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Inspection report

Date of Inspection: 15 March and 13 April 2011
Date of Publication: 6 June 2011
Inspection Report published 6 June 2011 PDF

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People should get safe and coordinated care when they move between different services (outcome 6)

Meeting this standard

We checked that people who use this service

  • Receive safe and coordinated care, treatment and support where more than one provider is involved, or they are moved between services.

How this check was done

Our judgement

People who use services receive safe and coordinated care, treatment and support where more than one provider is involved or they are moved between services.

User experience

We spoke with five patients and two of their relatives in the surgical and medical wards and the outpatients department. They all told us they had been given good information and explanations before discharge, about their treatments and follow-up care and support. One patient told us he was very pleased how follow-up care was explained to him and that staff had explained everything to his relative when he had asked them to, so they were both clear about what to expect. The findings of CQC’s trust-wide Survey of Adult Inpatients in the NHS (April 2011) support this, with mainly very positive responses from patients asked about the arrangements for leaving hospital.

People we spoke with were positive about the tests they had before surgery and the information they received to confirm the operation could go ahead. One person said they had hoped to be admitted earlier than they were but they were kept informed of the reason for the delay and were satisfied with this. They were then offered an earlier appointment due to a cancellation. Overall, their experience of the arrangements before admission and up to the point of discharge was very good. They told us:

“I’ve been so impressed with the quality of the service, and I’ve had excellent treatment…. everyone is professional and helpful…. I’ve been given the information I needed and I know what’s going to happen when I leave.”

We spoke with a patient who has a long term condition requiring coordinated care and support, and their relative. They said they were given the information needed to understand the condition and how best to manage the symptoms, and that everyone involved in their care was informed quickly about any changes in the treatment plan.

The Patient Advice and Liaison Service (PALS) shared with us the results of patient surveys between January and March 2011. Only about half of patients admitted for emergency care said staff had told them who to contact if they were worried about their condition or treatment after leaving hospital. About 80% of patients in hospital for planned medical care said they had this information and the figures showed an improvement over the three month period. In February and March, nearly all (95%) of outpatients said they knew who to contact if they were worried about their condition or treatment when they get home.

Other evidence

All the staff we spoke with told us there was good communication between different professional groups and we saw effective referrals and communication between specialities in patients’ records.

The local primary care trust (PCT) told us the trust and community health care staff work well together. The trust cooperates with other providers for safeguarding referrals and investigations, and engages with health community serious incident investigations. The PCT told us about ongoing concerns from local GPs about unsatisfactory discharges from the trust, and has arranged to meet with the trust to work on this.

The hospital’s discharge liaison nurse coordinates discharges and described the arrangements in place to meet the Community Care (Delayed Discharges etc.) Act (2003). This involves working with local social and health care services to put in place support to enable an individual to live in their own home, or in a care home, so they can be safely discharged from hospital. The discharge liaison nurse uses the hospital’s computerised records of in-patients and their planned date of discharge to identify any issues that might prevent or delay someone’s planned discharge. Some people are supported through a “fast track” system if they have end of life care needs and the wishes of the patient and their relatives are taken into account when deciding about arrangements for discharge.

The discharge liaison nurse told us she ensures good communication with providers of learning disability services to ensure there is a properly coordinated discharge plan. She also has links with the community learning disability teams who provide guidance and support. We asked staff about supporting people with a learning disability in the hospital. Outpatient staff gave us an example of someone who became distressed when asked to give a blood sample. The staff found a quiet area on a ward, away from the busy outpatient department, where he could sit quietly with his carers in private, and he then consented to giving the blood sample.

Patients showed us examples of discharge information that included a summary of the reason for being treated at the hospital, the name of the health care professional responsible for their assessment and treatment, medication on discharge including special instructions, dose and why it was prescribed. The discharge summary contained a description of the follow-up care they should expect and the date, for example when the district nurse would visit them at home. The form also confirmed that the same information was sent to the GP.

We spoke with two qualified nurses and one health care assistant who told us about the coordination of outpatient and day patient care: The consultant dictates letters recommending specific treatments and discharge planning, and these are transcribed and posted by medical secretaries. This makes sure that patient information is transferred securely. Patients remain under the care of the consultant whilst specialist services are accessed. Staff said: “The process works well because this is a small hospital and liaison is good.”