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Mount Gould Hospital Requires improvement

Reports


Inspection carried out on 19,20 and 21 July 2016

During an inspection looking at part of the service

We inspected Plymouth Hospitals NHS Trust as part of our programme of comprehensive inspections of all acute NHS trusts between 19 and 21 July 2016.

This inspection was a follow up to the comprehensive inspection covering the domains of safe, effective, responsive and well led.

During our inspection we inspected the following locations:

  • Derriford Hospital
  • Mount Gould Hospital

We rated Mount Gould Hospital as requires improvement overall, with improvements needed in the responsive and well led domain. Caring was not rated as part of this follow up inspection, but was rated as good on the previous inspection in April 2015 and has been included in the overall rating.

Our key findings were as follows:

  • The systems and arrangements for reporting and responding to governance and performance management data had improved but still did not effectively monitor and record risks and incidents.
  • The trust’s target of 100% for compliance with mandatory training for safeguarding of children was met, and staff were able to confidently describe their responsibilities in respect of the Mental Capacity Act 2005.
  • For some patients, access to new and follow-up appointments were delayed by an ongoing recognised backlog of appointments; however this had reduced since the last inspection. Also, a typing backlog of clinic letters was causing further delays for patients.
  • There was no centralised monitoring of safety issues in remote clinics, although leaders visibility and engagement had improved on a local level.
  • Patients were cared for in a clean and hygienic environment, and there were systems in place to reduce the risk and spread of hospital acquired infections, however, results of audits were not shared with all staff.
  • There were improved practices in respect of the management of prescription forms and the trust’s policy for the custody of the medicines keys which kept patients safe.
  • The systems and data used to monitor reasons for the short notice cancellation of clinics were not accurate or robust.

We saw several areas of outstanding practice including:

  • The results from programmes of audit in some specialities were being used to develop and improve services for patients.
  • Strengthened working relationships in both clinical and administrative teams had led to further improvements in the delivery of outpatient services across the trust.

However, there were also areas of poor practice where the trust must;

  • Reduce the number of clinics cancelled and capture the reasons why.
  • Reduce the numbers of patients waiting past their to be seen date.

In addition, the trust should consider:

  • Reviewing and sharing cleaning audits carried out by external companies.

  • Reviewing its systems and process which give assurance that services delivered by external companies are carried out in a way that keeps people safe.
  • Reviewing secretarial staff numbers to help clear the typing backlog of Mount Gould clinic letters and ensure the digital dictation system is fully implemented.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection carried out on 22 April 2015

During Reference: R6 not found

Inspection carried out on 22-24 April 2015

During a routine inspection

We inspected Plymouth Hospitals NHS Trust as part of our programme of comprehensive inspections of all acute NHS trusts between 22 and 24 April 2015.

The trust has 12 registered locations:

• Derriford Hospital

• Launceston General Hospital

• Liskeard Community Hospital

• Mount Gould Hospital

• Cumberland Centre

• Plymouth Dialysis Unit

• Plymouth Hospitals NHS Trust HQ

• Royal Cornwall Hospital

• South Hams Hospital (Kingsbridge Hospital)

• Stratton Hospital

• Tamar Science Park

• Tavistock Hospital.

During our inspection we inspected the following locations:

• Derriford Hospital

• Mount Gould Hospital.

We rated Mount Gould Hospital as requires improvement overall, with improvements needed in respect of the responsive and well-led key questions. Caring was rated as good.

Our key findings were as follows:

  • The systems and arrangements for reporting and responding to governance and performance management data were not operated effectively, as data and performance measurement were inaccurate and unreliable.
  • The trust’s target of 95% for compliance with mandatory training for safeguarding of children was not being met. Staff were unable to confidently describe their responsibilities in respect of the Mental Capacity Act 2005.
  • For some patients, access to new and follow-up appointments was delayed by a recognised backlog of appointments.
  • There was a lack of local leadership and leaders were out of touch with what was happening on the front line.
  • Patients were cared for in a clean and hygienic environment, and there were systems in place to reduce the risk and spread of hospital acquired infection. We saw safe practice in radiation protection.
  • There were unsafe practices in respect of the management of prescription forms and the trust’s policy for the custody of the medicines keys.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

  • Ensure staff have the competence, skill and experience to deliver patient care and treatment and meet patients’ needs. This includes the management and leadership roles.

