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Chelsea and Westminster Hospital Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 28 October 2014

The Chelsea and Westminster Hospital is part of Chelsea and Westminster Hospital NHS Foundation Trust. It is an acute hospital and provides accident and emergency (A&E), medical care, surgery, critical care, maternity, children and young people’s services, end of life care and outpatient services, which are the eight core services always inspected by the Care Quality Commission (CQC) as part of its new approach to hospital inspection.

The Chelsea and Westminster Hospital is a 430-bed general hospital, based in Kensington, North West London. The hospital employs over 3,000 staff. It provides a range of elective and non-elective inpatient surgical and medical services as well as a 24-hour adult and paediatric A&E departments and an Urgent Care Centre and outpatient services. It also provides specialist services including burns, high-risk obstetrics and neonatal care for patients from London, the South East and further afield.

As well as inspecting the eight core services at the Chelsea and Westminster Hospital, we also inspected: the HIV and sexual health services at the Kobler Clinic and John Hunter Clinic for Sexual Health, located in the St Stephen’s Centre next to Chelsea and Westminster Hospital; the West London Centre for Sexual Health (WLCSH) which is located at Charing Cross Hospital in Hammersmith; 56 Dean Street and Dean Street Express (at 34 Dean Street), which are both sexual health clinics located in Soho, central London.

The team included CQC inspectors and analysts, doctors, nurses, Experts by Experience and senior NHS managers. The inspection took place on 9 and 10 July 2014 with unannounced visits on 21 and 25 July 2014.

Overall, we rated this hospital as requires improvement. We rated it good for providing caring services, but it required improvement for providing safe, effective and responsive care and for providing services that are well-led.

We rated HIV and sexual health services as outstanding and critical care and maternity as good; we rated A&E, medical care, surgery, children and young people’s services, end of life care and outpatient services, as requires improvement.

Our key findings were as follows:

