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Inspection carried out on 21 January 2016

During an inspection to make sure that the improvements required had been made

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 carried out on 20-22 May 2014

During a routine inspection

Surrey and Sussex Healthcare NHS Trust provide outpatient and day surgery services at Crawley Hospital. This hospital is owned and managed by NHS Property Services. The trust provides day case surgery and outpatient services at this location, which are two of the eight core services that are always inspected by the Care Quality Commission( CQC) as part of its new approach to hospital inspection.

We carried out this comprehensive inspection to Surrey and Sussex Healthcare NHS Trust as an example of a low-risk trust as determined by CQC’s intelligent monitoring system. The inspection took place between 20 and 22 May 2014 and an unannounced inspection visit took place between 6pm and 10.30pm on 6 June 2014.

Overall, this hospital is good but the outpatient service required improvement.

Our key findings were as follows:

  • Staff were caring and compassionate and treated patients with dignity and respect.
  • The hospital was clean and well maintained. The trust’s infection rates for Clostridium difficile and MRSA were within an acceptable range, taking account of the size of the trust and the national level of infections.
  • Patients whose condition might deteriorate were identified and escalated appropriately and the mortality rates for the hospital were within the expected range.
  • The vast majority of patients reported a positive experience to us during our visits. The NHS Friends and Family Test showed the trust performed above the England average between November to February 2014.
  • Outpatient services required improvement. Patients were treated with compassion, but many appointments were cancelled at short notice; and because clinics were so busy, patients often had to wait a long time to be seen. Medical records were often incomplete because notes could not be obtained in time for clinic appointments.
  • Mortality rates were within expected ranges and there were no indicators flagged as being a risk or an elevated risk.
  • Medical records, medical secretaries and ward clerks felt they had not been listened to as much as they could have been and expressed concern about some of the changes that were taking place.
  • Without exception, clinical staff were proud to work for the trust and spoke very positively about the effective leadership within the trust. Staff recognised the significant progress the trust had made, particularly in the past two years. The commitment to the trust was exceptionally good.
  • The work the trust had done on major incident preparedness was good.
  • The trust was focusing on the performance of complaint handling and extra resources had been put into place within some of the divisions. We saw performance was improving and both clinical staff and the executive team were committed to this.

We saw several areas of outstanding practice including:

  • There was very poor mobile signal at the Crawley Hospital site. Relatives were given a bleep that meant they could be contacted if they left the clinical areas. This meant that people were not restricted to stay in one place for long periods and could be effectively contacted by staff.
  • The pre-assessment clinic at Crawley Hospital had been extended into the evening in a response to feedback and local demand.
  • We saw staff wearing “ask me anything” badges. These badges encouraged patients and their loved ones to engage with staff to improve communication.

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

Importantly, the trust must:

  • Carry out a review of the outpatient service to ensure there is adequate capacity to meet the demands of the service.
  • Implement a system to monitor and improve the quality of the outpatient service that includes the number of cancelled appointments, waiting times for appointments and the number of patients that do not have their medical records available for their appointment.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection carried out on 24 August 2012

During a routine inspection

People we spoke with were very pleased with the quality of care they received at Crawley Hospital. People said that their treatments and procedures had been explained to them and they felt reassured. They said that the written information they were provided with was of a good standard. They felt that their privacy and dignity was promoted and their independence and individuality respected at the hospital. Their consent to treatment was sought by appropriate staff and they were involved in making decisions about their care and treatment. One person told us that, “staff are really excellent here, they always explain what they are going to do. If I have a question I always get a sound reply. I feel that I am listened to.” Another person told us that they were lucky to have such a local facility because the care provided there was, “excellent in all respects.” When asked about the premises people said that the hospital appeared clean and hygienic if somewhat aged and tired in places. A patient attending Comet Ward told us. “.....the environment is really quite poor, but staff give superb care; the service is second to none.”