The Care Quality Commission
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  • NHS hospital

Archived: Hinchingbrooke Hospital

Overall: Good read more about inspection ratings

Hinchingbrooke Park, Huntingdon, Cambridgeshire, PE29 6NT (01480) 416416

Provided and run by:
Hinchingbrooke Health Care NHS Trust

Important: This service is now managed by a different provider - see new profile

All Inspections

Announced Inspection 10- 11th May 2016. Unannounced inspection: 20th May 2016.

During an inspection looking at part of the service

The Care Quality Commission (CQC) carried out a comprehensive inspection between the 15 and 18 September 2014 at which the trust was rated as inadequate and placed into special measures. The CQC undertook a review of the areas rated as inadequate in January 2015 to ensure the safety of patients. At this inspection we rated most elements as requiring improvement although the urgent and emergency services were rated as inadequate. We undertook a focused inspection to review all areas identified as requiring improvement or inadequate in October 2015 to monitor the trusts progress. We returned on 10 May 2016 to monitor whether the improvements seen at the previous inspection were sustained.

Since 1 April 2015 the trust has a traditional management structure of an NHS trust. The trust has a trust board and with non-executive directors. The chief executive has now been in post for nearly 10 months. The changes that had been put in place were beginning to embed and staff were aware of the process for escalating issues to the senior team. The trust were aware of challenges and had plans in place to address these. We were aware of ongoing talks with a neighbouring trusts about efficient use of resources across the county.

The comprehensive inspections result in a trust being assigned a rating of ‘outstanding’, ‘good’, ‘requires improvement’ or ‘inadequate’. Each section of the service receives an individual rating, which, in turn, informs an overall trust rating. The inspection found that overall the trust has a rating of ‘Good’.

Our key findings were as follows:

  • Most new systems and process were in place and these were embedded. Senior managers could articulate risks both internal and external to the organisation.
  • Some new systems in processes in the emergency department such as triaging patients arriving by ambulance were yet to be embedded.
  • There was an increased emphasis on incident reporting and disseminating learning to all areas of the trust though there were some delays in reporting incidents in surgery.
  • Medicines were well managed across the trust with consistent processes to investigate concerns.
  • Staff were caring and compassionate in their care of patients.
  • Organisational development work had significantly impacted on the trusts development into a learning organisation.
  • The emergency department continued to be under pressure through increasing volumes of attending patients and small numbers of emergency care consultants.
  • The care of patients with a mental health condition was improved in the emergency department.
  • There was an increased programme of audit including stroke audit though performance against some audits in the emergency department was below the England average.
  • Referral to treatment times (RTT) were met for medical and surgical patients.
  • There were clear visions for the services and visible leadership within the divisions.
  • The trust and individual divisions were working with other providers and stakeholders on sustainability and transformation plans. Staff and managers had plans for improving care pathways though there was some anxiety amongst staff about collaborative working with other providers.
  • There was a detailed end of life strategy in place which had received additional resourcing to meet the needs of patient and their relatives.

We saw several areas of outstanding practice including:

  • The trust employed an Admiral nurse to support people living with dementia, their relatives and carers as well as staff. This was one of only five Admiral nurses in acute trusts in England.
  • Staff worked with a local prison where consultants review patients that are at the end of their lives and work with prison and hospital staff to ensure that patients were safely admitted to the hospital or referred to the local hospice.

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

Importantly, the trust must:

  • Ensure that there are sufficient numbers of suitably qualified, skilled and experienced medical staff on duty in the emergency department. Also ensuring that there are robust contingency plans and which forecast shortages and ensure that sufficient cover is provided.
  • Ensure that the time to treatment from a clinician in the emergency department is reviewed and times to treatment are improved.
  • Ensure that the triage process for ambulance arrivals is received to ensure that the pathway for patients is safely and times of assessment accurately recorded.
  • Ensure that infection control practices within the emergency department are improved.
  • Ensure that the processes for the checking of equipment, particularly blood glucose and anaphylaxis boxes, in the emergency department is improved and safe for patients.

