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Inspection Summary


Overall summary & rating

Good

Updated 31 March 2016

We carried out a comprehensive inspection of Crawley Hospital in May 2014. At that time we rated the outpatients department as requiring improvement because we found many clinic appointments were cancelled at short notice. Clinics were busy and were often running late and where medical records for clinics were often not complete, therefore clinics often saw patients with temporary notes.

We judged the service was not fully compliant with Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 210, then in force. Consequently we issued a requirement notice, a form of enforcement action which demands providers make necessary improvements to meet the required standards.

The purpose of this inspection was to check improvements had been made, ensuring the terms of the requirement notice had been met. Therefore we did not rate this service.

Our key findings were as follows:

  • The trust had met the conditions of the requirement notice.

  • The trust had introduced systems to regularly assess and monitor the quality of outpatient services.

  • The trust had suitable arrangements for assessing and managing risks relating to the health, welfare and patients and others.

  • This had been achieved through the establishment of a new management and governance structure and a strengthening of nursing leadership.

  • Arrangements for the management of medical records had improved and more than 99% of full medical records were available at clinic appointments.

  • Punctuality of clinics was much improved and 87% of patients were seen within 30 minutes of their appointment.

  • Although there was an increase in the number of short notice clinics to meet increases in demands, there was now more stringent controls in place and better management of these.

  • There were improved management controls to minimize the number of cancelled clinics.

  • Thirteen additional consultants had been appointed, to assist in the provision of additional capacity to meet increasing demands.

However, there were areas of practice where the trust still needs to make improvements. The trust should:

  • Ensure all staff are trained and able to use the electronic incident reporting system.

  • Develop systems to ensure the consistent checking of emergency equipment in the outpatients department.

  • Ensure there are arrangements to ensure confidential patient notes are not left unattended in the outpatients department.

  • Ensure all staff have received training regarding the Mental Capacity Act, and are clear about the practical application of this legislation in their work.

  • Consider how the monitoring of actual versus scheduled appointment times could be used to inform further development and improvement.

  • Review signage in the department to improve patient flow through the department.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection areas

Safe

Good

Updated 31 March 2016

Effective

Good

Updated 31 March 2016

Caring

Good

Updated 31 March 2016

Responsive

Good

Updated 31 March 2016

Well-led

Good

Updated 31 March 2016

Checks on specific services

Outpatients and diagnostic imaging

Insufficient evidence to rate

Updated 31 March 2016

Since our last inspection there had been a significant change in the outpatient management structure to provide more robust governance. An outpatient board had been established and reported to the executive committee. This board was supported by an outpatient delivery group.

Nursing leadership had been strengthened in the department since our last visit with a new structure and an emphasis on stronger leadership with the introduction of more senior roles and a matron.

The trust had made significant changes and improvements to the management of medical records. We saw improvements in the level of reporting incidents and there were mechanisms in place to provide feedback following an incident. However, some staff were still unsure how to report incidents and had not accessed the training in the electronic system.

Although there was increased attendance in training in the Mental Capacity Act, some staff were unable to tell us how they would effectively apply the act in practice to situations that may arise in the department.

Surgery

Good

Updated 8 June 2014

Patients who used the service experienced safe, effective and appropriate care and treatment and support that met their individual needs and protected their rights. The care delivered was planned and delivered in a way that promoted safety and ensured that people’s individual care needs were met. We saw patients had their individual risks identified, monitored and managed and that the quality of service provided was regularly monitored. We found the clinical environments we visited and other communal areas in the hospital meticulously cleaned. Hospital-acquired infections were monitored and rates of infection were of a statistically acceptable range for the size of the trust.

Outcomes for patients were good and the department followed national guidelines. Complaints were investigated and handled in line with standard policy. We saw the trust use patient’s complaints and comments used as a service improvement tool and the trust actively encourage feedback from its patients and their relatives or loved ones.