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Inspection Summary


Overall summary & rating

Inadequate

Updated 12 July 2019

We rated it them as inadequate because:

  • Our rating of safe was inadequate overall. Risks to patients using the diagnostic imaging services were not routinely assessed, including risks to the deteriorating patient. There was no processes in place for learning from incidents and when things went wrong and staff were working with out of date regulations. Staff in the theatre recovery area did not have the appropriate level of life support training in line with Association of Anaesthetists of Great Britain and Ireland (AAGBI) guidance. The outpatient’s department did not consistently have enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and provide the right care and treatment. Records were not always available to all staff providing care. Records were not stored safely or securely within the department.
  • Our rating of effective was good overall. The services provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance
  • Our rating of caring was good overall. Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.
  • Our rating of responsive was good overall. The services planned and provided services in a way that met the needs of most local people. Services took account of patient’s individual needs and they could access services when they needed them.
  • Our rating of well led was inadequate overall. Diagnostic services were not managed appropriately, leaders did not understand the challenges to the quality and sustainability of the service and had little oversight or understanding of the significant issues in the service. Not all risks in the outpatient’s department were fully recognised or mitigated.
Inspection areas

Safe

Inadequate

Updated 12 July 2019

Effective

Good

Updated 12 July 2019

Caring

Good

Updated 12 July 2019

Responsive

Good

Updated 12 July 2019

Well-led

Inadequate

Updated 12 July 2019

Checks on specific services

Diagnostic imaging

Inadequate

Updated 12 July 2019

  • Risks to patients were not routinely assessed including risks to the deteriorating patient.
  • Medical emergencies were not responded to appropriately with staff confused about the process.
  • There were no track records on safety and no processes in place for learning from incidents when things went wrong.
  • Outcomes for patients were not routinely measured against national standards to ensure the best possible outcomes.
  • Staff were working with out of date regulations and protocols and were unsure of updates to regulations.
  • Staff were not up to date with mandatory training and trust targets were not met.
  • Staff competencies were not checked and continual professional development was not routinely taking place.
  • Complaints were not always managed in accordance with the trust’s complaint policy.
  • The service was not managed appropriately. Leaders did not understand the challenges to quality and sustainability of the service.
  • The leadership team lacked leadership skills and had little oversight and understanding of the significant issues in the service.
  • There were no robust systems in place for learning, continuous improvement and innovation.

However:

  • People were safeguarded from abuse.
  • The environment and equipment used was clean and well maintained.
  • Staff teams worked well together and with other health care professionals.
  • Staff understood the relevant consent and decision making requirements of legislation and guidance in relation to the Mental Health Act 2005.
  • Staff were caring and treated people with compassion, kindness, dignity and respect.
  • The service was responsive to the needs of the local community and took account of individual needs.
  • People could access x-rays and scans in a timely way.
  • Staff received annual appraisals.

Outpatients

Requires improvement

Updated 12 July 2019

  • The environment was not suitable for the number of patients seen. Leaders recognised the need to review patient flow through the department.
  • Risks to people such as deterioration of patients and sepsis were not always adequately assessed and were not always managed safely.
  • The service did not consistently have enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and provide the right care and treatment.
  • Records were not always available to all staff providing care. Records were not stored safely or securely within the department.
  • The service did not always plan services that took account of patient’s individual needs. The facilities and premises were not appropriate for the services delivered.
  • The service did not always take account of patients’ individual needs. Waiting areas were limited for patients in wheelchairs and there was no bariatric equipment, including chairs in the waiting area.
  • Complaints were not closed in line with the trust’s complaints policy timescales.
  • The organisation had the processes to manage current and future performance and there was a system in place to identify, understand, monitor and manage current and future risks. However, not all risks were fully recognised and mitigated. The outpatient services had the leadership capacity and capability to deliver high-quality, sustainable care.
  • The service did not always collect, analyse, manage and use information as well as it could to support all its activities.

