The Care Quality Commission
  • Hospital
  • NHS hospital

Ashford Hospital

Overall: Requires improvement read more about inspection ratings

London Road, Ashford, Middlesex, TW15 3FE (01784) 884488

Provided and run by:
Ashford and St. Peter's Hospitals NHS Foundation Trust

All Inspections

16th and 18th November 2021

During an inspection looking at part of the service

Ashford Hospital is in Surrey and is situated to the West of London and close to Heathrow Airport.

The hospital provides a wide range of medical and mainly day surgical services, outpatients services, ophthalmology, inpatient rehabilitation, and includes the Ashford Walk-in Centre (run by a different provider). The majority of planned care, like day surgery is provided at Ashford Hospital.

Services include:

  • Day-case surgery
  • Elective Surgery
  • Ophthalmology
  • Outpatients (including pediatrics) and diagnostics; X ray, ultrasound, and MRI scans
  • Inpatient Rehabilitation

We carried out this unannounced focused inspection of surgery because we received information of concern about the surgery service across the hospital from staff whistleblowing to the CQC.

We inspected surgery and focused on the safety and well led key questions as the information we received related to these key questions.

We rated surgery as good in both key questions.

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

  • The service had enough staff to care for patients and keep them safe. Staff understood how to protect patients from abuse, and managed safety well.
  • The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work.
  • The majority of staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However:

  • A minority of staff did not feel respected, supported and valued.
  • A minority of staff were not bare below the elbows in clinical areas.
  • Staff told us that divisional leaders were visible. However, staff perceived that the trust’s executive team were not visible.
  • Not all staff were up to date with mandatory training including safeguarding training.

How we carried out the inspection

We spoke to over 40 members of staff including; doctors in training, consultants, nurses, health care assistants, a student nurse, and allied health professionals. We reviewed a variety of data, meeting minutes and nine patient records.

You can find further information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

13 June to 11 July 2018

During a routine inspection

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.

3-5 December 2014

During a routine inspection

Ashford and St Peter’s Hospitals became a foundation trust on 1 December 2010. As an NHS Foundation Trust there is greater freedom and scope to provide services for patients and the communities and more financial control of investments and expenditure.

The trust provides district general hospital services to a population of around 410,000 people living in the boroughs of Runnymede, Spelthorne, Woking and parts of Elmbridge, Hounslow and Surrey Heath. There are variations in the ethnic diversity between the populations served: in Spelthorne the average proportion of Black and minority ethnic residents is (12.7%) lower than that of England (14.6%), the average proportion of Black and minority ethnic residents in Hounslow (48.6%) is higher than that of England (14.6%).In Runnymede it is 11.0%, lower than that of England (14.6%). Deprivation in all three areas is the same as the England average, rates of children in poverty and statutory homelessness are higher in Hounslow than the rest of England averages but better than the England averages in Runnymede and Spelthorne.

At the time of this inspection there had been some recent changes within the executive team. The chief executive officer (CEO) had been in post since September 2014, having previously been the chief nurse since 2010.The chief nurse had been in post since October 2014, having previously been the deputy chief nurse and associate director of quality. The chair had been in post since 2008.

We carried out this comprehensive inspection as part of our in-depth inspection programme. The trust had been assessed as band 6 and 5 in our ‘intelligent monitoring’ system between March 2014 and July 2014. (The intelligent monitoring looks at a wide range of data, including patient and staff surveys, hospital performance information, and the views of the public and local partner organisations.) Our inspection was carried out in two parts: the announced visit, which took place on 3–5 December 2014; and the unannounced visit, which took place on 14 December 2014.

Ashford Hospital has been rated as good.

Our key findings were as follows:

Safety

  • We found areas that needed to improve safety in medical care and outpatients, diagnostics and imaging and surgery.
  • We had concerns that patient confidentiality could be compromised as medical notes were left in corridors on trolleys, and computers in outpatient waiting areas were left unlocked and unattended.

Effective

  • We found all services inspected to be effective. Outpatients and diagnostic imaging is not currently rated for effectiveness.
  • All staff we spoke to found appraisals useful and we saw data which indicated that a large proportion of appraisals had been completed.
  • We saw good multidisciplinary working between all staffing groups in clinics we observed.
  • Specialist pain nurses were available to support patients who had complex pain management requirements.

Caring

  • All services were found to be caring.
  • All of the patients we spoke with were positive about the care they received at Ashford Hospital. One patient told us, “I am given whatever I need, they are very good”, and, “they are first class here”.
  • One relative told us, “they are very compassionate and respectful, I could not want more”, and, “the staff are delightful, I am extremely impressed, they are a fantastic team”.

