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Ashford Hospital Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 4 October 2018

Our rating of services went down. We rated them as requires improvement because:

The service had suitable premises and equipment but did not always look after them well. Emergency equipment in general outpatients and the ophthalmology clinic was not always checked in line with trust policy. Some items of clinical equipment in the ophthalmology clinic were seen to be overdue for maintenance. Overall, facilities and premises were appropriate for the services delivered. There were facilities for patients in wheelchairs in the outpatient department including disabled toilets.

Medicines and medicines-related stationary were not always managed in a way that kept people safe in relation to the storage temperatures of medicines and the tracking of prescription forms.

The service controlled infection risk well. Staff kept themselves, equipment and the premises clean. Standards of cleanliness and hygiene were generally maintained but cleaning schedules were not in use in all clinic areas such as the ophthalmology clinic.

People could access the service when they needed it. However, services did not always run on time, although patients were informed of delays. There was some overbooking in clinics which had caused delays.

Governance structures were not consistently in place to support the delivery and development of outpatient services. Arrangements for identifying, recording and managing risks, issues and mitigating actions were not consistent or comprehensive.

The trust had managers at all levels with the right skills and abilities to run a service but senior trust and divisional leaders were not perceived as visible within the outpatient department. Staff felt uncertain about the future of Ashford Hospital and did not feel engaged with the wider organisation.

However:

The trust had a vision for what it wanted to achieve and workable plans to turn it into action but there was no outpatient strategy recorded that showed how the service would develop to contribute to those strategic objectives. There was a clear set of values with quality of care and meeting patients’ needs as the top priority.

The service managed patient safety incidents well. Lessons were learned and improvements made when things went wrong. Staff recognised incidents and reported them appropriately but not all staff had received feedback on incidents reported and outpatient team meetings did not include safety incidents as a standing agenda item.

Staff kept appropriate records of patients’ care and treatment. People’s individual care records, including clinical data was written and managed in a way that kept people safe.

The service took account of patients’ individual needs. Patient’s physical, mental health and social needs were holistically assessed and staff delivered patient care in line with evidence based and best practice guidelines. There was evidence of multidisciplinary working with all necessary staff, including those in different teams, services and organisations, involved in assessing, planning and delivering care and treatment.

The trust collected, analysed, managed and used information well to support all its activities. Information about patient outcomes were recorded after each clinic appointment and there were processes to audit these to promote quality improvements. The trust closely monitored cancellations in fewer than six weeks’ notice and referral to treatment times.

People were treated with compassion, kindness, dignity and respect when receiving care.

There were processes to manage current and future performance which were regularly reviewed and improved. There were clear and robust service performance measures, which were reported and monitored.

We did not inspect all core services. The previous rating for those services we did not inspect were taken into account when working out the overall trust ratings for this inspection.

Inspection areas

Safe

Requires improvement

Updated 4 October 2018

Effective

Not sufficient evidence to rate

Updated 4 October 2018

Caring

Good

Updated 4 October 2018

Responsive

Good

Updated 4 October 2018

Well-led

Requires improvement

Updated 4 October 2018

Checks on specific services

Medical care (including older people’s care)

Good

Updated 10 March 2015

Patients received compassionate care. We witnessed positive interactions between staff and patients.

All staff we spoke with were positive about working at Ashford Hospital.

Safety in medicine was compromised because staff were not clear about the monitoring of risks to patients and staff. There were shortfalls in the number of staff attending basic life support and manual handling training. There were risks to patient confidentiality as care records were not consistently securely stored.

The trust monitored the effectiveness of care delivered at divisional level. We were not able to view data which was specific to Ashford Hospital and, therefore, could not be assured how the trust measured the performance of the hospital. The medical wards and the rapid access centre did not reach the trust’s targets for appraisals.

There was confusion from ward staff on two wards about the changes to the level of care provided on their wards.

The clinical nurse leader for the medical wards was seen as a good role model and passionate about patient care, however, there was a lack of clarity about their other management duties.

Critical care

Updated 10 March 2015

<Summary here>

Surgery

Good

Updated 10 March 2015

Patients received compassionate care at Ashford Hospital. We witnessed positive interactions between staff and patients.

There had been two recent Never Events (serious, largely preventable patient safety incidents which should not occur if the available preventative measures have been implemented) which had happened in theatres. Staff were able to demonstrate learning from the investigations and effective plans had been implemented to ensure there was no repeat of these incidents.

