You are here

Andover War Memorial Hospital Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 26 September 2018

Our rating of services stayed the same. We rated it as requires improvement because:

  • Compliance with mandatory training in key skills was below the trust’s target. This meant we could not be assured staff had the necessary knowledge and skills to deliver safe and effective care.
  • Medicines were not managed effectively. We identified issues with the storage, administration and disposal of medicines.
  • There was limited pharmacy input into services to support staff and patients. Despite there being a pharmacy rota, which identified when pharmacy visits were planned, these visits did not take place.
  • Emergency equipment was not consistently checked in line with the trust’s policy to ensure it was fit for purpose and available when needed.
  • Emergency procedures were not effective as staff were not clear about their responsibilities and not all were trained and assessed as competent to respond in the event of an emergency.
  • There was limited assurance of the trust’s process for managing and declaring to NHS England mixed sex breaches, in line with the national guidance, on the endoscopy unit.
  • The governance processes and culture at the hospital did not always support the delivery of high-quality care.
  • There was a risk that staff may not recognise or respond appropriately to signs of deteriorating health or medical emergencies. This meant that patients may not receive appropriate care and treatment.

However:

  • Patient care records were detailed, clear, up-to-date and easily available to all staff providing care. This ensured individual’s needs were identified and there was evidence that they had received care and treatment as planned.
  • People were treated with respect and supported to be involved in their care.
  • Patients were assessed and monitored regularly to identify if they were in pain, and action was taken to provide pain relief when necessary. Staff supported those patients unable to communicate using suitable assessment tools and gave additional pain relief to ease their pain as necessary.
  • Staff appraisal rates were above the trust’s target. This demonstrated that the majority of staff had participated in an annual appraisal.

Inspection areas

Safe

Requires improvement

Updated 26 September 2018

Effective

Good

Updated 26 September 2018

Caring

Good

Updated 26 September 2018

Responsive

Requires improvement

Updated 26 September 2018

Well-led

Requires improvement

Updated 26 September 2018

Checks on specific services

Urgent and emergency services

Good

Updated 7 February 2018

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.

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.

Medical care (including older people’s care)

Requires improvement

Updated 26 September 2018

Our rating of this service went down. We rated it as requires improvement because:

  • There was limited assurance about safety which put patients at an increased risk of harm. Emergency procedures were not effective as staff were not clear about their responsibilities.
  • Medicines were not managed safely and processes were not followed for safe storage, administration and stock checks. There was limited pharmacy input to support the staff and patients. Emergency equipment was not checked regularly and in line with the trust’s policy to ensure that they were safe to use and available to provide safe care to patients in an emergency.
  • There was limited assurance of the trust’s process for managing and declaring mixed sex breaches on the endoscopy unit.
  • The governance processes and culture at the hospital did not always support the delivery of high-quality care.
  • There was not a clear process in place for accessing support during a medical emergency.

However:

  • People received effective care that met their needs.
  • People were supported, treated with respect and involved in their care.

Surgery

Requires improvement

Updated 26 September 2018

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

  • There was limited assurance about safety processes and procedures.
  • There was a risk that staff may not recognise or respond appropriately to signs of deteriorating health or medical emergencies.
  • Emergency equipment was not checked to ensure it was fit for purpose and available when needed.
  • The service did not have effective processes to manage medicines safely including stock management and safe storage.
  • The process for protecting their privacy and dignity was not managed effectively.
  • The delivery of high-quality care was not assured by the leadership, governance or culture.

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