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Queen Elizabeth II Hospital Requires improvement

This service was previously managed by a different provider - see old profile

Inspection Summary


Overall summary & rating

Requires improvement

Updated 18 December 2019

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

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

  • There had been significant improvements in the Urgent Care Centre (UCC) and the rating had improved from inadequate to requires improvement. The leaders of the service had made a number of changes to improve the quality of services.
  • Whilst there were significant improvements in the UCC we found that there had been a decline in safety practices in outpatient services and patients could not always access care and treatment when they needed it.
Inspection areas

Safe

Requires improvement

Updated 18 December 2019

Effective

Good

Updated 18 December 2019

Caring

Good

Updated 18 December 2019

Responsive

Requires improvement

Updated 18 December 2019

Well-led

Requires improvement

Updated 18 December 2019

Checks on specific services

Outpatients and diagnostic imaging

Good

Updated 5 April 2016

Staff were encouraged to report incidents and the learning was shared to improve services. In diagnostic imaging, staff were confident in reporting ionised radiation medical exposure (IR(ME)R) incidents.

The environments we observed were visibly clean and staff followed infection control procedures. Equipment was generally maintained regularly and medicines were appropriately managed and stored.

Ocular computed tomography (OCT) imaging systems across the trust were not compatible. This meant that the images could not be compared to monitor disease progression as they were on different systems. The trust confirmed that clinical decisions using either machine were valid as both machines were in working order and that they were in process of procuring a central server to run all OCT machines on to allow image comparison on different sites.

The OCT machine in the ophthalmology department was eight years old and had not been recently serviced. The trust confirmed that the machine was no longer supported for software updates or servicing by the manufacturer. We were therefore unable to confirm that the machine had recently been suitably serviced and calibrated.

Medical records were stored centrally off-site and were not always available for outpatient clinics. Staff prepared a temporary file for the patient that included correspondence and diagnostic test results so that their appointment could go ahead.

Patients were very happy with the care they received and found it to be caring and compassionate. Staff worked within nationally agreed guidance to ensure that patients received the most appropriate care and treatment for their conditions. Patients were asked for their consent before care and treatment was given.

Staff were suitably qualified and skilled to carry out their roles effectively and in line with best practice. Staff felt supported to deliver care and treatment to an appropriate standard.

There were effective systems for identifying and managing the risks associated with outpatient appointments at the team, directorate or organisation levels. Regular governance meetings were held and staff felt updated and involved in the outcomes of these meetings. There was a strong culture of team working across the areas we visited.

Urgent and emergency services

Requires improvement

Updated 18 December 2019

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

  • We rated safe and well-led as requires improvement. Effective, caring and responsive were rated as good.
  • Leaders were starting to operate effective governance processes, throughout the service and with partner organisations; however, this was not yet embedded. Staff were not always clear about their roles and accountabilities.
  • The service was starting to develop processes and systems to improve the quality of services through audit and triangulation of other quality indicators; however, this was yet to be embedded.
  • The service had made some improvements to the assessment processes since our last inspection. However, evidence provided by the trust demonstrated that staff were not always acting appropriately to escalate deteriorating patients.
  • Although the service had made improvements in training staff in the recognition of sepsis, there was a lack of clarity around the treatment for patients with suspected sepsis. A lack of formalised processes meant that there was a risk that life-saving treatment would be delayed.
  • The design, maintenance and use of facilities and premises mostly met national guidance to keep patients safe. However, the children’s waiting area was still not completely separate from adults in the main waiting area. The service had made some adjustments since our last inspection; however, we were not assured that all reasonable steps had been taken to minimise the potential risks.
  • The service had a vision for what it wanted to achieve but the new leadership team had not had time to convert the vision to a strategy.

However,

  • The service had enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Managers had reviewed and adjusted staffing levels and skill mix, and gave bank and agency staff a full induction.
  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.
  • The service now made sure staff were competent for their roles. Managers appraised staff’s work performance and held meetings with them to provide support and development.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
  • The service planned and provided care in a way that generally 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. People could access the service when they needed it.
  • Leaders had the skills and abilities to run the service. They understood 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 was now having regular opportunities to meet, discuss and learn from the performance of the service.
  • Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service promoted equality and diversity in daily work, and provided opportunities for career development. The service had an open culture where patients, their families and staff could raise concerns without fear.

Outpatients

Updated 18 December 2019

This is the first time we have inspected outpatients separately from diagnostic imaging so we cannot compare against previous ratings. We rated it as requires improvement 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 mostly 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.
Other CQC inspections of services

Community & mental health inspection reports for Queen Elizabeth II Hospital can be found at East and North Hertfordshire NHS Trust.