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Inspection Summary


Overall summary & rating

Good

Updated 15 February 2019

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

  • There were robust systems in place to ensure nursing staff completed their mandatory and safeguarding training, nursing staff training compliance exceeded the trust’s target of 80%.
  • Nurse staffing was managed using recognised tools and professional judgement.
  • Medical records and medicines including intravenous fluids were accessible to staff and stored securely. Patients food, hydration and pain management needs were met and there were effective processes in place to ensure that guidance used by staff was in line with national guidance such as those issued by the National Institute for Health and Care Excellence (NICE).
  • The ward environment was visibly clean, with good infection control and in the period August 2017 to August 2018 there had been no cases of methicillin resistant staphylococcus aureus (MRSA), clostridium difficile (C.Diff) or methicillin susceptible staphylococcus (MSSA). The environment was free from clutter with disabled access and enough equipment for staff to perform their role. The service also used audits to improve patient outcomes and staff were supported by practice educators. Staff in the service demonstrated effective multi-disciplinary team working and a good understanding of consent and mental capacity. Staff we spoke to were able to confidently describe how to report incidents.
  • Staff were caring; there were stronger than England average response rates in the Friends and Family test. 90% of those who responded said that they would recommend the service to family and friends. Staff provided support for the emotional needs of the patients and involved patients and carers in decision making where it was safe to do so.
  • Senior leadership within the service were visible, approachable and responsive and worked as a cohesive team to promote a positive culture. There were clear governance processes in place to advance patient safety which were implemented and monitored at CSU level. The service engaged with staff and the public through meetings and surveys. All specialities we visited at Chapel Allerton Hospital had examples of innovation, learning and continuous improvement.
  • Staff told us that they felt supported by their managers and colleagues at ward level and enjoyed working for the trust.

However

  • Medical staff training compliance was not as strong as nursing, with medical staff meeting the trust target of 80% in only one of 16 modules in the medical care service and two in the surgical service.
  • Trust performance in some of the national audits, for example those around falls were below the national aspirational targets however action plans were in place to improve performance.
Inspection areas

Safe

Good

Updated 15 February 2019

Effective

Good

Updated 15 February 2019

Caring

Good

Updated 15 February 2019

Responsive

Good

Updated 15 February 2019

Well-led

Good

Updated 15 February 2019

Checks on specific services

Outpatients and diagnostic imaging

Good

Updated 1 July 2014

Overall patients received safe and appropriate care in the department. The outpatient areas were clean and well maintained and measures were taken to control and prevent infection. The outpatient department was adequately staffed by a professional and caring staff team.

We do not currently assess whether the outpatient’s services are effective. Regular audits of patient records were undertaken, although staff told us that work to improve the quality of patient records was ‘work in progress.’ Care was delivered in line with best practice guidelines.

Outpatient services were caring. Patients visiting the outpatients department were treated with respect, dignity, and compassion. Patients were supported when they received a difficult diagnosis and staff explained choices of treatment. On the whole analysis of patient feedback survey data was positive, although cancelled appointments and waiting in clinics was a frustration for patients and their carers.

The outpatients’ service was responsive. The department understood the needs of the different communities it served and reviewed clinic statistics monthly to improve efficiency and reduce waiting times. The department had improved its clinic attendance rate using electronic messaging to contact patients. Patients with a dementia related condition, with a learning disability, a visual or hearing impairment were supported. The hospital wrote to patients and their GP within one week of the outpatient clinic. Car parking was available at the hospital on payment of a fee, although some patients felt this was an issue.

The service was well led. Staff liked working for the hospital and felt well informed and supported. Executive directors visited the service and staff knew who they were. Risk management processes were in place and each CSU operated its own risk register. The potential of staff of various grades and disciplines was developed. Staff recognised the need to develop more nurse led clinics for the department.

