Good Hope Hospital

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We rated effective as required improvement which remained the same as the previous inspection. We reviewed 4 quality statements during this assessment.

People’s outcomes although monitored were not always positive or consistent and did not always meet expectations. Processes for making decisions about resuscitation and treatment escalation did not always consider the patients wishes or views.

However, staff planned and delivered care in line with legislation and current evidence-based good practice and standards. Staff worked well together to ensure people were supported.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

The service planned and delivered people's care and treatment with them, including what was important and mattered to them. Staff did this in line with legislation and current evidence-based good practice and standards.

The service's systems ensured staff followed up-to-date policies to plan and deliver high quality care according to evidence-based practice and national.

Staff gave patients information and advice about their care and treatment which included their physical, psychological and emotional wellbeing. Staff protected the rights of patients subject to the Mental Health Act and followed the Code of Practice. During handover meetings staff routinely referred to patients psychological and emotional needs of patients.

Staff made sure patients nutrition needs were assessed and met in line with current guidance. However, we found there were issues related to the completion of hydration documentation. We reviewed 22 medical records and found all patients had their nutritional needs assessed and where concerns were identified, staff referred patients to the dietitians for further specialist care. We also reviewed the fluid balance charts for these patients and found these were not always recorded accurately in 11 of the records. The information for both input and output was not accurate and this made it difficult to assess whether the patient was in a positive or negative fluid balance which could impact their medical condition. This was a concern which was identified during the previous inspection.

The service worked well across teams and services to support people. Staff made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Most staff told us they had access to the information they needed to appropriately assess, plan and deliver patient care and treatment. Patient records were mostly electronic which made them more accessible. However, some staff raised concerns over small delays between accessing electronic records for patients who were previously admitted to another location.

When people received care and treatment from members of the multidisciplinary team (MDT) it was co-ordinated and effective. All relevant staff, teams and services were involved in assessing, planning and delivering patient care and treatment and staff worked collaboratively to understand and meet patient needs. Staff told us they worked well with all members of the MDT and regularly held meetings to discuss patients who had complex requirements. We also observed all staff working well together to ensure the holistic needs of a patient were met.

When people were moved between services and wards, all necessary staff, teams and services were involved in assessing their needs to maintain continuity of care. Where patients were due to be discharged, consideration of their needs, circumstances and ongoing care arrangements and expected outcomes were the priority of all members of the MDT. All wards had staff working to ensure discharges of all complexity were managed and ensured these were completed as seamlessly as possible.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

The service routinely monitored people’s care and treatment with the purpose of trying to identify areas for improvement. However, the outcomes were not always positive or consistent, and did not always meet both clinical expectations and the expectations of people themselves.

People who used the services expected to experience positive outcomes which were in line with the expectations set out in legislation, standards and evidence-based clinical guidance. The service participated in many national and local audits including but not limited to the National Respiratory Audit Programme, Myocardial Ischaemia National Audit Project (MINAP), Society for Acute Medicine Benchmarking Audit (SAMBA) and the Royal College of Emergency Medicine: Care of Older People and Time Critical Medications. Most of the audits identified the service was performing in line with national averages or better than the national average.

However, information from the Sentinel Stroke National Audit Programme (SSNAP) did not consistently identify all patients at this location received the expected positive outcomes. Further discussions held with leaders about the SSNAP data identified the areas of concern highlighted by the audit reflected the model of stroke care provided by the trust as a whole. Acute stroke patients were mostly admitted to another location run by the trust. However, Good Hope Hospital still saw a significant number of stroke patients due to emergency services taking patients to the nearest hospital to receive urgent care and treatment.

The leadership team were currently reviewing the pathways for stroke patients which would improve patient experience and outcomes. However, this was challenging due to the different regions which the hospital covered and therefore required all partners to agree to ensure all patients received equitable services. Staff told us despite still being graded D on SSNAP, there were many positive patient examples which they were able to discuss where the level of skilled intervention by the staff at this location had led to a positive outcome for patients.

