You are here

St Helier Hospital and Queen Mary's Hospital for Children Good

We are carrying out a review of quality at St Helier Hospital and Queen Mary's Hospital for Children. We will publish a report when our review is complete. Find out more about our inspection reports.

Inspection Summary


Overall summary & rating

Good

Updated 19 September 2019

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

  • The hospital mostly had enough staff to care for patients. The hospital controlled infection risks well. Most staff assessed risks to patients, acted on them and kept good care records.
  • Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Staff worked well together for the benefit of patients, and key services were available seven days a week.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. Staff provided emotional support to patients, families and carers.
  • Most staff planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback.
  • Most leaders ran services well and supported staff to develop their skills. Staff felt respected, supported and valued. Staff were clear about their roles and accountabilities.

However:

  • There was not a suitable and safe environment for children and young people presenting with mental ill health to be assessed in the paediatric emergency department.
  • There were not effective systems for identifying risks, planning to eliminate or reduce them, in the paediatric emergency department.
  • There was not adequate staffing across all surgical units at St Helier Hospital to provide safe delivery of care to patients.
  • There were not proper governance arrangements for the management of medicines.

Inspection areas

Safe

Requires improvement

Updated 19 September 2019

Effective

Good

Updated 19 September 2019

Caring

Good

Updated 19 September 2019

Responsive

Good

Updated 19 September 2019

Well-led

Good

Updated 19 September 2019

Checks on specific services

Medical care (including older people’s care)

Updated 14 May 2018

  • The hospital had reviewed systems and processes to improve patient flow through the medical department.
  • The hospital had improved the discharge process with the introduction of a new ward for patients who were medically fit and waiting to be discharged.
  • The hospital had reviewed staffing levels in the department and had highlighted where extra staff are required and had made significant improvement in nurse recruitment from abroad.
  • The hospital had a system in place to respond to deteriorating patients and had a clear sepsis assessment tool and pathway.
  • Medical wards used a combination of best practice and national guidance to deliver care and treatment to patients, and staff were competent to provide this care.
  • Staff understanding of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards was good. We saw examples of Deprivation of Liberty Safeguards in place for patients, and staff were aware of the importance of mental capacity assessments.

However:

  • Mandatory training figures were not in line with trust targets. Most staff had not completed the required mandatory training.
  • Controlled drugs were not always stored appropriately. The controlled drugs register did not always match the contents of the cupboard in ward B5.
  • Readmission rates were above the England average in clinical haematology services, general medicine, and geriatric medicine.

Services for children & young people

Good

Updated 14 May 2018

Our rating of this service improved. We rated it as good because:

  • There was a good overall safety performance in the service and a culture of learning to ensure safety improvements. Staff were encouraged to report incidents and received timely feedback. There was evidence of learning from incidents, which was shared in a number of ways.
  • There were processes in place to ensure safe staffing levels. The service had 24 hour consultant cover.
  • There were effective processes in place to assess and escalate deteriorating patients.
  • There was good compliance with infection prevention and control processes. Equipment was checked regularly and medicines were stored appropriately.
  • Staff had a good understanding of safeguarding and were aware of their responsibilities in relation to safeguarding children. The service had good multi-agency partnerships to share relevant safeguarding information.
  • Patient records were completed to a good standard.
  • Staff provided care and treatment in line with national guidance and good practice. The service monitored the effectiveness of care and treatment through continuous local and national audits.
  • There were effective processes in place to ensure that patients’ nutritional and pain management needs were met.
  • Staff were supported to develop and there was a culture of learning and teaching within the service.
  • There was effective multidisciplinary team (MDT) working both internally and externally to support patients’ health and wellbeing.
  • There was a range of information and support available for patients and their families and carers. Staff helped patients manage their own health.
  • Staff understood their responsibilities as set out in the Mental Capacity Act (MCA).
  • Staff in children and young people’s services demonstrated a patient-centred approach which encouraged family members to take an active role in their child’s healthcare.
  • All staff interacted with patients and their family members and carers in in a caring, polite and friendly manner.
  • The service had a broad programme of emotional support services for children and young people and their families and carers. This included a variety of therapeutic support services.
  • There was timely access to a broad range of children and young people services including a number of highly specialist paediatric services. The flow of patients through children and young people services from admission, through theatres, wards and discharge was mostly managed effectively.
  • There was provision to meet the individual needs of children and young people using services at the hospital, including vulnerable patients and those with specific needs. There were efforts across the hospital to make the environment more child-friendly and welcoming for young people.
  • There was an established and stable leadership team in the CYP service. Staff told us senior leaders of the service were visible, approachable and supportive. There was an inclusive and constructive working culture within the services. We found dedicated staff that were knowledgeable about their work.
  • The department used appropriate governance, risk management and quality measures to improve patient care, safety and outcomes. Senior staff understood their local challenges and demonstrated a desire to improve CYP services for the benefit of patients.

