Moorfields at Bedford

Updated 12 March 2019

Moorfield at Bedford covers a large geographical area and treated patients not just from the local Bedford area but from other regions such as South Essex, Milton Keynes, and Cambridge. It is part of the Moorfields North Directorate.

It provides comprehensive outpatient and diagnostic care as well as more complex eye surgery.

During 2017 until the time of the inspection during November 2018, surgery at Moorfields at Bedford Hospital undertook 2,691 operations.

The trust had 572,615 first and follow up outpatient appointments from June 2017 to May 2018.

During the inspection we spoke with 10 patients, 39 staff and reviewed over twelve sets of patient medical records.

Updated 12 March 2019

• Patients received compassionate care and were involved in discussions and decisions about their care and treatment.
• Staff knew how to report incidents and received feedback with learning shared with the wider team.
• Staff were aware of the signs of potential and actual abuse and the action to take in the event of this occurring.
• Patients received effective care and treatment. Outcomes were monitored and information was used to improve care and treatment.
• Staff followed infection prevention and control procedures which minimised risks to patients.
• Patients were cared for in a safe appropriate environment.
• Medicines were managed safely and staff followed best practice when prescribing, administering and storing medicines.
• Services were planned to meet the individual needs of patients.
• Patients living with a learning disability or cognitive impairment had access to a hospital passport and a similar document had been developed for patients living with dementia.
• The leadership team promoted an open and supportive culture.
• Services had systems to continually monitor and improve the quality and safety of care provided.

However:

• Outpatients did not have a separate waiting and clinical area for children.
• In surgery staff were unaware of the pain assessment tool for patients living with a learning disability or dementia.
• Outpatients were not always meeting national referral to treatment times.
• At the time of the inspection there were vacancies for medical staff in outpatients and surgery and following the inspection the trust told us these had all been filled.

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:

• Staff cared for patients and demonstrated compassion. Staff understood patients’ holistic needs and the impact of their diagnosis, care and treatment to them and their loved ones.
• Staff involved patients and those close to them in decisions about their care and treatment.
• There were enough nursing and allied health professional staff on duty to meet the needs of the patients. Staff had the right qualifications, skills, training, and experience to keep people safe from avoidable harm and to provide the right care and treatment.
• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
• The service controlled infection risk well. They used control measures to prevent the spread of infection.
• The service had suitable premises and equipment and looked after them well.
• Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date, and easily available to all staff providing care.
• The service followed best practice when prescribing, administering, recording, and storing medicines. Patients received the right medicines at the right dose at the right time.
• The service provided care and treatment based on national guidance and evidence of its effectiveness.
• 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 of different kinds worked together as a team to benefit patients. Doctors, nurses, and other healthcare professionals supported each other to provide good care.
• The service took account of patients’ individual and diverse needs such as disability, gender, religion and belief.
• The service had system for capturing and learning from complaints.
• The trust had a vision for what it wanted to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community.
• Managers across the trust promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
• The trust used a systematic approach to continually improve the quality of its services and safeguarding high standards of care by creating an environment in which excellence in clinical care would flourish.
• The department had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected.
• The department engaged well with patients, staff, the public and local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively.

However, we also found:

• The service had vacancies for medical staff. This meant there was not always sufficient number of doctors to provide the right care and treatment.
• Children’s waiting and clinical areas were not separated from adults and staff did not follow best practice in relation to organising children’s clinics.
• Patients experienced delays and long appointment waiting times on the day of their clinic due to capacity issues and occasional clinics overbooking.
• There was limited capacity in accessing glaucoma and cataract clinics.
• The service did not meet the 18-week referral to treatment standard.

Updated 12 March 2019

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

• The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.
• Managers monitored the effectiveness of care and treatment and used the findings to improve them.
• Staff involved patients and those close to them in decisions about their care and treatment.
• The service took account of patients’ individual needs.
• The trust engaged well with patients, staff, the public and local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively.

However:

• Leaflets in braille had to be requested from City Road; they were not immediately available as the trust stated they have not been requested for many years.