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Mount Vernon Cancer Centre Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 18 December 2019

Our rating of services stayed the same. We rated it them as requires improvement because:

  • We rated safe, responsive and well-led as requires improvement. Caring and effective were rated as good.
  • We rated two of the services we inspected as requires improvement and one as good.
  • The trust did not make sure the design, maintenance and use of facilities, premises and equipment kept people safe. However, this was challenging due to the complex nature of leasing the premises from another NHS Trust.
  • Staff were passionate and committed to delivering quality care; however, the on-going uncertainty surrounding the future of MVCC had an impact on staff morale.
Checks on specific services

Reference: safe not found

Requires improvement

Updated 18 December 2019

Our rating of safe went down. We rated it as requires improvement because:

  • Staff did not always comply with infection prevention and control policy. Audits showed variable compliance with hand hygiene principles. However, we observed appropriate hand hygiene during the inspection.
  • We were not assured that staff were always made aware of learning from incidents and there was a variable level of awareness regarding the regulatory duty of candour. However, managers were aware of the duty of candour. They had ensured that a patient had been fully informed regarding a potential serious incident that had occurred, at the time of our inspection.
  • Despite systems to ensure that equipment was checked and serviced regularly, there were two items in the vascular service clinic (a bed and an ultrasound machine) that had not been appropriately maintained. Staff rectified this during the inspection.
  • There were gaps in the systems to minimise risk to patients. For example, there was no formal sepsis training for staff and an incident occurred when the trust’s identification policy was not followed.

However:

  • The service provided mandatory training in key subjects to all staff and made sure everyone completed it.
  • The service has systems and processes in place in order to provide medicines including Systemic Anti-Cancer Therapy (SACT) safely. Medicines were stored, prescribed and administered appropriately.
  • Staff we spoke with were aware of the signs of potential abuse and the different types of abuse. They described their training and understood how to raise concerns.
  • The clinical areas we visited were visibly clean. There were low infection rates.
  • The service had a suitable environment and equipment available in order to provide safe care and treatment.
  • Staff had access to records and information in order to provide safe care and treatment. We found that entries made in healthcare records were legible, signed and dated.
  • Staff we spoke with understood their responsibilities regarding reporting incidents. Incidents were reported and investigated.

Reference: effective not found

Good

Updated 18 December 2019

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

  • The service provided care and treatment that was planned and delivered in line with evidence-based guidance such as from the National Institute for Health and Care Excellence (NICE).
  • Staff across different disciplines worked well together to deliver effective care and treatment.
  • Patients were asked for consent prior to treatment and in accordance with the Mental Capacity Act 2005. We found from reviewing healthcare records that patients who were to undergo treatment had copies of documented consent forms.

However:

  • Although the service made sure staff were competent for their roles and managers aimed to appraise staff’s work performance. The annual appraisal compliance rate for the chemotherapy suite was 74%. This did not meet the trust target of 90%.

Reference: caring not found

Good

Updated 18 December 2019

Our rating of caring went down. We rated it as good because:

  • Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.
  • Staff provided emotional support to patients to minimise their distress. Staff took time to allay patients’ fears.
  • Staff involved patients and those close to them in decisions about their care and treatment. The service encouraged patients to attend with a member of their family or close friend for support.
  • The trust performed within the expected range (England average) for two questions relating to chemotherapy, in the 2016 National Cancer Patient Experience Survey. In addition, the service collected patient’s feedback through surveys each month which showed many positive comments.

Reference: responsive not found

Requires improvement

Updated 18 December 2019

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

  • Patient access for first treatment in 62 days of urgent national screening referral was lower (worse than) than the England average.

  • We were not assured that patients were always provided with translation services when they were required.
  • Patients were experiencing delays when attending the chemotherapy suite.
  • Complaints were not consistently responded to in a timely manner

However:

  • The trust planned and provided services in a way that met the needs of patients. There had been changes in the provision of services to meet the increasing demand.
  • The service was responsive to meet patients’ individual needs. The service had access to various teams or specialists to assist them to meet individual’s needs. These included: leads for safeguarding, dementia, learning disabilities and social workers
  • Patients could access treatment when they needed it for some aspects of their care. Times from referral to first treatment in line with the England average for the first treatment in 31 days of decision to treat and the first treatment in 62 days of urgent referral. Patients seen within 14 days of referral was better than the England average.

  • The service received low numbers of complaints. Staff were aware of general themes, which included waiting times.

