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Inspection Summary


Overall summary & rating

Good

Updated 1 March 2018

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

A summary of our findings about this location appears in the overall summary.

Inspection areas

Safe

Requires improvement

Updated 1 March 2018

Effective

Good

Updated 1 March 2018

Caring

Good

Updated 1 March 2018

Responsive

Good

Updated 1 March 2018

Well-led

Good

Updated 1 March 2018

Checks on specific services

Outpatients and diagnostic imaging

Good

Updated 12 August 2016

We judged outpatients and diagnostic imaging services as Good overall this was because

              • Staff were confident about raising incidents and told us that they were encouraged to do so.

            • Staffing levels were appropriate to meet patient needs although increased demand on the Radiology services meant some reporting on diagnostic imaging is outsourced overnight to ensure that turnaround times for reports are within national guidelines.

          • There were appropriate protocols for safeguarding vulnerable adults and children and staff were aware of their roles and responsibilities in regard to safeguarding.

        • The departments inspected were visibly clean and staff followed good practice guidance in relation to the control and prevention of infection.

    • We observed that the equipment used in the care and treatment of patient’s was clean and in good work order.

  • An electronic patient record system allowed the filtering out of relevant information and facilitated information being available to different teams very quickly.
  • Outpatient and diagnostic services were delivered by caring, committed and compassionate staff who treated people with dignity and respect
  • Departmental managers were knowledgeable and supportive and had vision improve their services.
  • Staff in outpatients and diagnostic services, demonstrated good team working (including multidisciplinary working) and were competent and well trained.

However

  • Not all notes had been scanned and paper notes were still in use for some patients.

Medical care (including older people’s care)

Outstanding

Updated 1 March 2018

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

  • There were systems and processes in place to reduce the risk of harm to patients. The service had introduced a nursing and accreditation system to assess and work towards improving the quality and safety of care.
  • Both medical and nurse staffing had improved and the acute medical unit was fully staffed with nurses. On other wards we saw that shifts were covered by overtime and agency staff and there were new starters with starting dates.
  • Infection control processes were in place and there had been a successful approach to reducing the incidence of hospital acquired infections.
  • There was effective multi-disciplinary team working in place across the service between all staff including nurses and allied health professionals and consultants from different specialties.
  • Staff were observed to be caring and had gone the extra mile for patients and their relatives. On a number of wards we saw that staff worked closely with patients and their relatives to improve outcomes for patients. There was involvement of families during the patient’s journey through the service.
  • There were activity co-ordinators on the ward for patients with dementia. There was a programme of activities and some of these involved families. Staff said that there was a positive impact on those who participated in the activities.
  • Governance structures were in place and we saw that there was good communication up and down the organisation. Staff meetings were used to discuss complaints and incidents and also the introduction of any new guidance.
  • The senior management team were very visible in the organisation and staff knew who they were. Staff were aware of the vision and strategy for the organisation and there had been staff participation and engagement in the development of the strategy.
  • The service had appointed a mortality lead and systems and processes had been improved since the appointment. The service standardised mortality rate had consistently reduced and was now within normal range.
  • There was a rapid access transient ischaemic attack (also known as mini stroke) clinic on the stroke unit.

However:

  • Patient records were both paper and electronic and some paper records were not always in the correct order. The medical staff preferred to use the paper records as did the allied health professionals.
  • Services were not always a seven day service. In cardiology this was because consultants were on other rotas across the health economy and in the stroke service there were not enough speech and language therapists to provide a full seven day service.
  • Allied health professional did not feel that they were represented at a strategic level in the organisation.
  • Staff did not always close the doors to side rooms when patients were barrier nursed.

Urgent and emergency services (A&E)

Good

Updated 1 March 2018

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

  • The service was delivered by staff that were competent, trained and supported by their managers, and in sufficient numbers, to provide safe and effective care.
  • A learning culture encouraged staff to recognise and report patient safety incidents and safeguarding concerns. Complaints and concerns were managed appropriately.
  • The service used local and national audits to identify areas of weakness, to develop improvement plans, and to increase the effectiveness and responsiveness of the department.
  • Staff focused on what matters to their patients, their emotional needs, and included patients in their care and were compassionate in their delivery of care.
  • Performance was benchmarked across the trust and against national targets. Performance across a range of measures had significantly improved and was in line with or better than the expected improvement trajectory.
  • The service worked with the local commissioners and other agencies to plan, deliver and further develop the urgent and emergency services offered to meet the needs of the local community.
  • Leaders across the directorate, division, and hospital had a strategy for the service, were visible, and supported their staff. Leaders understood the risks and challenges to the service.