Appropriate infection control procedures were in place to prevent the risk of transmission of infection.

Robust assessment procedures were used to ensure that it was appropriate for people to have their operations at Ashford Hospital.

Not all staff had received mandatory training to ensure they updated their knowledge to enable them to support patients appropriately.

Information regarding patient outcomes was held at divisional level. We were not able to view data which was specific to Ashford Hospital and, therefore, could not be assured how the trust measured the performance of the hospital.

Not all staff were able to access further training to enable them to develop their skills. Staff in theatres told us they had difficulty accessing training courses.

Patients reported that there was good access to care and that systems worked well. For example, they felt the flow through day surgery was well-organised.

All staff were aware of the trust’s values and all staff were aware of the potential increase of services to be offered at Ashford.

Governance was monitored at a divisional level and, although we were assured that there were robust governance arrangements overall, it was difficult for us to understand how the trust monitored governance on an individual site basis.

Outpatients

Requires improvement

Updated 4 October 2018

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

  • Standards of cleanliness and hygiene were maintained in some areas; however cleaning schedules were not in use in all clinic areas such as the ophthalmology clinic.
  • Emergency equipment in general outpatients and the ophthalmology clinic was not always checked in line with trust policy. Some items of clinical equipment in the ophthalmology clinic were seen to be overdue for maintenance.
  • Medicines and medicines-related stationary were not always managed in a way that kept people safe in relation to the storage temperatures of medicines and the tracking of prescription forms.
  • Not all staff had received feedback on incidents reported and outpatient team meetings did not include safety incidents as a standing agenda item.
  • The trust had not participated in the national benchmarking programme for outpatient departments in 2017.
  • Services did not always run on time, although patients were informed of delays. There was evidence of some overbooking in clinics which staff reported had caused delays. Managers told us that action was being taken to address the overbooking of clinics.
  • Senior trust and divisional leaders were not visible within the outpatient department. Staff in general outpatients were uncertain about who to report to outside of their immediate line managers.
  • There was no outpatient strategy recorded in line with the trust wide strategy. Staff felt uncertain about the future of Ashford Hospital and did not feel engaged with the wider organisation.
  • Governance structures were not consistently in place to support the delivery and development of outpatient services.
  • Arrangements for identifying, recording and managing risks, issues and mitigating actions were not consistent or comprehensive.

However:

  • Safeguarding training attendance for nurses was above trust target.
  • People’s individual care records, including clinical data was written and managed in a way that kept people safe.
  • Lessons were learned and improvements made when things went wrong.
  • Patient’s physical, mental health and social needs were holistically assessed and staff delivered patient care in line with evidence based care and best practice guidelines.
  • Information about patient outcomes were recorded after each clinic appointment and there were processes to audit these to promote quality improvements. This supported efforts to reduce the volume of patients potentially lost to follow up. The follow-up to new rate for Ashford Hospital was consistently better than the England average.
  • There was evidence of multidisciplinary working with all necessary staff, including those in different teams, services and organisations, involved in assessing, planning and delivering care and treatment.
  • People were treated with compassion, kindness, dignity and respect, when receiving care. Feedback from people who used the service, those who are close to them and stakeholders was positive about the way staff treated people.
  • Outpatient services ensured people’s needs were met through the way services were organised and developed. Patients with dementia were identified through the use of a symbol on their patient record and there was a dedicated dementia waiting area.
  • The facilities and premises were appropriate for the services delivered. There were facilities for patients in wheelchairs in the outpatient department including disabled toilets and a ‘changing places’ toilet.
  • People had timely access to initial assessment, test results and diagnosis and treatment. Referral to treatment times were monitored and performance for non-admitted and incomplete pathways was better than the national average.
  • Trust performance for cancer waiting times was better than the operational standard and the national average.
  • Action was taken to minimise the length of time people have to wait for care, treatment of advice. There was close monitoring of waiting lists and patient follow ups.
  • Delays and cancellations were explained to people and the trust closely monitored cancellations in fewer than six weeks. Data showed a reduction in cancellations in fewer than six weeks.
  • Complaints were reviewed at the bi-monthly outpatient clinical governance meetings and lessons identified to improve practice.
  • There was a clear vision and set of values with quality of care and meeting patients’ needs as the top priority.
  • Staff we spoke with during our inspection were focused on the needs of patients and the culture was centred on the needs and experience of people who use the services.
  • There were processes to manage current and future performance which were regularly reviewed and improved. There were clear and robust service performance measures, which were reported and monitored.