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Inspection Summary


Overall summary & rating

Good

Updated 7 June 2019

During this inspection we inspected the core services of gynaecology and surgery. We rated the gynaecology services as requires improvement and the surgery as good. In reaching our final rating for this location we have taken in to account the ratings for the core service medicine and end of life care also provided at this location, which were not inspected on this occasion.

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

  • Incident reporting systems were in place and there was a culture of reporting, investigating and learning from incidents.
  • Staff kept detailed records of patients’ care and treatment. Detailed risk assessments were carried out for patients who used the services and risk management plans were developed in line with national guidance. There were effective arrangements in place to safeguard patients from abuse and mitigate the risk of it happening.
  • Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness. Patients said they were involved in decisions about their care and that staff considered their emotional well-being, not just their physical condition.
  • The service followed best practice when prescribing, giving and recording medicines and patients received the right medication at the right dose at the right time.
  • Staff assessed and monitored patients regularly to see if they were in pain and had enough to eat and drink.
  • The trust engaged well with patients, staff, the public and local organisations to plan and manage appropriate services.

However

  • In general, services provided care and treatment based on national guidance and managers monitored the effectiveness of care and treatment and used the findings to improve them. Most leaders had the skills, knowledge, experience and integrity they needed to fulfil their roles.
  • However, recent organisation changes meant there were new leaders at directorate and divisional levels for the gynaecology service. While these teams were working to ensure there were clear reporting structures and a sustained level of scrutiny to ensure they were delivering a quality service where risk were known and managed this was still under development. Therefore, it was not possible to fully assess the effectiveness or impact of the governance and risk management processes.
  • There were structures, processes and systems of accountability to support the delivery of the strategy and sustainable services. However in the gynaecology services audits and quality outcomes conducted at a local and divisional level to monitor the effectiveness of care and treatment were not always effective in identifying areas for improvement.
  • Evidence was not provided to show staffing levels were always planned, implemented and reviewed to keep people safe.
  • Staff did not always receive training identified as necessary for their role.
Inspection areas

Safe

Good

Updated 7 June 2019

Effective

Good

Updated 7 June 2019

Caring

Good

Updated 7 June 2019

Responsive

Good

Updated 7 June 2019

Well-led

Good

Updated 7 June 2019

Checks on specific services

Medical care (including older people’s care)

Good

Updated 14 May 2014

Patients received safe care and were protected from risks. Infection rates were low and the hospital was clean. However, risks to people’s safety increased during busy times. Medical patients were transferred to surgical wards and did not always see a specialist in a timely manner. Some equipment needed to be better maintained and some areas were in need of refurbishment. Patient records needed to include accurate and appropriate information.

Staffing levels were regularly monitored to ensure wards and departments were staffed with the right number of staff with the skills and knowledge to meet people’s needs. The hospital continued to recruit into vacancies.

Integrated care pathways for inpatients with diabetes were still being formalised. In the trust diabetes affects 14.7% of adult inpatients. The diabetes quality group was responsible for the monitoring and delivery of the “Think Glucose” project to improve the quality of care. Diabetes specialist nurses were to be recruited and training was also being delivered to ensure that inpatient diabetes treatment protocols were implemented effectively and consistently in line with national guidance.

Some patients had multiple health, social and/or psychological needs which required the input of several specialist teams. The multidisciplinary teams in the division were well integrated and had a strong collaborative approach to care. Care and treatment that was agreed and delivered was not always recorded. A written record was not always available to all parties to ensure continuity of care.

Staff were caring. Patients and relatives told us they were treated with dignity, compassion and respect. Patients were involved in planning their treatment and staff knew how to protect the rights of patients who lacked capacity to make decisions about their treatment. 

The hospital staff faced significant challenges when discharging patients to community services. They were working with stakeholders to deliver the discharge improvement programme including improving medication discharge arrangements.

The service was well-led. Clearly defined governance arrangements were in place in the division which led to improvements in quality. Staff felt supported, valued and proud to be part of the organisation. Opportunities were available for staff to develop their leadership skills. Patients and staff informed service delivery and their views were understood at division and trust board level

Critical care

Good

Updated 14 May 2014

Patients received safe care. Clinical outcomes were monitored and demonstrated good outcomes for patients. Care provided was effective with a multidisciplinary approach taken and good standards of facilities to meet patient’s needs. Whilst staff recruitment and retention was recognised by the trust as an issue, the levels and skills of staff on a day to day basis were consistently managed by using staff from John Radcliffe Hospital.

Patients told us the kindness and care of staff was outstanding. The unit was responsive to the needs of the patient and learned from safety events or incidents. The departments were well led and demonstrated a positive leadership and open culture to enable staff to feel involved in changes.

End of life care

Good

Updated 14 May 2014

Patients received effective and sensitive end of life care. Patients told us they felt safe and their needs were met by skilled staff. Patients knew the reasons for their admissions and had made decisions about where to have their end of life care. Patients’ pain was well managed by the clinical staff and they did not have to wait for their medicines. Staff respected patients’ rights and, in particular, their privacy and dignity.

