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Queen Elizabeth II Hospital Requires improvement

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

Reports


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.

Inspection carried out on 23 July to 11 September 2019

During an inspection to make sure that the improvements required had been made

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 carried out on 23 April 2018

During a routine inspection

A summary of services at this hospital appears in the Overall summary section at the start of this report.

Inspection carried out on 20 - 23 October 2015

During a routine inspection

Queen Elizabeth II (QEII) hospital is part of East and North Hertfordshire NHS Trust and it provides outpatient and diagnostic imaging services for a wide range of medical and surgical specialities. The hospital opened fully for patients in June 2015. Outpatient appointments are available from 8:30am to 5:30pm, Monday to Friday. The diagnostic imaging department is open for appointments from 8:30am to 5:30pm and offers plain film radiography, computerised tomography (CT), magnetic resonance imaging (MRI), ultrasound, fluoroscopy and breast imaging. This department is open between 8.30am and 4.30pm Monday to Friday for routine appointments.

During January to December 2014, the hospital facilitated 16,2278 outpatient appointments of which 40% were new appointments and 60% were follow up appointments (8% of appointments were not attended by patients).

The hospital also provides an urgent care centre (UCC) which is open 24 hours a day seven days per week. The UCC comprises a nurse led minor injuries unit and a GP led minor illness service. Since opening the unit has had 18,867 attendances, with 5,904 of these being patients under the age of 16. The UCC is designed to treat adults and children with minor illness and injuries and does not admit patients.

We carried out an announced inspection from 20 to 23 October 2015 and inspected a number of the outpatient clinics and diagnostic services and the urgent care centre at QEII. We spoke with 22 patients and 25 staff including nursing, medical, allied health professionals and support staff. We also reviewed the trust’s performance data and looked at twelve individual care records.

We inspected two core services, urgent and emergency care and outpatients, and rated the UCC as requiring improvement and outpatients as good. Both services were rated as good for caring.

We rated QEII as good for two of the five key questions which we always rate, which were whether the service was caring and responsive. We rated the hospital as requiring improvement for safety, effectiveness and for being well led. Overall, we rated the hospital as requiring improvement.

Our key findings were as follows:

  • Staff interactions with patients were positive and showed compassion and empathy.

  • Feedback from patients was generally very positive.

  • The service consistently met the four hour target for referral, discharge or admission of patients in the UCC.

  • The environments we observed were visibly clean and staff followed infection control procedures.

  • Nurse staffing levels were generally appropriate with minimal vacancies.

  • Patients’ needs were assessed and their care and treatment was delivered following local and national guidance for best practice.

  • Staff were suitably qualified and skilled to carry out their roles effectively and in line with best practice.

  • We found that both services were generally responsive to the needs of patients who used the services.

  • Waiting times were within acceptable timescales.

  • Clinic cancellations were around 2%.

  • There were effective systems for identifying and managing the risks associated with Outpatient appointments at the team, directorate or organisation levels.

  • There was a strong culture of local team working across the areas we visited.

However, there were also areas of poor practice where the trust needs to make improvements.

  • Staff in the UCC did not always report incidents appropriately, and learning from incidents was not always shared effectively.

  • During the inspection, staff told us that leaders in UCC were not always visible in the department and it was the perception of staff that they did not feel adequately supported as a result of this.

  • Mandatory training attendance in the UCC was not sufficient to meet the trust’s target, and did not ensure that all staff were trained appropriately.

  • Medicines were not always stored and handled safely in the UCC.

  • Reassessments of patients’ pain levels were not always completed following treatment in the UCC.

  • There was not a robust system of clinical audits in the UCC to drive improvements in service delivery.

  • Most nursing staff we spoke with in the UCC lacked an understanding of the Mental Capacity Act (MCA) and how to assess whether a patient had capacity to consent to or decline treatment.

  • Whilst the majority of equipment was fit for use and had been maintained well, the 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.

  • Medical records were stored centrally off-site and were not always available for outpatient clinics.

The trust should therefore:

  • ensure robust systems are in place to learn lessons from incidents and embed learning throughout the UCC.

  • ensure staff receive mandatory training in accordance with trust procedures in the UCC.

  • should ensure effective procedures are in place for the storage and management of medicines in the UCC.

  • ensure effective arrangements are in place when patients are transferred or advised to attend other accident and emergency locations to ensure the other service is aware.

