• Hospital
  • NHS hospital

The Tunbridge Wells Hospital at Pembury

Overall: Requires improvement read more about inspection ratings

Tonbridge Road, Pembury, Tunbridge Wells, Kent, TN2 4QJ

Provided and run by:
Maidstone and Tunbridge Wells NHS Trust

Latest inspection summary

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Medical care (including older people’s care)

Good

Updated 9 March 2018

  • Since our last inspection in 2015, we saw a number of changes.
  • There was an improved culture of incident reporting. Incidents were recorded on electronic systems that incorporated fail-safes about aspects such as duty of candour.
  • Patients and relatives we spoke with gave positive feedback about the care they received on the unit.
  • Staff showed compassion when dealing with patients and protected their privacy and dignity.

However:

  • Although medicines were better managed and more available, some aspects of medicines management still needed improvement.

Services for children & young people

Good

Updated 9 March 2018

  • Staff recognised incidents and reported them. Managers investigated incidents and shared lessons learn with the paediatric directorate.
  • There was comprehensive assessment of children, including a history of any past or current mental health problems alongside the assessment of their physical health needs. This included age-related pain assessments and children’s pain levels were regularly assessed and acted upon.
  • Children had individualised care pathways for their care and risk assessments were completed for all patients including National Paediatric Early Warning Scores in order to rapidly detect any child whose health was of deteriorating.
  • Staff had training in the assessment and management of sepsis antibiotics were given in line with guidance. Reports on antimicrobial prescribing and sepsis management were escalated to the board through the trusts governance framework.
  • Staff demonstrated an understanding of the relevant consent and decision-making requirements of legislation and guidance, including the Mental Capacity Act 2005, with regard to children over 16 years and the Children Acts 1989 and 2004.
  • There was evidence of good multidisciplinary working both within the trust and with external stakeholders.
  • The service was responsive to children, young people and their family’s needs. They delivered personalised care and took into account needs and choices of different people.
  • There was a children’s strategy in place that staff we spoke to knew about and were committed to improving child health experiences and outcomes. There was a clear governance framework in place that was led by the chief nurse.
  • Staff told us they were supported and felt valued; they thought highly of the matron who they said was very visible supportive and kept them well informed.

However:

  • Although it was evident that lessons learned in the children’s services was shared within the directorate and practice changed as a result, it was less clear how learning was systematically identified, disseminated or audited across the trust.
  • There were no safeguarding level 3 trained staff on adult wards where 16-18-year-old patients were cared for.

Critical care

Requires improvement

Updated 9 March 2018

Since our last inspection in 2015, we saw a vast number of improvements in critical care.

  • There was a good culture of incident reporting and learning, and all incidents were recorded on the trust wide electronic reporting system.
  • Medicines were well managed.
  • Patient outcomes were mostly in line with or better than other similar critical care units.
  • Compliance with national guidelines had improved.
  • Patients and relatives we spoke to gave positive feedback about the care they received on the unit.
  • Staff showed compassion when dealing with patients and protected their privacy and dignity.

However:

  • It was not clear if all intensive care unit deaths were discussed at the morbidity and mortality meetings.
  • Delayed discharges from the unit remained an issue.

Outpatients and diagnostic imaging

Requires improvement

Updated 3 February 2015

All the patients we spoke with told us that they had been treated with dignity and their privacy protected. They spoke highly of the staff in outpatients and radiology. They found staff polite and caring. However, many patients complained to us about the waiting times in the outpatient clinics.

Staff were reporting incidents and these were discussed at the clinical governance meetings within the directorates. There were systems in place to reduce the risk and spread of infection. Medicines were stored and administered safely. The department held its own training records which were up to date and demonstrated that most staff had attended mandatory training.

The trust had met their national targets and consistently performed higher than the national average in regard to radiology waiting times. There had been a backlog in reporting CT and MRI scans for several months but there was evidence at the visit that these were reaching resolution. There was an ongoing backlog in clinic letters being sent out that was not resolved. There was risk to patients receiving delayed or inappropriate treatment and considerable stress caused to the staff.

Staff demonstrated a commitment to patient centred care and we found many examples of such care and attention to patient conditions and preferences.

Surgery

Requires improvement

Updated 9 March 2018

  • While the service improved in some areas, it stayed the same or became worse in others.
  • The escalated short stay surgery unit created risks to patient safety and dignity.
  • The hospital had had two never events during the reporting period and one additional never event in the week before this inspection.
  • Learning from incidents had not significantly improved since the prior inspection. Information about learning was not always complete and there was not a system to ensure learning was shared with staff.
  • Capacity to manage the number of patients being admitted led to significant shortfalls in the responsiveness of the service. This issue was identified at the previous inspection and continued to require improvement.
  • Some senior staff did not reflect an understanding of the risks in their departments.
  • Significant challenges to recruiting caused gaps in rota coverage and high reliance on bank and agency staff. This issue was identified at the previous inspection and continued to require improvement.
  • Resuscitation trolleys in the department were not tamper evident which meant items could be taken from the trolley or tampered with without staff knowledge. We raised this issue with the trust. The trust reported that it reacted throughout the trust immediately and effectively to rectify the issue by putting tamper-evident security on resuscitation trolleys.

However:

  • The hospital had improved its supplication of World Health Organisation Safer Surgery Checklists. This was an improvement since our last inspection.
  • The department had improved staff retention.

Urgent and emergency services

Requires improvement

Updated 9 March 2018

  • Between October 2016 and September 2017 there was an upward trend in the monthly percentage of ambulance journeys with turnaround times over 30 minutes at Maidstone Hospital.
  • Over the period an average of 42% of ambulance journeys had a turnaround time over 30 minutes.
  • From August 2016 to July 2017 the trust reported 364 “black breaches”, with an upward trend over the period. A black breach occurs when a patient spends more than 60 minutes on an ambulance waiting to be seen in the emergency department.
  • A significant backlog of incident investigations and limited evidence of learning from incidents meant we were not assured safety improved as a result.
  • Triage processes were inconsistent and did not always keep people safe. In addition, the results of triage records indicated a need for improved quality.
  • Audits identified a need for improvement in the quality of patient records.
  • There was very limited evidence of health promotion work or intervention despite a significant number of patients presenting with alcohol or drug overdoses, or with suicidal intent.

However:

  • The Royal College of Emergency Medicine recommends that the time patients should wait from time of arrival to receiving treatment is no more than one hour. The trust met the standard for all months over the 12-month period between September 2016 and August 2017 although this did not include patients who arrived by ambulance.
  • The unit performed consistently well in the national patient-led assessment of the care environment (PLACE) and in weekly environmental audits. In the previous 12 months, the unit performed better than national and trust averages in all categories.
  • From September 2016 to August 2017, the trust reported no incidents classified as never events for urgent and emergency care.
  • The recruitment of practice development nurses had significantly improved the training and professional development opportunities for staff. This improved tracking and assessment of staff competencies and enabled individuals in different roles to work and develop together.
  • There was a demonstrable track record of well-coordinated multidisciplinary working that contributed to patient outcomes.
  • From January 2017 the trust showed a general trend of improvement in performance against Department of Health access and flow metrics, including the national standard to be seen, discharged or admitted within four hours.
  • There were clear and demonstrable improvements in clinical governance and leadership, and this was reflected in the morale of staff and initiatives to improve performance and risk management.