  • Staff were caring and compassionate and treated patients with dignity and respect.
  • Patients told us their experiences of care were good. However, the results of the NHS Friends and Family Test were below (worse than) the national average for inpatient wards, and above the national average for A&E.
  • National data indicated that the trust was similar to other trusts for reporting incidents but was potentially an under-reporter of  patient safety incidents resulting in death or severe harm. We found that incidents were reported, investigated and appropriate action was taken in most cases. However, learning was not always shared across the trust. Incidents were under-reported in outpatient areas and some areas had not undertaken appropriate investigations. Serious untoward incidents took a long time to investigate, with only 36% being reported within the 45-day standard. Staff in a few areas identified that there could be a blame culture when reporting serious untoward incidents. 
  • The trust was clean and infection control practices were observed. Most staff followed the trust’s infection control policy, including being bare below the elbows, and observed hand hygiene. Infection control rates were within an acceptable range for Clostridium difficile (C. difficile) but were higher than the expected range when compared to other trusts for MRSA in 2013/14 – but no cases had been reported from April 2014.
  • The NHS Safety Thermometer is a monthly snapshot audit of the prevalence of avoidable harms, including new pressure ulcers, venous thromboembolism (VTE or blood clots), catheter urinary tract infections and falls. The hospital was better than the national average in all areas except for the incidence of pressure ulcers in surgery, which was higher than average. The information was monitored throughout the hospital but the results were not displayed for the public in clinical areas.
  • The National Early Warning Score (NEWS) was used effectively to identify deteriorating patients. Care pathways were being used to standardise care for patients who were acutely ill. Seven-day services had been developed in emergency care and mortality rates were lower (better) than the expected range.
  • Most medicines were stored safely but some medicines were not appropriately locked or stored at correct fridge temperatures.
  • Not all staff had appropriate knowledge of the Mental Capacity Act 2005 and its associated deprivation of liberty safeguards to ensure that patients’ best interests were protected. There was guidance for staff to follow on the action they should take if they considered that a person lacked mental capacity.
  • Nursing staffing levels had been reviewed and assessed using the Safer Nursing Care Tool in some areas but had not been completed across the trust. Some staff involved in this work were not clear about what tool had been used and some staff indicated that that the trust had taken a ‘one size fits all approach’ and had not taken the complexity of patients into consideration. Some staff also reported that there could also be an unresponsive culture when they tried to report significant staff concerns. There had not been a board report to demonstrate appropriate application of the Safer Nursing Care Tool across the organisation. Nurse recruitment was a recognised as a priority for the trust, as some wards were below establishment. Around 85 nurses and midwives had been recruited and it was intended that they would be in post by the end of the year. Bank (overtime), agency and locum staff were used to fill vacancies where possible, but some areas, including the acute assessment unit (AAU), and children’s services did not always have safe  staffing levels.
  • Medical staffing levels did not meet national recommended standards in A&E and palliative care medicine. However, there was a comparatively higher number of consultant staff in other specialities, which was improving access to specialist care.
  • Agency nurses did not have access to the electronic patient records, including risk assessments, prescription and administration records. Therefore, the electronic system could only be updated by a permanent member of staff, which resulted in delays in updating records. The agency staff also had to rely on information provided at handover to identify the risks for the patients they were caring for. This also caused delays in updating the electronic record and administering medication.
  • The trust had a major incident procedure, which most staff were aware of. Most staff had participated in training in how to respond to major incidents.
  • Staff had access to a range of mandatory training and attendance was monitored electronically and by paper. However, completion of this training was below the trust’s targets. Staff were supported to access training, there was evidence of appraisal but the clinical supervision was not well embedded. The profile of nursing and midwifery needed to be raised, there were examples, where staff were qualified and experienced to delivery care, such as ordering tests and prescribing, but were restricted from doing so.
  • The trust had a learning disability ‘passport’ in which key information about how the individual should be supported was documented. However, this document was not widely used in the trust and many staff were not aware of it.
  • There had been an increase in demand for services, and the capacity in some areas of the trust, such as A&E, experienced difficulties in meeting this additional demand. Staff reported that a contributing factor to this increase was due to the local reconfiguration of services across London. However, as many of these changes had been recently introduced there was no evidence to support this view.
  • Patient care in A&E was good but the service was under increasing pressure as attendances were increasing and this was causing delays in assessment and treatment.
  • Emergency medical care was well supported by consultant staff. There were good outcomes for medical patients, for example, in stroke care and for heart attacks, but diabetes care needed better coordination.
  • Overall, the trust was not meeting the national target of 18 weeks for surgery and patients had longer waiting times for general surgery, trauma and orthopaedics, urology and plastic surgery.  Patient outcomes varied and compliance with the Five Steps to Safer Surgery checklist needed to improve.
  • Critical care services were good and the outreach team was responsive and supportive of patients in the hospital who required access to specialist critical care.
  • The maternity department’s leadership and culture needed to improve to support staff and ensure women did not have interventions that might not be needed.
  • The Chelsea Children’s Hospital officially opened in March 2014 and provided bright, modern and child-friendly facilities. However, the leadership of the service needed to improve its governance arrangements for safety and compliance with national standards of care. The culture in the neonatal unit also needed to improve.
  • End of life care standards were being rolled out across the hospital but these needed to be monitored. Overall, the hospital performed well in the National Care of the Dying Audit.
  • Waiting times for outpatient appointments were within national waiting times. At times, appointments could be cancelled at short notice and it was difficult for patients to contact the service by telephone.
  • We rated the HIV and sexual health services as outstanding.
  • Patient discharge was supported by the rapid response teams in A&E and coordinators in other services. However, some patients reported that their discharge from the wards felt “rushed” and there could be long waits, particularly in the discharge lounge for transport or medication. Providing discharge summaries to GPs was taking longer than 48 hours.
  • The hospital at night team triaged (assessed and prioritised) patients and escalated safety issues. Junior doctors appreciated that they were only contacted when there was a concern, making their workload manageable.
  • The trust had introduced Schwartz rounds (monthly one-hour sessions) for all staff to discuss aspects of the emotional and social dilemmas that arise from caring for patients. Staff who had attended were positive about the learning and emotional support and the focus on improving outcomes for patients.
  • The trust was supportive of art and music therapy and there were excellent examples of uplifting art on display, and music was played on Thursday lunchtime in the main corridor of the trust.
  • Staff were positive about working for the trust and said it was a friendly and positive place to work but it was not without its challenges, which staff described as concerning IT, human resources, staffing levels and support from leadership.
  • Staff were aware of the trust’s vision. Most service areas had a strategy or transformation plans that identified how the service would develop and build capacity to respond to the predicted increase in attendances and admissions under ‘Shaping a healthier future’.
  • The leadership team had created an environment where all members of staff were part of quality project teams. These teams were then given time to undertake innovative  projects and research to improve the quality of the service. As a result, a number of staff throughout the hospital had been nominated for the trust’s award for clinical excellence. Staff told us how these projects had led to improvement to services.
  • There were examples of the trust’s research that were nationally and internationally recognised (see below).