In addition, the trust should:

  • Review the observation and seating arrangements for the children’s area to ensure parents and children only sit in this areas.
  • Should ensure that fridge temperatures are routinely checked.
  • Should allow staff to attend and receive updated mandatory training.
  • Review the need to monitor the culture of staff within the emergency department.
  • Review the environment and provision of children’s services and where children are treated.
  • Ensure that records are used in a consistent way across wards, that they are contemporaneous; reflect patient needs and appropriate actions taken following risk assessment.
  • Review the relative risk of readmission for surgery patients as data shows this to be significantly above the England average.
  • Review the complaints process and the time taken to provide people who complain with a full response.
  • Should ensure that audits are undertaken locally within the emergency department to improve quality measurement and assurance.
  • Should ensure a consistent monitoring of preferred place of death for patients receiving end of life care.
  • Should ensure that there is a clear target for fast track discharge of patients requiring end of life care and ensure consistent monitoring of the timeliness of these discharges.

Based on the findings of this inspection I would recommend the trust be removed from special measures. However I would recommend that ongoing support continue during this period of transition.

Professor Sir Mike Richards

Chief Inspector of Hospitals

20- 21st October 2015. Unannounced inspections on 26 & 27 October and 5 November 2015

During an inspection looking at part of the service

The Care Quality Commission (CQC) carried out a comprehensive inspection between the 15 and 18 September 2014 at which the trust was rated as inadequate and placed into special measures. The CQC undertook a review of the areas rated as inadequate in January 2015 to ensure the safety of patients. At this inspection we rated most elements as requiring improvement. We undertook a focused inspection to review all areas identified as requiring improvement and inadequate in October 2015 to monitor the trusts progress.

At our previous inspection the trust the trust had been privately managed by an independent company. This company withdrew its management of the trust at the end of March 2015. Since 1 April 2015 the trust has reverted to the traditional management structure of an NHS trust. A new board and new non-executive directors have been appointed. There is a new interim chief executive who replaces the previous chief executive. This has meant a number of changes have occurred at the trust since this time and we found a service in transition on inspection.

The comprehensive inspections result in a trust being assigned a rating of ‘outstanding’, ‘good’, ‘requires improvement’ or ‘inadequate’. Each section of the service receives an individual rating, which, in turn, informs an overall trust rating. The inspection found that overall, the trust has a rating of 'Requires Improvement'. However the trust was rated as inadequate in ensuring that patients were protected from avoidable harm in urgent and emergency services.

Our key findings were as follows:

  • Due to the structural management changes that had occurred over the past six months we found a service in transition. New systems and process were in place but these had yet to be embedded.
  • Staff were caring and compassionate in their care of patients.
  • The emergency and medical services required significant improvement to ensure patients were protected from avoidable harm.
  • Services for patients at the end of their lives required improvement to ensure that patients received a safe, effective and responsive service that was well led.

We saw several areas of outstanding practice including:

  • A member of staff on Apple Tree ward had introduced ‘sensory bands’ for the ward’s dementia patients. These were knitted pockets which would be embellished with buttons and beads etc. There was an example band on display with an explanation within the ward. The intention of these sensory bands was that patients could wear or hold them to give them an immediate focus to explore.
  • Good infection prevention and control initiative including different coloured aprons for different ward bays highlighting if staff move out of these areas without removing or changing their apron.
  • The chaplaincy service continued to provide an excellent service, supportive of patients, families, carers and staff.
  • There was robust implementation of Duty of Candour.

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

Importantly, the trust must:

  • Be able to provide assurance that all members of staff are aware of the procedure for and necessity to, report all clinical incidents and near misses in a timely and accurate manner, ensuring these are thoroughly investigated and reported externally where necessary.
  • Ensure that all staff responsible for supporting the feeding of patients have had adequate training in relation to the risks associated with various medical conditions.
  • Ensure the end of life risk register records all the relevant risks involved in delivering end of life care to patients in the hospital setting.
  • Ensure patient outcomes are monitored and audited and the information is used when reviewing the service.
  • Ensure that there is a robust incident and accident reporting system in place and that lessons learnt from investigations of reports are shared with staff to improve patient safety and experience.
  • Ensure the service has an effective governance and risk management systems that reflect current risk and is understood by all staff.
  • Ensure that environmental risk assessments are undertaken to ensure that mental health patients are safe from ligatures and self-harm within the department.
  • Ensure that there is an effective process for monitoring ECGs and observations to ensure the safety of patients.
  • Ensure that there is an immediate review of the environment and provision of children’s services.
  • Ensure that the time to treatment from a clinician in the emergency department is reviewed and times to treatment are improved.
  • Ensure that the triage process for ambulance arrivals is received to ensure that the pathway for patients is safely and times of assessment accurately recorded.
  • Ensure that infection control practices within the emergency department are improved.
  • Ensure that the processes for the checking of equipment in the emergency department is improved and safe for patients.
  • Ensure that allergies are recorded on medicines charts.

