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Queen Elizabeth Hospital Outstanding

Reports


Other CQC inspections of services

Community & mental health inspection reports for Queen Elizabeth Hospital can be found at Gateshead Health NHS Foundation Trust.

Inspection carried out on 02 April to 11 April

During a routine inspection

  • Staff were open and transparent, and fully committed to reporting incidents and near misses. Learning was based on a thorough analysis and investigation when things went wrong.
  • Patient’s care and treatment was planned and delivered in line with current evidence-based guidance, standards, best practice and legislation. This was monitored to ensure consistency of practice.
  • Feedback from patients who used the service, and those who were close to them were positive about the way staff treated patients. Staff cared for patients with compassion.
  • In surgery, there were innovative approaches to providing integrated person-centred pathways of care that involved other service providers, particularly for patients with multiple and complex needs.
  • Staff were proud of the organisation as a place to work and spoke highly of the culture.
  • There were processes in place to identify, understand, monitor and address current and future risks. The trust had clear governance processes in place to drive patient safety forward. The service proactively engaged and involved all staff.

However:

  • We found the medicine service did not always provide patients with a safe environment for the safe use and storage of substances hazardous to health. Across four wards, on different days of our inspection, we found examples of unimpeded access for patients to substances hazardous to health.
  • In the previous inspection we found that staff did not always check that resuscitation equipment was ready for use. At this inspection, while most medical care wards we visited had successfully checked their resuscitation equipment in accord with a new process introduced by the trust, two wards had not done so, and on one of these wards this applied to both resuscitation trolleys, which had only had a partial weekly check.
  • Staff in medical care (including older person’s care) did not reach the trust’s target for mandatory training in key skills or appraisals. But the trust did have systems in place to ensure staff completed mandatory training and appraisals. The trust told us compliance with its targets would improve as the year progressed.

Inspection carried out on 26 September 2018

During an inspection to make sure that the improvements required had been made

The Care Quality Commission (CQC) carried out an unannounced inspection at the Gateshead Health NHS Foundation Trust on 26 September 2018 following two serious patient safety incidents within the short stay unit within 18 months.

Gateshead Health NHS Foundation Trust was subject to a comprehensive inspection in Septemeber 2015. We did not gather sufficient evidence to impact upon trust ratings from that inspection. During this inspection we visited the emergency department and the short stay unit (ward 2) in the Queen Elizabeth Hospital.

This focussed inspection confirmed that lessons had been learnt following the incidents and in addition, processes and risk assessments had been put in place to reduce the risk of further serious patient safety incidents.

We will continue to monitor the trust’s action plan through our routine engagement with the trust.

Professor Edward Baker

Chief Inspector of Hospitals

Inspection carried out on 7 December 2016

During Reference: R6 not found

Inspection carried out on 29 September to 2 October 2015

During a routine inspection

Queen Elizabeth Hospital is the acute hospital forming part of Gateshead Health NHS Foundation Trust. It provides a range of services including medical, surgical, maternity and gynaecology and services for children and young people, end of life and critical care. It has approximately 580 beds. The hospital also provides emergency and urgent care, outpatients and diagnostic imaging.

We inspected Queen Elizabeth Hospital as part of the comprehensive inspection of the Foundation Trust from 29 September to 2 October 2015 and undertook an unannounced inspection on 23 October 2015.

Overall, we rated Queen Elizabeth Hospital as good. We rated it good for being safe, effective, responsive and well-led and outstanding for caring.

Our key findings were as follows:

  • The majority of areas inspected were clean; however, we did identify some infection control issues in the critical care unit and the waste disposal unit.

  • Rates of infection were within an expected range for the size of the trust.

  • Patients were able to access suitable nutrition and hydration, including special diets, and they reported that, overall, they were content with the quality and quantity of food.

  • There were processes for using and monitoring evidence-based guidelines and standards to meet patients’ care needs. Although policies and care pathways held electronically on the trust systems were in-date some paper copies held in ECC and SCBU were out of date or had no review date.

  • The trust promoted a positive incident reporting culture. Processes were in place for being open and honest when things went wrong and patients given an apology and explanation when incidents occurred.