We saw several areas of outstanding practice, including:

  • The A&E department staff had taken part in a research project to routinely test patients for HIV (with their consent). This had now been embedded practice for over a year and testing had resulted in a higher-than-normal proportion of patients being identified as HIV positive.
  • The clinical sterile services department (CSSD) had introduced a metal detector which was used to identify surgical equipment that had been incorrectly discarded into rubbish bags. The aim of this initiative was to promote staff safety and reduce the cost of lost equipment.
  • The burns unit had international recognition and published numerous research papers annually, which identified best practice.
  • The physiotherapy team in intensive care had an extensive research portfolio. For example, they had developed an innovative simulation-based physiotherapy course to improve quality and safety, and developed a standardised functional score assessment tool to improve compliance with National Institute for Health and Care Excellence (NICE) guidance. The tool is now used in more than 50% of intensive care units nationally.
  • The female genital mutilation (FGM) service in maternity had achieved a national award for innovation and care.
  • The neonatal palliative care nurse had developed national standards on caring for very young babies with life-limiting conditions who need palliative or end of life care on neonatal units. These standards had recently been shared with medical royal colleges and other hospitals for national use.
  • The HIV and sexual health services provided outreach clinics at London’s G-A-Y Bar, Manbar and Sweatbox Gay Sauna, and in hostels and community venues to engage with hard-to-reach groups such as the Chinese and Muslim communities, young people and people socially excluded or those who used Supporting People programme services, such as the homeless.
  • The HIV and sexual health services gained community engagement through outreach work, taking part in London Pride, publicity stunts such as the Guinness World Record attempt for taking the most HIV tests at G-A-Y Bar on World Aids Day in 2011 and the House of Lords campaign to provide HIV tests for legislators.
  • 56 Dean Street and Dean Street Express brought sexual health services to a high street location. Dean Street Express provided fast, self-testing modern facilities for asymptomatic patients.
  • Public engagement in the HIV and sexual health services was an integral part of the service and had led to innovation and excellence in services across London. The service had two patient representatives on a part-time basis, funded by the trust to obtain the views of people using the service to help make positive changes.
  • The HIV and sexual health services provided speciality clinics such as: SWISH for people employed in the sex industry; CODE clinic for men who were into harder sex or using drugs during sex; Pearl clinic for people with a learning or physical disability; and cliniQ and the Gold Service for the transsexual community. CliniQ and the Gold Service are the only specialist sexual health clinics in the country for the transsexual community. The model for this service was led by the transsexual community through public engagement.
  • The HIV and sexual health services have consistently been shortlisted and won awards for a variety of projects every year since 2007. One of their most recent awards was for the work with the West London African Women’s Service for dedication to improving the care of women living with FGM. The trust had won the BMJ Group Award 2013 for transforming patient care using technology, and the  adult sex project of the year at the Brook Sexual Health Awards 2013 for Dean Street at Home and cliniQ.
  • The leadership team had created an environment where all members of staff were part of quality project teams. These teams were then given time to undertake innovate projects and research to improve the quality of the service. As a result, a number of staff throughout the trust had been nominated for the trusts award for clinical excellence. Staff we spoke with told us how improvement to services had been undertaken through these projects.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must ensure that:

