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Andover War Memorial Hospital Good

Inspection Summary


Overall summary & rating

Good

Updated 7 April 2020

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

  • 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.

However:

  • Staff had not received training in quality improvement methods.
  • Governance processes and mechanisms for identifying and understanding of risk were not always robust.
  • The day surgery unit did not benchmark its performance.
  • The service did not consistently use the World Health Organisation Safer Surgery Checklist.
  • Staff were not aware of the surgical division’s vision or strategy.
Inspection areas

Safe

Good

Updated 7 April 2020

Effective

Good

Updated 7 April 2020

Caring

Good

Updated 7 April 2020

Responsive

Good

Updated 7 April 2020

Well-led

Requires improvement

Updated 7 April 2020

Checks on specific services

Medical care (including older people’s care)

Requires improvement

Updated 1 July 2019

This rating is from the previous comprehensive inspection. We did not re-rate this service as part of this focused inspection.

The staff had responded to issues raised at our previous inspection in June 2018:

  • Equipment was serviced and labelled with dates for the next service and therefore ready for use.
  • Resuscitation equipment was accessible and readily for use. Staff checked the contents for dates and recorded the checks.
  • Senior clinical staff were trained and confident to respond to calls for assistance in emergency situations.
  • Medicines were managed and stored safely and kept at optimum temperature.
  • Pharmacy support was available to staff if required.
  • Endoscopy and general day surgery lists were managed effectively with regard to patient dignity, and any breaches of mixed sex guidance were reported.

End of life care

Outstanding

Updated 12 November 2015

End of life care at this hospice was “outstanding”. We rated the service good for safe, effective and responsive care and outstanding for caring and well-led care.

Our key findings are:

People were protected from avoidable harm and abuse. There were reliable systems and processes were to ensure the delivery of safe care.

Care and treatment was delivered in line with local and national guidance and, a holistic patient-centred approach was evident.

There was good multidisciplinary working, staff were appropriately qualified and had good access to a comprehensive training programme dedicated to end of life care.

Patient outcomes were routinely monitored and where these were lower than expected, comprehensive plans had been put in place to improve. ‘Do Not Attempt Cardio Pulmonary Resuscitation’ (DNACPR) forms had been completed.

Staff treated people with compassion, kindness, dignity and respect and feedback from patients and their families were consistently positive.

People’s needs were mostly met through the way end of life care was organised and delivered. However, the rapid discharge of those patients expressing a wish to die at home did not always happen in a timely way. Where delays to discharge had occurred, these were mostly subject to circumstances outside the control of the trust.

The leadership for end of life care was strong. There were robust governance arrangements and an engaged staff culture all of which contributed to driving and improving the delivery of high quality person-centred care.

This was an innovative service with a clear vision and a strong focus on patient centred care and was supported by a board structure that believed in the importance of good end of life care for the local population

Maternity and gynaecology

Good

Updated 12 November 2015

We found maternity services were good for providing safe, effective, caring, responsive and well led services.

Our key findings are:

Midwifery staff were encouraged to report incidents and robust systems were in place to ensure lessons information and learning was disseminated trust wide.Procedures to protect people from abuse and avoidable harm were being followed. Midwife staffing levels were appropriate to provide one to one care.

Care and treatment was delivered in line with current legislation and nationally recognised evidence based guidance. Policies and guidelines were developed in line with the Royal College Of Gynaecologists (RCOG), Safer childbirth (2007) and National Institute for Health and Care Excellence (NICE) guidelines. The guidelines had been unified across the trust for the maternity service to ensure all services worked to the same guidelines.

Although patient outcomes were recorded on the trust wide maternity dashboard, outcomes appropriate for a midwifery led centre were not being measured and recorded. This needed further development.

Women throughout the service consistently gave us positive feedback about the care and treatment they had received. We observed women were treated with dignity and respect and were included in decision making about their care. Women were able to make choices about where they would like to deliver their babies. Women and families had access to sufficient emotional support if required.

There was a strategy and vision for the service which was focused towards the development of a new hospital. However, there was not a specific strategy or plans for the maternity centre in the short and medium term. The overall plan was for the service to remain open to increase choice for women but the plans to increase birth rates or expand and develop the service were not developed.

There were comprehensive risk, quality and governance structures and systems were in place to share information and learning. Staff across the service described an open culture and felt well supported by their managers. Staff continually told us they felt “proud” to work for the trust.

Outpatients and diagnostic imaging

Good

Updated 12 November 2015

Outpatients and diagnostic imaging services were good for providing safe, caring, responsive services, but required improvement to provide well-led services.

Staff were encouraged to report incidents and the learning was shared to improve services. In diagnostic imaging, staff were confident in reporting ionised radiation medical exposure (IR(ME)R) incidents and followed procedures to report incidents to the radiation protection team and the care quality commission.

