University Hospital

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

The service had access to risk assessments which were based on nationally recognised, evidence-based assessments. The service managers effectively monitored outcomes and used information from audits to improve care and treatment for patients. Staff followed national guidance to gain patients' consent.

We have not awarded this service a score for Effective.

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

People’s experience

Patients told us their needs were assessed and their care and treatment was explained to them. The service used a care bundle called ‘Forget Me Not’ to assess the needs of dementia patients and gather information from their family and carers to help staff understand their needs and preferences.

Feedback from staff and leaders

Staff completed risk assessments for patients and understood their needs. Most patients had their needs met and we saw that adjustments had been made.

There was a multidisciplinary team approach to assessing patient’s needs, ward rounds we observed were attended by staff for various disciplines, information was shared about patients, needs assessed and plans made for their care.

We spoke to staff in the dementia and delirium team, they supported patients and their families of cares with behavioral symptoms, recognising triggers and referrals to support services. The team also supported the staff at the service with de-escalation techniques and capacity assessments and provided training for staff. There were also dementia link workers who had been trained by the dementia and delirium team to provide support to colleagues.

The service had deconditioning champions whose role was to support both the therapeutic and nursing aspects of care to promote independence for patients during their admission with the aim to reduce length of stay, prevent deconditioning and improve patient experience. The deconditioning champions planned and carried out engaging activities for patients on the Acute Frailty Unit (AFU) and assisted with activities of daily living including supporting nutrition, mobility, and personal care. They used accessible communication tools with patients and cue cards.

Processes

The service had a process for auditing patient records and compliance with care planning. There were processes for staff to follow to assess and meet the needs of patients. The service used clinical tools which were relevant to the patients’ needs. For example, falls assessments and pressure ulcer assessments. Processes enabled staff to provide patients with translation and interpretation services to enable them to be involved in the assessment of their needs and to ensure that care was patient centred. There was a multidisciplinary team approach to assessing patient’s needs, ward rounds we observed were attended by staff for various disciplines, information was shared about patients, needs assessed and plans made for their care.

People’s experience

Patients had access to staff members with specialist knowledge in a range of different subjects including diabetes, falls, tissue viability, sepsis, dementia and learning disabilities. This meant there was someone who could offer additional up to date advice or support to other staff working with a patient with additional or complex needs.

Patients were offered food and drinks on a regular basis and patients told us staff had brought them a cup of tea or some toast late in the evenings if they had requested it.

On the drug round we observed staff discussing with patients their pain, and if they were taking pain relief, and if they required more pain relief or if they felt the pain medicine was working.

Feedback from staff and leaders

Staff followed up-to-date policies to plan and deliver high quality care according to best practice and national guidance. At handover meetings, staff discussed the psychological and emotional needs of the patients and their relatives. Staff completed patients’ fluid and nutrition charts.

Processes

The service used National Institute for Health and Care Excellence (NICE) guidelines to ensure care was evidence-based. The risk assessments staff used were evidence-based and widely used and recognised across healthcare. There was a deep vein thrombosis pathway which had been implemented to avoid hospital admission. The service used intentional rounding with patients; this is a structured process where nurses regularly check in with patients to assess their needs and plan care accordingly.

People’s experience

Patients told us that their care was regularly reviewed by a doctor or consultant and a member of the nursing team.

Feedback from staff and leaders

Staff told us they worked effectively across all wards within the medical services and that handovers were done in a timely manner with accurate patient information to help ensure continuity of care. Staff in the discharge lounge told us they worked with other wards and areas to facilitate the move of patients to the lounge ready for discharge; this helped with the flow and bed occupancy within the service. Patients transferring to the discharge lounge were risk assessed to ensure they were safe to be seated in the area. Staff would not move patients who needed 1 to 1 nursing care, palliative care or patients who would be distressed due to change of environment.

Consultants led daily ward rounds on all wards, including weekends. Patients were reviewed by consultants depending on the care pathway. Staff we spoke to said they could call for support from doctors and other disciplines, including mental health services and diagnostic tests, 24 hours a day, seven days a week.

Feedback from partners

People with complex needs received prompt screening by a multi-professional team, including physiotherapy, occupational therapy, dementia, and delirium teams, and if required, social services and other organisations.