  • Patients are cared for in appropriate areas in the A&E department so that there is safe monitoring of their condition.
  • All staff in A&E receive training in mental health awareness, and when and how to safely restrain patients.
  • All staff receive training in the Mental Capacity Act 2005 and its associated deprivation of liberty safeguards.
  • Pain scores are recorded and reassessed for all patients in the A&E department.
  • Consultants in A&E sign off and agree to the discharge of patients with complex needs in line with national guidance.
  • There are suitable environments in outpatients areas to ensure accessibility for patients with a physical disability or poor mobility, to promote the privacy and dignity of patients, and protect patient confidentiality.
  • Patient records and care plans are accessible to all staff, including agency staff.
  • Regular checks of medicines are undertaken, that all medicines are stored safely, and are in date and fit for use.
  • Nurse staffing levels are compliant with safer staffing levels guidance.
  • A recognised acuity tool is used in all areas and staffing levels and skills mix reflects the findings of these as well as national guidance.
  • Appropriate equipment is available and regularly checked and records maintained.
  • Compliance with the ‘five steps to safer surgery’ checklist is improved and is embedded in surgical practice.
  • The incidences of pressure ulcers in surgery and critical care are reduced.
  • A record of the termination of pregnancy (TOP) forms (HSA4) sent to the Department of Health is kept by the trust. 
  • Compliance with statutory and mandatory training is improved.
  • All staff use the incident reporting system, and that feedback is provided and learning from incidents is cascaded and shared. There should be evidence of appropriate action in response to any never event (serious harm that is largely preventable).
  • Risks identified on the risk register have appropriate actions to mitigate them, with timely reviews and updates. Information on risks should be owned by the divisions.
  • The safety thermometer is embedded across the trust and information on avoidable harms is available and displayed for the public to access.
  • The time taken for the root cause analysis investigation of serious incidents improves so that issues are identified quickly to prevent recurrence.
  • Clinical guidelines are up to date, in line with national guidance and action is taken as a result of audits.
  • Governance and risk management procedures in children and young people’s services improve.
  • The trust continues to support staff and investigate and resolve the culture of intimidation and bullying identified in the neonatal unit.
  • Staff are aware of and use the trust’s learning disability passport and operational standards for people with a learning disability are appropriately assessed and implemented.
  • Do not attempt cardio-pulmonary resuscitation (DNACPR) forms are appropriately completed so that the decision and sign-off is clear and there is appropriate communication with patients, their relatives or carers. 
  • End of life care standards are appropriately monitored against national standards.
  • Patients receiving end of life care are appropriately identified and referred to the specialist palliative care to receive timely support and treatment advice.
  • There is an operational policy or guidance for the management of a deceased patient’s belongings.
  • Clinical governance arrangements are simplified so that there are effective processes to prioritise and escalate concerns.
  • Discharge summaries are sent to GPs in a timely manner and include all relevant information in line with Department of Health guidelines
  • Support is given to frontline nursing staff to be involved in change and to ensure there is a just culture.
  • Staff in lower pay bands feel they are treated similarly to all staff in the trust.
  • Cost improvement programmes are developed and are also reviewed by the board.

In addition the trust should ensure that:

  • Medical staffing levels meet national recommendations in A&E and palliative care medicine.
  • Develop the nursing and midwifery profile so that their advanced skills can be used appropriately; this is particularly the case in A&E, maternity and for end of life care.
  • Agency staff receive appropriate induction when working in the hospital.
  • Patients living with dementia are appropriately screened and identified and that staff access the tools and advice available to ensure there is consistent care and support in all areas of the hospital.
  • Information on staffing levels, safety and performance activity is displayed and accessible to patients and the public in wards and outpatient areas.
  • Discharge is effectively planned and organised and patients are not waiting for long periods in the discharge lounge, or waiting after their outpatient appointment.
  • Clinical supervision is developed for all staff.
  • There is a ‘just culture’ for all staff when dealing with serious incidents.
  • The critical care unit participates in the Intensive Care National Audit & Research Centre (ICNARC).
  • There is better multidisciplinary working in maternity and children and young people’s services.
  • Governance arrangements in maternity continue to improve.
  • All staff follow infection control practices, particularly the bare below elbow guidance in ward and outpatient areas.
  • Waiting times meet the national referral time target of 18 weeks.
  • Information leaflets and signs are available in other languages where relevant.
  • Bereavement support is appropriately maintained when the officer is on leave.
  • Outpatients clinics are not cancelled at short notice and patient waiting times are improved to within 15 minutes of clinic appointments.
  • Staff engagement improves so that staff feel listened to and consulted about specific issues that affect service development, particularly in A&E and outpatients, and where job roles are affected for administrative, clerical and support staff.
  • Patient and public engagement continues to develop to improve services, including formal approaches for patient feedback across all services.
  • Human resources, IT and finance support improve for staff, in terms of payroll and consultation on job roles.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection areas

Safe

Requires improvement

Updated 28 October 2014

Effective

Requires improvement

Updated 28 October 2014

Caring

Good

Updated 28 October 2014

Responsive

Requires improvement

Updated 28 October 2014

Well-led

Requires improvement

Updated 28 October 2014

Checks on specific services

Maternity and gynaecology

Good

Updated 28 October 2014

There were effective procedures that supported safe and effective care for women. Staff were caring and compassionate and treated women with dignity and respect. There were adequate numbers of staff to meet the needs of women. The shortage of midwives had been addressed and vacant posts had recently been recruited to. Staff had relevant training and a good awareness of safeguarding and child protection issues. National guidelines were being used but monitoring compliance needed to improve.  Overall, outcomes for women were good, although the caesarean section rate was higher than the England average. There was good multidisciplinary working between hospital and community midwives and GPs and across hospital departments.

