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Archived: Barnet Hospital

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Inspection carried out on 27, 28, 30 January 2014

During a routine inspection

We carried out inspections of the hospital over a three day period and were accompanied by three specialist advisors, a pharmacist inspector and a team of ten inspectors. We visited the accident and emergency department (A&E), the Acute Assessment Unit, four in-patient wards (Beech, Larch, Walnut and Olive) and the operating theatre suite. We inspected an additional four wards, Clinical Decisions Unit (CDU), Galaxy, Rowan, and Palm, and outpatients in respect of the arrangements in place for medicines management. We spoke separately with the Head of Patient Engagement and staff from the Patient Advice and Liaison Service (PALS) about complaints management in the trust.

At our last inspection of the hospital in May 2013 we had found that the very long delays experienced by a significant number of patients in A&E meant that the planning and delivery of care and treatment did not always meet their needs and ensure their welfare and safety. During the current inspection on 27 January 2014 we found that significant improvement had been made. Although a few patients had spent long periods in the department action was being taken to mitigate the risks to their health and well-being and ensure their stay was as comfortable as possible.

During the inspection we spoke with more than 60 patients and relatives about their experiences of care and treatment in the hospital. The majority of patients and relatives were pleased with the standards of care provided. For example, a patient on Beech ward told us that from the moment they had come arrived at A&E they had been “entirely satisfied and impressed” by the care and treatment they had received. Staff on the wards were said to have “gone out of their way to be helpful and considerate.” Physiotherapists were described as “very good, they know how to speak to people” and “really excellent.” A patient who had just undergone a surgical procedure told us, “I left very reassured as they (staff) made sure I knew what was happening and who was who.” Parents of children we spoke with in paediatric A&E were very positive about their experience describing staff as “fabulous” and having the “patience of saints.”

Patients had mixed views about the quality of meals provided on the in-patient wards but the majority were positive. For example, one patient told us “the food is really very good; there is a good menu choice.” Another patient said, “the menu is fantastic, I’m amazed at the amount of choice, including healthy options.” A few patients considered the meals were “just OK” or not to their liking.

The trust was well-led and responsive to people’s needs. Systems were in place to assess and monitor the quality of service that patients received and ensure care was provided safely and effectively. Systems in place for managing complaints about care and treatment were improving. Action plans were in place to address a backlog of complaints and the quality of responses to complaints had improved. Medicines were managed appropriately. They were stored securely and patients received the medicines they needed at the right time.

However, we identified some shortfalls in record keeping in different areas of the hospital. Some of these related to incomplete records of checks of key equipment used in the care and treatment of patients. In addition, some patient records were not accurately maintained in respect of checks carried out during and after surgery to ensure surgical procedures were conducted safely.

Inspection carried out on 3, 4 December 2013

During a routine inspection

We carried out an inspection of the maternity unit at the hospital involving three compliance inspectors and a midwife specialist advisor. We spoke with nine women and their partners in the ante-natal and post-natal ward about their experiences of the maternity service. We spoke with ten midwives, the consultant midwife, senior managers and two consultant obstetricians. In addition, we reviewed records maintained by the service, including documents related to the management of the service.

The service had been significantly reconfigured and expanded in size the week before our inspection, following the closure of in-patient maternity services at another local hospital. We noted that the Trust had prepared effectively for the reorganisation of the service and arrival of numbers of new members of staff so as to ensure that the quality of service provided to women and babies was maintained and the service was safe.

The women and partners we spoke with were positive about the care and treatment they had received. They told us they had been treated with respect by staff. All the women had received one to one care from a midwife once they were in established labour and many praised individual midwives. For example, one woman said, “all the midwives were great, I was given lots of time and didn’t feel rushed” and another woman told us the midwife had been “compassionate throughout.” Women and partners were pleased with the quality of information they had received before, during and after the birth of their baby.