In addition the trust should:

  • Ensure risk assessments on medical wards are fully completed, personalised to the patient and regularly reviewed for any changes.
  • Ensure specialist palliative and end of life care patients are assessed and referred promptly to end of life care team.
  • Ensure all appropriate paperwork is completed in a timely way and following best practice guidance.
  • Ensure that the plan for end of life care is rolled out and embedded across the trust.
  • Ensure there is adequate numbers of specialist medical staff.
  • Ensure medicines records include all necessary information.
  • Review the collection of audit data in relation stroke care to benchmark outcomes.
  • Review the provision of nurse staffing at night within the emergency department.
  • Review the need to monitor the culture of staff within the emergency department.
  • Review the environment to ensure that environment supports good infection control.

On the basis of this inspection I have recommended that Hinchingbrooke Health Care NHS Trust remains in special measures. 

Professor Sir Mike Richards

Chief Inspector of Hospitals

16 - 18 Sept, Unannounced visits on 21 and 28 Sept 2014, Unannounced Focused Inspection 2 January 2015

During an inspection looking at part of the service

The Care Quality Commission (CQC) carried out a comprehensive inspection which included an announced inspection visit between the 16 and 18 September 2014 and subsequent unannounced inspection visits on 21 and 28 September. We carried out this comprehensive inspection of the acute core services provided by the trust as part of Care Quality Commission’s (CQC) new approach to hospital inspection. We returned on 2 January 2015 to ensure that the care provided on Apple Tree and Juniper wards and in the Emergency department had improved. We did not re-inspect the whole hospital nor did we look at every aspect of care at this inspection. We reviewed many aspects of the domains of safe and well led in the Emergency services, safe caring and well led in Medicine and caring in Surgery as these were all previously rated as inadequate. Where we inspected we have amended the report in line with our most recent findings.

Hinchingbrooke Hospital is an established 304 bed general hospital, which provides healthcare services to North Cambridge and Peterborough. The trust provides a comprehensive range of acute and obstetrics services, but does not provide inpatient paediatric care, as this is provided within the location by a different trust. The trust is the only privately-managed NHS trust in the country, being managed by Circle since 2012. The Trust's governance is derived from the Franchise Agreement and Intervention Order approved by the Secretary of State for Health. This approach empowers all members of staff to take accountability and responsibility for the planning and implementing of a high quality service.

Prior to undertaking the inspection in September 2014 we spoke with stakeholders and reviewed the information we held about the trust. Hinchingbrooke Health Care NHS Trust had been identified as low risk on the Care Quality Commission’s (CQC) Intelligent Monitoring system. The trust was in band 6, which is the lowest band.

The hospital was first built in the 1980s. It was the first trust in the country to be managed by an independent healthcare company, Circle, which occurred in February 2012. It is led by a multidisciplinary team of clinical and non-clinical executives partnered with a non-executive Trust Board. However we found that the trust was predominantly medically led but a new director of nursing had been appointed four months prior to our visit and was beginning to address the input of nursing within the hospital.

We found significant areas of concern during our inspection visit in September 2014 which we raised with the chief executive, director of nursing, head of midwifery and the chief operating officer of the trust and the next day with the NHS Trust Development Authority. We were concerned about patients safety and referred a number of patients to the Local Authority safeguarding team. Since the inspection the Trust Development Authority have given the trust significant support to address the issues raised in this report. CQC served a letter which informed the trust of the nature of our concerns in order that action could be taken in a timely manner. CQC also requested further information from the trust as we considered taking urgent action to reduce the number of beds available on Apple Tree Ward. However the trust took the decision to reduce the number of beds as part of their action plan and so this regulatory action was therefore not necessary. The matter has been kept under review and the CQC has undertaken two unannounced inspections, attended the Annual Public Meeting [i.e. the Annual General Meeting] on 25 September 2014 and held two follow up meetings with the trust to ensure that action has been taken. We returned on 2 January 2015 to review progress made in Apple Tree and Juniper wards and in the ED in respect of the inadequate ratings. We found that improvements had been made in respect of the inadequate ratings for medicine and surgery but that there was little or no improvement within the emergency department. We have rated the domains of safe, caring and well led in medicine and caring in surgery as requiring improvement but the emergency department remains inadequate for well led but has moved to requires improvement in safe. Overall the location is now rated as requires improvement.