Women had choices during birth and were involved in decisions about their care and treatment. Staff on the unit were polite and friendly. We observed women being treated with dignity and privacy. The environment was clean and spacious. The atmosphere in the maternity unit was calm and peaceful. The antenatal department offered a comprehensive screening programme and the maternity urgent care centre had a triage (assessment and prioritising) system for women.

A new governance structure had been implemented in January 2014 and this had improved assurance around quality and safety but there needed to be better monitoring of action plans, and lessons learned from incidents needed to be effectively disseminated to all staff. The monitoring of compliance with guidelines through audit but action plans to address identified issues were not always developed and implemented. The leadership and culture within the department needed to improve to ensure there was effective joint working between doctors and midwives to support women having a reduction in interventions, and so that staff felt supported and listened to. The department demonstrated public engagement, improvements and examples of innovative practice

Medical care (including older people’s care)

Requires improvement

Updated 28 October 2014

The medical care services needed to improve safety procedures around safe staffing levels, learning from incidents and using the electronic records. The environment was clean and staff followed the trust policy on infection control. Patients whose condition deteriorated were appropriately escalated and action was taken to ensure harm-free care. There were procedures to provide effective and responsive care. Care was provided in line with national best practice guidelines; however, staff did not always adhere to care pathway protocols and local monitoring of guidelines needed to improve. There was participation in national audits and outcomes were good for patients who had a stroke or heart attack but were worse than other trusts for diabetes care. There were seven-day, consultant-led services.

Patients received compassionate care and were treated with dignity and respect and services were responsive to patient needs. There was specific care for patients living with dementia, for those who had alcohol problems or a mental health condition. There were effective governance arrangements but staff felt unsupported by division and trust management. Public and staff engagement needed to improve.

Urgent and emergency services (A&E)

Requires improvement

Updated 28 October 2014

A&E services were under pressure from the increasing demand for services. The flow of patients through the department was meeting the national four-hour waiting time target. However, there were, at times, waits between 40 minutes and one hour for triage. Due to capacity issues, some patients were placed in inappropriate areas within the department for monitoring, care and treatment. This put patients at risk of harm. There had not been appropriate actions to address these issues and the trust did not have interim plans. Safety standards were not being met for medicines management, and staff had limited awareness of the Mental Capacity Act 2005, but there was reporting and learning from incidents.  Infection control processes were followed and equipment was available and was regularly checked. Patients whose condition might deteriorate were monitored and escalated appropriately.

Best practice guidelines were being used to care for patients and there was participation in research projects. Patients were involved in their care and treatment and were treated with respect. There was a positive culture within the service and a clear vision for the future. The service had governance processes to monitor quality and risks.

Surgery

Requires improvement

Updated 28 October 2014

The surgery division required better procedures to provide safe, effective and responsive care. The hospital’s surgical safety checklist was not fully completed for all patients and needed to be updated to improve compliance with the ‘Five steps to safer surgery’ procedures. There needed to be better learning from incidents and improved use of the electronic records. Equipment was available and appropriately checked but standards to manage medicines were not met. Infection control practices were followed and overall infection rates were within expected levels. Policies and procedures were accessible to staff on the trust intranet but not all staff were aware of these and many had not been reviewed to ensure they were in accordance with evidence-based national guidelines.  Practice was not appropriately monitored to demonstrate adherence to standards..

Patients received compassionate care and we saw that they were treated with dignity and respect. Patients and relatives we spoke with said they felt involved in their care. National waiting times, however for patients waiting for surgery were not being met and some patients were waiting longer than 18 weeks. There was strong, supportive leadership at ward and matron level but the service did not have an appropriate governance structure to manage risks. Staff reported that the trust had, at times, a ‘blame’ rather than a learning culture following incidents. Public and staff engagement needed to improve. There was innovation in some areas and outstanding practice in the burns unit.

Intensive/critical care

Good

Updated 28 October 2014

The unit had sufficient numbers of nursing and medical staff on duty and there were effective procedures for safe care. The patient Safety Thermometer was not embedded but there were plans to develop this. Medicines were safely and securely stored. Patients received care and treatment according to national guidelines and there was good multidisciplinary team working to support patients. Patient and performance outcomes were compared across North West London but the trust had re-evaluated this and intended to participate in the Intensive Care National Audit & Research Centre (ICNARC) from July 2014.

Staff cared for patients in a compassionate manner with dignity and respect. They involved patients and, where appropriate, their relatives in the care of the patient. Patients and their relatives were happy with the care provided. Emotional and spiritual support were provided. The leadership on the unit was visible and staff were passionate about providing excellent quality care. Governance arrangements supported assurance around quality, risk and safety. There was a culture that supported staff to develop innovative ways of working. Patients’ engagement was well developed through a range of feedback approaches.

