Crawley Hospital

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

The service had a good learning culture and people could raise concerns. Managers investigated incidents thoroughly using comprehensive systems to enable reviews. Staff understood and managed risks. The facilities and equipment met the needs of people, were clean and well-maintained. There were appropriate levels of staff with the suitable skill mix to maintain patient safety. There was appropriate infection prevention and control measures and understanding. Local leaders were visible, known and supportive to their staff. However, there was variation in the community prescription records and prescription pad tracking systems, this meant there was potential for prescriptions to be lost due to the lack of oversight. We raised our concerns with staff who reviewed the process and following the inspection the trust provided us with details of the revised records and how they had been implemented.

When the service was last inspected and rated, the rating for this key question was requires improvement. At this assessment, the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We spoke with patients who told us they felt well informed about their care and treatment and were involved in the decision making about their treatment. People felt staff took time to understand their needs and their concerns were listened to. There were family and friend’s tests at the front of reception which people could see when they checked in for their appointment.

Staff were confident to escalate concerns and felt they would be taken seriously. Staff were able to provide examples of times they had raised issues to senior staff, which managers had acted on to resolve. Managers shared outcomes from incidents with the people who raised them. Following incidents managers also shared learning across the department to ensure wider learning was achieved. Feedback and outcomes were shared via safety huddles, emails, audits and through channels on the online system such as newsletters and team chat groups.

The service had processes in place to raise and review concerns from complainants effectively and to ensure safety and learning. Staff knew there was a clear complaints pathway to follow and understood the escalation process. The service’s incident and duty of candour policy supported the principles of providing an open and honest approach to issues and being proactive in the management of complaints.

Crawley outpatients had 3 recorded complaints for the previous year, with the most common theme being staff attitude.

The trust had moved from reporting incidents on one electronic system to another. The current system being used was aligned to the patient safety incident reporting framework (PSIRF). There were 5 low rated incidents in the outpatient’s department in the past year.

People had mixed opinions about waiting times. Some people told us their letters were clear and they knew where to go for their appointments, however, staff recalled one person who reported their letter was not clear enough which resulted in them going to the wrong site. People felt supported and able to communicate with the team through telephone calls and the patient portal app, however, the majority felt the time from referral to the appointment was quite long and some people felt the app was not easy to use.

Staff reported a collaborative approach to ensure there was continuity of care for the patient’s journey. The electronic system granted easy access to relevant information regarding appointments such as the patient initiated follow up service, and the follow up service. After their appointment, patients were contacted to arrange a follow up appointment. The service liaised with GPs to ensure care and support was planned and organised. Faster diagnostic service waiting times were improving and on trajectory to meet standard.

Partners had no specific feedback on this area.

The service had policies in place for dealing with a deteriorating patient. As the location did not have an emergency department, staff were aware they would need to contact the emergency services. Staff knew there was an Urgent Treatment Centre on site, which although not run by the provider, may be suitable depending on the patient’s needs. Staff were aware of when to make these escalations to ensure prompt intervention for the patient. There were emergency grab bags available, which had daily tag checks and monthly checklists completed to ensure equipment was in date and available.

People reported clear communication from staff. They told us staff did not rush them, and that staff took time to explain things to them. One person shared that their consultant advocated for them.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve this. Staff understood the need to protect people from abuse and discrimination. We spoke with a manager who demonstrated knowledge of informed consent. We also heard how staff were able to set up interpreters in advance of an appointment to ensure consent was fully understood with no barriers in place. The manager told us booking an in-person interpreter was always preferable to relying on telephone interpretation to ensure patients received accurate information.

Staff had received safeguarding, Mental Capacity Act and consent training, they demonstrated a good understanding and discussed how they supported patients including best interest meetings. Staff understood their responsibilities to identify and report safeguarding concerns.

There were policies and processes in place to support people to raise concerns, examples of this were seen through safeguarding information in the eye treatment room and through the well displayed notice board which contained information on how to report concerns to the relevant agencies. Staff could also utilise the online system to raise a safeguarding concern, for which there was guidance readily available.

