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Mount Gould Hospital Requires improvement

Reports


Inspection carried out on 19,20 and 21 July 2016

During an inspection to make sure that the improvements required had been made

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