University Hospital

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

People, those who support them, and staff could easily access information, advice, and advocacy. This supported them in managing and understanding their care and treatment. There was partnership working to make sure that care and treatment meets the diverse needs of communities. People were encouraged to give feedback, which was acted on and used to deliver improvements. People’s care was not always person centred or designed to meet the diverse needs of the individual.

We have not awarded this service a score for Responsive.

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

People's experience

People's care was not always person centred or designed to meet the needs of the individual. The approach to meeting individual needs was inconsistent. One patient we met with a learning disability on a medical ward explained they had been provided with 1:1 support, but this was a bank member of staff who had never met the patient before and was sat in the corner of the room. We did not see the member of staff interacting with the patient. The support was not designed to meet any specific needs the patient may have had.

On the acute medical short stay unit, we spoke to a patient with a learning disability who had been accompanied by a relative. This patient had been in hospital (across different departments) for five days but had no hospital passport and had not been seen by the liaison team. We raised this with staff at the time of our assessment and actions were taken. Also, at the time of our assessment there was not a flag on the electronic patient record (EPR) to highlight this patient had a learning disability. However, the patient's learning disability was recorded in the nursing notes on the electronic patient record. Despite this patient being able to describe their likes and dislikes and feelings, we observed staff asking the relative about the patient's lunch requirements and not the patient themselves. Also, the relative told us no provision had been made to support them to stay, and they had sourced a chair themselves, which was broken. Following our assessment, the trust told us there is guidance for relatives relating to visiting times and relatives can request to extend their visit in special circumstances, for example, to support patients with learning disabilities. The chair was labelled as broken and reported for repair and not in use.

However, a patient that we met on ward 32 had a hospital passport and had been seen by the liaison team. A dependency scoring tool had been used which identified any additional support needed and this was in place when we visited. There were clear and accurate records for this patient in relation to her capacity assessments and best interest decisions.

Some patients told us they felt that any information shared with them in relation to their care and treatment had been explained in a manner they could understand. Also, if they had any questions, they felt the doctor had answered these, which helped the patient understand their care and any treatment required.

There were processes to support people with different needs. For example, patients living with dementia had blue pillowcases so staff could identify they might need more support. However, these processes were not always effective or consistent in meeting the needs of patients and their families and carers.

Feedback from staff and leaders

The trust's electronic patient record (EPR) system did not consistently apply a flag to alert staff to patients with a learning disability or autism. It was also not available for all staff to use. While staff in all areas were able to describe processes and support for patients with a learning disability, the same could not be said for the support of autistic patients. We were not assured that staff were able to recognise or therefore meet the individual needs of autistic patients.

There was not a consistent application of the digital flag to highlight a patient on the electronic patient record. After the on-site assessment, we heard this was because in the rollout of EPR it had been decided that safeguarding leads added this information onto EPR. Furthermore, this meant the ability of staff to make adjustments (the reason for a flag) was hampered by a lack of awareness of a person's needs, that could be recorded on their EPR if the system allowed.

We asked upon arrival at the trust for a list of patients throughout the trust with a learning disability and who were autistic. The lack of a reliable flag meant this was not possible. We were presented on day two with a list of patients that missed off those we had met and did not include any autistic patients. If the trust could not reliably identify where patients were or what their needs were, they cannot be assured they were meeting them. The learning disability liaison nurse described how they themselves did not get a list of patients in the trust and largely "found" them by walking the wards if ward staff did not contact them.

In the endoscopy department, patients, their carer, or family member would be contacted prior to their appointment and any adjustments such as seeing the patient first on the appointment list. Also, relatives could stay with the patient until they were sedated and then in the recovery ward would also be able to be with the patient. Patients with any adjustments would be allocated one named nurse for their treatment to ensure continuity of care.

Staff we spoke with had completed training in supporting people with a learning disability and autistic people and valued the learning and the compliance rate for this within the trust was 90%. Many said that it had made them think about people with a learning disability and autistic people more in their work.

