Epsom General Hospital

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

At our last assessment we rated this key question good. At this assessment the rating changed to Requires Improvement. People’s privacy, dignity and immediate needs were not always met. Overcrowding and prolonged use of escalation areas meant patients were frequently cared for on trolleys in environments that lacked privacy and confidentiality. Access to food and drink was not always timely, particularly when demand was high. However, staff were kind, compassionate and respectful in their interactions with patients and families. We observed staff listening, introducing themselves and responding sensitively to people in pain, distress or with mental health needs. Patients were positive about staff attitudes, and staff understood how to support people who communicated in different ways, including using interpreters and reasonable adjustments. In the paediatric emergency department, staff engaged well with children and families and provided accessible information to support understanding.

We have not awarded this service a score for Caring.

Find out about when we will not publish a key question score and what we look at when we assess Caring.

The service did not always treat people as individuals or make sure people’s care, support and treatment met people’s needs and preferences.

On the first day of our inspection, the department was very busy, and patients were not kept up to date about their care and treatment. Some patients and families we spoke with were not sure what they were waiting for or what the plan was for their care. Some patient’s relatives we spoke with told us they had not been given an update for over 6 hours. However, on the third day of our inspection, the department was less busy and patients we spoke with told us they were kept informed in a sensitive and appropriate manner about investigation results and subsequent actions.

Due to the lack of flow in the department, we saw there was a lack of privacy and dignity in the escalation areas. We saw conversations were not confidential however we observed patients being treated with kindness and communicated to in a way they could understand. Staff we spoke to knew how to contact the interpretation services and reported that they were used so patients could understand their care and provide support.

Staff displayed knowledge and understood how to support people who communicated differently. Staff we spoke to had completed the Oliver McGowan training.

Due to overcrowding and use of escalation spaces in the department, staff attempted to maintain the confidentiality of information about patients where possible, but this was not always possible. However, patients were positive about staff and the trust. Patients said staff treated them well and behaved appropriately towards them. We observed staff listening to patients and their families.

Although privacy screens were available, we were told these were rarely used. We saw patients on trolleys in these areas through our assessment. We heard from staff how the escalation areas rarely closed and patients could spend long periods of time in the escalation areas on a regular basis. Staff told us, if patients were particularly elderly, then a bed would try to be sourced for them instead of a trolley. However, issues with patient flow made this challenging. However, we observed staff responding to patient’s needs, especially patients that were in pain, discomfort, or distress.

There were allocated areas and cubicles for mental health patients however the time taken to review the patients varied. Staff we spoke with had had relevant training in caring for mental health patients.

There was no electronic board displaying waiting times. Staff we spoke to recognised this was a problem in the unit.

The members of staff we spoke with all spoke compassionately about the need to support people with mental health needs. A patient we spoke with told us that some support workers had engaged well with them.

We did not look at Treating people as individuals during this assessment. The score for this quality statement is based on the previous rating for Caring.

We did not look at Independence, choice and control during this assessment. The score for this quality statement is based on the previous rating for Caring.

The service did not always listen to and understand people’s needs, views and wishes. Staff did not always respond to people’s needs in the moment or act to minimise any discomfort, concern or distress.

On the first day of our inspection, patients who were waiting in the escalation spaces, some for considerable periods of time, did not have sufficient access to water, hot drinks or food. We were told that food and drinks were available within the ED three times per day, however this was not evidenced in the patient notes we reviewed. This was not sufficient to ensure patients did not become dehydrated.

We spoke with patients who said they hadn’t had food for long periods of time. On the third day of our inspection, the department was less busy and patients we spoke with had been offered food and drink. We observed food being served to patients throughout the day. We observed patients being supported to eat food if they were not able. However, some patients also commented that there was a poor allergy menu.

We observed how staff always introduced themselves and established a warm relationship with their patients. Staff across all professions demonstrated caring and compassionate attitudes towards patients.

In the paediatric department we observed nursing team effectively handing over to the medical team to review children. We saw there was a designated doctor from Emergency Department (ED) to cover the paediatric ED. However, there were still long delays in department with patients waiting over 4 hours.

In the paediatric department we observed information boards in place in waiting areas for families to scan QR codes which gave them information on their child’s condition, the process of making a complaint or complement and the latest scores from parents’ feedback.

In paediatric ED relatives we spoke with told us they were not sure who they were waiting for. However, we observed posters displayed on boards for families of which pathway their child may be on. Staff we spoke to were confident in escalating clinical concerns to the medical team and said paediatric teams came down to review patients.

Staff we spoke to knew how to access patient advice liaison services to assist patients to communicate complaints or compliments to the trust. Staff we spoke to knew how to access language line and access interpreters for their patients and the correct use of chaperones.

The service cared about and promoted the wellbeing of their staff, and supported and enabled staff to always deliver person-centred care.

Staff we spoke with felt respected, supported and valued within their immediate team. Wellbeing was actively addressed in daily routines, including regular huddles. Office areas displayed information on raising concerns and promoting inclusive practice. Staff reported a culture of open communication and inclusivity, where their feedback was welcomed by local managers and responded to when necessary.

However, throughout our assessment we heard how staff felt that senior leaders did not recognise and act on the risks and pressure felt within the department. We heard how concerns had been raised regarding escalation areas and although these had been heard staff saw no changes to improve this or wider recognition throughout the trust of shared responsibility of risk.

There was a wellbeing hub for staff and access to a variety of wellbeing services such as physical wellbeing support with a physiotherapy service, occupational therapy and sport fitness challenges. There were mental health wellbeing services providing stress management, staff psychology service and counselling. There was access to Freedom to Speak Up Guardians (FTSUG) and a pension scheme. Staff we spoke with were not aware of any financial wellbeing advice or support.

Staff told us about the trust wide care awards which was held annually. This allowed the trust to celebrate individuals and their teams who delivered outstanding care.

Staff we spoke with had yearly appraisals. Staff appraisals included conversations about career development and how this could be supported. From the data provided by the trust, they had completed 87.54% of appraisals in the last 12 months prior to the inspection.

Staff said they could raise concerns about disrespectful, discriminatory or abusive behaviour or attitudes towards patients without fear of the consequences. We also saw evidence that staff would report violence and aggression towards them from patients, and this would be investigated.

The adult emergency department had self-rostering where staff could choose their own shifts. Staff told us this worked really well. Staff told us there were flexible working arrangements in place and the management team would accommodate them as best as possible.