Surgery

Good

Updated 15 February 2019

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

  • There were multidisciplinary team (MDT) meetings held each morning attended by doctors, senior physiotherapists, senior occupational therapists and the nurse in charge. The ward held safety huddles each morning and evening, during the shift changeovers.
  • The ward had their own physiotherapy team seven-days a week and the occupational therapy team were on the ward five-days a week 9 am – 5 pm.
  • The ward provided timely elective surgical treatments for patients. The ward conducted all types of surgery except spinal.
  • Staff felt supported by their managers and colleagues at ward level. Staff enjoyed working for the trust and the directorate.
  • From our observations it was apparent that the five steps to safer surgery checklist, was embedded as a routine part of the surgical pathway.
  • The majority of patients we spoke with were complementary about the care and experience they had received.
  • The service had an electronic system in place for reporting, monitoring and learning from incidents. Staff we spoke with could confidently describe how to report incidents.
  • We found wards and departments we visited, visibly clean, tidy and free from clutter.

However;

  • There was a high number of cancelled operations which were attributed to scheduling concerns and lack of ward beds. The average length of stay was also longer than the England average.
  • The trust must ensure that mandatory training compliance for medical staff meets their own target. At Chapel Allerton Hospital the surgery service had an overall training compliance rate of 73.2% for medical staff. The 80% target was met for two out of 14 mandatory training modules for which medical staff were eligible. Less than 60% of staff had completed the two advanced resuscitation training modules which equated to 14 staff not completing them in each case.
  • The trust must ensure that safeguarding training compliance for medical staff meets their own target. At Chapel Allerton the 80% target was not met in any of the seven safeguarding training modules for which medical staff were eligible.
  • There were no posters on display informing patients that information leaflets were available in other languages than English.

Medical care (including older people’s care)

Good

Updated 15 February 2019

We had not previously inspected medical care services at this site.

At this inspection we rated the services as good because:

  • The services were safe because there were systems in place to ensure staff completed mandatory training and safeguarding training. Nursing and midwifery staff exceeded the trust target of 80% for all 13 mandatory training modules and all seven safeguarding training modules.
  • The ward environment was visibly clean with good infection control: in the period August 2017 to August 2018, there had been no cases of methicillin resistant staphylococcus aureus (MRSA), clostridium difficile (C. diff), or methicillin susceptible staphylococcus aureus (MSSA). The environment was clutter free, wheelchair accessible with enough equipment for staff to perform their role.
  • Nurse staffing was managed using recognised tools and professional judgment. Staff had access to records which were stored securely. Medicines, including intravenous fluids, were stored and managed safely. Staff knew how to report incidents and tools such as the safety thermometer were used to keep patients safe.
  • The services were effective because processes were in place to ensure that guidance used by staff complied with national guidance, such as that issued by National Institute for Health and Care Excellence (NICE). Patients’ food, hydration and pain management needs were met. The service used audits within the specialities we visited to improve patient outcomes. Staff received training to ensure they were competent supported by practice educators. Staff worked effectively as a multi-disciplinary team and had good knowledge about consent and mental capacity.
  • The services were caring, with response rates in the friends and family test better than the England average. The inpatient score for recommending the service to friends and family from May 2017 to April 2018 was 90%. Staff supported the emotional needs of patients and could, for example, arrange psychological support. Staff tried to understand and involve patients and their carers where it was safe to do so.
  • The services were responsive, with a process in place at clinical service/support (CSU) to trust level to plan services. Wards had link nurses to champion the needs of patients with additional needs. Wards used various approaches to respond to challenges with access and flow. The service was responsive to complaints and had made changes to services, such as creation of stroke buddies.
  • The senior leadership team running the specialities were visible, approachable, and responsive and worked as a cohesive team to promote a positive culture. The trust had clear governance processes in place to drive patient safety forward; these were implemented and monitored at CSU level. Staff and the public were engaged through meetings and surveys. The specialities we visited had access to directorate dashboards to help monitor patient sensitive indicators and act when necessary. The specialities we visited all had examples of innovation, learning and continuous improvement.

However:

  • Medical staffing compliance with the mandatory training target of 80% was met for only one of the 16 modules, and was not met for any of the safeguarding modules, or the mental capacity level 2 training. The trust told us it had updated its training needs analysis and this was being measured against a plan to ensure the trust target would be achieved so that the compliance figures would improve as the year progressed and so patient safety was not at risk.
  • Trust performance in some of the national audits, for example around falls, were below national aspirational targets albeit the trust had an action plan in place to improve performance going forward.