The service had effective approaches to monitor patient care and treatment and their outcomes. The service completed learning from death reviews quarterly where they would review deaths for potential learning which ultimately would lead to improvements in patient care.

As well as national audits, the service completed local audits which were completed by staff of all grades and roles. These audits were key to improving the care and treatment patients received within specific specialties. We reviewed examples of audit reports which were completed and found the authors had identified areas for improvement and recommendations. However, the reports did not identify any information about re-auditing or processes to ensure the improvements implemented had an impact on patient outcomes.

The endoscopy unit underwent a Joint Advisory Group (JAG) accreditation review in April 2024. The report identified areas which the endoscopy department were required to improve before accreditation could be awarded. The service completed an action plan and were given until June 2025 to make the required improvements before any further decisions about the service would be made.

The service told people about their rights around consent. However, we identified concerns over the processes for patients making decisions about their resuscitation status and decisions to support treatment escalation.

Staff understood the importance of ensuring people fully understood what they were consenting to and the importance of obtaining consent before they delivered care and treatment. All staff were aware of gaining consent from patients prior to completing any treatment or procedure. This also involved implied consent from patients when undertaking activities such as monitoring a patient’s blood pressure. Where more formal consent was required to undertake clinical procedures, this was completed in accordance with policy and legislation.

There were effective practices to ensure patients understood the care and treatment being provided. This helped patients to make informed decisions about their care. Staff ensured patients were provided enough information to make informed decisions and give informed consent. Patients we spoke with told us they received enough information to give their consent for procedures.

Patients’ capacity and ability to consent was considered. Staff generally understood the relevant consent and decision-making requirements of legislation and guidance, including the Mental Health Act, Mental Capacity Act 2005 and the Children Acts 1989 and 2004 and they knew who to contact for advice. Staff were able to describe and knew how to access the trust’s policy and get accurate advice on Mental Capacity Act and Deprivation of Liberty Safeguards.

Staff spoke confidently about identifying patients who they had concerns over their capacity to make decisions over their care and treatment and actions they needed to take to assess this. We reviewed 22 patient notes and found all mental capacity assessments had been completed for the 14 patients who required this. These assessments were completed appropriately and in line with legislation.

Patients understood their rights around consent. However, we were not assured their wishes and views were always considered when aspects of their care was being planned. During our assessment, we reviewed 11 do not attempt cardiopulmonary resuscitation (DNACPR) and recommended summary plan for emergency care and treatment (ReSPECT) forms and found only 1 which contained adequate details around the patient wishes and views in relation to end of life decisions. Another document had expired although information noted on the form was minimal. The remaining 9 forms had minimal details about patients’ wishes and views when it came to end of life decisions.

Where patients did not have capacity to make these decisions, we could not always identify a person lawfully acting on their behalf was always involved in planning, managing and reviewing their care and treatment. There were 2 DNACPR and ReSPECT forms for patients who did not have capacity where we could not find evidence of where the patients’ next of kin had been involved in expressing the wishes and views on behalf of the patient.

Staff provided audit results for DNACPR completion for the period of 2024 to 2025, and covered 33 documents. Patient preference was documented within 70% of the documents reviewed. When staff looked for evidence of patient involvement in the plans being made, 42% were found to have patient involvement, with 48% noted to have family or legal proxy involvement due to the patient having no capacity. Within 9% of the documents reviewed, ‘other’ individuals were recorded as involved in planning the care for the patient. However, no details of who these ‘other’ individuals were, was recorded.

The service had insufficient assurance of how the outcome of audits would be used to drive improvements in the decision making and completion of resuscitation records. The audit also reviewed the capacity of the patient for whom the DNACPR form was produced. Of the 33 records reviewed, 55% of patients did not have the capacity to make this decision for themselves. However, 67% of these patients did not have a mental capacity assessment completed to support this assessment. We requested action plans to accompany any audits which were completed however no action plan accompanied this audit. Although these were requested, no audits related to the completion of ReSPECT forms were provided. However, a document which identified the progress for DNACPR and ReSPECT was shared which identified an audit was required but at the time had no audit lead identified.