The service provided training in key skills such as safeguarding, on average over 93% of staff were complaint with adult and children safeguarding training. Over 93% of staff were compliant with their Mental Capacity Act training. Overall staff mandatory training rates were over 90% which was in line with the trust’s targets.

We spoke with patients who told us they were involved with the decision making about their treatment. Patients said the clinicians had been “very helpful and explained things well”. One person reported their relative had difficulties speaking over the phone, so they appreciated the paper letter that they received. Others reported they liked to use the online app.

The service worked with people to understand and manage risks by thinking holistically. Staff provided safe and supportive care to meet people’s needs. There were dedicated quiet rooms to accommodate private and sometimes challenging conversations, these rooms provided privacy for people to communicate their needs and emotions in a safe space.

Managers had met with a divisional chief nurse three times a week to ensure team leads were kept informed of relevant risks. There were no examples of restrictive practice being used, however, staff were aware of what to do if restraint was deemed necessary. An example of this was provided about an aggressive patient, where they escalated concerns to the emergency services and to service management who provided security. If it was known that a disruptive or challenging patient was attending the clinic the staff were able to inform security.

Staff were aware to call 999 to escalate concerns which could not be managed in the department.

There were monthly checks in place for resuscitation equipment. There was a risk register which at the time of assessment contained no risks for the department.

People felt one of the areas was very outdated with facilities not as good as another trust site.

Staff and leaders were aware one of the departments required redecoration to bring it in line with the other outpatient department which had undergone recent refurbishment. In addition to this, 1 consulting room was not wide enough to accommodate a wheelchair user. Staff told us they were aware of this and knew not to use this room for people who may require a wheelchair. This may however cause delays if multiple patients attended appointments who required accessible space. Equipment was maintained and checked regularly. There were two quiet rooms that were organised and patient friendly, these rooms were private and contained comfortable seating. Staff knew they could utilise the quiet rooms for breaking bad news, quiet conversations where they could listen and provide a hot drink, but also for those with sensory needs as they could adjust the lighting to reduce stimulation.

We saw 2 main outpatient areas, one which had been newly redecorated. The other was outdated, with staff needing to find workarounds for certain rooms to ensure they were suitable for patients.

There was a display board which was updated with the names of staff working in the department. However, the estimated wait time on the board was not updated, although appointments were running mostly on time when we visited.

There were effective processes in place to monitor and review the locations with plans in place for the maintenance that was required. There was a preventative maintenance audit which allowed management to have oversight of planned maintenance to ensure all devices were working correctly.

Regular environmental audits were undertaken by matrons, these acknowledged dust, stained sinks and the need for one of the areas to be refurbished. These concerns were reported to the relevant teams, such as the facilities team to ensure the actions were taken to address the matters.

People told us the staff were very good; they did not feel rushed by staff and their appointments generally ran on time. One person told us they received a call to say their appointment venue had changed, the appointment was immediately updated on a phone application and also by letter, this ensured changes were received and understood by the person prior to the appointment.

There was a safe recruitment process, with suitable staffing mix levels which included development and supervision. To support staff development, new staff started off in clinics that were less demanding to gain clinical knowledge and to complete their induction competencies in a less pressured environment. Supernumerary and performance reviews were undertaken to determine development. When staff were deemed to have a high level of experience, they were allocated to more specialist clinics such as urology where interventional treatments were performed. We were told there were more appointments being made than previously. This meant established staff levels did not meet demand, which meant there was a high use of NHS bank staff. We heard an example of local leaders advocating for staff when more clinics had recently been requested. Leaders identified that this could have resulted in unsafe staffing levels, therefore, to ensure safe care was provided they rejected the request on this basis. The trust listened and did not enforce further clinics. These actions meant staff felt valued and supported in their roles. There had been recent improvements with more senior presence at the site, however, due to the isolation of the location, staff felt they would benefit from higher visibility and further engagement from senior trust management.

The service had enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care. The atmosphere during our onsite visit was calm and clinics appeared to run smoothly.