  • The trust was not meeting all its waiting time targets; the national target for two week cancer waiting times had not been met for a number of tumour sites for four consecutive quarters. This was identified by the trust as a governance concern.

  • Systems and processes on some wards for the storage of medicine and the checking of resuscitation equipment did not comply with trust policy and guidance.

  • Nurse staffing was maintained at safe levels in most areas. However, there were occasions where staff had asked for additional support to provide ‘special’ nursing care (individual attention) to meet the physical and mental health needs of patients and shifts had not been covered. The trust had a business case to increase staffing levels in certain areas and had escalation processes when staffing fell below recommended levels.

  • The trust had gaps in medical staffing because of national shortages in certain specialties however; the trust was actively recruiting to these including international recruitment. This risk was further reduced by the use of advance nurse practitioners to support doctors.

  • Safeguarding procedures were in place and staff could demonstrate an understanding of their role and what action to take if they were concerned about a person.

  • Feedback from patients and their relatives was very positive about the care they received and there were examples of some outstanding caring practice.

  • Patient outcome measures showed the trust performed mostly within or better than national averages when compared against other hospitals. Death rates were within expected levels.

  • Following an external review of governance processes, the trust was reviewing its service strategies to ensure that they remained achievable and relevant. The Board had the experience, capacity and capability to ensure that the strategy was delivered.

We saw several areas of outstanding practice including:

  • The Rehabilitation after Critical Illness Team (RaCI) led by nurses, health care assistants and physiotherapists had developed new pathways to help patients recover from critical illness. The team provide rehabilitation while a patient was in the critical care unit, throughout their stay and following discharge.

  • Therapy staff were part of the frailty model and worked in the emergency care centre to support elderly patients with mobility aids and discharge plans avoiding unnecessary admissions to hospital.

  • A combined referral pathway and documentation was being used by GP practices to refer into the trust’s diabetes-integrated service. It included advice and guidance for GPs, a specialist nursing helpline and multi-disciplinary clinical assessment. Clear protocols were in place to identify when a patient could be managed within primary and/or secondary care and when care transfer was appropriate and/or possible.

  • Pathology services had achieved the national external quality assurance scheme (NEQAS) accreditation for cellular pathology and was recognised as a national centre for excellence.

  • Ward 23 was a 24 bedded acute ward providing specialist care to older people with physical and mental health illness (predominantly dementia care) in a dementia friendly therapeutic environment, respecting patient’s dignity whilst also promoting their independence in preparation for discharge from hospital. A team of specialists who had both physical and mental health skills and knowledge cared for patients, their philosophy was to deliver holistic, timely care to patients and their carers.

  • The design of the Emergency Care Centre was innovative and recognised by NHS England as a best practice model providing a single point of access for emergency care.

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

Importantly, the trust must:

  • Ensure that a clean and appropriate environment is maintained throughout the critical care department and waste disposal unit for the prevention and control of infection; including the provision of appropriate personal protective clothing for staff working in the waste disposal unit.

In addition the trust should:

  • Take action to meet the national 2-week cancer waiting time targets in all tumour sites.

  • Ensure that staffing and skill mix is reviewed on ward 23 to take account of the dependency of patients and ensure that sufficient staff are in place, particularly where special one to one support is identified as being required.

  • Ensure that processes are consistently followed in all areas for checking the storage of medicines particularly recording of fridge temperatures and signing and dating medication entries.

  • Ensure that SCBU moves towards introducing a National Early Warning Score chart.

  • Ensure that there is a strategy for optimising patient outcomes from medicines in line with best practice guidance from the Royal Pharmaceutical Society that has Board approval and reviewed regularly.

  • Ensure processes are consistently followed particularly in SCBU and critical care for the checking of resuscitation equipment.

  • Ensure where required, staff are up to date with Paediatric Immediate Life Support (PILS) and Advanced Paediatric Life Support (APLS) training.

  • Review processes to reduce the number of clinic appointments cancelled.

  • Continue to implement and strengthen governance processes in response to recommendations following an external independent review including strengthening the board assurance framework, clinical engagement and management of performance and risk.

  • Review version control arrangements for the updating of paper copies of polices and care pathways held in clinical areas to ensure staff are using policies which are in date and reflect the latest best practice guidelines.