  • Ensure systems, processes and standard operating procedures are reliable and appropriate to keep people safe, and monitor whether safety systems are implemented.

  • Ensure the consistent application of medicines optimisation across the services, in particular: safe storage and management of stocks of FP10 (prescriptions are the prescriptions used for outpatients that can be taken to any community pharmacy) and outpatient prescription forms; safe disposal of surplus or wasted medicines; and safe custody of medicines keys – so that prescription forms and medicines are only accessible to staff with suitable authority.

  • Review the managerial and governance arrangements in outpatients, so that systems and processes to minimise likelihood of risk in relation to access to services and a standard booking process for appointments across all departments are fully implemented.

  • Ensure all staff understand and work within the requirements of the Mental Capacity Act 2005 where they work with people who may lack the mental capacity to make decisions.

In addition the trust should:

  • Review the process for incident reporting to ensure that all staff act in accordance with the risk and incident reporting policy.
  • Improve the dissemination of learning from safety incidents and complaints.
  • Assess the impact of using temporary notes for clinics, to ensure systems do not compromise patient safety.
  • Ensure that only current copies of the BNF British National Formulary for prescribing are available for staff reference.
  • Ensure all staff have undertaken basic life support training relevant to their role.
  • Ensure GP letters are typed and sent within the required time scale, so that information is available to relevant practitioners when required.
  • Consider reviewing the Did Not Attend rates and discharge of patients, in order to optimise the clinic capacity.
  • Ensure patients have access to information on translation services should these be required.
  • Review and implement the recommendations of the Plymouth Healthwatch consultation to improve services for patients.
  • Ensure feedback from patients using Mount Gould Hospital is gathered, reviewed and acted on.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection carried out on 14 July 2011

During a routine inspection

The views of all people seen at all locations at Plymouth Hospitals NHS Trust are incorporated in this section of this report. The views for each separate hospital is listed below.

Derriford Hospital

During our site visits to Derriford Hospital and the Child Development Centre, we went to twenty ward and clinical areas in addition to the outpatient clinics at the hospital. We spoke to over 100 patients and visitors. We also spoke with many members of staff.

Most patients said they felt safe and said staff were very kind to them. We had many positive comments about staff. One patient said, �The staff are very kind and I shall miss them.� Another told us that staff were �all quite friendly�.

We were told that patients thought their privacy was protected and that they felt staff were respectful during their visit to the hospital. Patients also told us that they had felt involved in planning their care or treatment.

Staffing levels were identified as a problem by patients. Comments included �There are not enough staff.� �Things never happen when they [the staff] say they will�. �The staff are always smiling when they do come to assist but there just aren�t enough of them.�

Although, on our visit, at least 95 of the 100 patients and visitors, we spoke to told us they felt well cared for, we were informed that sometimes this was not the case. Patients mainly described the response to call bells the main problem with their care. Patients on other wards said were very satisfied with the amount of time they were waiting. Some patients told us they had not been told of why delays in treatment had occurred during their stay. Other patients on other wards described having to be moved in the middle of the night as disruptive.

There was confusion about the different uniforms staff wore. Other patients said the uniforms were very confusing meaning they did not know who to ask for what. One person said �It�s enough to make any one muddled�.

We were told that patients were pleased with the way they received their medicines in hospital. Some patients told us that they had to wait for medicines to take home on some occasions, but most patients said that they hadn�t had to wait too long.