However:

  • There remained some challenges with staffing vacancies, for example, nurse staffing in the neonatal unit (NNU) and on the children’s ward. Managers were aware of these challenges and there were interim measures in place to ensure safety.
  • The hospital had one lift to serve all floors. The lift was taken out of service when routine maintenance was required. However, a business plan was in place to build a new external lift.
  • There was no formal clinical supervision for nursing staff.

Critical care

Updated 14 May 2018

Our rating of this service improved. We rated it as good because:

  • There had been a lot of improvements since the last CQC visit.
  • Multidisciplinary (MDT) working was well embedded, the culture on the unit had changed and the leadership team had achieved good team dynamics. The ward had implemented MDT ward rounds, safety huddles, launched monthly newsletters, consultant meetings to agree guidelines and monthly governance meetings.
  • The risks identified on inspection reflected the risks on the risk register. The appointment of an external advisor helped in conducting a gap analysis, monitoring Guidelines for the Provision of Intensive Care Services (GPICS) and developing the strategy with the trust.
  • Relatives of patients were impressed with the care provided and felt involved in the decision making process.
  • The ICNARC standardised mortality ratio showed a trend of good outcomes on critical care.
  • Mortality rates were within the expected range and risk-adjusted acute hospital mortality data was better than expected in comparison with data submitted by similar units.
  • Staff including agency received a good induction and support prior to caring for patients independently.
  • There was an organ donation committee to ensure no missed organ donations and potential organ donations.
  • The governance structure had improved, there was a governance lead, a quality manager and more allied health professionals who attended the meetings.

However;

  • There were a high number of delayed discharges compared to similar units.
  • The unit did not meet the minimum environment standards.
  • Staff did not routinely receive feedback from incidents.

End of life care

Good

Updated 27 May 2016

The Specialist Palliative Care (SPCT) team provided end of life care and support six days a week, with on call rota covering out-of-hours. There was visible clinical leadership resulting in a well-developed, motivated team.

Patients told us the ward based staff and the palliative care clinical nurse specialists were caring and compassionate and we saw the service was responsive to patients’ needs. The SPCT responded promptly to referrals. There was fast track discharge for patients at the end of life wishing to be at home or their preferred place of death.

Staff throughout the hospital knew how to make referrals to the SPCT and referred people appropriately. The team assessed patients promptly, to meet patient needs. The chaplaincy and bereavement service supported patients’ and families’ emotional and spiritual needs when people were at the end of life.

Most hospital staff were complimentary about the support they received from the SPCT. Junior doctors particularly appreciated their support and advice, and said they could access the SPCT at any time during the day. They recognised that the SPCT worked hard to ensure that end of life care was well embedded in the trust.

The director of nursing had taken the executive lead role for end of life care, along with a non-executive director (NED), to ensure issues and concerns were raised and highlighted at board level. The trust's board received EOLC reports, outlining progress against key priorities within the EOLC strategy, including audit findings, themes from complaints and incidents, evidence of learning and compliance with end of life training requirements.

The SPCT provided a rapid response to referrals, assessed most patients within one working day. Their services included symptom control and support for patients and families, advise on spiritual and religious needs and fast-track discharge for patients wanting to die at home.

