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Listen to a sound recording of the inspection report on Moorfields at Bedford that we published on 06 January 2017.

Reports


Inspection carried out on 14 November to 6 December 2018

During a routine inspection

  • 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.

Inspection carried out on 9 - 13 May 2016

During a routine inspection

Moorfields Eye Centre at Bedford Hospital is one of the trust’s largest satellite locations. Patient services at Moorfields are sub-divided into four clinical directorates, each of which is led by one or more clinical directors. Bedford Hospital services are part of the Moorfields North directorate. Moorfields North covers number of eye centres in north London (Bedford, Northwick Park, Ealing, Potters Bar, Watford, Tottenham, Mile End, Barking, Loxford, Darent Valley, Stratford) and the satellite locations that support them.

The Bedford South eye centre was co-located with general hospital services; they provided comprehensive outpatient and diagnostic care as well as more complex eye surgery. They also supported eye research and ophthalmic education. This centre offered cataract, external disease, glaucoma, medical retina, oculoplastic, paediatric ophthalmology and adult strabismus clinics.

The Bedford North Eye Centre was located in the Bedford Enhanced Services Centre (or Bedford Hospital North Wing as it is known locally). It focused on outpatient and diagnostic services for eye conditions including cataract, paediatrics, and strabismus.

We carried out an announced inspection between 9 and 13 May 2016.

We inspected the two core services being undertaken by the trust on this site: Surgery and Outpatients.

This was the first inspection of Moorfields at Bedford Hospital under the new methodology. We have rated the service overall as requires improvement. Surgical services and outpatients and diagnostic imaging services were both rated as good.

Our key findings were as follows:

  • Staff were aware of incidents that had happened at other sites and we saw evidence of change in practice that took place as a result of a never event.

  • We observed staff complying with hand hygiene and the infection rates were low. Care and treatment were delivered by a competent and experienced team of consultants and nurses.

  • Staff were kind and caring and worked hard to ensure the needs of each individual patient were met. Patient told us they were happy with the service they received and staff were ‘kind and helpful’.

  • In the last year, the services had consistently met the referral to treatment times targets. Staff used every opportunity to increase capacity and reduce cancellations in order to meet the increasing demand on the service.

  • There was evidence of good multidisciplinary working between Moorfields staff but staff told us the relationship with Bedford Hospital staff required improvement.

  • Staff were caring and compassionate; they maintained patients’ privacy and dignity. Feedback provided by patients was positive and indicated that patients were involved in their treatment.
  • There were sufficient doctors and other staff in posts to respond to needs of the local population and provide the commissioned service.
  • There were clear pathways, thresholds and guidance for referrals and patients were seen according to clinical priority. The trust consistently performed better than the England average for referral to treatment target for non-admitted and incomplete pathways in 2015, and for the percentage of people seen by a specialist within two weeks from the urgent referral made by the GP.
  • Staff felt listened to and said they could contact senior managers easily should there be a need. There were clear lines of responsibility and accountability.

However:

  • There was limited capacity in the glaucoma clinic. The environment was not adjusted to meet the needs of visually impaired patients.
  • There was lack of clarity in relation to competencies required by a healthcare assistant or a nurse as the trust did not set up a baseline for staff competencies and it was not department specific.
  • Not all of the clinical staff working with children and young people received level 3 safeguarding training.

We saw several areas of good practice at the trust. However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

  • Ensure slit lamps are decontaminated after each patient and regular audits are carried out to monitor compliance.

  • Ensure staff on the day surgery unit at Bedford Hospital receive appropriate training to care for patients following ophthalmic surgery.

  • Ensure adequate pain relief is provided in a timely manner to all ophthalmic patients on the day surgery unit at Bedford Hospital.

  • Ensure all controlled drugs records are completed in line with the trust policy and carry out regular audits to monitor compliance.

In addition the trust should:

  • Encourage all staff to be up to date with all of their mandatory training.

  • Ensure patient information leaflets are available for visually impaired and blind patients.

  • Take necessary action to deal with reports of bullying and harassment among staff.

  • Ensure all relevant staff receive safeguarding training at the appropriate level as guided by job roles and duties.
  • Ensure staff are able to benchmark clinical outcomes and quality indicators with other similar departments and sites managed by the trust.
  • Ensure the environment is appropriately assessed and adjusted, to meet visually impaired patients’ needs.
  • Ensure policies and clinical protocols are updated regularly and there is system which allows effective monitoring of it.

Professor Sir Mike Richards

Chief Inspector of Hospitals