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Inspection report

Date of Inspection: 14 September 2010 and 11 July 2011
Date of Publication: 3 February 2011
Inspection Report published 3 February 2011 PDF

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People should get safe and appropriate care that meets their needs and supports their rights (outcome 4)

Not met this standard

We checked that people who use this service

  • Experience effective, safe and appropriate care, treatment and support that meets their needs and protects their rights.

How this check was done

Our judgement

There are significant concerns in relation to patient waiting times for treatments following referral and for waiting times for cancer treatment. There are also high numbers of patients waiting to be transferred from hospital to care placements. While the trust is monitoring and putting plans in place, evidence of actions taken and their impact is limited. Radiology turnaround times, while improved are still not routinely meeting the target times required. The trust also needs to ensure that all relevant NICE clinical guidelines are implemented and monitored for their impact on patient outcomes.

Overall, we found that the Churchill Hospital was not meeting this essential standard and action needs to be taken to become compliant.

User experience

This outcome covers a range of key issues including how providers assess patient needs, the planning and delivery of care, whether providers take account of published research and guidance, adjusting care to meet people’s needs, values and diversity and having arrangements for dealing with foreseeable emergencies.

Delayed transfers of care

Delays in transferring patients to other care provision remains an ongoing concern. The weekly report for the last week in October 2010, from the Oxfordshire County Council shows that Oxfordshire delayed transfers of care increased from 146 to 170 in a short period of time. The year-to-date figures for Oxford Radcliffe Hospitals NHS Trust are more than double the target figure.

The council states that the biggest reason for delays is the provision of care services being provided in people’s homes. The second biggest reason is delays in obtaining care home placements. These have recently been reduced by the council. These two reasons count for two thirds of all delays. This is an issue that spans health and social care. There is a taskforce to address delayed transfers of care that includes representatives from the county council, the primary care trust and the Oxford Radcliffe Hospitals NHS Trust. The trust provided copies of the action notes from these meetings. While attempts are being made to reduce delays, further cross-sector work is required to decrease the length of time patients have to wait before leaving hospital.

Radiology reporting

Inconsistencies have been identified in the way radiology reporting is managed across the trust. The time taken to assess scans and report back has varied between hospital sites. The processes used also varied. This has been identified and performance-managed by the primary care trust commissioning team. The commissioning team is responsible for identifying the health needs of the local population and how to best to meet those needs. The trust has an action plan in place and provided evidence of recent improvements in consistency and reporting times at the John Radcliffe Hospital. Improvements have also been made at the Churchill Hospital, though the five day reporting turnaround time is not being met for all reports. In August 2010, 94.8% of computerised tomography scanning, known as a CT scan were produced within 5 days. 89.5% of magnetic resonance imaging scanning reports (known as a MRI scan) had been produced within this timeframe. While reporting times for plain film were not being met (93.7% in August 2010), this was a marked improvement from April 2010, where 38% of reports were being produced within five days.

Patient waiting times for treatment

A number of performance management targets, which are systems used to plan and measure achievements and outcomes, are no longer monitored by the Department of Health. These included the 18 weeks waiting time which relates to time taken from a patient being referred for treatment to when they are actually treated. The trust has previously not been meeting the 18 weeks target. The Department of Health states that the time taken from referral to patients receiving treatment will continue to be published and monitored.

The primary care trust also monitors waiting times. Figures from August 2010 show that that just over 80% of patients were seen within 18 weeks for specific treatment. The trust has a committee in place to specifically address waiting times. A review of the minutes shows that the trust has spent time determining the accuracy of the number of patients on the waiting list. This includes those who have been waiting for longer than 26 weeks. While the situation is monitored and discussed, there is limited reference to what actions are to be taken specifically to improve waiting time and who will be responsible for these actions.

The trust is, however, meeting other waiting times including the two week maximum wait for rapid access to the chest pain clinic and patients not having to wait

Other evidence