Our key findings were as follows:

  • We found many instances of staff wishing to care for patients in the best way, but unable to raise concerns or prevent service demands from severely impinging on the quality and kindness of care for patients. In both maternity and critical care we noted good care, focused on patients’ needs, meeting national standards.
  •  In September 2014 we found that the provision of care on Apple Tree Ward, a medical ward, was inadequate and there were risks to patient safety. This required urgent action to address the concerns of the inspection team. We re-inspected this area in September 2014 and in January 2015 and found that the hospital had taken action. We found that risks to patient safety were reduced on this visit.
  • In September 2014 we found that there was a lack of paediatric cover within the ED and theatres that meant that the care of children in these departments was, at times, increasing potential risks to patient safety. However the trust took immediate action and employed temporary peadiatric staff. The trust has since appointed permenent peadiatric start who should be in place by the end of February 2015. Therefore mitigating the risks in this area, however we have yet to be assured that the risks are sufficiently mitigated.
  • The senior management team of the trust are well known within the hospital; however, the values and beliefs of the trust were not embedded, nor were staff engaged or empowered to raise concerns by taking responsibility to 'Stop the Line'. Stop the line is a process which empowers all members of staff to raise immediate concerns when they believe that patient safety is being compromised. Initiating a "Stop the Line" facilitates management support to the area identified and action to address the issue. We did not review this issue in January 2015 as we were aware that the trust was reviewing their governance systems. 
  • In September 2014 we found that there was a lack of knowledge around Adult Safeguarding procedures, Mental Capacity Act and Deprivation of Liberty processes. The trust has taken action to improve the knowledge of staff in these areas however we did not inspect all areas of the trust in January 2015.
  • In September 2014 we found that response to call bells in a number of areas, in Juniper Ward, Apple Tree ward and the Reablement Unit for example, was so poor that two patients of the 53 we spoke to in the medical and surgical areas stated that they had been told to soil themselves. A further one patient advised that they had soiled themselves whilst awaiting assistance. We brought this to the attention of the trust and they investigated. However neither CQC nor the trust could corroborate these claims. Since September we have had information of concern that supports that this was still occurring in November 2014. At our January 2015 inspection we found that responses to call bells had improved on the two wards we inspected.
  • In September 2014 we found that risk assessments were not always reflective of the needs of patients in surgery and medical wards. This was evidenced by review of 46 sets of notes of which 19 were found to have incomplete information or review. At our inspection in January 2015 we reviewed eight sets of notes and found that risk assessments continued to be poorly documented and personalised to individual patients.
  • In September 2014 we found that infection control practices were not always complied with in ED, Apple Tree ward, Cherry Tree ward, Walnut ward and in the Treatment Centre. When we inspected Apple Tree ward in January 2015 we noted significant improvements in infection control practices.
  • In September 2014 we found that medicines, including controlled drugs, were not always stored or administered appropriately in ED, Juniper ward, Apple Tree ward or Cherry Tree ward. When we inspected in January 2015 we found that medicines in ED, Apple Tree and Juniper wards had improved but required action to be taken to ensure the safety and efficacy of medication.

In September 2014 we saw several areas of good practice, which we did not reinspect in January 2015,  including:

  • In both maternity and critical care we noted good care, focused on patients’ needs, meeting national standards.
  • The paediatric specialist nurse in the emergency department was dynamic and motivated in supporting children and parents. This was seen through the engagement of children in the local community, in a project to develop an understanding of the hospital from a child’s perspective, through the '999 club'.
  • The support that the chaplaincy staff gave to patients and hospital staff was outstanding. The chaplain had a good relationship with the staff, and was considered one of the team. The number of initiatives set up by the chaplain to support patients was outstanding.