Palliative patients were able to make decisions about the medical procedures to be followed in the event of a cardiopulmonary arrest. If the decision was not to resuscitate in the event of a cardiopulmonary arrest, the decision was recorded and professionals made aware of the decision.

Patients were cared for with compassion by staff who knew how to care for patients at the end of their life. Hospital staff attended palliative care training and were able to attend study days on end of life care to update their knowledge.

Palliative patients had access to a centralised helpline which offered advice and referrals for admissions. End of life patients arriving on the emergency medical unit were assessed and transferred to the most appropriate ward to meet their care and treatment needs.

Systems were in place to provide sensitive care to patients on end of life pathways and their families. Haematology palliative patients were able to receive treatment as day patients in a recently opened ambulatory room enabling them to remain longer in their own homes. A four-bed flat was available on site for families who wanted to be close to their relative during their end of life pathway.

Outpatients and diagnostic imaging

Good

Updated 14 May 2014

Patients received safe and effective care. Some outpatient and day services were in an old part of the hospital not well suited to the delivery of modern day healthcare. We saw that this was recorded in the risk register and that temporary actions had been taken to mitigate the risk. Identified remedial work had not been undertaken and genetics and cystic fibrosis services affected had not been relocated as planned. We were not able to establish when this would be completed. The clinics we visited were well led and patients told us that the care was excellent.

Surgery

Good

Updated 7 June 2019

Our rating of this service stayed the same. We rated it as good because:

  • Staff knew what incidents to report and how to report them. Managers investigated incidents and shared lessons learned.
  • Staff kept detailed records of patients’ care and treatment. Detailed risk assessments were carried out for patients who used the services and risk management plans were developed in line with national guidance.
  • The service followed best practice when prescribing, giving and recording medicines and patients received the right medication at the right dose at the right time.
  • Staff assessed and monitored patients regularly to see if they were in pain and had enough to eat and drink.
  • Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness. Patients said they were involved in decisions about their care and that staff considered their emotional well-being, not just their physical condition.
  • The service provided care and treatment based on national guidance and evidence of its effectiveness, and staff worked together to assess, plan and deliver care and treatment. Managers monitored the effectiveness of care and treatment and used the findings to improve them.
  • The trust planned and provided services in a way that met the needs of local people and took account of patients’ individual needs.
  • The average length of stay for all non-elective patients at Churchill Hospital was slightly lower than the England average.
  • Leaders had the skills, knowledge, experience and integrity they needed to fulfil their roles. There were structures, processes and systems of accountability to support the delivery of the strategy and sustainable services.
  • 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.
  • The trust engaged well with patients, staff, the public and local organisations to plan and manage appropriate services.

However:

  • The service provided mandatory training in key skills to all staff but not everyone had completed it.
  • The service did not always have enough nursing staff, with the right mix of qualification and skills, but were working hard to improve recruitment. The service did not always make sure staff were competent for their roles.
  • The Churchill Hospital did not always meet national standards for care and treatment in some key areas such as re-admission rates. From June 2017 to May 2018, the average length of stay for all elective patients at Churchill Hospital was higher than the England average.

Gynaecology

Requires improvement

Updated 7 June 2019

This was the first inspection of the core service of gynaecology and termination of pregnancy as a separate service therefore we cannot compare our new ratings directly with previous maternity and gynaecology ratings.

We rated it as requires improvement because:

  • Recent organisation changes meant there were new leaders at directorate and divisional levels. While these teams were working to ensure there were clear reporting structures and a sustained level of scrutiny to ensure they were delivering a quality service where risks were known and managed this was still under development. Therefore, it was not possible to fully assess the effectiveness or impact of the governance and risk management processes.
  • People could not always access services within the national guidelines identified timescales.
  • Audits and quality outcomes conducted at a local and divisional level to monitor the effectiveness of care and treatment were not always effective in identifying areas for improvement.
  • Evidence was not provided to show staffing levels were always planned, implemented and reviewed to keep people safe.
  • Staff did not always receive training identified as necessary for their role.
  • Infection prevention and control processes were not always practiced and completed in accordance with local and national policy.
  • Patients’ care records were not always stored in a way which protected patient confidentiality.
  • Medicines were not always stored in line with best practice.

However,

  • Incident reporting systems were in place and there was a culture of reporting, investigating and learning from incidents.
  • There were effective arrangements in place to safeguard patients from abuse and mitigate the risk of it happening.
  • Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
  • Emotional support was provided by people with appropriate skills and experience.
  • Feedback from patients about their experience of care was consistently positive. Patients were treated with respect and dignity.
  • There was a clear statement of vision and values which was understood by staff at all levels.
  • The service had taken proactive action to reduce waiting lists for gynaecology services.
  • Staff praised local, divisional and directorate management for their leadership skills.