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Tameside General Hospital Good

This service was previously managed by a different provider - see old profile

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Inspection report

Date of Inspection: 3, 4, 6, 7, 8, 10 January 2014
Date of Publication: 19 March 2014
Inspection Report published 19 March 2014 PDF | 167.41 KB

Overview

Inspection carried out on 3, 4, 6, 7, 8, 10 January 2014

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

We have found eight breaches of the regulations which would normally lead to enforcement action. This Trust however is in Special Measures and it is the responsibility of the Trust working with Monitor to ensure that any non- compliance is addressed in a timely way. We will report on this following our next inspection.

In the hospital, we talked to over 75 patients, over 20 relatives or carers and over 50 staff, as well as 24 senior managers. At our listening event held off site, we spoke with twelve people who had used the hospital’s services or who cared for someone who had. We also spoke with a range of stakeholders before and during the inspection.

Most patients, relatives, carers and staff spoke positively about the recent changes to the governance of the hospital. Although the systems were not yet fully implemented, we found that the hospital was responsive to concerns raised during the course of the inspection. The hospital had taken reasonable steps to put an effective system in place, given the resources available, and had suitable plans in place to meet the requirements of other regulations. We will be following up to see whether these improvements have been sustained.

Staff said that the culture was now “changing quite quickly” which was challenging for some staff. One senior manager said: “For the first time, I feel like I’m able to be [a senior manager]”.

The patients, relatives or carers we spoke with described staff as friendly, patient, caring, hands-on, and courteous, even while reporting concerns about their experience.

One patient said that, because of their previous experience, they had delayed their current admission to hospital, which made their condition worse. They told us that so far they had “brilliant care”, “much better” than their previous experience. Another patient said the hospital was “better than it used to be. I still think they need more staff.” One patient on the medical assessment and admissions unit (MAAU) said: “[MAAU is] a bit of a madhouse – nurses and staff run off their feet.”

One patient said: “I’m fed up of waiting to hear something from a doctor.” Another patient said: “I’m frustrated by the lack of information from doctors….They don’t seem to talk to each other.”

Staff said: “the new processes are working well and improving patient flow.” One junior doctor in the emergency department told us the senior cover had improved and there was more support than there used to be, stating: “Things are so much better now.” A nurse on an adult medical ward said “we sometimes have to wait quite a while when we have requested a doctor to come to the ward.”

Senior managers told us that the hospital’s aim was to encourage staff on the wards to “recognise what ‘good’ looks like.”

We found adequate systems in place to manage medicines, to maintain cleanliness, and to control the risk of infections. Generally, we found that people consented to and received appropriate care and treatment in the paediatric and surgical units. Paediatric patients and their relatives or carers were safe and adequately involved.

In the adult medical wards, however, we found that staff did not demonstrate an adequate understanding of the legal processes established by the Mental Health Act 1983 and Mental Capacity Act 2005. Staff disclosed that some patients were restrained without safeguards in place.

We observed that adult medical patients were not protected against the risks of inappropriate or unsafe care and treatment, because staff did not adequately assess their needs. Patients’ medical records were inaccurate and incomplete. Care and treatment did not reflect guidance issued by appropriate professional and expert bodies.

We saw that there were not enough staff to meet the needs of patients in the MAAU and some adult medical wards. Supervision of staff, including doctors, was variable, although some staff felt there had been improvements since the change in senior and ward management. Staff spoke positively about their induction and mandatory training. We observed poor staff competencies in other areas, such as caring for patients with dementia.

We observed variation in how staff interacted with adult medical patients, relatives and carers. Some staff did not ensure the dignity and privacy of patients or involve them in their care and treatment. Several people raised concerns about communication with the hospital. Although the hospital had a number of programmes in place to engage with people who used the service, most of the people we asked did not know how to provide feedback or make a complaint.

We saw that the hospital had made improvements to the system for managing complaints; however, the system was not yet effective.