  • ensure participation in appropriate clinical audits in order to enhance performance and service delivery in the UCC.

  • ensure patients are reassessed following pain relief.

  • ensure that leadership within the UCC facilitates effective staff engagement.

  • The trust should ensure all equipment in Outpatients is suitable for use.

  • The trust should ensure that patient records are available for all clinic appointments in Outpatients.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection carried out on 3 February 2014

During a themed inspection looking at Dementia Services

As part of the inspection we visited the Accident and Emergency department, the Medical Assessment Unit and three inpatient wards. We spoke with 27 staff who worked across these departments and wards, two relatives of patients with dementia, 10 patients with dementia and pathway tracked the care of five patients with dementia. We also provided the wards with comments cards to help gain patient�s view on the service. Unfortunately we received no responses to these comment cards.

We spent time in the Accident and Emergency department to see what arrangements were in place in relation to patients with dementia. We found staff had limited knowledge and training in relation to dementia care and were not aware of the National Institute for Clinical Excellence NICE guidelines regarding standards of dementia care.

We found that the wards were well led. The senior staff were able to identify who was on the ward with dementia, and what support they needed. In most cases, staff were motivated to provide a high standard of dementia care. Most of the staff we spoke with told us they had received training in relation to dementia care. They were able to give examples of how they used it in their daily roles.

There was good evidence in patient�s notes, and through discussion with staff, that there was regular effective working with other departments for a Multidisciplinary Team (MDT) approach.

There was information throughout the wards about ways to improve the quality of dementia care and systems for gaining feedback about the patient�s experiences.

We saw and we were told that there were systems in place to share good practice and lessons learned. Staff told us, and we saw from records, that there were quality assurance audits and checks carried out by the dementia lead and dementia/elderly care matron. This included skill sharing on the job, observing staff, spot checking records and dealing with any issues that had arisen.

Inspection carried out on 21 March 2012

During a themed inspection looking at Termination of Pregnancy Services

We did not speak to people who used this service as part of this review. We looked at a random sample of medical records. This was to check that current practice ensured that no treatment for the termination of pregnancy was commenced unless two certificated opinions from doctors had been obtained.

Inspection carried out on 17 January and 5 April 2011

During a themed inspection looking at Dignity and Nutrition

We spoke with nine patients, two relatives and seven members of staff. Most patients we spoke to were very positive about their experiences of care and treatment. Patients said they were kept informed, were involved in making decisions about their treatment and were given enough information, both written and verbally, to help them choose or to understand their treatment options.

The majority of patients felt that the staff treated them with respect and dignity and that their independence was promoted. Patients told us that they were not rushed and that staff delivered their care at a pace that met their needs.

The patients we spoke to told us that on admission, staff asked them what name they would like to be called. One person told us that it was lovely to be referred to by preferred name as they had been called �mum� for so long.

All the patients we spoke with told us that staff would always close the curtain when delivering personal care, this ensured their privacy was maintained.

The stroke rehabilitation unit was also visited as part of this visit and patients without exception commented that their individual needs were being met.

We spoke to a relative who visited daily, where possible, to attend to their parent�s care. They told us that the staff always involved them in making decisions about the care of their relative They said staff encouraged them to assist the person with their meals and that the protected meal times did not prevent this level of involvement.

Patients and relatives were very complimentary about their experiences of mealtimes. They commented that the staff made an effort to make it a pleasant experience by ensuring the patients are not interrupted during meal times, and ensuring that their food was served hot and that assistance was provided when necessary.

Patients stated that they were supported to eat and drink, that there was a good choice of food, including meals that met different cultural requirements. One patient told us that she had put on weight since being admitted to Stanborough ward, another said that the salads were lovely.

People taking a soft diet said their food was hot and well-presented. We observed that staff took care to make sure meals looked appetising. Pureed food was served with the different elements of the meals pureed and served separately.

Overall, there were few concerns about food or mealtimes. Patients were able to give their comments to the catering team and these were collated and used to plan improvement

Inspection carried out on 30 December 2010

During an inspection in response to concerns

The people we spoke to on the day of the visit told us that they were happy with the services offered by the QE II. They said that the staff treated them with respect and in a manner that promoted their dignity. People using the service felt that their privacy and confidentiality was maintained at all times.

They told us that the staff were professional and caring and that they had confidence in the treatment they received. They also told us that they were happy with the environment they were treated in.