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

Importantly, the trust must:

  • Ensure all patients' health and safety is safeguarded, including patient’s nutrition and hydration needs are adequately monitored and responded to.
  • Ensure that staffing levels and skill mix on wards is reviewed and the high usage of agency and bank staff to ensure that numbers and competencies are appropriate to deliver the level of care Hinchingbrooke Hospital requires.
  • Ensure records, including risk assessments, are completed, updated and reflective of the needs of patients.
  • Ensure that there are sufficient appropriately skilled nursing staff on medical and surgical wards to meet patients’ needs in a timely manner.
  • Ensure medicines are stored securely and administered correctly in the ED and that liquid preparations are marked with opening dates in the medical and surgical wards.
  • Ensure that all staff are trained in, and have knowledge of their responsibilities under the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS).
  • Ensure that patients are treated with dignity and respect in the Emergency department.
  • Ensure that all staff are adequately supported through appraisal, supervision and training to deliver care to patients.
  • Ensure pressure ulcer care is consistently provided in accordance with National Institute for Health and Care Excellence (NICE) guideline CG:179.
  • Ensure that catheter and intravenous (IV) care is undertaken in accordance with best practice guidelines.
  • Ensure patients are treated in accordance with the Mental Capacity Act 2005.
  • Ensure that the staff to patient ratio is adjusted to reflect changing patient dependency.
  • Review the ‘Stop the Line’ procedures and whistle blowing procedures, to improve and drive an open culture within the trust.
  • Standardise and improve the dissemination of lessons learnt from incidents to support the improvement of the provision of high quality care for all patients.
  • Ensure that all appropriate patients receive timely referral to the palliative care service.
  • Ensure action is taken to improve the communication with patients, to ensure that they are involved in decision-making in relation to, their care treatment, and that these discussions are reflected in care plans.
  • Review mechanisms for using feedback from patients, so that the quality of service improves.
  • Ensure that the checking of resuscitation equipment in the A&E department, and across the trust, to ensure that it occurs as per policy.

In addition, the trust should:

  • Take action to reduce the over burdensome administration processes when admitting patients into the acute assessment unit (AAU).
  • Review intentional rounding checks to ensure that they cover requirements for meeting patient’s nutrition and hydration needs.
  • Involve patients in making decisions about their care in the A&E department.
  • Review the training given to staff, and the environment provided, for having difficult discussions with patients.
  • Provide adequate training on caring for patients living with dementia, to improve the service to patients living with dementia.
  • Review the clinical pathways for termination of pregnancies in the acute medical area.
  • Review the policy on moving patients late at night.
  • Review the out-of-hours arrangements for diagnostic services, such as radiology and pathology, to ensure that patients receive a timely service.
  • Review mechanisms for fast track discharge, so that terminally ill patients die in a place of their choice.

Professor Sir Mike Richards

Chief Inspector of Hospitals

16 - 18 Sept, Unannounced visits on 21 and 28 Sept 2014

During a routine inspection

The Care Quality Commission (CQC) carried out a comprehensive inspection which included an announced inspection visit between the 16 and 18 September 2014 and subsequent unannounced inspection visits on 21 and 28 September. We carried out this comprehensive inspection of the acute core services provided by the trust as part of Care Quality Commission’s (CQC) new approach to hospital inspection.

Hinchingbrooke Hospital is an established 304 bed general hospital, which provides healthcare services to North Cambridge and Peterborough. The trust provides a comprehensive range of acute and obstetrics services, but does not provide inpatient paediatric care, as this is provided within the location by a different trust. The trust is the only privately-managed NHS trust in the country, being managed by Circle since 2012.The Trust's governance is derived from the Franchise Agreement and Intervention Order approved by the Secretary of State for Health. This approach empowers all members of staff to take accountability and responsibility for the planning and implementing of a high quality service.

Prior to undertaking this inspection we spoke with stakeholders and reviewed the information we held about the trust. Hinchingbrooke Health Care NHS Trust had been identified as low risk on the Care Quality Commission’s (CQC) Intelligent Monitoring system. The trust was in band 6, which is the lowest band.

The hospital was first built in the 1980s. It was the first trust in the country to be managed by an independent healthcare company, Circle, which occurred in February 2012. It is led by a multidisciplinary team of clinical and non-clinical executives partnered with a non-executive Trust Board.However we found that the trust was predominantly medically led but a new director of nursing had been appointed four months prior to our visit and was beginning to address the input of nursing within the hospital.

We found significant areas of concern during our inspection visit which we raised with the chief executive, director of nursing, head of midwifery and the chief operating officer of the trust and the next day with the NHS Trust Development Authority. We were concerned about patients safety and referred a number of patients to the Local Authority safeguarding team. Since the inspection the Trust Development Authority have given the trust significant support to address the issues raised in this report. CQC served a letter which informed the trust of the nature of our concerns in order that action could be taken in a timely manner. CQC also requested further information from the trust as we considered taking urgent action to reduce the number of beds available on Apple Tree Ward. However the trust took the decision to reduce the number of beds as part of their action plan and so this regulatory action was therefore not necessary. The matter has been kept under review and the CQC has undertaken two unannounced inspections, attended the Annual Public Meeting [i.e. the Annual General Meeting] on 25 September 2014 and held two follow up meetings with the trust to ensure that action have been taken.