Responsive

  • All services were found to be responsive.
  • The hospital was meeting its 18-week referral-to-treatment time targets, the average wait being 5.9 weeks. Targets for urgent referrals and cancer referral-to-treatment times were also being met.
  • The rapid discharge team identified patients who could be discharged home and supported the discharge process to enable patients to go home or to community placements if spaces were available.

Well-led

  • Services for surgery and medical care were found to be well-led, however, outpatients, diagnostics and imaging were found to require improvements in this area.
  • Staff said they were well-supported by their managers and regularly saw the chief executive officer and chief nurse on site. During these times, they had been approachable and listened to concerns.
  • All staff we spoke with told us that Ashford Hospital was a lovely place to work in. They enjoyed their jobs and, although it was very busy, they would not like to work anywhere else.
  • There was a lack of clarify among staff about how to access the risk register in medical services and outpatients diagnostics and imaging.
  • Managers in medical services had been unable to attend the divisional governance meetings and had not received minutes, although there was a view that the divisional governance lead would inform them of anything pertinent to the Ashford site.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

  • Take action to ensure that medications are being used and stored appropriately and are safe for use.
  • Take action to ensure that records are secured appropriately to protect patient confidentiality.

In addition the trust should:

  • Ensure that all relevant staff receive feedback and information from divisional governance meetings to be able to identify and address risks in their area of work.
  • Ensure that outcome data enables identification of site-specific patient outcomes.
  • Improve the storage facilities for equipment on the medical wards to reduce clutter and prevent the risk of patient falls.
  • Ensure that all staff are up to date with mandatory training requirements including for the Mental Capacity Act 2005 and learning disability.
  • Ensure that there is a robust process for the referral and handover when transferring patients from St Peter’s to Ashford Hospital.
  • Ensure, where the acuity (health needs) of patients increase, that there are sufficient staff to meet patients’ needs.
  • Ensure that all staff are aware of the process for alerting the emergency ‘crash team’ in the event of a patient becoming acutely unwell.
  • Ensure that the systems for risk assessments and governance in the outpatient department are appropriate to identify and manage risk.
  • Ensure that pharmacy staff have sufficient time to check medication prescription charts for errors in prescribing.
  • Ensure that all staff are supported to attend training courses.
  • Consider the arrangements for clinical nurse leader overview and support for theatres.
  • Ensure that the reasons for ‘as required’ medications (drugs administered when needed) are clearly described on prescription charts.

Professor Sir Mike RichardsChief Inspector of Hospitals

Professor Sir Mike Richards

Chief Inspector of Hospitals

14 January 2014

During a routine inspection

Paediatric acute and emergency services were provided at St Peter's Hospital. The paediatric outpatient service provided at Ashford Hospital is part of the trust's Women's and Children's clinical division.

We spoke with staff at all levels of the trust as well as members of the Council of Governors to gain their views about the delivery and safety of the services we reviewed. We looked at systems, and reviewed documentation. We spoke with two senior nursing staff on site but as there were no clinics we were unable to speak with patients or parents at the time of our visit. As part of the overall inspection we spoke with the Clinical Lead for Women's and Children's service as well as the leads for safeguarding children and the Chief Nurse. The paediatric outpatient staff worked to the trust wide and clinical division protocols and guidance.

From the feedback we received and records viewed we were satisfied that the trust was providing a safe, effective, responsive, caring and well led paediatric outpatient service.

10 October 2012

During a routine inspection

During our inspection we visited the operating theatre, three wards and spoke to seventeen patients in detail. We looked at seventeen individual care plans for patients, talked to staff and met some relatives.

People that we spoke with told us they were happy with the care they received and that generally staff had time to spend with them and the atmosphere was relaxed. We were told 'the nurses are very kind' and another person told us 'they do a good job here, the wards are light and airy with plenty of space.'

Two people on one of the wards made us aware of concerns they had and when we discussed these with the management, they acted swiftly to address the issues raised.

The staff that we spoke with were knowledgeable about the patients needs and with the procedures on the wards and in theatre to ensure people were cared for safely.

21 March 2012

During a themed inspection looking at Termination of Pregnancy Services

We did not speak to people who used this service as part of this review. We looked at a random sample of medical records. This was to check that current practice ensured that no treatment for the termination of pregnancy was commenced unless two certificated opinions from doctors had been obtained.