You are here

Kidderminster Hospital and Treatment Centre Inadequate

We are carrying out checks at Kidderminster Hospital and Treatment Centre. We will publish a report when our check is complete.

Inspection Summary


Overall summary & rating

Inadequate

Updated 5 June 2018

Inspection areas

Safe

Inadequate

Updated 5 June 2018

Effective

Requires improvement

Updated 5 June 2018

Caring

Good

Updated 5 June 2018

Responsive

Inadequate

Updated 5 June 2018

Well-led

Inadequate

Updated 5 June 2018

Checks on specific services

Outpatients and diagnostic imaging

Inadequate

Updated 20 June 2017

We rated outpatients and diagnostic imaging as inadequate because:

  • There was a lack of radiation protection infrastructure.
  • Examination protocols for standard x-ray examinations were not routinely reviewed and not subject to document control. Patients were unable to access the majority of services in a timely way for initial assessments, diagnoses and/or treatment
  • The trust did not consistently meet all cancer targets for referral to treatment times.
  • Staff we spoke with were unaware of any patient harm reviews undertaken to mitigate risks to patients who had breached the RTT / cancer waits.
  • We could not ensure that all equipment was suitable for purpose. We saw a blood pressure monitoring machine had not been calibrated. Aging and unsafe equipment across the trust that was being inadequately risk rated with a lack of capital rolling replacement programmes in place.
  • Whilst staff were aware of their roles and responsibilities with regards to reporting patient safety incidents, incidents reporting in outpatients was low and where incidents had been reported, the dissemination of lessons learnt was insufficiently robust.
  • The trust was failing to meet a range of benchmarked standards with regards to the time with which patients could expect to access care.
  • Not all nursing and medical staff had had appropriate levels of children’s safeguarding training.
  • Compliance with mandatory training had improved since the last inspection. Training figures showed training compliance met the trust’s target of 90%.
  • There were moderate to high level of clinic cancellations with less than six weeks’ notice across particular specialties.
  • Hand hygiene and arms bare below the elbow audits were not regularly carried out with only one weekly audit carried out so far in the current financial year.
  • There was a shortage of medical staff across all specialities. This meant there could be a delay in patients being seen for new or follow-up appointments.
  • We were not assured that all complaints were dealt with in a timely manner and in accordance with trust policy.
  • We could not be assured the service had a robust, realistic strategy for achieving the priorities and delivering good quality care.

However:

  • Staff were dedicated and caring staff. Patients were treated with kindness, dignity and respect and were provided the appropriate emotional support.
  • The premises were visibly clean.
  • The process for keeping patients informed when clinics overran was good.
  • There were effective systems in place regarding the handling of medicines.
  • FP10 prescription pads were stored securely.
  • Patient’s medical records were accurate, complete, legible, up to date and stored securely.
  • Leadership within the outpatient’s team was visible however, the management of risk was insufficiently robust and further improvements were necessary.
  • Staff were proud to work at the hospital. They were passionate about the care they provided for their patients and felt they did a good job.

Outpatients

Inadequate

Updated 5 June 2018

We previously inspected outpatients jointly with diagnostics imaging and therefore, ratings cannot be directly compared to the core service only.

We rated the service as inadequate because:

  • We rated safe, responsive and well-led as inadequate and rated caring as good. We do not currently rate effective for outpatients.
  • Mandatory training attendance was low and did not meet the trust targets for all modules.
  • Mental Capacity Act 2005 and Deprivation of Liberty Safeguards training was low and did not meet the trust target of 90%.
  • Clinical harm reviews were carried out, however we were not assured these were carried out in a timely manner, psychological harm was considered or that those identified as coming to harm were reported as a serious incident as appropriate.
  • Incidents were not managed well and we were not assured that harm was categorised appropriately.
  • Patients could not always access the service when they needed it. Waiting times from treatment and arrangements to admit, treat and discharge patients were not in line with good practice. There were long waiting lists with many patients waiting up to 52 weeks for outpatient services. There was no improvement in most areas since our inspection in November 2016.
  • Due to the limited improvement in performance, we were not assured the leadership team could deliver the significant change required to improve patient outcomes.

