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East Surrey Hospital Outstanding

Reports


Inspection carried out on 16th to 17th October, Well Led 13th to 14th November 2018

During a routine inspection

Our rating of services improved. We rated it them as outstanding because:

  • There was a genuinely open culture in which all safety concerns raised by staff and people who use the service was highly valued as integral to learning and improvement.
  • All staff were open and transparent, and fully committed to reporting incidents and near misses. The level and quality of incident reporting showed the levels of harm and near misses, which ensured a robust picture of quality. There was ongoing, consistent progress towards safety goals reflected in a zero-harm culture.
  • The service had enough staff with the right qualifications, skills, training and experience to keep people safe. Staff understood how to protect patients from abuse. Staff had training on how to recognise and report abuse and they knew how to apply it.
  • There was an exceptional culture of data-driven continuous improvement and transformation at the trust, and this was supported by a comprehensive meeting structure and detailed performance reporting processes. All staff were actively engaged in activities to monitor and improve quality and outcomes.
  • We saw unmistakable evidence of sustained improvement achieved through investment in new facilities and increased capacity that resulted in enhanced effectiveness and responsiveness. This was due to a firmly-embedded and positive culture of openness and transparency, supported by a skilled, stable leadership and clear systems of control and governance.
  • There was a strong, visible person-centered culture. Staff were highly motivated and inspired to offer care that was kind and promoted people’s dignity. Relationships between people who use the service, those close to them and staff, was strong, caring and supportive.
  • Staff at all levels clearly and passionately described how they met patients’ needs and demonstrated a good awareness of protected characteristics including race, sexuality, and disability. We saw a variety of resources made available to staff to help them support these population groups. We saw flexibility, choice and continuity of care reflected in the service delivered. Staff were well supported by the mental health liaison team and the frailty and interface team.
  • People’s emotional and social needs was highly valued by staff and was embedded in their care and treatment.
  • The trust overall score for the National NHS Staff Survey was in the top 20% for the three years preceding the inspection.  In some scores they ranked in the top 4 organisations nationally.
  • Patients could access the service when they needed it, seven days a week. Services ran on time. Patients were kept informed of any disruption to their care or treatment.
  • Trust performance for cancer waiting times was better than the operational standard and the national average in the most recent two quarters.
  • There was an active review of complaints, how they were managed and responded to, and improvements were made as a result across the services.
  • We saw comprehensive leadership strategies in place, such as the SASH+ programme, which helped promote and sustain the desired organisational culture. We found a skilled, stable and highly visible senior management team that possessed a deep understanding of issues, challenges and priorities affecting their service.
  • The strategy and supporting objectives are stretching, challenging and innovative while remaining achievable. A systematic approach is taken to working with other organisations to improve care outcomes, tackle health inequalities and obtain best value for money.
  • The trust engaged well with patients, staff, the public and local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively.

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 the East Surrey 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 a 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

East Surrey Hospital is the only hospital that forms Surrey and Sussex Healthcare NHS Trust. This hospital was an acute hospital and provided accident and emergency (A&E), medical care, surgery, critical care, maternity, children and young people’s service, end of life care and outpatients services, which are the eight core services always inspected by the Care Quality Commission( CQC) as part of its new approach to hospital inspection.

East Surrey Hospital had 650 beds and provided a wide range of inpatients medical, surgical and specialist services as well as 24-hour A&E, maternity and outpatients services.

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 outpatients 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. The A&E friends and family test was above the England average.
  • We found patients were supported to eat and drink, but we found a small number of patients on one ward who had dry mouths and did not have the appropriate documentation completed to indicate they had received mouth care.
  • Nurse staffing levels on the wards were generally satisfactory and staff, although busy, could meet the needs of their patients. There was some reliance on bank/agency or locum staff but this was very well managed and did not have any adverse effects on the delivery of care. The trust was actively recruiting more doctors but faced the same challenges that many trusts in England faced.
  • The maternity service was very busy but was providing good care to women with excellent facilities.
  • The trust consistently met the four-hour waiting time target in the A&E department. The flow of patients within the department was good and we did not witness any patient who had waited in excess of four hours before a decision was made to admit them.
  • We found patients who were placed in beds on wards that were not their specialism were given safe care. There were good processes in place to track these patients and ensure they received the appropriate care and treatment.
  • Critical care services provided safe and effective care. The caring and emotional support, as well as the leadership on the unit, was exceptionally good.
  • Children received safe and effective care but the environment limited the ability to provide care to adolescents that was individualised to their specific needs. Staffing levels for children were safe and there was good leadership in place.
  • Patients received good quality end of life care. Staff were supported by a specialist palliative care team. Patient care was well managed and we found some excellent examples of care being delivered.
  • 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 visited one surgical ward where a patient who had a dementia diagnosis was being cared for. The circumstances around the admission meant that the patient’s spouse was also admitted to hospital at the same time. This caused anxiety for both patients, especially for the patient with dementia. This ward identified a two bedded side room and ensured that both patients were kept together to alleviate the anxiety and distress of the rest of their admission.
  • We saw staff wearing “ask me anything” badges. These badges encouraged patients and their loved ones to engage with staff to improve communication.
  • Staff (including the chaplain, catering and ward staff) had arranged for a patient near the end of life to have a “wedding” with a small party afterwards. The catering staff provided a wedding cake for the celebration. Although there wasn’t time for this to be an official marriage ceremony it was an example of staff working together to meet the individual needs of their patients.
  • The facilities provided for women in the midwife-led birthing unit were outstanding.
  • The care on the neonatal intensive care unit was outstanding. The staff team were committed to ensuring best practice and optimal care for the babies admitted to the unit.
  • We visited Woodland ward within the surgical directorate, where we judged the leadership to be outstanding. We saw a very effective multidisciplinary approach to care delivery and consistent commitment to ensuring patients’ individual needs were met.
  • The trust has recognised that their location, close to a major international airport, increased the likelihood of girls presenting in the A&E department with complications of female genital mutilation. The safeguarding implications of this had been incorporated into the training programme.

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 outpatients 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 outpatients 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.

In addition the trust should:

  • Review the training provided to clinical staff on the Mental Capacity Act to ensure all staff understand the relevance of this in relation to their work.
  • Ensure that a review of mouth care is undertaken so that staff are clear where this should be recorded in the patient’s care record.
  • Review the action taken to engage with medical secretaries, ward clerks and medical records staff to ensure these groups feel more included in decisions relating to their role.
  • Review the working environment for the medical records staff.
  • Continue to focus on improving the trust’s performance on complaints handling.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection carried out on 26, 27 February 2013

During a routine inspection

As part of our inspection we looked at care in Accident and Emergency (A&E), Neonatal Intensive Care (NICU), the children's ward and three wards dedicated to care of the elderly who required medical and/or surgical treatment. We observed staff speaking with patients in a polite and respectful manner.

Most of the people that we spoke with told us that they were happy with the care they received and could not criticise the staff or environment in which they were cared for, in any way. People told us that they had felt involved in the decisions relating to their care and treatment. One person said "staff are all very pleasant". Another said "I was dreading coming into hospital (...) but just look, it's excellent in here".

Patients were able to express their views and were involved in making decisions about their care and treatment. People felt nursing and medical staff were "smashing", "excellent" and "hard working" and explained treatments to them. Care and treatment was planned and delivered in a way that ensured patient's safety and welfare during short stays, however we considered that those people who experienced prolonged stays in hospital did not always have a comprehensive plan of care.

There were effective systems in place to seek appropriate consent from people before care or treatment was carried out.

There were effective systems in place to safeguard people from the risk of harm.