Hospital of St Cross

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

We rated responsive as good. We assessed 7 quality statements. People received person-centred care and did not experience discrimination. The service was inclusive and took account of people’s individual needs and preferences. Staff understood the diverse health and social care needs of their local communities. Staff listened to people’s concerns to improve the service.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People's Experience

Patients spoke of care being person-centred. A patient told us they were offered an ice pack and strong pain relief following their surgery. Patients told us the hospital was flexible with appointment dates and offered earlier dates when these became available. The service had a nutrition champion who liaised with other staff to ensure patients were sitting in upright positions ready for their meals, tables were cleared and there was no activity during protected mealtimes.

A patient who spoke very little English told us they had an interpreter by video call when nurses carried out their assessment. They had been given enough information prior to their surgery and were satisfied with the care they had received.

Feedback from staff and leaders

Staff completed care plans to reflect the physical, mental, emotional and social needs of their patients. Staff made sure people were able to be involved in the planning of their care and made shared decisions. Staff made sure people understood what was happening and reasonable adjustments were made where needed to make sure care was person-centred.

Staff made sure patients living with mental health problems and learning disabilities received the necessary care to meet all their needs. They were knowledgeable about the actions they could take and resources they could call upon if a patient was seen who had a learning disability. We reviewed a patient’s notes which documented clearly how needs were met and adjustments required. A learning disability liaison team was available, and staff described them as responsive. Communication aides and other tools were available on Cedar ward to support staff caring for patients living with learning disability.

Staff respected patients’ personal, cultural, social, and religious needs. Services were generally planned and delivered in a way that took the needs of different patients into account. Patients received written information ahead of their appointment which included specific instructions and information about what to expect as part of their care and treatment. For patients having a surgical procedure, the information included guidance on staying nil by mouth, arrival time, the procedure and aftercare. Managers ensured that patients who did not attend appointments were contacted. Staff told us they would make arrangement for them to have an alternative appointment.

Observation

The service was inclusive and took account of people’s individual needs and preferences. Staff made reasonable adjustments to help people, and their families access services. Side rooms and extended visiting were facilitated for patients with a learning disability.

People's Experience

A patient told us they received care and support that was coordinated, and everyone worked well together and with them.

Feedback from staff and leaders

Staff understood the diverse health and social care needs of their local communities. There was continuity in care to ensure that all the procedures required from the start of treatment until the end were arranged and joined up. Staff understood the needs and preferences of people with protected characteristics. Staff worked across healthcare disciplines and with other teams when required to care for patients. We observed staff including physiotherapists and occupational therapists work closely with ward staff to provide treatment and support. The therapists collaborated on falls risk assessments with ward staff. Staff told us that they worked well with therapy staff, and regularly shared information such as at daily handover meetings or when therapy teams attended the ward to treat patients.

Feedback from Partners

We did not gather this evidence at the time of our assessment.

Processes

The service planned and provided care in a way that met the needs of local people, and the communities served. It also worked with others in the wider system and local organisations to plan care. Managers planned and organised services, so they met the changing needs of the local population.

People's Experience

Patients told us they were informed about their care. They all knew why they were in hospital, what operation they were having and what the next steps were for their recovery. However, during day 2 of our assessment, we met relatives waiting over 4 hours in the day surgery unit. There was generally lack of information about waiting times and relatives could spend a number of hours waiting for patients. We raised this with staff on the ward who said relatives were usually asked to go home and come back later. However, more than 3 relatives we spoke with had not been given this information to enable them to make an informed decision. A relative said, “a clear explanation of admission and procedure time would have made it easier to organise things.” We fed this back to the trust to consider improving this for all patients and families. The trust’s internet page had a section dedicated to patient information leaflets for every type of surgery, outlining in easy-to-understand language, what happens from the beginning to end of surgery. The patient information leaflets also explained what patients may expect post operatively.

Feedback from staff and leaders

Staff provided people with accurate and up-to-date information in formats tailored to their individual needs. They were able to adapt information to meet the needs of people to ensure it could be understood.

Processes

Information needed to deliver effective care and treatment was available to relevant staff in a timely and accessible way. 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.

People's Experience

We spoke with a patient who said staff had communicated their plan of care with them and they had been involved in decisions about their care. Patients, relatives and carers knew how to complain or raise concerns. Patients told us they knew how to raise a complaint should the need to.

Feedback from staff and leaders

Managers investigated complaints and identified themes. Staff knew how to acknowledge complaints and patients received feedback from managers after the investigation into their complaint. Managers shared feedback from complaints with staff and learning was used to improve the service. Staff understood the policy on complaints and knew how to manage them. Staff tried to address complaints or concerns immediately to see if they could be solved straight away. Staff told us if the problem could not be resolved, patients were given details on how to make a complaint.