However:

  • Patients were treated with kindness, dignity and respect and staff were attentive to their needs. They were involved in decision making about their care and treatment and were supported in this.
  • Staff and teams worked well together to deliver effective care and treatment. We saw good examples of multidisciplinary working and most staff had opportunities to develop their skills and roles to improve patient experience.

Maternity and gynaecology

Requires improvement

Updated 20 June 2017

We rated maternity and gynaecology as requiring improvement because:

  • Environmental checks were inconsistent. Systems for monitoring equipment safety were not robust.
  • Limited use of local audit meant that some outcomes with regards to patient safety, care and effectiveness were not fully understood. This was especially noticeable with regards to documentation and assessment.
  • Compliance with mandatory training modules remained below the trusts target of 90%.
  • Multiple sets of patient notes led to gaps in information in some records that we saw.
  • Senior leaders were not always visible and some had limited capacity due to multiple roles.
  • New pathways were not dated or referenced with up to date evidence.
  • Staff had a poor understanding of female genital mutilation, child sexual exploitation, the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Leaders had told us that all staff had been trained in these areas.
  • Medical staff vacancy rates in obstetrics and gynaecology were above the national average, leading to cancellation of clinics.
  • There was no awareness, amongst staff, of major incident plans or roles that individuals would take should there be a major incident.
  • Midwives were not rotated to different areas, potentially resulting in loss of some skills.

However:

  • All staff considered patients’ needs, were respectful and caring in their interactions.
  • Staff were valued and respected. There was open and honest communication between staff and managers. Local leaders were visible and approachable.
  • Divisional leaders had a clear vision and strategy for maternity services.
  • Incident, comments and complaints processes were thorough; lessons were learned and disseminated well. However, the target to complete these was often missed.
  • Nursing and midwifery leaders were always available on the telephone or email.

We rated maternity and gynaecology as requiring improvement because:

  • Environmental checks were inconsistent. Systems for monitoring equipment safety were not robust.
  • Limited use of local audit meant that some outcomes with regards to patient safety, care and effectiveness were not fully understood. This was especially noticeable with regards to documentation and assessment.
  • Compliance with mandatory training modules remained below the trusts target of 90%.
  • Multiple sets of patient notes led to gaps in information in some records that we saw.
  • Senior leaders were not always visible and some had limited capacity due to multiple roles.
  • New pathways were not dated or referenced with up to date evidence.
  • Staff had a poor understanding of female genital mutilation, child sexual exploitation, the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Leaders had told us that all staff had been trained in these areas.
  • Medical staff vacancy rates in obstetrics and gynaecology were above the national average, leading to cancellation of clinics.
  • There was no awareness, amongst staff, of major incident plans or roles that individuals would take should there be a major incident.
  • Midwives were not rotated to different areas, potentially resulting in loss of some skills.

However:

  • All staff considered patients’ needs, were respectful and caring in their interactions.
  • Staff were valued and respected. There was open and honest communication between staff and managers. Local leaders were visible and approachable.
  • Divisional leaders had a clear vision and strategy for maternity services.
  • Incident, comments and complaints processes were thorough; lessons were learned and disseminated well. However, the target to complete these was often missed.
  • Nursing and midwifery leaders were always available on the telephone or email.

Medical care (including older people’s care)

Updated 8 August 2017

We carried out a focused inspection on 11 and 12 April 2017 to review concerns found during our previous comprehensive inspection on 22 to 25 November 2016. We inspected one part of the five key questions but did not rate it. We observed the following improvement to the endoscopy suite since our last inspection:

  • Appropriate systems were in place for the management of controlled drugs within the endoscopy unit.

However, we also found that:

  • Not all staff had completed their medicines’ management training in the medical care service. Figures from the trust showed a completion rate of 30% against a trust target of 90%. This meant that not all staff had up-to-date knowledge relating to potential risks associated with medicines.
  • The Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) training was mandatory training and only 33% of medical care staff were up-to-date on this training. This was below the trust target of 90%.

Diagnostic imaging

Requires improvement

Updated 5 June 2018

We previously inspected diagnostic imaging jointly with outpatients and therefore, ratings cannot be directly compared to this core service only.

We have rated the service as requires improvement because:

  • The service failed to meet trust targets for most mandatory training topics, including safeguarding adults and children and Mental Capacity Act 2005.
  • Appraisal rates for all staff groups were below the trust target.
  • Patients could not always access the service when they needed it. Waiting times for referral to treatment and reporting on investigations were variable.
  • Reporting times were not consistently within targets.
  • There was limited engagement with patients and service users.

