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Inspection Summary


Overall summary & rating

Good

Updated 18 November 2015

The Buckland Hospital, Dover is a community hospital that has recently re-opened following redevelopment supported by a £23million investment by East Kent Hospitals University NHS Foundation Trust with the objective of bringing services closer to the local population of the Kent coast.

Services on site include outpatients, renal satellite services, day hospital services and child health plus a minor injures unit.

Our key findings were as follows:

  • With the exception of the reception desk within the MIU the facilities and practice afforded a safe environment for patients.
  • The trust has benefited from a highly successful outpatients transformation plan that has led to improved services to patients. The Buckland Hospital is a significant part of that transformation plan.
  • Children's services were well designed and met the needs of that patient group and attracted positive feedback from patients.
  • Governance arrangements were satisfactory and there was a link with the trust structure.

We saw several areas of outstanding practice including:

  • The Nurse leadership in outpatients was outstanding with staff inspired to provide a good service to patients. The main outpatient’s matron provided knowledgeable and inspirational support to staff whilst working hard to maintain and improve the service.

However, there were also areas of poor practice where the trust needs to make improvements.

In addition the trust should:

  • The Trust should continue to improve Referral to Treatment times across all specialities to ensure that patients are treated in an acceptable timeframe following referral to the service.
  • Attend to the lack of privacy and dignity that the MIU reception affords patients and mitigate the risk that reception staff do not identify at risk patients.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection areas

Safe

Good

Updated 18 November 2015

Effective

Good

Updated 18 November 2015

Caring

Good

Updated 18 November 2015

Responsive

Good

Updated 18 November 2015

Well-led

Good

Updated 18 November 2015

Checks on specific services

Services for children & young people

Good

Updated 18 November 2015

The children’s and young people’s service at Buckland Hospital was rated overall as Good.

No never events or serious incidents have been reported. There have been no safeguarding incidents and no complaints have been received. Any incident would be reported through Datix, the online reporting system. The service was well managed.

Parents and children gave positive feedback about the care and treatment provided in the Children’s Assessment Unit. Parents felt that both doctors and nursing staff were understanding, compassionate and supportive.

People were able to access the Children’s Assessment Unit through their GP, community services and other healthcare providers. Multidisciplinary working was in evidence.

The environment was clean and tidy and there had been no problems with infection control. Equipment had been serviced appropriately and the resuscitation trolley had been checked daily. Medicines had been stored and administered safely. Patients were able to collect their medicines from the pharmacy on site.

Staff had completed mandatory training and other relevant training to meet the needs of the community. They had received safeguarding training to the appropriate level for their role. All nurses had been trained in paediatric nursing and all staff had completed Paediatric Immediate Life Support, which included simulation training.

Staff felt they worked in supportive teams and responded to patients’ needs effectively. Staff carried out appropriate observations when a child was being seen and the patient’s clinical records had been well maintained.

Care was provided in accordance with evidence-based national guidelines. The service had not been involved in any national clinical audits since moving to the new hospital building. However, local audits had been undertaken such as recordkeeping, health and safety and hand hygiene.

Minor injuries unit

Good

Updated 18 November 2015

There had been no never events or serious incidents reported and there had been no incidents reported in the first month of the unit being open.

Cleanliness, infection control and hygiene were meeting the standards expected. .

The environment was well laid out and organised within the department, however the reception area did not always maintain patients privacy and dignity and nursing staff relied upon reception staff to pick up if a patient’s condition warranted speedier attention.

Stocks of equipment and medicines were maintained appropriately with evidence of good stock rotation and assurance that equipment to be used on multiple patients was clean, well maintained or serviced. Medication was stored safely and dispensed in line with trust policies and patient group directives (PGDs).

Records were held on a computer programme widely used in the NHS. Processes were in place to safeguard patients and staff were well versed with safeguarding and deprivation of liberty standards.

Mandatory training rates were good and staffing levels were adequate to cover the unit. Staff were suitably qualified to assess patient risks.

Staff had access to training and development and were well supported to carry out their duties. Staff underwent annual appraisal. People had their competencies checked regularly.

The unit used National Institute for Health and Care Excellence (NICE) guidance and there was evidence of local audits being undertaken to monitor quality and patients’ outcomes.

Systems were in place to provide patients with pain relief which was offered to patients on arrival at the unit and regularly during the duration of their stay.

Food and drinks were available and could be bought when needed.

Staff understood the principles of the Mental Capacity Act 2005 and understood their responsibilities in relation to obtaining consent from patients. Patients were cared for with privacy and dignity with doors and curtains closed. Whilst we saw only one patient being treated and cared for this was done in a professional and courteous manner. The two patients we spoke with were very happy with their care. Whilst there was no information readily available about expected waiting times staff would go out into the reception area and tell people waiting if there was to be a delay.

Interpreting services were available and there were no complaints about the service since its opening. Staff we spoke with felt they were well-led at departmental level and had regular contact with the matron. Staff were kept up to date via regular meetings and regular practitioner nurse meetings.

There was evidence of good team work and staff told us they loved working on the unit. Staff were engaged in developing their service.

Outpatients and diagnostic imaging

Good

Updated 18 November 2015

Buckland Hospital had been opened just before our inspection. The hospital was purpose built and provided excellent facilities for patients.

The Outpatient department was well led and had improved since implementing an outpatient improvement strategy. Despite the strategy being relatively new, through structured audit and review the department was able to evidence improvements in health records management, call centre management, Referral to Treatment processes, increased opening hours, clinic capacity and improved patient experience.

Although there was still improvement required in referral to treatment pathways the outpatients department and Trust demonstrated a commitment to continuing to improve the service long term.

As a part of the strategy the Trust had pulled its outpatient services from fifteen locations to six. We inspected five of these locations during our visit.

Managers and staff working in the department understood the strategy and there was a real sense that staff were proud of the improvements that had been made. Progress with the strategy was monitored during weekly strategy meetings with the senior team and fed down to department staff through staff meetings and bulletins.

Outpatients at Buckland Hospital were providing safe care to patients. There were systems in place, supported by adequate resources to enable the department to provide good quality care to patients attending for appointments.

Evidence based assessment, care and treatment was delivered in line with National Institute for Health and Care Excellence (NICE) guidelines by appropriately trained and qualified staff.

A multi-disciplinary team approach was evident across all the services provided from the outpatients and diagnostic imaging department. We observed a shared responsibility for care and treatment delivery. Staff were trained and assessed as competent before using new equipment or performing aspects of their roles.

We saw caring and compassionate care delivered by all staff working at outpatients and diagnostic imaging department. We observed throughout the outpatients department that staff treated patients, relatives and visitors in a respectful manner.

Nurse management and nursing care was particularly good. Nurses were well informed, competent and went the extra mile to improve patient’s journey through their department. Nurses and receptionists followed a ‘Meet and Greet’ protocol to ensure that patients received a consistently high level of communication and service from staff in the department.

The diagnostic imaging service at the Buckland Hospital had opened just prior to our inspection. We found that staff were providing safe care and meeting the requirements for Ionising Radiation regulations 1999 and IR(ME)R regulations 2000.