matrons were visible and active in clinical areas. Predominantly staff felt valued for the work they did.
  • The trust had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected. The risk register was reviewed regularly and staff had an awareness of the risks throughout the unit.
  • The trust engaged well with women, staff, the public and local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively. The service’s vision and strategy was in line with national priorities.

However:

  • Although there was no evidence of impact on the care women received, there were gaps in the junior doctors’ rota which were being filled by staff working flexibly and covering additional shifts. This had an impact on individuals’ morale and ability to access training.

Outpatients

Good

Updated 15 August 2018

We previously inspected outpatients jointly with diagnostic imaging so we cannot compare our new ratings directly with previous ratings.

We rated it as good because:

  • Our rating of this service improved. We rated it as good because:
  • There was a positive incident reporting culture with evidence of learning and sharing following incident investigations.
  • Mandatory training and appraisal rates exceeded the trust target.
  • Staffing levels showed minimum vacancies and a low staff turnover rate.
  • Staff complied with infection prevention guidelines.
  • There was efficient medical records management with over 98% availability for all outpatient clinics.
  • Medicines were stored in line with local and national guidance.
  • Policies, protocols and patient pathways were based on national guidance.
  • Staff were suitably qualified and trained to carry out their roles within the outpatient environment.
  • Appraisal rates were 100% throughout the department.
  • Specialities were involved in local networks for sharing best practice,
  • We saw evidence of multidisciplinary working.
  • We received consistently positive feedback from patients
  • We observed positive interactions between staff and patients.
  • There were opportunities for patients to receive psychological support when receiving bad news.
  • There was an ethos of open leadership with senior management becoming more visible throughout the trust.
  • Local management had a strong influence, enabling staff make comments and suggestions for improvement.
  • Medical records had undergone a reorganisation over the previous two years resulting in over 98% records availability across the trust.
  • There was a clear vision and strategy.
  • Governance practices were cascaded down throughout the department with information shared at all levels.
  • There had been positive engagement with staff, reflected in the staff survey response rate and outcomes.