The National Care of the Dying Audit 2013/2014 (NCDAH) demonstrated that the trust had not achieved three out of seven organisational key performance indicators. At the time of the inspection, the trust had not fully rolled out the replacement of the LCP, and this delay meant that staff were not fully supported to deliver best practice care to patients who were dying. The leadership failed to apply enough urgency to have an individual plan of care in place.

Outpatients and diagnostic imaging

Good

Updated 27 May 2016

Overall, we found that outpatients and diagnostic imaging were good. The service was rated as good for safety, caring, responsive and well-led. The effective domain was inspected but not rated. Some aspects of the delivery of safe patient care in relation to radiation safety were excellent.

Patients, visitors and staff were kept safe as systems were in place to monitor risk. Staff were encouraged to report incidents and we saw evidence of learning being shared with the staff to improve services. There was a robust process in place to report ionising radiation medical exposure (IR(ME)R) incidents and the correct procedures were followed. The pathology department had a comprehensive quality management system in place with compliance targets set at higher than the national average to improve safety and quality. There was evidence of excellent practice for the monitoring and administering of patient radiation doses to be as low as possible.

The environments we inspected were visibly clean and staff followed infection control procedures. Records were almost always available for clinics and if not, a temporary file was made using available electronic records of the patient. Staff were aware of their responsibilities within adult and children safeguarding practices and good support was available within the hospital.

Nurse staffing levels were appropriate and there were few vacancies. The diagnostic imaging vacancies were higher, particularly ultra sonographers. There was an ongoing recruitment and retention plan in place.

There was evidence of service planning to meet patient need such as the emergency eye service offered Monday to Friday 8.30am to 4.30pm for patients with sight threatening eye conditions, requiring urgent specialist ophthalmic treatment. National waiting times were met for outpatient appointments and access to diagnostic imaging. A higher percentage of patients were seen within two weeks for all cancers than the national average, but the cancer waiting times for people waiting less than 31 days from diagnosis to first definitive treatment and the proportion of people waiting less than 62 days from urgent GP referral to first definitive treatment were both below the national average.

Staff had good access to evidence based protocols and pathways. There was limited audit of patient waiting times for clinics, but patients received good communication and support during their time in the outpatients and diagnostics departments. Staff followed consent procedures and had a good understanding of the Mental Capacity Act 2005.

We observed and were told that the staff were caring and involved patients, their carers and family members in decisions about their care. There was good support for patients with a learning disability or living with dementia.

Staff were aware of the complaints policy and told us how most complaints and concerns were resolved locally.

The outpatients and diagnostic imaging departments had a local strategy plan in place to improve services and the estates facilities. From December 2015, the current outpatient services that are in Clinical Services Directorate will move to a new Outpatients and Medical Records Division. Staff expressed some concern over these changes.

Governance processes were embedded across outpatients and diagnostics. The directorate was commended on its risk register in a recent review of risk registers in the trust. Senior managers told us the newly appointed quality manager had made significant improvements in making sure priorities, challenges and risks were well understood. Good progress was evident for improving services for patients.

We found good evidence of strong, local leadership and a positive culture of support, teamwork and innovation.

Renal

Good

Updated 27 May 2016

Overall, we found renal services were good. Reviews of care through incident investigation and morbidity and mortality were completed throughout the service and opportunities for learning were shared with staff. Infection control practices were robust in all areas. Staffing levels and skill mix were appropriate in all areas across the service with low agency staff usage.

Patient outcomes were in line or exceeded with national standards and effectiveness was regularly assessed and benchmarked. There was effective multidisciplinary working, with specialist nurses and allied health professionals and joint clinics were held with relevant specialties including diabetes. However we noted that standards for vascular access for haemodialysis were not met.

Most patients’ spoke positively of the care they received within the hospital, and individual patient needs were met. Delays in transport were noted as a particular concern by patients’ and their carers.

The environments in the dialysis units were cramped and in some areas, including at St Helier, facilities for patients were limited.