The comprehensive inspections result in a trust being assigned a rating of ‘outstanding’, ‘good’, ‘requires improvement’ or ‘inadequate’. Each core service receives an individual rating, which, in turn, informs an overall trust rating. The inspection found that overall; the trust has a rating of 'inadequate'.

Our key findings were as follows:

  • We found many instances of staff wishing to care for patients in the best way, but unable to raise concerns or prevent service demands from severely impinging on the quality and kindness of care for patients. In both maternity and critical care we noted good care, focused on patients’ needs, meeting national standards.
  • The provision of care on Apple Tree Ward, a medical ward, was inadequate and there were risks to patient safety. This required urgent action to address the concerns of the inspection team.
  • There was a lack of paediatric cover within the A&E department and theatres that meant that the care of children in these departments was, at times,increasing potential risks to patient safety.
  • The senior management team of the trust are well known within the hospital; however, the values and beliefs of the trust were not embedded, nor were staff engaged or empowered to raise concerns by taking responsibility to 'Stop the Line'. Stop the line is a process which empowers all members of staff to raise immediate concerns when they believe that patient safety is being compromised. Initiating a "Stop the Line" facilitates management support to the area identified and action to address the issue.
  • There was a lack of knowledge around Adult Safeguarding procedures, Mental Capacity Act and Deprivation of Liberty processes.
  • A response to call bells in a number of areas, in Juniper Ward, Apple Tree ward and the Reablement Unit for example, was so poor that two patients of the 53 we spoke to in the medical and surgical areas stated that they had been told to soil themselves. A further one patient advised that they had soiled themselves whilst awaiting assistance. We brought this to the attention of the trust and they investigated. However neither CQC nor the trust could corroborate these claims.
  • Risk assessments were not always reflective of the needs of patients in surgery and medical wards. This was evidenced by review of 46 sets of notes of which 19 were found to have incomplete information or review.
  • Infection control practices were not always complied with in A&E Apple Tree ward, Cherry Tree ward, Walnut ward and in the Treatment Centre.
  • Medicines, including controlled drugs, were not always stored or administered appropriately in A&E, Juniper ward, Apple Tree ward or Cherry Tree ward.

We saw several areas of good practice including:

  • In both maternity and critical care we noted good care, focused on patients’ needs, meeting national standards.
  • The paediatric specialist nurse in the emergency department was dynamic and motivated in supporting children and parents. This was seen through the engagement of children in the local community, in a project to develop an understanding of the hospital from a child’s perspective, through the '999 club'.
  • The support that the chaplaincy staff gave to patients and hospital staff was outstanding. The chaplain had a good relationship with the staff, and was considered one of the team. The number of initiatives set up by the chaplain to support patients was outstanding.

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

Importantly, the trust must:

  • Ensure all patients health and safety is safeguarded, including ensuring that call bells are answered in order to meet patients’ needs in respect of dignity, and patient’s nutrition and hydration needs are adequately monitored and responded to.
  • Ensure that staffing levels and skill mix on wards is reviewed and the high usage of agency and bank staff to ensure that numbers and competencies are appropriate to deliver the level of care Hinchingbrooke Hospital requires.
  • Ensure that the arrangements for the provision of services to children in A&E, operating theatres and outpatients areas provided by the trust, is reviewed to ensure that it meets their needs, and that staff have the appropriate support to raise issues on the service provision.
  • Ensure records, including risk assessments, are completed, updated and reflective of the needs of patients.
  • Ensure the care pathways, including peadiatric pathways, in place are consistently followed by staff.
  • Ensure an adequate skill mix in the emergency department and theatres to ensure that paediatric patients receive a service that meets their needs in a timely manner.
  • Ensure that there are sufficient appropriately skilled nursing staff on medical and surgical wards to meet patients’ needs in a timely manner.
  • Ensure medicines are stored securely and administered correctly.
  • Improve infection control measures in the Emergency department and medical wards to protect patients from infection through cross contamination.
  • Ensure staff are trained in, and have knowledge of their responsibilities under the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS).
  • Ensure that patients are treated with dignity and respect.
  • Ensure that all staff are adequately supported through appraisal, supervision and training to deliver care to patients.
  • Ensure pressure ulcer care is consistently provided in accordance with National Institute for Health and Care Excellence (NICE) guideline CG:179.
  • Ensure that catheter and intravenous (IV) care is undertaken in accordance with best practice guidelines.
  • Ensure patients are treated in accordance with the Mental Capacity Act 2005.
  • Ensure that the staff to patient ratio is adjusted to reflect changing patient dependency.
  • Review the ‘Stop the Line’ procedures and whistle blowing procedures, to improve and drive an open culture within the trust.
  • Standardise and improve the dissemination of lessons learnt from incidents to support the improvement of the provision of high quality care for all patients.
  • Ensure that all appropriate patients receive timely referral to the palliative care service.
  • Ensure action is taken to improve the communication with patients, to ensure that they are involved in decision-making in relation to, their care treatment, and that these discussions are reflected in care plans.
  • Review mechanisms for using feedback from patients, so that the quality of service improves.