The environments were visibly clean and staff followed infection control procedures. Equipment was well maintained and medicines were appropriately managed and stored. Most records were available for clinics and, if not available, temporary files and test results from the electronic patient record were used. Patients were assessed and observations were performed, where appropriate. However, there was not an assessment tool in use to identify patient’s whose condition might deteriorate.

Nurse staffing levels were appropriate as there were few vacancies. Radiographer vacancies were higher and they reported a heavy workload. There was an ongoing recruitment plan.

There was evidence of National Institute for Health and Care Excellence (NICE) guidelines being adhered to in rheumatology and ophthalmology. However, there was not a local audit programme to monitor clinical standards. Staff had access to training and had annual supervision but did not have formal clinical supervision.

Staff followed consent procedures but did not have an understanding of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards which ensures that decisions are made in patients’ best interests.

Patients consistently told us that they had experienced a good standard of care from staff across outpatients and diagnostic imaging services. We observed compassionate, caring interactions from nursing and radiography staff. Patients told us that they were included in the decision making regarding their care and treatment and staff recognised when a patient required extra support to be able to be included in understanding their treatment plans.

There was some evidence of service planning to meet people’s needs. For example, the breast unit offered access to one stop clinics where patients could see a clinician, have a biopsy and see a radiologist if required. National waiting times were met for outpatient appointments, cancer referrals and treatment and diagnostic imaging. However, the trust had a higher number of cancelled clinics, many of which were at short notice. The reasons for this varied and included cancellation for staff sickness, training and annual leave. There was a plan to address this but this was in development. Patients were not appropriately monitored to ensure the timeliness of re-appointments. Some patients had long waiting times whilst waiting in clinic for diagnostic imaging, and there could be delays of up to an hour.

There was good support for patients with a learning disability or living with dementia. Patients whose first language might not be English had access to interpreters although some staff were not aware of how to access this service. The service received very few complaints and concerns were resolved locally. Staff were not aware of complaints across the trust or the learning from complaints.

The outpatient department had a strategy in development. There were plans to deliver local consultant led services, including more one stop, nurse led and complex procedure clinics for outpatient services. Staff were not aware of how the strategy would develop in their departments and there were no immediate plans to tackle capacity issues and clinic cancellations. In diagnostic imaging there was an action plan planned to increase the skill mix of staff, the capacity of services and service integration across sites. This had had yet to be considered at divisional and trust board levels and interim actions were not specified.

Governance processes required further development in the outpatient department to monitor risks and quality although these were well developed in diagnostic imaging.

Staff were not clear about the overall vision and values of the trust but told us that the patient experience and the provision of high quality care was their main concern. Staff identified a disconnect with local services and the wider trust. Many staff in outpatients did not see their service leads frequently and said that trust board members did not have a visible presence.

Nurses and radiographers spoke highly of their immediate line managers and told us they worked in strong, supportive teams which they valued. There were however, few examples of local innovation and improvement to services. In diagnostic imaging, a staff representative role was being introduced to support and implement positive changes within the department that staff members themselves had recommended.

Public and patient engagement occurred through feedback such as surveys and comment cards.

Surgery

Good

Updated 7 April 2020

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

  • 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 were trained to recognise and respond appropriately to signs of deteriorating health or medical emergencies.
  • The service used systems and processes to safely prescribe, manage, record and store medicines and there was increased pharmacy support.
  • Emergency equipment was available and checked to ensure it was fit for purpose and available when needed.
  • Staff kept appropriate records of patients’ care and treatment. Records were clear, up-to-date and available to all staff providing care.
  • The service managed patients’ pain effectively and provided or offered pain relief regularly.
  • 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. Feedback from patients confirmed that staff treated them well and with kindness.
  • The trust generally planned and provided services in a way that met the needs of local people.

However:

  • We found medicines given for general anaesthesia which is not performed in the day surgery unit. There was no specialist equipment to support patients having general anaesthetics. There was a lack of risk assessments and governance detailing in what circumstances these would be used in an emergency.
  • There was a lack of overarching governance processes. There was no formal process for staff and senior managers to discuss and manage risk, issues and performance. Although staff had formal meetings and discussed learning, incidents and risks there was limited opportunities for wider learning within the surgical division.
  • Although senior oversight and visibility had improved since our last inspection had improved, this still needed building upon, to ensure senior managers understood the service and the risks.
  • The service used the World Health Organisation Checklist Safer Surgery Checklist for some procedures but not all, which could lead to confusion amongst staff.
  • Although there was a trust strategy, staff were unaware of whether there would be any changes to the services in the future. There was no vision or strategy for the development of the service.
  • Patients could not access the service when they needed it. Waiting times for treatment for ear, nose and throat and ophthalmology were not in line with good practice. However, it was not possible to tell how well the day surgery unit was performing as their data was included in the Royal Hampshire County hospital data.
  • Staff had ideas of additional procedures could be performed within the unit which would alleviate capacity on the other two hospitals. However, these had not been developed and implemented. Staff felt this was because the focus of the senior leadership team was on the projects on the other two acute hospitals.

Urgent and emergency services

Good

Updated 7 February 2018