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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. Orthopaedic surgical infection site rates for the hospital were one of the lowest within the NHS. 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 services 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 seven 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. People could access the services when they needed it and did not have to wait too long for treatment.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. 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 hospital engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However

  • In surgery, patient records were not always secured securely and could be accessed by unauthorised persons in pre-operative assessment and ward areas.
  • In surgery, the design, use and maintenance of facilities, premises and equipment did not always reduce the risks to patients to keep them safe. The older theatre area was in poor condition and was affected by leaks and flooding at times of heavy rainfall. There were outstanding repairs at the time of our inspection such as the main theatre access door magnetic lock and theatre two door was broken.
  • In surgery, the service did not always record environmental risks it had identified and the actions to mitigate the risks in a timely manner.
Inspection areas

Safe

Requires improvement

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

Outpatients and diagnostic imaging

Good

Updated 22 June 2016

Incidents were recorded and investigated appropriately. Areas were visibly clean and tidy with the exception of two small areas. The infrastructure was old but some financial investment had taken place to refurbish areas such as re-flooring the outpatient department.

Records were usually available, of good quality and stored securely overnight. Medicines were appropriately stored and were within expiry date. Patient risks were identified and mitigated. Nurse and medical staffing was adequate. Staff received appraisals annually and were given opportunities to develop their skills.

Patients received care based on local and national guidelines. Services were not operating seven days a week at the time of our inspection but occasional evening and Saturday morning clinics occasionally took place.

Patients told us staff were caring and we saw them deal with patients in a kind and polite manner and understood the principles of consent and best interest decision making. Staff were able to meet the needs of local people with translators available for patients whose first language was not English. There was ample car parking on site.

The hospital met the department of health target in providing appointments for patients within 18 weeks. Upon arrival at clinic, wait times varied dependent upon the specialty. Patients attending for plain film x-rays did not have to wait, but there were waits of up to two hours for patients attending orthopaedic clinics. Staff offered patients a pager to enable them to leave the waiting area and any delays were displayed on noticeboards.

Service values were evident and staff and public engagement took place regularly. Staff felt that managers listened. Governance was in place and reviewed in monthly meetings. Risk was also managed and mitigated.

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. Orthopaedic surgical infection site rates for the service were one of the lowest within the NHS. 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 seven 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. People could access the service when they needed it and did not have to wait too long for treatment.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. 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

  • Patient records were not always secured securely and could be accessed by unauthorised persons in pre-operative assessment and ward areas.
  • The older theatre area was in poor condition and was affected by leaks and flooding at times of heavy rainfall. There were outstanding repairs at the time of our inspection such as the main theatre access door magnetic lock and theatre two door was broken.
  • The service did not record the risks in relation to the fabrication and environment of the older theatre area in a timely manner. Longstanding risks had only been recorded shortly before the inspection and there were limited plans detailing the actions to reduce and mitigate the risks.