In addition, the trust should:

  • Review the checking of resuscitation equipment in the A&E department, and across the trust, to ensure that it occurs as per policy.
  • Take action to reduce the overburdensome administration processes when admitting patients into the acute assessment unit (AAU).
  • Review intentional rounding checks to ensure that they cover requirements for meeting patient’s nutrition and hydration needs.
  • Involve patients in making decisions about their care in the A&E department.
  • Review the training given to staff, and the environment provided, for having difficult discussions with patients.
  • Review translation usage in A&E, to ensure that patients receive information appropriate to their needs.
  • Provide adequate training on caring for patients living with dementia, to improve the service to patients living with dementia.
  • Discontinue the practice of adapting day rooms in rehabilitation wards to use as additional inpatient bed spaces.
  • Review the clinical pathways for termination of pregnancies in the acute medical area.
  • Review the policy on moving patients late at night.
  • Review the out-of-hours arrangements for diagnostic services, such as radiology and pathology, to ensure that patients receive a timely service.
  • Review mechanisms for fast track discharge, so that terminally ill patients die in a place of their choice.

Professor Sir Mike Richards

Chief Inspector of Hospitals

2, 4 November 2013

During a routine inspection

On 02 and 04 November 2013 we carried out an inspection of two wards at Hinchingbrooke Hospital. This included the dedicated stroke ward and a medical ward which also cared for patients who had undergone orthopaedic surgery.

During the inspection we spoke with 23 patients, 11 visitors and 37 members of staff. Staff we spoke with included registered and un-registered nurses, ward matrons, members of the risk management and human resources team, infection control nurses, specialist nurses and a consultant, managers who supported patients and staff and senior members of the trust's management team.

We found that patients had been given good information about their care and treatment and that, on the whole, there was good interaction between staff and patients on the two wards. We found that patients were fully involved in their rehabilitation which was carried out by members of the therapy team on the stroke ward. Patients told us: 'I have been here two weeks now, it's busy but the staff are great and have looked after me well'. Another told us: 'Everything is ok. The physio tells me everything I need to know. They are great'.

We saw that patients were cared for in a safe and caring environment. Staff were aware of patient's care needs and this ensured continuity of care. We saw that patients had care plans and risk assessments in place and that these had been updated regularly to ensure that patients' current needs were recorded correctly. We were told by patients, relatives and staff that patients received a 'five day rehabilitation service' as there were no therapists available at the weekends. We were told that this issue was being addressed by the trust and that further communication would happen with key stakeholders who worked in this area.

We spoke with patients and visitors during our inspection and they told us that they were satisfied with the level of cleanliness on their ward. We saw that staff followed infection prevention control procedures and wore personal protective equipment when required. We found that the trust had policies and procedures in place which protected patients and staff from the risk of infection. Regular reviews of practice had taken place and outcomes were monitored. We identified some shortfalls during our inspection concerning the care of patients' cannulas and noted that documentation had not been completed. The trust told us that they were addressing this by carrying out staff training and auditing the practice to identify any themes or trends.

During our inspection we observed staffing levels on the two wards. We found that the wards were adequately staffed and were supported by the use of bank and agency nurses. We saw that recent recruitment days had been successful and that new staff had been secured for these wards. We also found that the trust had contingency plans in place to address any staff shortages.