On the renal ward, there was a link staff member with a focus on people with a learning disability, who undertook more learning opportunities and had the opportunity to provide support for other staff.

Staff knew how to contact the learning disability liaison team and said they were responsive.

Staff were able to describe what arrangements they could make to accommodate the specialised needs of patients with a learning disability.

In all areas we visited, people with a learning disability were able to have families, visitors/ carers with them at all times. Blank hospital passports were available in paper form if required.

Observation

The environment in fast-paced areas did not always enable staff to make adjustments in order to meet people's needs. We observed in the medical assessment unit (MAU), the lack of quiet areas, the constant noise, the harsh lighting. At the time of our visit, there were no patients on MAU with a learning disability or who had been identified as autistic. However, staff confirmed that they had access to a range of resources to support patients such as hospital passports, the liaison team, and additional equipment, but there were limited amounts of environmental or capacity adjustments they could make.

People’s experience

Patients we spoke to said that their wishes and needs had been considered when decisions had been made and their cultural values or beliefs had been included.

Feedback from staff and leaders

Patients had care from staff who understood their diverse health and social care needs and those of their community. Staff recognised how different needs arose from people’s backgrounds and made adjustments to support them, such as respecting their cultural values.

The service endeavoured to make care joined up for patients as much as possible. Even with medical care being exceptionally busy much of the time, staff and services tried to be flexible and worked together to ensure care was as continuous as possible.

The staff understood how some parts of their community would be subject to a poorer experience of care for many reasons and took this into account when caring for them.

People's experience

Most patients we spoke to said information had been provided to them in a way they could understand, and adjustments had been made as necessary, departments had information leaflets available about procedures. However, our equality and diversity team observed this was not done for some patients and that the needs of patients with learning and disability needs or requiring adjustments to their treatment plans were not easily tracked or identified.

Feedback from staff and leaders

There were systems for staff to access patient information for the majority of patients and make informed decisions. However, we were told across multiple wards that healthcare assistants (HCAs) did not have the right access to the area of the patient's electronic patient record (EPR) to read and understand all patients care needs. Subsequently we learnt that there was some confusion about access and skills of staff to access the EPR. However, there were a significant number of HCAs relying on registered nurses to tell them information about the patients in their care despite the EPR having been in use for a number of months at the time of the on-site assessment. Staff in the discharge lounge told us the new electronic patient record was still being adapted for their use as the oversight of the patient remained with the ward they had been transferred from.

There was confusion about which area of the EPR system contained information about patient's next of kin. In some areas staff could demonstrate where they found information. However, we were told by some staff of a glitch in the implementation of the EPR system which meant it was not always easy to find. We were told of a situation whereby staff had taken 90 minutes (by working through the old system) to find next of kin details after a patient had died.

Staff kept records of patients' care and treatment. Records were stored securely, and most were easily available to all staff providing care.

Processes

The service had effective policies and processes to ensure the information which patients received met their needs and where adjustments were required, these were made.

The service had provided staff training on the new electronic patient record system and evidence they shared with us showed that 91% of staff had completed this training. However, some staff still had access issues and had told us there had been issues with the roll out which while these were being addressed by leaders had caused a reduction in efficiency in some areas.

There were processes to ensure all patient information was kept in a way which complied with data protection and legal requirements.

People’s experience

Most patients we spoke to felt listened to, some commented that even though staff were very busy they had time to listen to their concerns. Information displayed was in wards and reception areas about how to make a complaint. We saw evidence that patients had been contacted following incident or complaints. Patients had received an apology and explanation. On the response we saw, patients had been advised of next steps and any follow up that would happen after the conclusion of the investigation. We saw that duty of candour had been applied where appropriate.

Feedback from staff and leaders

Staff we spoke to knew the complaints policy and told us all complaints were investigated and feedback given to staff.

