Glenfield Hospital

Updated 25 November 2022

Our rating of this surgical service went down. We rated it as requires improvement because:

• Many wards did not have enough nursing staff to be able to spend time with their patients and met their individual needs. There was a high reliance on bank and agency nurses.
• There were numerous examples of medical devices that were past their next service date and staff were not checking this themselves before use.
• People could not always access the service when they needed it and sometimes had to wait too long for treatment.
• Staff did not always appropriately monitor room temperatures and take appropriate action if medicines have been stored outside of their required parameters.
• Staff did not always ensure that full, partly full and empty oxygen cylinders are segregated.
• Several patients who spent a long time in hospital complained that there were no entertainment facilities in their rooms.

However:

• The service had enough staff to keep patients safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them.
• 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.
• 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.

Updated 5 February 2020

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

• Mandatory training was not up to date. Staff working with young people did not have the correct level of safeguarding training. Hand hygiene practices were not consistently followed by staff. Staff did not always minimise specific risks such as care of peripheral venous catheters (PVC) sites. Ligature risk assessments did not identify potential harms to vulnerable patients. Patients’ were not all reviewed by a consultant upon admission. There was not always enough medical or nursing staff to keep people safe. The service did not always use systems and processes effectively to safely record the levels of controlled drugs. Records were not always clear, up-to-date or stored securely.
• Outcomes for patients did not always meet national standards. Managers did not hold regular clinical supervision meetings with staff. Key services were not available seven days a week. The service was not compliant with mandatory training in Mental Capacity Act or Deprivation of Liberty Safeguards.
• The service planned and provided care in a way that met the needs of local people. The service was inclusive and took account of patients’ individual needs and preferences. The service treated concerns and complaints seriously.
• We were not assured the service identified all risks. The service had not made significant improvements in medical care following our previous inspection in 2017 and 2018.

However,

• Staff understood how to protect adult patients from abuse. The service mostly controlled infection risk well. The premises and equipment kept people safe. Staff identified and quickly acted upon patients at risk of deterioration. Staff in post had the right qualifications, skills, training and experience. Staff kept detailed records of patients’ care and treatment. The service used systems and processes to safely prescribe, administer and store medicines. The service managed patient safety incidents well.
• The service provided care and treatment based on national guidance. Staff gave patients enough food and drink. Staff assessed and monitored patients regularly to see if they were in pain. Staff monitored the effectiveness of care and treatment. Doctors, nurses and other healthcare professionals worked together as a team to benefit patients. Staff supported patients to make informed decisions about their care and treatment.
• Staff treated patients with compassion and kindness. Staff provided emotional support to patients, families and carers to minimise their distress. Staff supported and involved patients, families and carers.
• Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were not all in line with national standards.
• Leaders had the skills and abilities to run the service. Most staff we spoke to felt respected, supported and valued. The service had a vision for what it wanted to achieve. Leaders operated effective governance processes. The service collected reliable data and analysed it. The information systems were integrated and secure. Leaders and teams used systems to manage performance effectively. Systems were in place to identify and escalate risks and issues. Leaders and staff actively and openly engaged with patients, staff, equality groups, the public and local organisations to plan and manage services. All staff were committed to continually learning and improving services.

Updated 26 January 2017

We rated the children’s and young people’s service as good overall because there was a positive incident reporting culture. Staff knew how to report incidents and gave examples of when they had done so. There was appropriate incident investigation with actions and learning shared amongst staff. Staff adhered to trust infection prevention and control policies and we saw staff using hand sanitiser between patient contacts. All equipment including resuscitation equipment had been tested and checked regularly.Escalation plans were available for the Children’s Hospital, paediatric intensive care and the ECMO Unit.Staff conducted nursing handovers called ‘safety huddles’ to ensure all staff had up to date information about patients. Staff discussed new and existing patients, their medical history and care plans highlighting any key information including potential risks to patients.Medicines management was mainly in line with trust policy.

We observed positive, compassionate care and staff were sensitive to the needs of babies, children, young people and those close to them. Without exception, patients and those close to them were positive about their care and treatment. Patients felt involved in their care and treatment. Staff communicated in ways, which enabled patients and those close to them to understand what was happening.

The hospital provided specialist services for patients, including the Congenital Heart Centre and extracorporeal membrane oxygenation (ECMO) care. Staff met patient’s individual needs and could access specialist support such as interpretation, spiritual support and specialist nurses.

Staff assessed and responded to pain appropriately therefore patients had timely access to pain relief. Staff had access to a children’s pain team who performed daily ward rounds.

Services for Children and Young people conducted audits to monitor patient outcomes. The majority of the results of these audits were positive or showed improvement.

There was a clear vision and strategy for the service. There was a positive and open culture and staff were proud to work at the hospital. Leaders were visible and they engaged and listened to staff. We saw positive examples of innovation to improve services delivered.