  • Ensure cause for concern-safeguarding forms identify if a child is, or is not, subject to a child protection plan to enable swift and appropriate action.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection carried out on 4, 5 December 2013

During a routine inspection

The team for this inspection consisted of three compliance inspectors and three experts by experience who obtained patient views. The inspection focused on the medical pathway within the Queen Elizabeth Hospital and the governance and complaints handling systems in place and how these ensured continuous improvement of patients' care.

We visited the accident and emergency department, the medical assessment unit and the associated wards 3, 23, 24 and 25. We spoke with 70 patients and relatives during the inspection and reviewed the records of 22 patients. We spoke with matrons, ward managers, ward sisters, nurses and healthcare assistants.

We also held meetings with staff and held discussions with trust representatives about the governance and complaints handling arrangements within the trust. In total we spoke with 82 members of staff.

We observed many interventions from medical and nursing staff throughout the inspection. Staff in each department and ward visited were seen to be very responsive, professional and appropriate in their interactions with patients.

Patient feedback on the care received was universally positive. They felt they had been kept informed by doctors, consultants and the nursing staff regarding their treatment. They felt that staff caring for them were skilled to do so appropriately. Comments received directly and through experts by experience were "� can't find any fault", " ...staff are excellent", ��they�re marvellous in here, always caring, always cleaning around� and �I drove past two hospitals to come to this one � I can�t fault this hospital. It�s very clean, there�s no rubbish, no smell, everyone is polite. They don�t rush you, they�ve got empathy and are very patient at reception�.

We found patients had their health care needs assessed and received appropriate treatment to meet them. We saw assessments and plans for care had been reviewed regularly and updated when required.

We found there were appropriate arrangements in place to assess and monitor the quality of service provision, including clear evidence of a governance structure within the hospital.

All staff we interviewed were dedicated, committed and passionate and wanted to improve patient care. There was an evident culture of openness where staff had been prepared to admit when things had gone wrong and had acted appropriately to learn from incidents and improve patient care. We found there was a genuine willingness to engage and learn from others.

As part of this inspection, the Care Quality Commission (CQC) liaised with other statutory bodies to identify an overall view of how the trust was performing and any areas of concern. Contact was made with Healthwatch England, the Clinical Commissioning Group and Monitor, and their views were taken into account in arriving at the judgements on compliance.

No specific areas of concern affecting this inspection were received from local Healthwatch England, the independent consumer champion for health and social care.

Monitor has the responsibility for ensuring foundation trusts, such as Gateshead Health NHS Foundation Trust, are well led in terms of quality and finance. CQC received confirmation that the trust had a governance risk rating of green and a financial risk rating of 3 (5 is best). Relevant to this inspection, Monitor also informed CQC that although the trust had breached the accident and emergency target in quarter three of 2012/13, it had achieved the target for the last three quarters.

The Gateshead Clinical Commissioning Group (CCG) has the responsibility for commissioning services and ensuring the provision of high quality services. The CCG told us �...there are no issues, (we) have a good relationship with the trust, they are open and proactive and resolve issues when raised.�

We found there were robust governance arrangements that provided �ward to board� assurance in quality and safety across the trust. There was an overarching Patient, Quality, Risk and Safety (PQRS) Committee chaired by the Director of Nursing, Midwifery and Quality, which was underpinned by service-led locality governance groups. These groups discussed, amongst other things, serious incidents, complaints and patient experiences and linked into a number of sub-groups. At ward level we saw evidence that these areas had been discussed within teams.

We saw the trust had established a quality governance framework (Safecare) which involved all staff and was complemented by various groups and committees e.g. mortality group, infection control committee. We were told that staff were encouraged to challenge the strategic priorities of the trust � this was confirmed during individual and group discussions with staff.

We found the trust had an internal complaints team which managed complaints received. We saw that when a complaint was made the trust had acknowledged the complaint and allocated a person to investigate.

As well as speaking with staff at ward level, two �open door� sessions were held where staff from across the trust were invited to meet CQC inspectors. These sessions were attended by 37 staff of all designations. Staff we spoke with described a visible, approachable and open culture of senior management.