The service was well led with a clear vision and strategy and effective governance and risk management processes. Managers in the service were aware of shortfalls and took steps to address them. Staff spoke positively of the leaders and culture within the service

Surgery

Good

Updated 19 September 2019

  • Following our inspection in 2018, there had been improvements to the surgical service. The trust had strengthened the leadership of the service with the recruitment of senior nursing staff. In addition, the trust appointed two joint directors of planned care to oversee surgical services. There were clear lines of responsibility and accountability on the units and staff understood how to escalate problems.
  • There were effective systems in place to protect patients from harm and a good incident reporting culture.
  • Patients received effective, evidence-based care from staff who were appropriately qualified to care for them. The service monitored the effectiveness of care and treatment and achieved good outcomes for patients.
  • Feedback for the services inspected were mostly positive. Staff respected confidentiality, dignity and privacy of patients.
  • Services were developed to meet the needs of patients. The service had recently opened a new Surgical Ambulatory Care Unit (SACU) for rapid assessment and treatment of patients. There were dedicated surgical wards for different specialities and good patient flow across surgical services.
  • Most staff were positive about the local leadership across surgical services. In contrast to findings during our last inspection, staff felt the senior leadership were visible and approachable. Nursing staff felt senior staff listened when they raised concerns about staffing and they were willing to improve the service.

However:

  • Staff on Mary Moore ward and the SACU said they were caring for too many patients and did not always have enough time to provide the appropriate level of care.
  • Medicines management was not always in line with best practice. Allergy statuses were not recorded for nine out of 10 patient prescription sheets reviewed on the SACU. The fridge temperature on B3 Ward was not checked regularly and the room temperature was not checked. Staff did not update the controlled drugs register to reflect when patients were discharged with “to take out” (TTO) medication.

Urgent and emergency services

Requires improvement

Updated 19 September 2019

Our rating of this service stayed the same. We rated it as requires improvement because:

  • Staff we spoke with were not always able to demonstrate they understood how to protect patients from avoidable harm or abuse.
  • The service did not always monitor the effectiveness of care and had limited scope to improving the service as a result.
  • The paediatric ED did not have a suitable room for assessing children and young people presenting with mental ill health.
  • The service did not adequately safeguard children and young people who had left the department without being assessed by a member of the nursing or medical team.
  • The service was not achieving national key performance indicators in line with the Royal College of Emergency Medicine (RCEM).
  • Appraisal rates for staff in urgent care and emergency services across staff grades had not attained the trust’s target of 85%. Yearly appraisals were not completed in line with the trust’s target for any of the staffing groups working in the emergency department.
  • Governance and risk management processes were not as strong or effective as would be expected. There service did not have effective systems for identifying risks, planning to eliminate or reduce them.

However:

  • There was good multidisciplinary team working both within the department and with teams outside the department, including external partners.
  • Staff were using latest guidelines to provide effective treatment, these were up-to-date with national guidance, regularly reviewed and audited.
  • Staff delivered care and treatment with kindness and compassion.

Maternity

Good

Updated 19 September 2019

Our rating of this service stayed the same. We rated it as good because:

  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse, and they knew how to apply it.
  • Staff completed and updated risk assessments for each patient. They kept clear records and asked for support when necessary.
  • The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.
  • Staff made sure women and their babies had enough nutrition and hydration to meet their needs and improve their health, by providing outstanding support for breastfeeding.
  • Staff monitored the effectiveness of care and treatment. They used the findings to make improvements and achieved good outcomes for patients.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
  • The service planned and provided care in a way that met the needs of local people and the communities served. It also worked with others in the wider system and local organisations to plan care.
  • Managers at all levels in the trust had the right skills and abilities to run a service providing high-quality sustainable care.
  • Managers across the trust promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values. The service had made positive progress towards ensuring all midwives were treated fairly in accordance with the Health and Social Care Act and Workforce Race Equality Standards.
  • The trust had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected.

However:

  • Vacancy rates for medical staff did not meet the trust target of 10%. However, many medical staff rotated into different posts, and staff such as clinical fellows were on fixed term contracts.
  • We received mixed feedback from staff about their understanding of and involvement of the vision and strategy for the service, and not all staff were aware of it.