The service collaborated well with partners from other NHS trusts. For example, the cardiology unit admitted patients from 3 other local trusts for angiograms, pacemakers, and stents. The staff discussed these transfers with the onsite team from the transferring trust and had an established pathway which staff told us worked effectively. Consultants from the cardiology ward attended other areas of the hospital to discuss any patients would be needing transfer to and to discuss bed availability.

Staff in all areas worked with staff and partners in other services within the hospital, the pharmacy teams, and estates teams.

Observation

The governance board huddle was held daily and attended by staff from all clinical roles. We observed this meeting, and this was well attended by approximately 20 members of staff at all levels including consultants, doctors, matrons, senior nurses, and nursing staff including health care assistants. Topics discussed included complaints, audit results, positive feedback, and incidents. At this meeting staff shared experiences and were able to ask questions.

Processes

There were processes to ensure members of the multidisciplinary team (MDT) worked together to ensure the needs of the patients were met. There were referral processes for staff to use when supporting patients. Key governance meetings were attended by members of the MDT. The meeting we observed and minutes from various meetings showed these were well attended and effective.

People’s experience

Patients had access to dietitians. The oncology department dietitians offered nutrition support and meal plans for patients undergoing chemotherapy. The service offered food menus to reflect the needs of patients such as vegans, vegetarians, halal, and healthy eating options.

We saw posters relating to the ‘my care’ app, bereavement care, sepsis, and questions relating to cancer, and diabetes information.

Feedback from staff and leaders

Staff supported patients to access support from substance mis-use services, smoking cessation, and dietitians. Staff made referrals to external services such as GP surgeries.

Processes

There were processes to provide patients with relevant information to support a healthy lifestyle. There were also programmes in place to support patients in their home and reduced risks of readmission for example to 'Improving Lives' work.

People’s experience

There were effective approaches to monitor people’s care and treatment and their outcomes.

Feedback from staff and leaders

Managers and staff conducted a comprehensive programme of repeated audits to check improvement over time. Managers used information from the audits to improve care and treatment. Managers shared and made sure staff understood information from the audits.

The endoscopy service had received Joint Advisory Group on GI Endoscopy (JAG) accreditation.

Processes

The service participated in relevant national clinical audits. This included but was not limited to: National Diabetes Programme, National Obesity Audit, National Early Inflammatory Arthritis Audit, Heart Failure Audit, Myocardial Ischaemia National Audit Programme (MINAP), Delirium Screening, National Audit of Dementia, and Cardiac Rehabilitation. These audits generated reports from which action plans developing improvements in the service were agreed and monitored. Audits were routinely discussed at specialty Quality Improvement and Patient Safety Meetings. The trust also participated in cancer audits, for example National Gastric Cancer, National Pancreatic Cancer Audit, National Non-Hodgkin Lymphoma audit, and National Kidney Cancer audit.

People's experience

Patients we spoke to said that consent had been obtained from them prior to care and treatment and procedures had been explained to them. Patient files we reviewed showed that consent had been obtained, discussed, and reviewed. We saw appropriate consent forms were used for patients who were undergoing procedures, such as endoscopy, who lacked capacity.

Feedback from staff and leaders

Staff understood how to support patients to make informed decisions and act in their best interests. Best interest and consent forms were completed for patients who lacked capacity. Staff we spoke to were able to explain the Mental Capacity Act (MCA) and its applications. These staff explained to us that MCA and Deprivation of Liberty Safeguards training was mandatory at the service. Files we reviewed showed that staff gained consent from patients for their care and treatment in line with legislation and guidance.

Staff were able to explain the consent process to us and explain the trust policy. When patients could not give consent, staff made decisions in their best interest, considering patients' wishes, culture and traditions.

Processes

Managers audited the use and quality of mental capacity assessments and the completion of consent documents. This was done in line with National Institute of Health and Care Excellent (NICE) guidelines. We saw the outcome of the audit for June 2024, and the service had made improvements on the previous audit for example: 96% (83 out of 86) of decisions demonstrated Mental Capacity was assessed and 89% had involved a representative of the patient. Recommendations were also made following the audit, such as sharing the audit outcomes with relevant clinical areas and offering support where needed.