Hospital of St Cross

Updated 11 February 2020

University Hospitals Coventry and Warwickshire NHS Trust has approximately 1,175 inpatient beds and 116 day case beds located across two acute locations: University Hospital which is located in Coventry and Hospital of St Cross which is located in Rugby. These two hospitals serve a combined population of over one million people. The trust is a major trauma centre and the specialist cancer centre for the region. In addition, it specialises in cardiology, neurosurgery, stroke, joint replacements, invitro fertilisation (IVF) and maternal health, diabetes and kidney transplants. The number of staff employed by the trust as of January 2018 was 8,136. The trust’s services are commissioned by Coventry and Rugby Clinical Commissioning Group.

Services provided at this hospital include:

• Diagnostics.
• Medical care.
• Outpatients.
• Surgery.
• Urgent care centre.

Updated 11 February 2020

During our inspection we:

• visited the main outpatient departments.
• spoke with two relatives and six patients.
• spoke with 12 members of staff including, nurses and specialist nurses, domestic staff, health care assistants and consultants.
• looked at seven sets of patient records in detail.
• observed interactions between patients, relatives and staff.

Updated 31 August 2018

Our rating of this service improved. We rated it as good because:

• Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness. We observed staff members were courteous and helpful to patients and treated them with dignity and respect.
• Generally, the service prescribed, gave, recorded and stored medicines in accordance with best practice. Patients received the right medication at the right dose at the right time.
• The service generally had suitable premises and equipment and looked after them according to the manufacturer’s instructions. The service generally controlled infection risk well. Most staff complied with infection prevention and control policy.
• There were effective systems in place to recognise and respond to deteriorating patients’ needs.
• Staff generally kept appropriate records of patients’ care and treatment. Records were clear, up-to-date and available to all staff providing care. Entries were clear and legible and most entries were dated and signed.
• The service generally had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and abuse and to provide the right care and treatment.
• The service used safety monitoring results well. Staff collected safety information and shared it with staff, patients and visitors. The service used information to improve the service.
• The service provided care and treatment based on national guidance and evidence of its effectiveness. Audits were completed to ensure staff followed guidance and progress with implementation of guidance was monitored.
• The service monitored the effectiveness of care and treatment and generally used the results to improve them. Information about the outcomes of patient’s care and treatment, both physical and mental where appropriate, were routinely collected and monitored. This was done through local audits and national audits.
• The service made sure staff were competent for their roles. Managers appraised most staff’s work performance and held supervision meetings with them to provide support and monitor the effectiveness of the service.
• The service had managers with the right skills and abilities to run a service providing high-quality sustainable care. Nursing staff reported that there was strong local leadership on the wards and that matrons and ward managers were both visible and supportive. They told us that they felt supported by the local management team.
• Managers across the trust promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
• The service had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected.

However:

• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. However, not all staff had received safeguarding training on how to recognise and report abuse. Staff were aware of how to recognise and report safeguarding concerns.
• The service provided mandatory training for staff, but not all had completed it to meet the trust’s standard of 95% compliance.
• There was no seven-day service provided at the hospital of St Cross within the medical service. The medical patients did not have access to physiotherapy, occupational therapy or SALT service during the weekends and bank holidays.
• People could access the service when they needed it. However, the length of stay for medical patients was higher than the England national average due in part to system wide pressures in social care support.

Updated 11 February 2020

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

Updated 31 August 2018

Our rating of this service stayed the same. We rated it as good because:

• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
• Staff assessed risks to patients and monitored their safety, so they were supported to stay safe. Assessments were in place to alert staff when a patient’s condition deteriorated.
• The service managed patient safety incidents well. Staff were aware of the importance of reporting incidents and learning from incidents was communicated within the trust.
• Systems were in place for the safe management of medicines. Staff prescribed, gave, recorded and stored medicines well.
• The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and abuse and to provide the right care and treatment. Managers appraised staff’s work performance and provided opportunities for staff to reflect on their practice
• The service provided care and treatment based on national guidance and evidence of its effectiveness. They assessed staff compliance with guidance and identified areas for improvement.
• Multi-disciplinary team working was good. Staff worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.
• Staff supported patients to manage their own health, care and well-being and to maximise their independence following surgery.
• Staff cared for patients with compassion. Patients universally praised staff for their kindness and their understanding of their needs.
• Staff involved patients and those close to them in decisions about their care and treatment. Patients were aware of plans for their care and treatment and said they had been provided with the information they required.
• The service planned and provided services to meet the needs of local people. They worked with local commissioners and other stakeholders to ensure the service was used as effectively as possible.
• The service took account of patients’ individual needs. Care records did not always provide individualised information about the patient’s nursing needs which was easily accessible but this was mitigated by other information available to staff.
• The trust used a systematic approach to continually improving the quality of its services and safeguarding high standards of care by creating an environment in which excellence in clinical care would flourish.
• The trust had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected.

However:

• People could not always access the service when they needed it. Waiting times from referral to treatment were longer than the England average although the position was improving and the trust had an action plan to address waiting times.
• Information about day procedures were not always communicated to the patient’s GP.
• Access to the wards was not controlled and therefore presented a potential security risk
• Theatre staff did not always change or cover their theatre attire when moving between theatres and the wards.

Updated 31 August 2018

Our rating of this service improved. We rated it as good because:

• Staff cared for patients with compassion. Patients universally praised staff for their kindness and their understanding of their needs.
• Risks to patients were assessed, and their safety monitored and managed so they were supported to stay safe.
• The service had enough staff with the right qualifications, skills, training, and experience to keep people safe from avoidable harm and abuse and to provide the right care and treatment.
• The UCC provided care and treatment that was based on national guidance.
• Staff gave patients enough food and drink to meet their needs and improve their health.
• Patients’ pain was assessed and managed well.
• The service generally took account of patients’ individual needs.
• The service treated concerns and complaints seriously, investigated them and learned lessons from the results, which were shared with all staff.
• The trust was planning services in a way that met the needs of local people.
• Patients could access services when they needed them.

However,

• There was a lack of visibility from senior trust leaders to the staff in the UCC.
• The service did not have a clear strategy and vision for what it wanted to achieve and lacked workable plans to turn it into action.
• Local managers promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values: however, recent changes in the UCC had affected morale.
• The UCC lacked a systematic approach to continually improving the quality of its services and to safeguard high standards of care.
• The service engaged with patients, staff, the public and local organisations to plan and manage appropriate services, but this could be improved.
• There was limited evidence that the UCC was committed to improving services by learning from when things went well and when they went wrong, promoting training, research and innovation.