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Inspection Summary


Overall summary & rating

Good

Updated 24 June 2020

  • We rated safe, effective, caring, responsive and well led as good.
  • The hospital provided mandatory training in key skills to all staff and made sure most staff completed it. Staff understood how to protect patients from abuse. Staff kept equipment and the premises visibly clean. Staff managed clinical waste well. Staff completed and updated risk assessments for each patient. The hospital had enough nursing and medical staff with the right qualifications, skills, training and experience to keep patients safe. Records were clear, up to date and easily available to all staff providing care. The service used systems and processes to safely prescribe, administer, record and store medicines. The service managed patient safety incidents well.
  • The service provided care and treatment based on national guidance and evidence-based practice. Managers checked to make sure staff followed guidance. Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way. Staff monitored the effectiveness of care and treatment. The service made sure most staff were competent for their roles. Most key services were available seven days a week to support timely patient care. Staff supported patients to make informed decisions about their care and treatment.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. Staff provided emotional support to patients, families and carers to minimise their distress. They understood patients personal, cultural and religious needs. Staff supported patients, families and carers to understand their condition and make decisions about their care and treatment.
  • The service planned and provided care in a way that met the needs of local people and the communities served. The service was inclusive and took account of patients’ individual needs and preferences. People could access the service when they needed it and received the right care promptly.
  • Leaders had the skills and abilities to run the service. The service had a vision for what it wanted to achieve and a strategy to turn it into action. Most services operated effective governance and risk processes. Staff felt respected, supported and valued. The service had an open culture where patients, their families and staff could raise concerns without fear. Staff had regular opportunities to meet. The service collected reliable data and analysed it.
Inspection areas

Safe

Good

Updated 24 June 2020

Effective

Good

Updated 24 June 2020

Caring

Good

Updated 24 June 2020

Responsive

Good

Updated 24 June 2020

Well-led

Good

Updated 24 June 2020

Checks on specific services

Medical care (including older people’s care)

Good

Updated 24 June 2020

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

  • We rated safe, effective, caring, responsive and well led as good.
  • Managers took additional steps to ensure staffing numbers were reviewed regularly, to mitigate risk. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. The trust following our last inspection ensured risks to patients were assessed, acted on and documented clearly within care records. Managers regularly reviewed staffing levels and skill mix, and gave bank and agency staff a full induction. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
  • Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. 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. They provided emotional support to patients, families and carers.
  • The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However:

  • Not all staff had completed mandatory training, including safeguarding and mental capacity training. Medical staff completed training figures, fell below the trust’s internal compliance target.
  • The service did not always have enough nursing staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and provide the right care and treatment.
  • Referral to treatment times (RTT) for patients within cardiology were significantly lower than the England average.
  • The process for assessing and recording mental capacity was not fully embedded across the speciality.

Critical care

Good

Updated 24 June 2020

  • We rated safe, effective, caring and responsive as good. We rated well led as requires improvement.
  • The service provided mandatory training in key skills to all staff and made sure most staff completed it. Staff understood how to protect patients from abuse. Staff kept equipment and the premises visibly clean. Staff managed clinical waste well. Staff completed and updated risk assessments for each patient. The critical care units had enough nursing and medical staff with the right qualifications, skills, training and experience to keep patients safe. Records were clear, up to date and easily available to all staff providing care. The service used systems and processes to safely prescribe, administer, record and store medicines. The service managed patient safety incidents well.
  • Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way. Staff monitored the effectiveness of care and treatment. The service made sure most staff were competent for their roles. Most key services were available seven days a week to support timely patient care. Staff supported patients to make informed decisions about their care and treatment.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. Staff provided emotional support to patients, families and carers to minimise their distress. They understood patients personal, cultural and religious needs. Staff supported patients, families and carers to understand their condition and make decisions about their care and treatment.
  • 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. The service was inclusive and took account of patients’ individual needs and preferences. Bedside diaries were used to support patients and their families during critical illness. People could access the service when they needed it and received the right care promptly.
  • Leaders had the skills and abilities to run the service. The service had a vision for what it wanted to achieve and a strategy to turn it into action. Staff felt respected, supported and valued. The service had an open culture where patients, their families and staff could raise concerns without fear. Staff had regular opportunities to meet. The service collected reliable data and analysed it.

However:

  • Castle Hill Intensive care unit 2 (CICU 2) did not meet the most recent health building note guidance in terms of the environment.
  • Whilst there had been some improvement, to the numbers of staff in the critical care outreach team, this was still not adequately staffed out of hours and at weekends. The service did not have enough allied health professionals with the right qualifications, skills, training and experience.
  • We were concerned that care and treatment might not always be based on national guidance and best practice. at the time of our inspection. Not all staff had an up to date appraisal. The trust were not meeting the GPICS standard for the number of registered nurses with a post registration critical care award.
  • The service was still not providing a formal follow up clinic in line with GPICS standards and the National Institute of Health and Care Excellence (NICE) CG83 best practice guidance.
  • Leaders did not always operate effective governance processes. We were concerned about the lack of oversight in relation to the review of policies and procedures relevant to the units. There had been a lack of pace to address risks on the risk register. For example, we were told a business case to address the isolation facilities had been submitted for consideration but this had not been approved consistently.