Processes

The trust had a clear policy for complaints management and staff followed this.

People’s experience

Some patients told us that their needs had been assessed prior to admission or on arrival.

Feedback from staff and leaders

Staff told us that prior to appointments most patients were contacted to see if they needed any reasonable adjustments prior to attending their appointments, for example patients who were anxious could request to be seen early in the day on the endoscopy patient list. This was not always possible for all patients as the service systems did not always flag those patients. Not all people with a learning disability were provided with a care plan that reflected their needs or was effective.

Staff completed ‘getting to know me’ forms with patients upon their admittance to wards, these forms were to help healthcare professionals understand patients' needs and preferences.

Processes

There were processes to monitor bed occupancy, in the 12 months prior to our assessment the bed occupancy was between 95% and 98%. The service had several initiatives to help with the flow in the department such as the improving lives work which aimed at helping people to remain in their homes rather than being readmitted to hospital.

Along with a national backlog of delays, the service was not meeting cancer targets to see patients in 28-days. The service provided 6 months of data relating to the 28-Day Faster Diagnosis Standard (FDS) which was when suspected cancer was diagnosed or ruled out within 28 days. The 28-day target was met for just one cancer pathway in the 6 months prior to our assessment which was haematology. However, the trust had a weekly cancer patient tracking list meetings to track waiting times and progress patients along their cancer pathways. There was a cancer specialty action plan with analysis to identify any themes and learning.

People’s experience

The patient experience and outcomes were reviewed and discussed at meetings. Minutes we saw of meetings reflected the importance the service placed on improving services and patient satisfaction.

Feedback from staff and leaders

Department leaders reviewed and monitored patient experiences and outcomes with a programme of audits and feedback from patients. Managers discussed outcomes at meetings. For example, the stroke operation group meeting minutes detailed reviews of service key performance indicators, case studies and trials for new patient drugs. Quality improvement plan groups were held to discuss complaints, patient liaison team feedback, and incident reporting. Expansion to services and plans to improve the patient experience were discussed.

Processes

The trust was participating in national mandatory audits, for example Diabetes Programme, National Obesity Audit, National Early Inflammatory Arthritis Audit and Heart Failure Audit. Outcomes of these audits were shared with the specialty Quality Improvement and Patient Safety (QIPS) meetings and action plans for improvements are agreed. The service completed cancer audits for example: National Gastric Cancer Lonsurf, National Pancreatic Cancer Audit (NPaCA) and National Ovarian Cancer (NOCA). These audits were also used to drive improvements in care and provision of services.

The service had completed an audit on the use of Janus kinase (JAK) inhibitors, these are a type of drug that treat chronic inflammatory conditions like rheumatoid arthritis and ulcerative colitis. The aim of the audit was to inform the consultants about patients on a prescription of JAK inhibitors and review the care of these patients.

The service reviewed staffing and planned recruitment, where possible in line with demand. Processes and meetings were multidisciplinary, and teams worked effectively together.

People’s experience

We observed discussions with patients relating to their care and treatment and what was happening now and what were the next steps. Staff held honest conversations with patients and ensured they were aware of the options of their next steps. Patients told us that they were happy with how consultants shared information and in a way they understood.

We also observed staff having difficult conversations with patients relating to future treatment and plans. Staff listened to patients and family members’ thoughts and choices.

Feedback from staff and leaders

Staff were trained to have difficult conversations with patients relating to future treatment and plans. Staff listened to patients and family members’ thoughts and choices. Plans were made with occupational therapists for ongoing support and assessments of needs for discharge and ongoing care.

We observed staff updating patients’ records, this was to ensure that any discussions between the patient and staff were recorded and any actions that had been agreed were all logged.

Processes

We observed ward rounds where staff made plans for patients discharges and discussions about action which needed to be in place for a successful discharge. Unfortunately, not all discharges were successful, and not all patients felt they had been kept informed. They were often waiting funding or beds within the community.