Reference: wellled not found

Requires improvement

Updated 18 December 2019

Our rating of well-led stayed the same. We rated it as requires improvement because:

  • The service had systems for identifying risks, although this did not appear to be effective or reviewed during meetings. The service was often reactive when things went wrong.
  • The service collected information and used secure electronic systems. However, it did not always analyse information support activities and continually improve.
  • Staff did not always feel actively engaged or empowered.
  • There was a new strategy for Mount Vernon Cancer Centre. However, as this was new, staff were not all clear about the vision and strategy.
  • There was a system to provide governance of the chemotherapy service. The arrangements were undergoing some development at a divisional level.

However:

  • The service leaders were experienced, available and accessible to staff. There was a lead nurse for chemotherapy services across the trust. Who was supported by unit managers, consultants and a senior management team for Mount Vernon Cancer Centre
  • The service engaged well with patients, to improve services.

Chemotherapy

Requires improvement

Updated 5 April 2016

Overall the service offered within chemotherapy required improvement, although the service was outstanding for caring.

Although the hospital gathered patient information such as hospital acquired infections and reviewed these through its clinical governance processes, there was no oversight of urgent transfers.

There was a process in place to obtain rapid treatment for patients who were suspected of having neutropenic sepsis via an acute oncology service. Only 30% of patients who were suspected of having neutropenic sepsis received antibiotics within two hours of admission. However, not all these patients were seen at MVCC, but at neighbouring trusts. There was an effective procedure in place to minimise chemotherapy being given via the incorrect route

Staff understood their responsibilities to raise concerns, record and report safety incidents, and near misses, and to report them internally and externally, although learning from incidents and complaints was limited.

All areas appeared clean, the units were bright. However, the building at Mount Vernon was old and required updating and refurbishment.

There were almost always long queues in the outpatients department at Mount Vernon for patients to be checked in for their treatment, although patients who were nervous, for example, if they were needle phobic, were seen and reassured as soon as possible. There were always long waits for treatment, whether the patient chose to have a one stop option, or blood tests on one day and treatment the next. Patients who required daily treatment, but did not need an in-patient bed, were able to stay in the hospital’s on-site hostel.

Patients often needed to go outside the main building to access other services. Often their individual needs were not always met with regards to keeping warm and dry.

Patients who required specialised treatment by a plastic surgeon for extravasation, needed to be transferred off site. The service to insert PICC lines, operated three days per week. This meant patients sometimes had their first treatment via a cannula, without the PICC line in situ.

Infection rates were low. There had been no reported incidents of MRSA or C Diff. in the two years prior to our inspection. Clinical waste was disposed of safely. This included chemotherapy waste. There were arrangements in place for managing medicines, including chemotherapy and radioactive substances to keep people safe.

Generally the hospital was adequately staffed. Mandatory training rates for all staff were at 87% against a hospital target of 90%.

The hospital took part in local, the trust’s and national audit programmes. Audits, undertaken of patients’ records each month were audited against compliance with assessment tools and care bundles.

The hospital was meeting the 31 day target for treating patients who required chemotherapy and radiotherapy for most tumour types.

All the consultants specialised in treating one or two tumour sites only. We found that there was a strong culture of multidisciplinary working between nurses, specialist nurses, doctors, allied health professionals and social workers.

None of the staff we spoke with had received training about the Mental Capacity Act 2005 (MCA).

Patients were given appropriate and timely support and information to cope emotionally with their care, treatment or condition. Patients and relatives were well supported and were given as much or as little information as they wanted. Staff often went out of their way to ensure patient care went beyond their remit as healthcare professionals.

There were links to access special care for patients with a learning disability. Staff had not had any training to care for patients living with dementia.

The ratio of compliments far exceeded the complaints. However, we found that not all complaints, particularly verbal complaints were recorded.

Although each division within the hospital had local objectives, there was no principal cancer strategy, nor was there a director with sole responsibility for cancer. There was no strategic oversight of the chemotherapy service. All staff were aware of the trust’s vision. There was a plan in place to be autonomous from Hillingdon NHS Trust. All the medical staff had an afternoon of management time written into their contracts.

All the staff we spoke with were proud to work for the Cancer Centre and would want their friends and family to be treated there should the need arise.