We found all areas of the maternity unit to be clean and well-maintained and infection prevention and control policies and procedures were implemented by staff. Midwives received appropriate training and support to enable them to provide the care and treatment that women needed. Multi-disciplinary training sessions enabled staff to work together effectively for the benefit of women and their babies. Systems were in place to assess and monitor the quality of service that women received and ensure care and treatment was provided safely and effectively.

Inspection carried out on 7 May 2013

During a routine inspection

This inspection focussed on the care and treatment provided in the accident and emergency (A&E) department. We spoke with patients attending A&E on the day of our inspection. They spoke positively about the care and treatment they had received. For example, one patient said, “I have received wonderful care.” Others were happy with the way they had been treated but commented on the length of time they had had to wait. For example, one patient said, “the staff are very pleasant and helpful but seeing an actual doctor has taken a long time.” Patients were given clear information about their care and treatment. A patient told us “staff explained everything about my condition such as what to expect and why.”

Staff worked in cooperation with other health professionals and shared information with them appropriately. There were sufficient staff available in A&E to care for and treat patients. The Trust assessed and monitored the service to make sure that risks to patients were minimised and an appropriate standard of care and treatment provided. However, significant delays were experienced by a number of patients and several spent more than 16 hours in A&E before being admitted to a ward. This meant that care and treatment was not always delivered in a way that met patients' needs or ensured their welfare and safety.

Inspection carried out on 26 September 2012

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

We carried out this unannounced inspection to check if the provider had complied with the compliance action issued at the last inspection of the service in April 2012. On that occasion we had found that medicines were not always being stored safely.

We did not speak with any patients during this inspection as our focus was on the way that medicines were being stored.

We visited six wards in the hospital and reviewed the arrangements for storing medicines on each ward. We found that medicines were being stored safely.

Inspection carried out on 20 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.

Inspection carried out on 25 April 2012

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

We visited two wards in the hospital, Larch and Juniper Wards. We spoke to two patients on Larch Ward about their experiences during their stay in Barnet Hospital. Both patients told us that staff asked them for their permission before providing care or treatment. They said they felt safe on the ward and confident in the staff caring for them. One patient described staff as ‘very busy, always rushing around’ but went on to say that they came ‘pretty quickly’ in response to the call bell. The other patient had a different experience and told us that staff somtimes took a long time to respond at night. For example, on one occasion they had to wait for 30 minutes for staff to answer the call bell.

We saw that healthcare records were accurate and fit for purpose. However, arrangements for the safe keeping of medicines and intravenous fluids were not always being followed by staff. As a result people were not adequately protected against the risks associated with the unsafe storage of medicines.

Inspection carried out on 2 August 2011

During a routine inspection

We spoke to women and their partners on Victoria Ward, the antenatal and postnatal ward on the maternity unit. They all spoke very highly of the midwives on the unit and the care and support they had been given during the delivery of their baby. Women had been treated with dignity and respect and had been given sufficient information to help them care for their baby and give informed consent. However, all the women we spoke to had concerns about the levels of staffing on Victoria Ward and several said that cleaning had not taken place at the weekend and the bins had not been emptied.

Inspection carried out on 25 February 2011

During a routine inspection

The majority of patients and relatives we spoke to were happy with the care and treatment provided. For example, one relative said, ‘I can’t speak highly enough of the care my father has received on this ward’. Parents of a baby admitted to the children’s ward told us ‘everyone had been very kind and very courteous. It has been a very traumatic time but we are confident in the nurses’. Patients told us they had been treated with dignity and had their privacy respected. People said they obtained pain relief when they needed it. Patients’ opinions on the quality of food varied greatly. For example, one patient told us, ‘it’s poor quality, I hate the food. It’s the same menu every day and I force myself to eat it’. However, another patient told us the food was ‘very good’ and a relative said, ‘my father is very happy with the food’. Patients told us they were given a choice of meal, received enough to eat and were provided with a range of snacks and drinks between meals. Everyone we spoke to thought the hospital wards and environment were clean. A patient on one ward told us, ‘it’s beautifully clean; you can run your fingers along the top of the curtain rail’. Several patients told us they had been kept informed of delays in out-patient clinics. The clinics were considered well organised, calm and clean.