The staff knew when they were assigned to work and were trained appropriately to ensure safe staff levels. There were processes in place to ensure staff had regular appraisals with training and skills documented and updated. There were staffing escalation procedures in place which would highlight staffing level concerns, these would result in actions being taken to ensure safe staffing.

People told us they thought the department was clean and they were satisfied with the facilities.

Leaders identified one of the top priorities for the service was the refurbishment for one of the areas.

Staff previously experienced issues with cleanliness in a particular area, this concern was raised and resulted in the area being cleaned more regularly. One staff member told us cleaning was ‘not always as good as it could be’ as they felt the staff room bins were not always emptied promptly. However, clinics were cleaned every evening after the final clinic finished.

The clinical areas were visibly clean and had suitable equipment available. The department provided staff with personal protective equipment (PPE) such as gloves and aprons. PPE stations were well stocked with in-date equipment. There were hand hygiene instruction prompts by sinks to encourage correct hand hygiene protocol was followed. There were wall sanitisers around the department which were working and in convenient areas for the public and staff to use. Staff were ‘bare below the elbow’ and were seen using hand sanitisers regularly. ‘I am clean’ stickers were applied to the appropriate cleaned equipment to demonstrate up to date cleaning was in place.

In one older consulting room, the sink was stained and the taps were coated in limescale. This was a known issue and replacement formed part of a planned refurbishment. We also saw an expired blue medical curtain in place, we informed the team and they reported this would be changed.

There was an appropriate area for the decontamination of scopes to be carried out. We observed the decontamination area and the accompanying completed documents onsite.

There were daily cleaning logs for the two main outpatient areas. We reviewed room cleaning logs for April – July 2024. Not all clinic rooms were used daily, which created gaps in the data as it was not identified which rooms were and were not in use and consequently cleaned. This increased the risk of rooms not being cleaned before clinical use. The facilities management services were provided by the NHS trust who managed the site. Staff could report to their seniors to contact facilities to increase cleaning schedules.

Staff undertook online training, hosted by the product manufacturer for the decontamination of some medical equipment. We were told the cleaning product manufacturer undertook regular audits, the service did not provide these.

One person told us that they were impressed they were able to access changes to their prescription over a weekend. Another person said the staff were ‘very thorough’ and that they ‘went over drugs needed and all the follow up is clear and in place’.

Staff explained how they ordered medicines and prescription pads from the hospital pharmacy. They also told us that following a review the resuscitation trolleys had been replaced with emergency ‘grab bags’, this meant it would be easier to respond to a medical emergency without delay. When patients attended the eye clinic they described how staff would administer dilating eye drops on arrival, this was in line with the person specific directions which allow specified health professionals to administer medicine without a prescription or instruction from a prescriber. In Haematology and Respiratory outpatients, staff explained that for hospital only medicines and a few other situations the prescriptions were sent to the Outpatient Pharmacy for dispensing. Then the dispensed medicines were sent to Crawley Hospital for the patient to collect.

Medicines were stored securely and emergency medicines could be accessed in an emergency.

Processes for monitoring medicines fridge temperature included automated remote monitoring and local record keeping. However, where vaccines were stored only the current fridge temperature was recorded, whilst vaccine guidance recommends the minimum, maximum and current temperatures are recorded and monitored. Therefore, we were not assured that all medicines requiring refrigeration were stored within their recommended temperature range. Processes were in place for prescribers to write prescriptions to be dispensed by local community pharmacies, hospital only medicines were sent from another trust site. Once dispensed hospital only medicines were transferred to Crawley hospital for the patient to collect. However, there was variation in the community prescription record systems across outpatients, which could hinder the tracking of prescriptions. There was a lack of a robust tracking system for the FP10 community prescription pads, we saw pads where it was not possible to track where they had originated from. There was a potential for prescriptions to be removed or lost due to the lack of oversight. When we raised this with senior staff, they started the process to review the record system. Following the inspection the trust provided us with details of the revised records and how they had been implemented.