However:

  • The overall mandatory training compliance rate for qualified nursing staff was above the trust target.
  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
  • Standards of cleanliness across the department were generally maintained, with systems to prevent healthcare associated infections. Staff kept the environment, premises and equipment clean.
  • The service followed best practice when prescribing, giving, recording and storing medicines, with the exception of a treatment room within the general outpatient department that did not have a working lock.
  • Lessons were learned and improvements made when things went wrong. Staff understood their responsibilities to raise concerns, record safety incidents and report them internally and externally.
  • The service provided care and treatment based on national guidance.
  • People’s nutrition and hydration needs were identified, monitored and met.
  • People’s pain was assessed and managed.
  • Managers monitored the effectiveness of care and treatment and used the findings to improve them. They compared local results with those of other services to learn from them.
  • The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and monitor the effectiveness of the service.
  • The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and monitor the effectiveness of the service.
  • The department took part in health promotion. Patients were supported to live healthier lives and were referred to other support services where appropriate.
  • Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. They followed the trusts policy and procedures when a patient could not give consent.
  • People were treated with compassion, kindness, dignity and respect, when receiving care. Feedback from people who used the service, those who were close to them and stakeholders was positive about the way staff treated people.
  • People were given appropriate and timely support and information to cope emotionally with their care, treatment or condition. Staff communicated well with patients so they understood their care, treatment and condition.
  • Staff routinely involved people who use services and those close to them in planning and making shared decisions about their care and treatment.
  • People could access the service when they needed it. Most waiting times from referral to treatment and arrangements to admit, treat and discharge patients were in line with good practice, action plans were in place for those that were not.
  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared those with staff.
  • Leaders had the skills, knowledge, experience and integrity needed and there were clear priorities for ensuring sustainable, compassionate, inclusive and effective leadership.
  • There was a clear vision and set of values, with quality and sustainability as the top priorities.
  • Managers across the service promoted a positive culture that supported and valued staff, created a sense of common purpose based on shared values.
  • There were clear structures, processes and systems of accountability. Staff at all levels were clear about their roles and what they were accountable for and to whom.
  • The service engaged well with patients, staff, the public and local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively.
  • The service was committed to improving services by learning from when things go well and when they go wrong, promoting training, research and innovation.

Surgery

Good

Updated 12 July 2019

We rated it as good because:

  • Staff kept patients safe from harm. Staff had a good understanding of safeguarding, assessed an understood patient risks and managed patient safety incidents well and learnt lessons from incidents.
  • Staff maintained a safe and clean environment. The premises and equipment were suitable and well maintained. Staff kept themselves, equipment and the unit clean at all times.
  • Staffing levels were appropriate and staff were well trained. Nursing and medical staffing levels and skill mix were always appropriate on the unit and staff had completed mandatory training.
  • Staff were competent in their roles and worked well together as a team. Managers regularly appraised staff and provided them with lots of opportunities to learn and develop. Staff on the unit worked well together.
  • The trust ensured staff followed best practice and guidance. Trust systems ensured staff were always aware of new guidance. Staff always followed best practice around patient capacity and consent.
  • Staff cared for patients with kindness and compassion. The unit had consistently high scores on the friends and family test. All patients told us staff treated them with kindness, understanding and compassion at all times. Staff always provided emotional support.
  • Staff were responsive to patient’s individual needs. Staff could access all the specialist teams that could be required and respected patients cultural, religious and personal preferences at all times.
  • Staff learned lessons from patient feedback and complaints. The unit actively sought as much patient feedback as possible. Staff took all patient feedback and complaints seriously and made changes to the service as a result.
  • Leaders at the service supported staff and created a positive culture for staff. All leaders and staff at the service spoke of a good morale and working environment. All staff members felt well supported by leaders within the service.
  • The trust had good governance systems in place and responded well to risk. Staff were all aware of their roles and responsibilities within the governance system and staff could explain what the risks in the service were.

However:

  • Staff in the recovery area did not have the appropriate level of life support training in line with Association of Anaesthetists of Great Britain and Ireland (AAGBI) guidance.
  • Some flammable liquids were incorrectly stored in wooden cupboards.
  • There was no major incident plan on the day case unit and most staff were not aware of the plan.