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Inspection Summary


Overall summary & rating

Good

Updated 22 February 2019

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

We rated safe, effective, caring, responsive and well-led as good.

Our rating for surgical services improved to outstanding. We rated safe and responsive good and effective, caring and well-led as outstanding.

  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

  • The hospital controlled infection risk well and used innovative approaches to reduce the rate of surgical site infections. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection. Key performance information reflected this.

  • The hospital managed patient safety incidents well. Services were committed to an open safety culture where all safety issues raised by staff and patients were highly valued. Staff recognised incidents and near misses and reported them appropriately.

  • The hospital continued to provide care and treatment that was planned and delivered in line with current evidence-based guidance, standards, best practice, legislation and technologies. There continued to be a truly holistic approach to assessing, planning and delivering care and treatment to people who use the service.

  • Staff gave patients enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary. The service made adjustments for patients’ religious, cultural and other preferences.

  • The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and monitor the effectiveness of the service. We saw that staff were supported to maintain and further develop their professional skills and experience. We saw that practice educators were available in each ward and department to support staff.

  • Staff of different kinds continued to work together as a team to benefit patients. Staff, teams and services were committed to working collaboratively and found innovative and efficient ways to deliver joined-up care to people who used services. For example, we saw the surgical service were split into care groups which were structures to involve MDT working. All relevant staff, were regularly involved in assessing, planning and delivering patients care and treatment. Staff worked well together to understand the range and complexity of people’s needs. There was a holistic approach to planning patients discharge, transfer or transition to other services which was started at the earliest possible stage.

  • Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.

  • Staff continued to involve patients and those close to them in decisions about their care and treatment.

  • The trust planned and provided services

    , amenities and care

    in a way that met the needs of all people

    using the service locally and nationally including patients and their families.

  • The service took account of patients’ individual needs in a holistic manner including mental, emotional and social care needs.

  • Managers at all levels in the trust had the right skills and abilities to run a service providing high-quality sustainable care.

However,

  • The hospital provided mandatory training in key skills to all staff. Compliance for nursing staff within surgical service was generally good and met the trust target, however, medical staff completion was below the trust target and there was a low completion rate of basic life support training.

  • There was no standardised procedure within surgical services to ensure medicines and equipment used for organ retrieval were checked and re stocked within surgical service. Although staff told us this was a task completed at the beginning of every shift there was no assurance and no way of knowing if the bag had been tampered with.

Written patient information was not available in other languages and formats suitable for patients with sensory disabilities such as blindness

Inspection areas

Safe

Good

Updated 22 February 2019

Effective

Good

Updated 22 February 2019

Caring

Good

Updated 22 February 2019

Responsive

Good

Updated 22 February 2019

Well-led

Good

Updated 22 February 2019

Checks on specific services

Surgery

Outstanding

Updated 22 February 2019

  • We rated effective, caring and well-led as outstanding, and safe and responsive as good.
  • The service demonstrated clear improvements which ensured patients were protected from avoidable harm. Since our last inspection the service had improved its use of the World Health Organisation Safer Surgery Checklist and ensured this was embedded in practice with a focus on all team members being present. We saw the service had improved the recording of National Early Warning Scores and ensured there was clear escalation processes.
  • We saw innovative ways used before, during and after surgery, to protect patients from surgical site infections. Surgical site infection rated remained below the national average.
  • The service continued to seek opportunities to participate in benchmarking and peer review. Accurate and up-to-date information about effectiveness was shared internally and externally and this information was used to improve services for patients.
  • Patients continued to have comprehensive assessments of their needs, which included consideration of clinical needs (including pain relief), mental health, physical health and wellbeing and nutrition and hydration needs. The expected outcomes and discharge times were identified early on and care and treatment was regularly reviewed and updated.
  • Staff continued to involve patients and those close to them in decisions about their care and treatment. We saw and were told that patients and their families were respected and valued as individuals and were empowered to be partners in their care, practically and emotionally.
  • Staff went above and beyond to care for patients who had to stay in hospital long term. Staff tried to make the hospital a home away from home and provided patients with independence and activities where possible.
  • The service planned and provided services, amenities and care in a way that met the needs of all people using the service locally and nationally including patients and their families. The service took account of patients’ individual needs in a holistic manner including mental, emotional and social care needs.
  • Managers at all levels in the trust had the right skills and abilities to run a service providing high-quality sustainable care and promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values. The culture was positive with a primary focus on patient care and experience.
  • The service used a systematic approach to continually improve the quality of its services and safeguarding high standards of care by creating an environment in which excellence in clinical care would flourish.
  • The service engaged well and effectively with patients, staff, the public and local organisations to plan and manage appropriate services. The service was focussed on using views gathered from engagement to drive improvement efforts.
  • The service was committed to improving services by learning from when things went well and when they went wrong, promoting training, research and innovation. The service had been recognised for innovative practices which had proven results in positively impacting safety, care and outcomes.