The views about the food provided within the hospital continued to vary. Comments included �very good� and �excellent� to �awful� and �like school dinners, you either loved them or hate them.�

Patients thought staff worked very hard to keep ward areas clean. Patients and visitors complained to us about the car park, because of the cost and additional stress when appointment times were delayed or were late. Patients appreciated the access to the faith-room facilities, religious services and mobile shop run by the voluntary service.

Patients told us they knew how to complain and that if they had any concerns they would raise them straight away with the staff on the ward. People also knew about the Patient Advisory and Liaison (PALS) team, although confidence was not high regarding the way complaints were currently managed.

Royal Eye Infirmary

We visited all areas of the Infirmary. We spoke with thirteen patients, four of which were children. We also spoke with 6 relatives, 6 parents and 9 members of staff.

Patients said they thought their care and treatment at the Eye Infirmary was very good. We were told �The staff care for me beautifully, they are wonderful and excellent� and �The staff are lovely, very reassuring and calming�.

We were told that patients were very satisfied with the information given either verbally or in leaflets (including some in large print) and all were confident that they knew exactly the nature of their treatment. One person said �The paperwork received was very good�.

Mount Gould

We visited the clinic areas, at Mount Gould Hospital, that Plymouth Hospitals NHS Trust use. We spoke with four members of staff and four patients. We also spoke with one relative.

All patients spoken with said they were well cared for and the treatment they had received was very good. All comments about staff were positive. Patients felt there were enough staff in attendance. Comments included �I waited no time at all�.

One patient said, �I was anxious, but the Dr made me feel so much better, she put me at ease�. This person went onto say that the Doctor had asked lots of questions and was very interested. �I felt very involved in my care�. Another patient said �The doctors are lovely.�

Headquarters

Headquarters is a �virtual location� based at Derriford Hospital. It is used to organise community services (mainly maternity). It involves the organisation of midwives working in the community including at peoples homes, local GP clinics and children centres. We visited one children�s centre where we spoke with one midwife, three women and one partner.

All women we spoke with said they had felt respected during the pregnancy, birth and post delivery period. Women explained that they had been given enough information throughout their pregnancy. The feedback regarding care was positive. One woman said �Its been nothing but brilliant�. Another woman said �My midwives have been lovely, I�ve had the same one most of the way through, it did not matter to me who I saw as they are all lovely.�

Two of the three women and the partner we spoke with said they had not needed to complain. However, none of the women or partner we spoke with knew how to make a complaint.

Tavistock Hospital

We visited the operating department and outpatient department at the hospital. We spoke with 7 patients, 3 relatives and 7 members of staff.

Patients said staff caring for them were respectful about what their needs were. One patient said �they really took time to find out about me and put me at my ease.�

Patients all agreed that the care and treatment they received was excellent. Each person said that from the time of entering Tavistock Hospital they were well cared for having everything clearly explained. The positive feedback also referred to reception staff, nurses and doctors.

Kingsbridge Hospital

We visited two departments at Kingsbridge Hospital. We spoke with 3 patients and 5 members of staff.

Patients said they had been given a choice of going to Kingsbridge hospital or Derriford. One patient told us �It is more convenient to visit Kingsbridge hospital rather than go into Plymouth.� All comments about the hospital and care were positive. One patient said �I come here regularly for treatment and they are all excellent.�

Cumberland Centre

We visited the x ray department, physiotherapy department and outpatients clinic. We spoke with 4 members of staff, three relatives or escorts and 4 patients.

All comments received about the staff, and the care provided at the Cumberland centre, were positive. Patients told us they thought staff had been �Very polite and friendly� during their care. One person said �It is so nice coming here rather than going up to the main hospital.� Another patient said the care they had received was, �Brilliant� and added that �they have cured my pain�.

Liskeard Hospital

We were unable to speak with any patients on the day of our visit to Liskeard Hospital because either clinics were not running that day, or had been cancelled. We were able to read a comment book left in reception in which people visiting the hospital had added numerous comments. All comments read were positive. These include people saying it was the best hospital they�d ever visited and commented about the excellent staff and excellent service provided.