Processes

There were effective policies and processes to support people who wanted to raise concerns and complaints about their care and treatment. Complaints and compliments were reviewed for learning and improvement. The trauma and neuro group held weekly collaborative meetings to discuss complaints and shared with their teams at production board/safety huddles. There had been 4 formal complaints, and many compliments received from October 2023 to October 2024. The trauma and neuro senior nurses worked closely with the patient advice and liaison service to address issues highlighted to them. They recently set up a patient experience group which was led by a matron.

People's Experience

People did not experience discrimination or inequality. People with additional needs did not feel they were disadvantaged. This included making reasonable adjustments for people with disabilities, those with communication difficulties or cognitive impairment. People were listened to when they wanted to share their experience. The department was fully accessible to people with disabilities or who used a wheelchair. At the time of our assessment, no patients from the surgical specialities we looked at were cared for outside of a surgical ward.

Feedback from staff and leaders

Staff worked hard to remove any barriers to access for patients. There was a culture to prevent discrimination and inequalities. Staff listened to people who had concerns or complaints and sought ways to improve the service.

Processes

The service did not meet NHS treatment standards due to the backlog caused by the COVID-19 pandemic across England. However, managers worked continuously to reduce waiting times and address the backlog, showing steady progress. The service worked with other healthcare professionals to provide a timely service for different healthcare needs and serious conditions needing specialist input. Referral to treatment (RTT) data for June 2024 showed general surgery had the largest number of patients on their waiting list than all other specialties. The trust’s focus was to reduce the number of patients treated at 52 weeks on the non-admitted pathway. The waiting list had reduced up until May 2024 when it started to increase as they responded to the increase in 18 week waits. The trust’s incomplete RTT pathway showed a backlog for waits over 18 weeks in July 2024 at 55.8% which was better than the NHS England average of 57.9%.

The elective hub leadership team had taken steps to identify areas for improving efficiency. For example, improving zero-day case numbers for day case arthroscopy, and using UHCW improvement methods to improve theatre utilisation and start/finish times. Leaders undertook a benchmarking exercise to identify how other organisations achieved success with day case hip and knee replacements. In September 2023, a multidisciplinary team of managers, surgeons, anaesthetists and nurses visited another hospital and immediately saw how principles and pathways could be adapted for patients receiving surgery at Hospital of St Cross. A revised pathway was launched in January 2024 with data indicating 1 in 4 patients requiring a hip or knee replacement, had it as a day case procedure.

Managers worked to keep the number of cancelled operations to a minimum. When patients had their operations cancelled at the last minute, managers made sure they were rearranged as soon as possible. Managers and staff started planning each patient’s discharge as early as possible. Managers monitored the number of patients whose discharge was delayed, knew which wards had the most delays, and took action to reduce them. The service audited waiting times and data shared following our assessment showed a general trend of improving performance. Chaired by the deputy group director of operations, the operational leadership team held weekly meetings to improve access to clinical services by reducing the waiting times. In order to ensure equality of patient access, there was a single patient waiting list for each clinical service.

People's Experience

People said they were able to give their views of their experiences and outcomes. Those we met had not experienced discrimination or inequality.

Feedback from staff and leaders

Staff tailored the care and treatment they provided to meet the experience of patients. Leaders we spoke with demonstrated they understood the local population. Staff proactively sought out ways to address barriers to improve people’s experience. People’s care, treatment and support promoted equality, removed barriers or delays and protected their rights.

Processes

The service complied with legal equality and human rights requirements, including avoiding discrimination, having regard to the needs of people with different protected characteristics and making reasonable adjustments to support equity in experience and outcomes. We saw staff treated all patients with respect. There were processes to engage with the local population and to ensure care was tailored to their needs. The processes and policies within the service ensured patients were treated in line with requirements under legal and human rights.

Staff carried out elective surgery on this site and in the event of an emergency, a transfer protocol was in place to facilitate safe transfer to the University Hospital, Coventry.

Outcomes
Managers and staff worked to make sure patients could be discharged as soon as they were ready to go home. The service participated in national monitoring and audit of which the length of stay for specific types of surgery was measured. Managers made sure they had arrangements for surgical staff to review any surgical patients on non-surgical wards. Managers worked to minimise the number of surgical patients on non-surgical wards.

People's Experience

People were supported to make informed choices about their care and plan their future care. Patients told us they were kept informed about future appointments. They felt staff had given them all information they required.

Feedback from staff and leaders

Staff helped people to make informed choices. Patients were able to express their wishes about cardiopulmonary resuscitation. Staff communicated with patients professionally when any treatment was changed or rearranged to help them plan for the new procedure. Staff worked together to ensure the care given to people was the right option and of benefit to them and their lifestyle overall.
Staff understood and worked in accordance with National Institute for Clinical Excellence best practice guidance around decision making and mental capacity. Staff we spoke with demonstrated a clear understanding of the trust’s resuscitation policy and ‘ReSPECT’ documentation. The ReSPECT process creates personalised recommendations for a person’s clinical care and treatment in a future emergency in which they are unable to make or express choices.

Processes

Processes ensured people could make decisions and informed choices and plan for their futures. Personalised care plans were required for patients and information was shared with others who may need to be informed.