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Inspection Summary


Overall summary & rating

Good

Updated 26 February 2020

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

  • The hospital had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The hospital controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The hospital managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
  • Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available five days a week.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
  • The hospital planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the trust’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However

  • We found areas of the theatre suite had not been maintained in order to reduce the risks to patients
  • We observed patient records unattended in one ward area.
  • Waiting times were not in line with national standards for some surgical specialities.
  • The surgical service did not have a clear vision for what it wanted to achieve or a strategy to turn this into action. The vision and strategy were dependent on progress in regional developments within the wider health economy. Risk registers did not identify environmental risks we observed during inspection.
Inspection areas

Safe

Good

Updated 26 February 2020

Effective

Good

Updated 26 February 2020

Caring

Good

Updated 26 February 2020

Responsive

Good

Updated 26 February 2020

Well-led

Good

Updated 26 February 2020

Checks on specific services

Medical care (including older people’s care)

Good

Updated 9 March 2018

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

  • Staffing levels were planned and meet the needs of the service and nurse staffing levels on Taylor Ward had improved. The service had enough staff with the right skills, qualifications and experience. Staff knew who their managers were and received regular feedback on their work.
  • Staff knew what incidents to report and how to report them. Managers investigated incidents and shared lessons learned. They identified any themes and monitored near misses
  • The service was meeting the trust’s target for staff completing mandatory training and staff were supported through individual competencies specific to their role.
  • Staff understood and followed procedures to protect vulnerable adults or children.
  • Staff always had access to up-to-date, accurate and comprehensive information on patients’ care and treatment.
  • The service engaged well with patients, staff, the public and local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively.
  • The service planned and provided services in a way that met the needs of local people and care and treatment provided was based on national guidance.
  • There was a cohesive and thorough multidisciplinary approach to assessing the range of people’s needs, setting individual goals and providing patient centred care.
  • Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. They knew how to support patients experiencing mental ill health and those who lacked the capacity to make decisions about their care.
  • Staff treated patients with compassion, dignity and respect. Staff involved patients and those close to them in decisions about their care and treatment. They made sure patients were aware of their goals and plan of care.
  • Staff described the culture within the service as open and transparent. Staff could raise concerns and the majority felt listened to.

However:

  • Divisional risk registers did not always demonstrate that actions were taken to mitigate and manage all risks effectively.
  • Some staff reported the executive team and senior managers were not visible at this site. Some staff reported low morale on Taylor Ward which would be closing in 2018.

Outpatients and diagnostic imaging

Good

Updated 22 June 2016

Whilst low numbers of incidents were recorded by the departments those that were reported were graded according to risk and shared to promote learning. There was an open and honest culture amongst staff. The environment differed depending upon location. Whilst the outpatient department was dated with little natural light, the Hanover Centre was light and spacious following refurbishment in 2013. The areas we inspected were visibly clean and tidy.

Safeguarding was managed by a central team who advised and supported staff who had been trained according to the level of contact with patients and those close to them. Patient risks were managed with resuscitation trolleys in departments.

Staffing was adequate with few vacancies and little or no use of agency staff. Staff used guidelines, procedures and policies to provide care for patients. Departments undertook audits and presented findings to colleagues to promote learning and improve services.

Staff received appraisals and were given opportunities to enhance learning. Radiology services were provided seven days a week. Outpatient clinics were not routinely provided on a seven day basis but clinics were held in the evenings and occasionally on a Saturday morning to manage waiting lists.

Patient records contained the necessary information. However medical signatures were not always legible and registration numbers and printed names were not always included. Approximately ten patient records per month were unavailable for clinic appointments. Staff accessed the electronic systems or contacted GPs if information was not available.

Staff understood consent and we saw evidence that written or verbal consent was obtained when required.

Outpatient services documented standards to maintain high levels of service and these were displayed for patients and visitors.

Patients were happy with the care they received and said staff had a polite and compassionate manner. Patients felt supported by staff during appointments.

A range of initiatives were in place to meet people’s needs.

The hospital met the department of health target of providing appointments for patients within 18 weeks. Ninety seven percent of patients referred for an urgent appointment for suspected cancer were seen within the department of health target time of two weeks. On average patients received appointments within 19 days for non-obstetric ultrasound scans, and two days for x-ray.

Waiting times following arrival in clinic varied depending on the type of appointment. At the time of our inspection there were no visible delays for patients waiting to be seen. Reporting time for scan results was one to two days. However, in September 2015, 1,367 x-rays were waiting for reports to be completed across all sites. Further staff were being recruited to manage this.

Verbal complaints were dealt with at the time through communication if possible, but verbal complaints were not always recorded by staff. Those that were recorded were monitored with results shared monthly to promote learning.

Staff had ideas about how to improve services. Trust values were evident in the areas we inspected. Governance meetings were held monthly. Risk was managed through a local risk register which documented the issue, mitigation, risk score and review date of each risk.

Staff felt supported by managers and services engaged with the public, through forums and questionnaires.

Urology staff offered ‘one-stop’ appointments for haematuria patients which enabled patients to undergo biopsies during initial appointments rather than having to re-attend on another day.

Surgery

Good

Updated 26 February 2020

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

  • The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
  • Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available five days a week.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
  • The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However,

  • We found areas of the theatre suite had not been maintained in order to reduce the risks to patients. We observed patient records unattended in one ward area.
  • Waiting times were not in line with national standards for some surgical specialities.
  • The service did not have a clear vision for what it wanted to achieve or a strategy to turn this into action. The vision and strategy were dependent on progress in regional developments within the wider health economy. Risk registers did not identify environmental risks we observed during inspection.