However:

  • The environment, documentation used, and quality of assessment records within the paediatric area meant there was an over-reliance on professional curiosity to identify potential signs of safeguarding concerns.
  • There was a poor responsiveness of the information technology in the department which had the potential to affect the timeliness and safety of care and treatment.

Surgery

Good

Updated 1 March 2018

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

  • The service had a good record of reporting patient safety incidents.
  • The trust’s ‘open and honest’ boards displayed information about staff and safety issues for patients and visitors.
  • All areas we visited were visibly clean and free from clutter.
  • Medicines were managed well and patient records were securely stored and completed appropriately.
  • Staff understood how to manage any safeguarding concerns and this was part of mandatory training requirements that were monitored by managers weekly.
  • The trust had recruited both nursing and medical staff and staffing was identified on department risk registers. Staffing was monitored daily and any shortfalls were supplemented with bank and agency staff to ensure sufficient numbers of suitably qualified staff.
  • There was a site-specific major incident plan and staff were familiar with this.
  • Ward managers were supportive of staff and proud of services provided.
  • The trust values were displayed in public areas and there was a strategy in place that included action plans to improve services. There was a positive culture where managers valued staff.
  • Risk registers were in place across the surgical departments with control measures in place. The trust collected data to monitor and drive improvement.

However

  • National guidance recommends that staff in theatre receive training in advanced life support training. However; training provided was for basic life support only.
  • The theatre environment was not fit for purpose and it was not clear when proposed refurbishment would take place.
  • Patient information boards displayed patient details visible to others.
  • Senior managers acknowledged that waiting times for certain specialities was a challenge with operations being cancelled for non-clinical reasons.
  • We found that the service did not investigate complaints in a timely manner, although managers recognised this.
  • The surgical safety checklist compliance figures had been supplied but we observed some gaps in the process.

Intensive/critical care

Requires improvement

Updated 12 August 2016

We  judged that overall the critical care service at Fairfield Hospital required some improvement.

The was because

  • The nurse staffing failed to meet the standard set by the Intensive Care Society for supernumerary shift co-ordinators at band 6/7.
  • There was no critical care outreach service provided at Fairfield Hospital.
  • The hospital was non-compliant with a number of elements of the NICE clinical guidance around the rehabilitation of critically ill patients.
  • There was a problem with delayed and out of hours discharges from critical care.
  • It was not clear how risks to critical care were being managed.
  • The risk register reported risks that had been identified for a number of years but there was a lack of clarity about mitigating actions, progress and review.

However

  • Critical care services were delivered by caring, compassionate and committed staff.
  • We saw patients, their relatives and friends being treated with dignity and respect.

End of life care

Requires improvement

Updated 12 August 2016

We judged End of life services at FGH require improvement this was because

  •  No specialist palliative care service is provided  after 5.00pm Monday to Friday or at all at the weekends. 
  • There was a lack of training in symptom control for middle grade staff  which compounded the lack of specialist palliative care available to patients out of hours and at the weekend.

  • We observed a number of examples where completion of Do not Attempt Cardiopulmonary Resuscitation (DNACPR) documentation did not conform to the standard set out in the trust policy.

  • The individual plan of care (IOPC) replacing the Liverpool care pathway was not embedded across FGH wards. Staff reported that they did not understand the IPOC documentation, did not feel confident using it and required more training before they would be happy to use it.

  • There was no robust, sustainable strategy proposed to address the risk regarding the lack of a seven day service.

  • Clinicians  believed that managers did not share their passion and commitment to EOL services, because of the reduction in staffing levels and did not feel involved in decisions about the future of services at FGH.

However

  • We observed care being delivered to patients, who were at the their end of life, with kindness, consideration and empathy.

  • We heard from relatives who reported that they and their loved ones were treated with kindness and received professional treatment and care.

  • We also, heard, observed and noted that rapid discharge services were arranged to be highly responsive to the needs and wishes of patients.