End of life care

Good

Updated 15 February 2017

The last comprehensive inspection of End of life care services at the hospital was in February 2014, when we found the service to be good. During this inspection we rated this core service as ‘good’ overall because;

  • Patients were protected from avoidable harm and abuse. Staff understood and fulfilled their responsibilities to raise concerns and report incidents and managers shared the learning from incidents. Mandatory training across most services was above the trust targets and medicines were prescribed and administered safely in line with policy and staffing levels were appropriate for the services provided.
  • People’s care and treatment was planned and delivered in line with current evidence-based guidance. Information about people’s care and treatment, and their outcomes, were routinely collected and monitored. Staff providing care at the end of life were highly skilled and competent. There was evidence of multidisciplinary working across all teams. The trust had recently employed more resources to provide seven-day specialist palliative care nursing availability. Consent to care and treatment was obtained in line with legislation and guidance.
  • Feedback we received from patients was consistently positive about the way staff treated them. We observed a number of staff and patient interactions during our inspection. We observed consistently caring and compassionate staff. Patients and their families were supported emotionally. We saw an initiative that had been implemented by the bereavement team that we thought was outstanding.
  • Services were planned and delivered in a way that meets the needs of the local population. All teams involved in caring for patients at the end of life were highly responsive to the needs of the patients in their care and those close to them. Care and treatment was coordinated with other services and other providers to ensure that specialist teams saw patients in a timely manner and patients’ choice in relation to where their care was delivered was achieved. We saw evidence that staff were responsive to meeting the needs of vulnerable patients including those living with dementia.
  • All teams were aware of the trust vision and values. Whilst there was no trust end of life strategy at the time of our inspection, the Specialist Palliative Care Team (SPCT) were working collaboratively with other providers and using the national End of Life Care strategy to benchmark and influence the care and treatment they provided to patients. Robust governance, risk management and quality measurement processes were embedded. Staff told us that senior staff were visible and supportive. There was a lead consultant for end of life care and a director who provided representation at the trust board. We found that staff in all teams were consistently positive, friendly, helpful and approachable in all areas we visited. All staff were team focused and we saw examples of innovation, improvement and sustainability.

Surgery

Good

Updated 24 June 2020

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

  • We rated safe, effective, caring, responsive and well led as good.
  • The service provided mandatory training in key skills to all staff. Staff understood how to protect patients from abuse. The service controlled infection risk well and kept the environment and equipment clean. Overall, staff kept detailed records of patients’ care and treatment; and they completed and updated risk assessments for each patient and removed or minimised risks. Staff identified and quickly acted upon patients at risk of deterioration. The service planned enough nursing and support staff to keep patients safe from avoidable harm and to provide the right care and treatment. The service used systems and processes to safely prescribe, administer, record and store medicines. The service managed patient safety incidents well.
  • The service provided care and treatment based on national guidance and evidence-based practice. Staff protected the rights of patient’s subject to the Mental Health Act 1983. Staff followed national guidelines to make sure patients fasting before surgery were not without food for long periods. Staff assessed and monitored patients regularly to see if they were in pain, and gave pain relief in a timely way. Staff monitored the effectiveness of care and treatment. They used the findings to make improvements and achieved good outcomes for patients. The service made sure staff were competent for their roles. Doctors, nurses and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care. Key services were available seven days a week to support timely patient care. Staff gave patients practical support and advice to lead healthier lives. Staff supported patients to make informed decisions about their care and treatment.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. Staff provided emotional support to patients, families and carers to minimise their distress. They understood patient's personal, cultural and religious needs. Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.
  • 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. The service was inclusive and took account of patients’ individual needs and preferences. Staff coordinated care with other services and providers. People could access the service when they needed it and received the right care promptly. It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff.
  • Leaders had the skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff. They supported staff to develop their skills and take on more senior roles. The service had a vision for what it wanted to achieve and a strategy to turn it into action. Leaders and staff understood and knew how to apply them and monitor progress. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service had an open culture where patients, their families and staff could raise concerns without fear. Leaders operated effective governance processes. Leaders and teams used systems to manage performance effectively. They identified and escalated relevant risks and issues and identified actions to reduce their impact. The service collected reliable data and analysed it. Leaders collaborated with partner organisations to help improve services for patients. All staff were committed to continually learning and improving services and leaders encouraged innovation and participation in research.

However:

  • Planned staffing number were not always maintained. The service did not consistently have enough medical staff; but had taken steps to help mitigate against this by recruiting advanced clinical practitioners, employing physician assistants, and extending locum contracts. Orthopaedic patients were not consistently reviewed by senior medical staff on a regular basis.
  • Some waiting times from referral to treatment were not always in line with national standards.
  • Leaders and staff did not always actively engage with patients, staff, equality groups, the public and local organisations to plan and manage services. The senior leadership team were aware of engagement ‘gaps’ and were developing plans to better engage service user and representation groups.

Outpatients

Good

Updated 1 June 2018

We previously inspected outpatients jointly with diagnostic imaging so we cannot compare our new ratings directly with previous ratings. We rated the service as good because:

  • The previous inspection identified a lack of effective governance processes within outpatients. At this inspection we saw the trust had strengthened these processes by introducing performance reports, performance and access meetings and a trustwide outpatients governance committee.
  • Staff we spoke with knew how to report incidents and about learning lessons from incidents within the individual health groups.
  • All staff we spoke with felt positive about the new management changes and the future of outpatients.
  • Some work had been undertaken to look at staff skills and develop training specific to the needs of individual staff.
  • Most patients we spoke with told us that staff were caring and friendly.
  • Complaints were investigated thoroughly and in a timely manner.
  • Mandatory training compliance figures were high.

However:

  • Some problems with the storage of patient records remained. Patient records were not always stored securely in some clinics visited.
  • The trust was not meeting its internal appraisal standard.
  • The previous inspection found issues with waiting times for patients and referral to treatment indicators not always being met. During this inspection, we found that referral to treatment indicators were still not always met.
  • We saw high numbers of patients waiting for first and follow up appointments across several outpatient areas, resulting in backlogs. This issue was also identified within the previous inspection report.