Staff told us that they were supported in their work. They attended mandatory training which ensured that they had the skills to carry out their job. Staff told us that appraisals of their performance took place, however, some told us that these were overdue. Staff told us that they felt supported by their team members and we saw that the trust had introduced new channels of communication which they hoped would improve staff engagement. We also noted that a new shift pattern had been introduced and we were told that a review would be taking place to evaluate the effect on staff and patient care.

The trust had appropriate quality assurance processes in place to monitor and improve the services that they provided. Patients, relatives and staff were asked for their opinion on how services were delivered and appropriate action was taken to address any concerns raised. Staff told us, and we saw evidence, that patient safety was a priority. We found that there was a culture of learning from unsafe events in the trust and saw that clinical care was assessed and monitored via a robust audit system.

We found that there were systems in place should a patient or their representative wish to raise a concern or make a complaint. The majority of patients we spoke with were aware of how to raise a complaint and we found that staff were able to tell us how they would escalate concerns or complaints. We found that there was a culture of learning from complaints and reviewing practice following any investigations that had taken place.

12 August 2012

During a themed inspection looking at Dignity and Nutrition

People told us what it was like to be a patient in two wards at Hinchingbrooke Hospital. They described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people in hospitals were treated with dignity and respect and whether their nutritional needs were met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by a second CQC inspector, an Expert by Experience, who has personal experience of using or caring for someone who uses this type of service and a practicing professional.

The inspection was carried out on a Sunday and we spent time on two wards where the majority of patients on the wards were older people. We spoke with seven patients and with three relatives. We observed the lunchtime meal on both wards and we also used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

Patients we spoke with spoke positively about the staff. One said staff were, 'So polite, just so good'. We observed positive communication between staff and patients during our inspection. Staff also spent time answering questions that relatives had. One relative told us that the nursing and care staff were always able to tell them how their relative had been that day.

We observed two examples of staff taking appropriate action to deal with a situation in which a patient was challenging others around them. The staff did so in a calm and sensitive way. They were mindful of the dignity of the patient themselves but also of the affect of their behaviour on other patients on the ward. In both situations that we observed the outcome was a positive one for all concerned.

The seven patients we spoke with told us that they had a choice at meals and that they made their choices the day before. They said that they had a written menu to choose from. We received varied comments about the food. One patient said that the menu was, 'Quite varied but nothing terribly exciting'. Another said that it was, 'Very nice but they bring so much'. Everyone confirmed that they regularly received hot drinks and that there was always water in the jugs on their tables.

Two patients who spoke with us told us that the staff respected their privacy. One said that staff were, 'So polite, just so good' whilst another told us that staff were, 'Very respectful'. All of the patients that we asked, except for one, told us that their call bells were answered promptly.

17 May 2011

During a routine inspection

During this review we spoke with a large number of patients and their relatives who were present on the day of our visit to the hospital.

The majority of people we spoke with told us that they were happy with the care they had received and felt informed and consulted about their treatment options. People also told us that staff were good and would do their best to meet individual needs.

People told us that they were treated with respect and dignity and we also observed this throughout our visit.

Most people know how to comment or complain about the service and they felt that any concerns were listened to.

30 December 2010 and 14 January 2011

During a routine inspection

People told us they were seen quickly when they first arrived at the department and did not have to wait long for treatment. They are kept informed of plans regarding their treatment in the department and after they leave. Referrals are either made by the hospital staff or people are given information to pass on to their own doctors.

One person told us there had been good communication from staff regarding the course of treatment and what the person should do. Another person said their injury had occurred previously in another part of the country and they were unsure if the department would see them, however, they were made to feel welcome and did receive the required treatment.

Staff members give pain killers quickly and make sure people are as comfortable as possible. The relative of one person told us the person had been in pain when they came in and had been assessed and given painkillers within half an hour of arriving.

People are offered something to eat if they are in department for a long time and are able to eat.

Comments we heard about the Accident and Emergency department and staff working there were:

"nursing staff were really, really pleasant and were courteous"

"they've all been thoughtful and kind"

"very kind"

"very considerate"

"treated very well"

and one person who has visited the department many times in the last few years said, "it's been superb and has improved".

During an inspection looking at part of the service

We have not spoken directly to people who use this service about this essential standard. Some information has been received in the form of alert notices from the National Patient Safety Agency that demonstrates examples of outcomes for people who use the service.