Services for children & young people

Requires improvement

Updated 28 October 2014

The Chelsea Children’s Hospital needed better procedures to provide effective and safe care for children. There was 24-hour resident paediatric medical cover at all levels, including consultants for paediatrics and the neonatal intensive care unit (NICU). However, nurse staffing levels needed to be monitored so that levels and skills mix were appropriate and in line with Royal College of Nursing guidelines. Incident reporting needed to improve and lessons learned shared more effectively. Staff mandatory training also needed to improve Clinical practice guidelines needed to be updated and monitored to ensure compliance with national standards. Staff were caring and child-centred and we received positive feedback from the majority of children, young people and parents that we spoke with about their caring attitude of staff. The Chelsea Children’s Hospital had excellent modern, spacious dedicated and child-friendly facilities. Services were responsive to children’s needs and there was good support for children with a learning disability or mental health needs, although out-of-hours support for mental health needed to improve. The service needed to develop clear strategies. Governance structures did not provide the assurance around quality, safety and risk and were described as “haphazard” by staff.

The leadership team in the department and the trust was described as “not visible or fully supportive of staff”. The culture in the service overall was described as “good” but staff identified a culture of bullying in neonatal care that needed to be addressed. The trust was taking action to improve the service. Public engagement was good but staff engagement needed to improve. There was innovation in the service in neonatal care, for example, there was outstanding practice in neonatal end of life care, although there was less evidence of improvement  in other areas of the service

End of life care

Requires improvement

Updated 28 October 2014

The services required better procedures to support safe care, particularly when DNACPR orders are used. The trust had introduced a new toolkit to replace the Liverpool Care Pathway and, overall, there was effective care and good practice observed against national audit standards. More staff, however, needed to be aware of and use the toolkit. Patients had appropriate pain relief, and staff were caring and compassionate and treated patients with dignity and respect. There was multidisciplinary working towards patient-centred care. Patients spoke positively about the way they were being supported with their care requirements.

There was no system to identify access to specialist palliative care team support and not all patients were appropriately referred.  It was not appropriately documented that patients and/or their relatives were communicated with over the decisions not to resuscitate, and the trust needed to update local policies in line with a recent Court of Appeal judgement on the need for this action. Patients did not always have a clear care plan which specified their wishes regarding end of life care and staff were not always aware of their wishes with regards to the preferred place of death. Some patients and their relatives were not being told in a timely way about dying. The leadership of the service was effective and public and staff engagement were being used to improve the service, although methods for patient feedback needed further development. The service had good plans for improvement and sustainability.

Outpatients

Requires improvement

Updated 28 October 2014

The department did not follow appropriate safety procedures for incident reporting and learning, equipment checks, safeguarding and mandatory training and local best practice guidelines were not up to date. Multidisciplinary working needed to improve. Staffing levels in the department had been assessed as appropriate.

National waiting times for appointments were being met but some clinics had short-notice cancellations. Patients were positive about their care but they were not always kept informed, for example, about delays in clinics. People with a learning or physical disability required better support to access services. The service had innovative plans for development but local and trust leadership needed to improve during its implementation. Governance and risk arrangements were fragmented and there was not always single responsibility for a programme or target. Staff and public engagement needed to improve.

HIV and sexual health services

Outstanding

Updated 28 October 2014

There were effective procedures to support a safe and effective service for patients. Clinical standards were adhered to and patients were appropriately involved in research and drug trials. The environment at clinics was clean and uncluttered. The clinics at 56 Dean Street and Dean Street Express were trendy, modern and bright. One patient representative told us the team had brought “sexual health and HIV services into the 21 century”. Patients described the service offered at each of the clinics as “exceptional”, “caring”, “confidential” and “quick”. Staff were highly trained and were compassionate and caring. They treated patients with dignity and respect and “normalised” conversations about sexual health. Staff worked in a multidisciplinary way to centre care around the patient.

Each location had identified the demographic of the people using their service and provided speciality clinics, outreach, community engagement and counsellors suited to the people using the service. The team constantly explored new and innovative ways to deliver the service. National guidelines were being used and most patients could access services at one of the locations within 48 hours. The service reviewed its performance through patient surveys and the patient champions. There was clear governance and strong leadership and staff at all levels felt involved in decisions and ideas that could help the division and individual locations run well. The service was well-recognised at local and national levels.