Moorfields at St George's

Updated 12 March 2019

The trust provided outpatient and urgent care services at Moorfields at St Georges. We inspected both of these services.

The outpatients was open Monday – Saturday and the urgent care centre was open seven days per week 9-5pm. Outside of these hours patients were seen in the St George’s Hospital urgent care centre.

During the inspection we spoke with 10 patients and one relative along with 19 staff. We reviewed 17 patient medical records.

Updated 12 March 2019

We rated it them as good because:

• We found there had been improvements since the previous inspection.
• The service had systems to identify and minimise risks to patients.
• Staff awareness of how to protect patients form abuse had improved since the previous inspection.
• There were enough staff to provide the right care and treatment for patients.
• Patients record were clear and up to date and available when needed. This was an improvement since the previous inspection.
• Care and treatment was provided in line with national best practice guidance.
• We observed that staff treated patients with kindness and compassion and involved them in decisions about their care and treatment.
• Care and treatment was delivered to meet the individual needs of patients. Services for children had been improved with the recruitment of a play therapist.
• Waiting times for care and treatment were better than the England average.
• There were systems to monitor the quality and safety of care and a clear commitment to develop and improve services.
• Staff morale was good and they were supported by their managers to access development opportunities.

However:

• The ‘did not attend’ rate for outpatients was higher than the England average.
• The environment in the outpatients was crowded with limited space.
• Patient involvement was still in the early stages.

Updated 12 March 2019

We previously inspected outpatients jointly with diagnostic imaging so we cannot compare our new ratings directly with previous ratings. We rated it as good because:

• Managers had the skills and abilities to run the service.
• The trust had a vision for what it wanted to achieve and workable plans.
• Managers promoted a positive culture that supported and valued staff. Staff were enthusiastic about the care and treatment they provided for the people who used their services.
• The service had a good governance system with processes to monitor performance on a regular basis.
• The service had systems for identifying risks and planning to eliminate them.
• The service provided mandatory training in key skills to all staff. Nursing staff training compliance was monitored through an electronic system and discussed as part the outpatient departments (OPD) monthly clinical staff meeting.
• Staff understood how to protect patients from abuse; they had training on how to recognise and report abuse. Staff working with children and young people had been trained to safeguarding level three. This had improved since the last inspection.
• The service controlled infection risks. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection.
• The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.
• Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date and available to staff providing care. This had improved since the last inspection.
• The service followed best practice when prescribing and storing medicines.
• Policies, procedures and guidelines had been developed in line with national policy. These included the National Institute for Health and Care Excellence (NICE) guidelines.
• 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.
• Staff assessed patients to see if they were in pain.
• The service made sure staff were competent for their roles. Managers appraised staff’s work performance to provide support and monitor the effectiveness of the service.
• Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
• Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.
• Staff provided emotional support to patients to minimise their distress.
• Staff involved patients and those close to them in decisions about their care and treatment.
• The trust planned and provided services in a way that met the needs of local people.
• The service took account of patients’ individual needs. Patients who needed physical assistance or guidance had a ‘helping hand’ sticker on the cover of medical notes to highlight patients with specific needs.
• People could access the service when they needed it. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were in line with good practice.
• The service investigated complaints and concerns and shared these with all staff.

However:

• Whilst there was some evidence of patient being involved in the plans for the service, this appeared to be in the initial stages.
• Staff working in treatment areas in a corridor outside the main outpatient area were separated from the main outpatient area. There was no CCTV. This was similar to what we found at the last inspection.
• During the inspection we still found the OPD was crowded and the waiting area cramped.
• The location of the Moorfields OPD within the Lanesborough suite was still difficult to find from the main reception at St George’s Hospital. This was the same at the last inspection. Signage within the OPD was still not clear.
• The ‘did not attend’ rate for Moorfields at St George's was higher than the England average.

Updated 6 January 2017

We rated surgery as requires improvement because:

• There were many long standing problems with the environment and equipment in both theatres and the ward area The problems included the ventilation system, which affected both the theatre preparation room (theatre 4) and the anaesthetic room (theatre 5).   A joint proposal to relocate the service was not approved by St George’s University Hospitals NHS Foundation Trust Board.  Following this, some remedial action had been taken including the relocation of the children's waiting area in outpatients but, no action had been taken in relation to surgery.
• The WHO surgical safety surgery checklist was not fully implemented in theatres.
• Male and female patients were on occasion cared for in the same bays on Duke Elder Ward, this was in breach of national guidance.
• Theatres were not child friendly.
• The trust had a rolling programme for staff to have Level 3 safeguarding. However, none of the permanent staff in surgery at this site had received the training.
• Patients on the Duke Elder ward who became unwell out of hours were cared for by medical staff who worked for St George’s University Hospitals NHS Foundation Trust.
• The service level agreement with St George’s University Hospitals NHS Foundation Trust had not been formally signed at time of the inspection.
• Staff expressed their frustration at the lack of action in response to the problems identified in this report.

However:

• Staff were aware of the incident reporting procedures and their responsibility under duty of candour.
• Medicines and controlled drugs were managed in line with best practice and controlled drugs were stored in locked cupboards on the wards.
• Care and treatment was evidence based and staff had access to guidelines on the intranet.
• Patients spoke positively about the staff and described them as “kind” and considerate”. We observed providing support and reassurance to patients.
• The service was meeting the national standard for referral to treatment times.
• Staff told us there was an open culture and they were able to raise concerns. There were opportunities for progression.
• Despite the difficult conditions in which they worked staff remained positive and focused on ensuring patients had a positive experience of the service.