However:

  • Equipment and premises were clean.
  • The service had enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and abuse and to provide the right care and treatment. The service outsourced activity to ensure timely treatment was provided.
  • There were processes in place to store, administer and manage medicines.
  • Patient safety incidents were reported, investigated and any learning shared across all areas.
  • Care and treatment was provided in line with national guidance. Policies and procedures were up to date.
  • There was effective team working across all staff groups.
  • Staff were compassionate and caring.
  • Patients and their relatives were included in care and treatment and provided with support throughout investigations.
  • Patients were able to access services across all sites.
  • Complaints and concerns were investigated fully and actions taken to reduce reoccurrence.
  • The service had managers with the right skills and abilities to run a service providing high-quality sustainable care. Managers promoted a positive culture that supported and valued staff.
  • Staff were generally happy with their work and the team.
  • There was a strong culture for delivering high-quality care.
  • The service had effective systems for identifying risks, planning to eliminate or reduce them, and a systematic approach to continually improving the quality of its services.
  • The service was committed to improving services by learning from when things go well and when they go wrong.

Urgent and emergency services (A&E)

Inadequate

Updated 5 June 2018

  • There was no documented local strategy for the MIU. A divisional strategy was being developed for the urgent care division; however, this had not been finalised or implemented.
  • Information was not always collected, analysed, managed and used well to support activity. Information on MIU performance was not readily accessible.
  • The MIU did not have a systematic programme of clinical audit and local audit and processes in place to review what action should be taken. Performance could not always be reviewed due to poor data management.
  • The unit did not have a compliant mental health room, in line with guidance in the Royal College of Emergency Medicine toolkit, Mental Health in Emergency Departments 2013.
  • Records of some patients’ care and treatment were not clear or up-to-date. Computer screens displaying patient details were sometimes left on in empty treatment rooms and at the nurses station.

  • The MIU had not achieved the trust target of 90% for staff annual appraisals.
  • There was limited use of national and local audit to monitor performance and drive improvement.

However:

  • Staff were compassionate and caring. Patients were positive about the service and the care they received.
  • All areas of the MIU were visibly clean and staff observed infection control measures.
  • We saw effective team working across the unit and with other areas in the hospital.
  • People could access the service when they needed it. Waiting times from treatment and arrangements to treat and discharge patients were in line with good practice.
  • The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and abuse and to provide the right care and treatment. The service outsourced activity to ensure timely treatment was provided.
  • There were processes in place to store, administer and manage medicines.
  • Patient safety incidents were reported, investigated and any learning shared across all areas.
  • Care and treatment was provided in line with national guidance. Policies and procedures were up to date.

Minor injuries unit

Updated 8 August 2017

We carried out a focused inspection on 11 and 12 April 2017 to review concerns found during our previous comprehensive inspection on 22 to 25 November 2016. We inspected one part of the five key questions but did not rate it. We found that:

  • Resuscitation equipment was not fit for purpose in an emergency situation. The defibrillator was not ready for use, as the electronic pads had expired at midnight on the night before our inspection.
  • The unit had a process in place for the monitoring of fridge temperatures where medicines were stored. However, there was no evidence of follow-up processes when areas of concern had been highlighted.

Surgery

Inadequate

Updated 5 June 2018

  • The service provided mandatory training in key skills to all staff but did not ensure all staff completed it. For some essential skills, including resuscitation training, fire and infection control, compliance fell short of the trust target. Most nursing staff had received safeguarding training on how to recognise and report abuse. However, not all medical staff had completed training to the required level. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
  • Some areas did not have enough nursing staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and abuse and to provide the right care and treatment.
  • The service did not have robust processes in place to ensure staff were competent for their roles.
  • Not all staff had received an appraisal. Not all staff received supervision to provide support and monitor the effectiveness of the service.
  • Effective systems were not always used to recognise and respond to deteriorating patients’ needs.
  • Not all staff had received training in the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards. Staff generally understood their roles and responsibilities under the Mental Health Act 1983 and the MCA.

