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 a good. Staff comprehensively assessed people, so the care and treatment provided met their needs. This included their physical health and any personal circumstances that needed to be considered. Staff worked in a strong culture of evidence-based practice. Staff worked together and with others when assessing people's needs and shared information to maintain continuity of care.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant people's outcomes were consistently good, and people's feedback confirmed this.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

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. We saw up to date guidelines displayed in triage and resuscitation areas.

Staff gave people clear information about their care and treatment needed to support their physical and mental health.

The trust's systems ensured staff were up to date with national legislation, evidence-based good practice and required standards. The service participated in clinical audits which enabled them to show care was being provided in line with national recommendations and best practice.

The trust kept its database of guidance up to date. Staff used information given regularly in safety briefings and newsletters to implement new guidance or changes to existing procedures. We saw in the paediatric newsletter from November 2024 Safety Flashes from the Royal College of Emergency Medicine (RCEM) were highlighted as reminders for staff to follow the guidance.

The trust's intranet contained a comprehensive range of up-to-date policies and standard operating procedures which reflected current practice. It had guidance for staff around collaboration with multi-agency teams and for delegation of clinical tasks to ensure the right people delivered evidence-based care and treatment.

However, staff did not always meet some of the patients' nutrition and hydration needs. Some patients we spoke to had not been offered drinks or food, and they had been in the department for over 12 hours. However, others we spoke to told us they had been offered hot food and there had been regular drinks rounds. The matron told us they had recently had to stop offering hot food in the department but patients we spoke to had been offered a hot meal.

The service worked well across teams and services to support people. Staff told us they could easily access support services. Patients who were frail and vulnerable were referred to older persons assessment and liaison team (OPAL). Staff worked closely with the OPAL team, the vulnerability team, and the psychiatric liaison team.

Most staff told us there were good relationships between doctors, consultants, nurses, and paramedics who worked together closely to provide the care to patients. One member of staff told us they felt it was the safest place to work, and they were surrounded by knowledgeable people who supported them. However, some staff felt relationships could be improved.

Information was shared between teams to ensure continuity of care. There were handovers at shift changeover for both the medical and nursing teams. We observed the medical handover and found it to be engaging and informative. We found staff also talked about any lessons learned and asked what support the resident doctors might need on shift.

There was a lack of clarity over responsibility for patients when they had been accepted to a speciality and were waiting for a bed on a ward. Once patients had been referred to a speciality there was confusion over which team the patient was under. This meant the nurses did not always know who to go to for task requirements such as prescribing analgesia as speciality resident doctors were not within the area. Emergency department doctors were under immense pressure to look after these patients on top of reviewing and treating all the new emergency department patients.

The trust worked with the local NHS ambulance trust and a hospital ambulance liaison officer who was based in the department's emergency ambulance entrance. They were the link between the ambulances arriving and waiting and the emergency department staff. This was to help ensure the transition of the patient from the ambulance into the emergency department.

There was an ambulance assessment bay, and another being created, within Majors A where rapid assessment and triage was undertaken for patients arriving on an ambulance. The nurses and doctors assigned to rapid triage worked alongside the ambulance staff to ensure there was safe and effective care for patients who were waiting on the ambulances for long periods of time.

There was support for patients with specific needs, including neurodiversity and substance misuse. We overheard staff liaising with each other regarding the needs of a patient with learning disabilities and how to ensure appropriate management for the patient to, so they were meeting the patient's specialist care needs. Patients we spoke with felt the staff worked together to care for them and deliver an effective service. We observed a calm environment in all areas of emergency department despite the challenges. We observed good multidisciplinary working with polite and caring interactions between staff. Staff referred patients for mental health assessments when they showed signs of mental ill health or depression. They also worked alongside the police to deliver the "Right Care, Right Person" model. This ensured patients under section 136 of the Mental Health Act 1983 were held in the right place. Staff referred patients to the alcohol care team who were available Monday to Friday from 8am until 4pm. They attended the department daily and supported patients with alcohol reliance.

There was a bed meeting 4 times a day which included managers from each department across the hospital. They worked together to try and bring patients from the emergency department among a significant shortfall of bed capacity, even though this was a complex task.

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 to continuously improve it. The service had participated with the quality improvement programme (QIP). Data completion for 2023/24 was completed on schedule and they were still awaiting their results. Results from the previous year showed they had participated in 3 audits. We did not see completed action plans for the 3 RCEM audits. The QIP had clear projects outlined for improving patient safety and experience in emergency department. Audit leads for each site told us they regularly monitored the audits, ensuring RCEM and local audits were regularly completed and shared with the team.

Managers and staff used the results to improve patients' outcomes. They carried out a comprehensive programme of repeated audits to check improvement over time. Improvements had been made. For example, compliance with 16- to 17-year-old safeguarding risk assessment had improved from 17% to 92%.

Managers shared and made sure staff understood information from the audits. The manager had attempted to have team meetings but found these were poorly attended. They had band 7 meetings and each band 7 disseminated any important information to their team. They also sent important updates by email, on their closed social media page and in their communications folder.

There was a paediatric newsletter which shared results of audits. For example, staff had audited whether patients who attended with bruising who were under one-years old and/or non-mobile were seen in line with policy. Results showed that 97% of staff did not follow the whole policy, and only 30% of these patients were fully examined by an emergency department consultant in line with the policy. Actions were documented to improve compliance.

The band 6 clinical support nurse completed spot checks on each shift. These included checking 8 sets of notes 4 times a day, equipment checks and infection prevention and control standards. We saw these spot checks being completed diligently. They found these were useful and standards had improved with documentation and daily checks within the department. There was also a weekly quality assurance check. While they were not formally presented or reported on, learning was put in the communication folder in the staff room.

Although staff asked patients about pain, patients did not always have their pain acted on promptly or recorded correctly. We looked at 21 sets of notes and found pain scores were not always documented. In 4 set of notes the pain scores were not always documented alongside the national early warning score (NEWS2) and in 3 sets, where the pain score was high, no analgesia was given. However, we did observe nurses asking patients about their pain and acting upon it promptly. Where staff recorded a pain score, if it was high, a pop-up box prompted staff to give analgesia. We saw evidence that staff, at times, closed this pop-up box without acting on it. Compliance to pain score completion was discussed in December 2024 emergency department clinical governance meeting. It was found patients' pain score was assessed within 15 minutes for only 32% of patients. The audit also showed 0.6% had pain relief within 15 minutes and 52.2% had it after 60 minutes. It was noted that more work was required to improve pain for patients in the department.

Paediatric nurses could only give analgesia once a pain score was documented. We found pain was well documented in the notes we reviewed for children. Patients we spoke with told us there was good pain management and they were being asked about their pain.

In a good indicator that people were being treated and receiving good outcomes, the department's unplanned reattendance rate within 7 days which included any readmissions within 7 days of departure was low at 5.7%.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff understood how and when to assess whether a patient had the mental capacity to make decisions about their care.

We observed staff gaining consent from patients in line with legislation and guidance in relation to care and treatment and saw this was documented in all records we looked at.

Staff supported children and their families in decision making about their care and treatment. Staff understood the process to assess whether a child had the maturity and competence to make their own decisions and give consent to any care or treatment.