End of life care

Requires improvement

Updated 17 July 2018

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

  • The service was not well led. Although efforts were made to improve leadership and management of the service, the trust had not overcome the challenges of providing a service at a significant distance from the main acute hospital and which served a wider population than that of the rest of the trust.
  • The trust did not have a clear vision and strategy for what it wanted to achieve in relation to end of life services at the Mount Vernon Cancer Centre (MVCC). There had been little progress since our inspection in October 2015. It did not have workable plans for the development of services at MVCC, developed with the involvement of stakeholders, patients and staff. There was no information about the model of care and the configuration of services at the MVCC.
  • The arrangements for clinical governance did not always operate effectively. The reporting structure was unclear and although there was some discussion of incidents, risks, complaints and patient feedback at the end of life care clinical governance group, information was sometimes missing and there was no clear escalation of issues.
  • The trust did not have effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected. Risks to the service were not always identified or progressed and there was a lack of robust challenge of performance issues.
  • The service did not have robust evidence to demonstrate that nurse staffing levels were set appropriately to meet the changing needs of their patients throughout the 24 hour period. Staffing levels at night increased risks to people using the service and had not been addressed over a significant period of time.
  • Facilities and premises were not appropriate for the services being delivered. The premises used by the service were not well maintained. Although some improvements to the environment in MSH had occurred since the inspection in 2015, we found significant concerns remained. The service did not control infection well.
  • The environment within the inpatient unit was not well adapted to the needs of people using it.
  • Training in end of life care was not mandatory in the trust and levels of completion of training in end of life care were low.
  • People could not always access the service when they needed it. Limits to the number of admissions and the triage systems meant that patients who required urgent admission were not always able to access the service.

However,

  • Staff took steps to safeguard vulnerable adults and responded appropriately to signs of abuse. They engaged appropriately in local safeguarding procedures.
  • Staff cared for patients with compassion. Staff provided emotional support to patients to minimise their distress. A range of emotional support was available to patients and their families.
  • Staff involved patients and those close to them in decisions about their care and treatment. Patients and their families were aware of the plans for their care and were involved in decision making at every step.
  • Staff from different disciplines worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.
  • The service managed patient’s pain and other symptoms well. The effectiveness of pain relieving medicines was monitored, reviewed and adjusted accordingly.
  • The service prescribed, gave, recorded and stored medicines well
  • The service provided care and treatment based on national guidance and evidence of its effectiveness. They assessed staff compliance with guidance and identified areas for improvement.

Radiotherapy

Good

Updated 18 December 2019

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

  • The service had enough staff to care for patients and keep them 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 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.

Medical care (including older people’s care)

Requires improvement

Updated 18 December 2019

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

  • Mandatory training was not up to date. The premises and equipment did not always keep people safe. Observations were not always completed on time. Patients’ were not always treated for sepsis within an hour. Patients’ were not reviewed by a consultant upon admission. There was not enough medical or nursing staff to keep people safe. Prescribing processes were not always followed. Not all incidents were reported.
  • The service did not plan and provide care in a way that met the needs of local people. People could not always access the service when they needed it and receive the right care promptly.
  • Not all staff were provided with regular opportunities to meet, discuss and learn from the performance of the service. The service did not always identify potential patient safety risks and issues and identify actions to reduce their impact. Continuous learning and improvement processes were not fully embedded.

However,

  • 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.
  • 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. The service made sure staff were competent for their roles. 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.

Outpatients

Requires improvement

Updated 18 December 2019

  • The service did not always plan care to meet the needs of local people, People could not always access the service when they needed it and sometimes had long waits to see staff at appointments.
  • Leaders did not always have the confidence of some staff and information systems did not enable staff to access the information they needed to manage patients and services well. Staff did not always feel respected, supported and valued. The service did not always engage well with staff and the community to plan and manage services.
  • Managers did not always monitor the effectiveness of the service. Outpatient services were not available seven days a week.

However,

  • The service had enough staff to care for patients and keep them 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 collected safety information and used it to improve the service.
  • 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.
  • Staff took account of patients’ individual needs and made it easy for people to give feedback.
  • Staff understood the service’s vision and values, and how to apply them in their work. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities and all staff were committed to improving services continually.
  • Staff provided good care and treatment, ensured patients were able to eat and drink sufficiently, and gave them pain relief when they needed it. Staff were competent and 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.

Reference: improvement not found

Updated 17 July 2018

We found areas for improvement in this service. See the Areas for Improvement section above.

Reference: keyfacts not found

Updated 17 July 2018

The chemotherapy services were provided at Mount Vernon Cancer Centre. The departments included the chemotherapy suite, supportive care unit, inpatient wards and outpatient services.

There was also a chemotherapy suite located at the Lister Hospital. We did not inspect this service.

We visited the chemotherapy suite and supportive care unit, as this was where the majority of the chemotherapy service took place at Mount Vernon Cancer Centre. There were 21 treatment chairs and two beds at the chemotherapy suite, which treated an average of 40 patients per day.

Our inspection was unannounced (staff did not know we were coming) to enable us to observe routine activity.

During the inspection, we spoke with 20 staff including, managers, nurses, allied health professionals and support staff. We also spoke with 12 patients and their relatives, checked patients’ healthcare records and the environment. We also considered information and data about the service.

Reference: outstandingpractice not found

Updated 17 July 2018

We found an example of outstanding practice in this service. See the Outstanding practice section above.