  • The trust planned but did not provide services in a way that met the needs of local people.
  • Patients could not access the service when they needed it. Waiting times for treatment were not in line with good practice. The percentage of patients whose operation was cancelled and were not treated within 28 days was worse than the national average.
  • The service did not have a documented vision for what it wanted to achieve. However, plans for the future vision were in development with involvement from staff, patients, and key groups representing the local community.
  • The service had a systematic approach to continually monitor the quality of its services, however, this was not fully embedded.
  • Staff recognised incidents but did not always report them. Managers investigated reported incidents and there were systems in place to share lessons learned when incidents had been reported.
  • Not all systems in place were effective in recognising and responding to deteriorating patients’ needs. This included screening patients for sepsis, harm reviews of patients waiting for a procedure, and reassessment within 24 hours for venous thromboembolism.
  • Information was not always collected, analysed, managed and used well to support activity.
  • Continuous improvement, and learning from when things go wrong was not evident across all areas.

However:

  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
  • The service generally controlled infection risk well. Most staff kept themselves, equipment and the premises clean. Some control measures were in place to prevent the spread of infection.
  • The service had suitable premises in most areas and systems were in place to ensure equipment was well looked after.
  • Most areas had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and abuse and to provide the right care and treatment.
  • Staff kept appropriate records of patients’ care and treatment. Records were clear, up-to-date and available to all staff providing care.
  • The service provided care and treatment based on national guidance and evidence of its effectiveness.
  • The service managed patients’ pain effectively and provided or offered pain relief regularly.
  • Staff generally gave patients enough food and drink to meet their needs and improve their health.
  • The service monitored the effectiveness of care and treatment and used the findings to improve them.
  • The service took account of patients’ individual needs.
  • Multidisciplinary staff worked together as a team to benefit patients.
  • 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 involved patients and those close to them in decisions about their care and treatment
  • Managers across the service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.

Services for children & young people

Requires improvement

Updated 5 June 2018

  • The trust provided mandatory training in key skills to all staff but data provided showed they did not ensure staff completed it. The trust identified issues with data quality which may have resulted in under reporting of the actual position.
  • Staff understood the need to protect patients from abuse, but had not always completed training at the appropriate level to ensure they had the appropriate level of knowledge to do so.
  • Although the environment was generally well maintained, equipment in the outpatient areas did not have up to date electrical safety checks.
  • Staff had access to policies and procedures based on national guidance and the service had an annual audit plan. However, there were few audits which considered the effectiveness of children’s outpatient services.
  • The facilities and premises were not always suitable for the service being delivered. More than two thirds of children were seen in adult outpatient areas. Play specialists were not available to support children in outpatient clinics.
  • Staff assessed children’s and young people’s pain in the day surgery unit and provided pain relief. However, we could not find evidence they monitored its effectiveness and in the fracture clinic where children and young people were seen, children’s pain was not assessed.
  • The service had systems to monitor the effectiveness of care and treatment for inpatients and used the findings to improve, but there was little monitoring of outcomes of outpatient care.
  • Waiting times targets from referral to treatment were not met in specialties where children were seen in adult services. Waiting times within the clinics were not monitored.
  • The service had a vision how children’s services would be configured in the future and what it wanted to achieve, but did not have a documented strategy or action plan to enable the vision to be realised.
  • Governance processes were becoming more established and had improved since the inspection in November 2016. However, there was little engagement and involvement of nursing staff at clinic level in governance processes and no flow of information between directorates.
  • The service did not have effective systems for identifying risks, and coping with the unexpected. They measured key performance indicators on a monthly basis but there was little evidence of improvement in some indicators over the period of a year.

However:

  • 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.
  • The service took account of patient’s individual care and support needs.
  • The service had measures to control infection risk. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection.
  • The trust had suitable arrangements in place for the ordering, dispensing, prescribing, recording and handling of medicines.
  • Staff recognised incidents and reported them appropriately. Managers investigated incidents and provided feedback to staff. When things went wrong, staff apologised and gave patients honest information and suitable support.
  • Children and young people were supported to make decisions. Consent to care and treatment was provided in line with legislation and guidance. Staff were aware of their roles and responsibilities under the Mental Capacity Act 2005 (MCA). However, staff completion of training in the MCA was low and no audits of consent were completed
  • The service engaged with children and young people using the service effectively. Staff showed an enthusiasm for their roles and a commitment to improving services for the benefit of patients.