However;

There were shortfalls regarding the numbers of staff training in Advanced Paediatric Life Support (APLS) and European Paediatric Life Support (EPLS). The service could not provide at least one nurse per shift in each clinical area trained in APLS or EPLS as identified by the Royal College of Nursing (RCN) 2013 staffing guidance.

The service did not meet the trust target of 95% for all subjects covered under mandatory training for both medical and nursing staff.

Updated 26 January 2017

Overall we rated the critical care service as good.

There were sufficient numbers of suitably qualified staff to care for patients.

We found a culture where incident reporting was encouraged and understood by staff.

There was strong clinical and managerial leadership at both unit and management group level and the service had a vision and strategy for the future. There was an effective governance structure in place which ensured that the risks to the service were known, recorded and discussed. The framework also enabled the dissemination of shared learning and service improvements.

Patients and their relatives were cared for in a supportive and sympathetic manner and were also treated with dignity and respect. However, There were some issues with access and flow. In 2015, 21 patients had their elective surgery cancelled.

The critical care unit did not achieve the intensive care core standard (ICS) of 50% of staff having a post registration course in critical care, 29% of staff had completed this.

Updated 26 January 2017

Overall, we rated end of life care services as requires improvement.

The medical staff levels were not in line with the recommendations from the National Council for Palliative Care who recommend that there is one whole time equivalent (WTE) consultant for every 250 beds. The service had 3.5 WTE and would require 7.0 WTE to provide cover to the three sites. The staffing was 50% lower than recommended.

The trust had 82 syringe drivers that were in line with best practice guidelines. However, only ten were ready for use. This meant another syringe driver was being used instead, which did not meet the NHS patient safety guidance.

Out of 25 Do Not Attempt Cardio Pulmonary Resuscitation’ orders (DNACPR), nine were completed correctly (38%).

The trust had taken part in the National Care of the Dying Audit 2016 and had achieved three of the eight organisational Key Performance Indicators (KPIs).The trust scored lower than the England average for all five Clinical KPIs.

The trust had undertaken an audit in April 2016 in response to the National Care of the Dying Audit 2016, and an action plan had been developed to address the KPIs that had not been achieved.

There was no strategic plan for end of life care throughout the trust and there was no non-executive director representing end of life care at board level.

We found care records were mostly maintained in line with trust policy. Staff understood their responsibilities in following safeguarding procedures.

Care and treatment was delivered in line with recognised guidance and evidence based practice. The last days of life care plan was in use throughout the trust.

Updated 26 January 2017

Overall we rated Glenfield Hospital Outpatient and Diagnostic Imaging services as requires improvement.

There were outpatient delays and cancellations across the trust. Some people were not able to access services for assessment, diagnosis and treatment when they needed to. The trust recognised this but arrangements to match future capacity to demand were not in place. Governance arrangements for better waiting list management were in development

Some arrangements lacked controls to keep patients safe. Fridge temperatures for medicines were not safely monitored but this was rectified during our inspection.

There was no audit process or record of the use of some FP10 prescription pads, which was a risk that the prescription issuing process could be abused.

The trust had not implemented and audited use of the WHO safety checklist across the trust.

Patient dignity was compromised in some areas . Some reception arrangements, for example diagnostic imaging reception, were not conducive to privacy or confidentiality. The ‘shuttle walk’ test, which formed part of the cardiac rehabilitation programme, was not performed in a location that respected dignity or privacy of patients.

Leadership for outpatient services was fragmented. Risks, issues and poor performance were not always dealt with appropriately or in a timely way, and this meant patients sometimes had long waits for new or follow up appointments and experienced in-clinic delays.

However, staff understood and fulfilled their responsibilities to raise safety concerns and report incidents and near misses; managers supported them when they did. If something went wrong, there was a thorough review or investigation involving all relevant staff and people who used services. Lessons were learned and communicated widely. Equipment checks were up to date and clinical areas were clean on the day we inspected. Staff had a good knowledge of safeguarding and the Mental Capacity Act or knew who they could go to for expertise. They knew what to do if a patient’s health started to deteriorate.

Diagnostic imaging services learned from incidents and improved safety. They used diagnostic reference levels to check dosage and had a range of safety related policies which staff understood and used. Imaging services were available seven days a week. GPs could refer patients to Glenfield for diagnostic imaging procedures with a 48 hour turnaround.

Patients, those who were close to them and stakeholders gave positive feedback about the way staff treated people. Glenfield based specialties had high ‘would recommend’ scores from patients. Patients we spoke with were happy with their care and spoke highly of staff at Glenfield hospital.

Care was planned and delivered in line with current evidence-based guidance. Examples of good practice included the Rapid Access Heart Failure Clinic. The services used local and national audit arrangements to maintain the effectiveness of treatment. Clinicians worked effectively in multidisciplinary teams to find solutions for complex patients. There were one-stop clinics in breast care and pulmonary embolism ambulatory clinic This meant patients could discuss a range of related issues on the same visit to the hospital. There was a positive working culture at Glenfield, and innovative practices, particularly in cardiac and respiratory rehabilitation.

Updated 25 November 2022