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Inspection Summary


Overall summary & rating

Good

Updated 22 February 2019

Our rating of services improved. We rated it as good because:

  • The ratings of safe, responsive and well-led have improved, the ratings of effective and caring have stayed the same.
  • Our rating for surgery and critical care services improved to good and the rating for children services stayed the same as good overall.
  • The hospital had successfully implemented improvements highlighted during last inspection regarding the use of the safer surgery checklist, cleaning processes within theatres, safeguarding children training in recovery, theatre staffing and management and culture issues within theatres.
  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.

  • The service had suitable premises and equipment and looked after them well.

  • Staff completed and updated risk assessments for each patient. They kept clear records and asked for support when necessary.

  • The service prescribed, gave, recorded and stored medicines well. Patients received the right medication at the right dose at the right time. However, we found that the surgical service did not always follow best practice when storing medicines.

  • Staff kept appropriate records of patients’ care and treatment. Records were clear, up-to-date and available to all staff providing care.

  • The hospital had enough staff with the right qualifications, skills, experience and training to keep patients safe from avoidable harm and abuse, and to provide them with the care and treatment they needed. Ward managers matched staffing levels to patient need and could increase staffing when care demands rose. All staff understood their responsibilities to safeguard patients from abuse and neglect, and had appropriate training and support.

  • The hospital managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.

  • The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.

  • 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.

  • Staff assessed and monitored patients regularly to see if they were in pain. They supported those unable to communicate using suitable assessment tools and gave additional pain relief to ease pain.

  • Managers monitored the effectiveness of care and treatment and used the findings to improve them. They compared local results with those of other services to learn from them.

  • The service made sure staff were competent for their roles. Except in surgery, managers appraised staff’s work performance and held supervision meetings with them to provide support and monitor the effectiveness of the service.

  • Staff of different kinds worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good 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 cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness. The unit had since introduced an animal therapy policy to enable dogs to be safely allowed on the unit for patients who wished to have them visit.

  • Staff provided emotional support to patients to minimise their distress.

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

  • The trust planned and provided services in a way that met the needs of local people.

  • People could access the service when they needed it. Waiting times from treatment were and arrangements to admit, treat and discharge patients were in line with good practice.

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

  • The trust had a vision for what it wanted to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community.

  • Managers across the trust promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values. However, staff survey results within surgery showed dissatisfaction in various areas.

  • The trust used a systematic approach to continually improving the quality of its services and safeguarding high standards of care by creating an environment in which excellence in clinical care would flourish.

However,

  • We observed a few lapses in strict adherence to infection control procedures within critical care. Although the hospital controlled infection risk well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection.

  • Although the service provided mandatory training in key skills to all staff. The trust target was set at a comparatively low 70% or 80% depending on the mandatory training module and the compliance rates for mandatory training for some staff groups were below these trust targets.

  • Although staff had training on safeguarding children and adults, the trust target was set at a comparatively low 75% and the compliance rates for mandatory training for some staff groups were below trust targets.

  • Managers did not always effectively appraise staff’s work performance.

  • There was no ratified strategy for critical care and children and young people services.

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

Services for children & young people

Good

Updated 22 February 2019

We rated safe, effective, responsive and well-led as good and caring as outstanding. Our rating of this service stayed the same. We rated it as good because:

  • The service made significant efforts to manage expectations around the step down process from PICU to the ward. The service had hired a nurse to lead on this and an advanced nurse practitioner worked to make the process more seamless.
  • There was clear evidence of research, innovative and outstanding practice. For example, the Simulated inter Professional Team training (SPRint) had won national awards and the paediatric Extracorporeal Membrane Oxygenation (ECMO) service had positive outcomes.
  • Staff spoke very highly of the culture of the service and the staff survey results were consistently high for workplace satisfaction.
  • The service went above and beyond for its patients and patient families. Including the creation of social clubs for patients of all ages.
  • The service took a consistently holistic approach to the care and wellbeing of parents and provided basic nursing training skills to patient family members.
  • The service had good links with local safeguarding agencies and staff very supported by in-house safeguarding team.
  • The service had a variety of link nurses and staff felt empowered and encouraged by managers to continue professional development.
  • The service used a collaborative multi-disciplinary approach to care planning and even made use of external agencies and stakeholders.
  • The service made special efforts to provide a home away from home for both patients and their families. They provided school curriculums for the patients and accommodation and food vouchers for family members as necessary.

However:

  • We found two separate occasions of missed doses on the system and found that the prescribing IT systems did not communicate well with one another.
  • The service had poor audit results for WHO surgical checklist compliance.
  • Staff informed us that they had access to good learning opportunities but rarely had time to attend.
  • The paediatric strategy was not dated and had no time scales for when it wanted to achieve key objectives.
  • Mandatory training rates were below the trust target.
  • Safeguarding training rates were below the trust target.
  • Not all staff received an appraisal.

Critical care

Good

Updated 22 February 2019

Our rating of this service improved. We rated it as good because:

  • We rated safe, effective, caring, responsive and well-led as good.
  • Following our inspection in 2016, the service had made significant improvements in the leadership and safety of the critical care service. These improvements contributed to the safety of patients.
  • The was an experienced leadership team who encouraged a culture of multidisciplinary team work, innovation and striving for excellence in care.
  • Effective reporting and governance systems protected patients from harm and ensured a no-blame culture of learning when incidents occurred.
  • Patients received effective, evidence-based care and patient outcomes were within the expected range. There was an extensive audit and research programme and an investment in finding new ways to improve patient outcomes.
  • Appropriately qualified staff cared for patients. There were excellent training and development opportunities for nursing, medical and allied health professional staff. The percentage of nursing staff with the post registration qualification in critical care exceeded the recommended minimum guidelines.
  • There was an embedded culture of supporting patients and their families during and after admission to critical care. The service was committed to engaging with patients and their relatives and tailored care to suit individual needs.

However:

  • Enteral feeding products were stored in an unsecure area, this posed a contamination risk and potentially compromised patient safety.
  • Although the service provided mandatory training in key skills to all staff and there was high uptake for mandatory training for medical and nursing staff in line with the trust target. There was lower uptake in the staff group which included health care assistants.
  • The service controlled infection risk well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection. However, we observed a few lapses in strict adherence to infection control procedures.
  • Approximately one third of consultant shifts were covered by consultants working additional shifts.
  • There was limited provision of hot beverages for visitors to the unit out of hours and the weekend.

Surgery

Good

Updated 22 February 2019

Our rating of this service improved. We rated it as good because:

  • The ratings of safe, responsive and well-led have improved, the ratings of effective and caring have stayed the same.
  • The service had successfully implemented improvements highlighted during last inspection regarding the use of the safer surgery checklist, cleaning processes within theatres, safeguarding children training in recovery, theatre staffing and management and culture issues within theatres.
  • The service had improved the percentage of cancelled operations where the patient was not treated within 28 days and the average length of stay. However, the average length of stay was higher compared to the England average.
  • The service controlled infection risk well. Surgical site infection rates were lower than national benchmark.
  • The service provided care and treatment based on national guidance and monitored the effectiveness of care and treatment.
  • Staff cared for patients with compassion and took account of patients’ individual needs.
  • The service used a systematic approach to continually improving the quality of care by creating an environment in which excellence in clinical care would flourish.

However:

  • Compliance rates for mandatory training were below trust targets.
  • The service did not always follow best practice when storing medicines.
  • Managers did not always effectively appraise staff’s work performance.
  • Cancellation rates and referral to treatment times were worse than national average.
  • Staff survey results showed dissatisfaction in various areas.