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Chorley and South Ribble Hospital Good

Inspection Summary


Overall summary & rating

Good

Updated 7 November 2019

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

  • The hospital had enough staff of most professions to care for patients and keep them safe. Most staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The hospital controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They generally managed medicines well. The hospital 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.
  • 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 hospital planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback.
  • 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 hospital engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However,

  • Patients could not always access services when they needed it. Patients waiting for emergency treatment had to wait longer than national standards and patients waiting for planned care had to wait longer than the England average.
  • In medical care records were not always stored securely and staff did not always document the time medicines had been administered.
  • In urgent and emergency care the trust did not have enough paediatric nurses to meet national standards. The service had put in place additional processes and staff training to mitigate the risks to paediatric patients.
  • Not all services were available seven days a week.
  • Some staff within medical care felt that leadership changes had slowed progress and development in the service.

Inspection areas

Safe

Good

Updated 7 November 2019

Effective

Good

Updated 7 November 2019

Caring

Good

Updated 7 November 2019

Responsive

Requires improvement

Updated 7 November 2019

Well-led

Good

Updated 7 November 2019

Checks on specific services

Medical care (including older people’s care)

Good

Updated 7 November 2019

Our rating of this service improved. 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.
  • 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.
  • 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.

However,

  • People could not always access the service when they needed it and had to wait for their treatment.

Critical care

Good

Updated 21 April 2017

We previously inspected the hospital in July 2014 and gave critical care services an overall rating of requires improvement. Following this inspection we have rated critical care services at Chorley and South Ribble Hospital overall as good because:

  • The critical care services were well led and staff were aware of the trusts vision and values.

  • We found that there were governance frameworks in place and risks were appropriately identified and monitored.
  • There was clear leadership throughout the service and staff spoke positively about their leaders.
  • Staff were able to report incidents and were knowledgeable about the types of incident they should report.
  • We saw evidence that learning from incidents and complaints was routine and this learning was disseminated.
  • Infection control was effectively managed and the department was visibly clean. Routine infection control audits were undertaken.
  • Nurse and medical staffing was sufficient to meet patient’s needs.
  • Patients received effective care and treatment that followed national clinical guidelines and was tailored to their individual needs.
  • This care was delivered by competent and professional staff.
  • The service participated in local and national audits.
  • Staff sought appropriate consent from patients before delivering treatment and care.
  • Staff treated patients with kindness, dignity and respect and provided care to patients while maintaining their privacy, dignity and confidentiality.
  • Patients spoke positively about the way staff treated them.

However:

  • Mandatory training uptake levels were low for some subjects, including safeguarding children and adult training.
  • Appraisal rates were low at 62% and this was a deterioration from the previous inspection.
  • Audits were not always followed up with action plans and a number of action plans had not been update for years in some cases.
  • The service, as a whole, was not meeting the Intensive Care Standards guidelines for 50% of nursing staff to have undertaken a post qualification course in critical care nursing.
  • There was limited monitoring of patient satisfaction.

End of life care

Good

Updated 14 November 2014

Care for patients at the end of life was supported by a consultant-led specialist palliative care team. Staff effectively followed end of life care pathways that were in line with national guidelines. Staff were clearly motivated and committed to meeting patients’ different needs at the end of life. Nursing and care staff were appropriately trained and supervised and they were encouraged to learn from incidents.

The palliative care team staff were clear about their roles and benefited from good leadership. We observed that care was given by supportive and compassionate staff. People spoke positively about the care and treatment they received and they told us they were treated with dignity and that their privacy was respected. The nursing staff and doctors spoke positively about the service provided from the specialist team.

Surgery

Good

Updated 17 October 2018

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

  • We previously rated this service in April 2017, when we rated responsive as requires improvement. At this inspection we rated responsive as good. We also rated safe, effective caring and well-led as good.
  • Compliance rates with mandatory safeguarding training and staff appraisals had improved since the last inspection.
  • Staff across different disciplines worked together well to meet patients’ care and treatment needs.
  • Staff treated patients with compassion, dignity and respect and feedback from patients about staff was positive.
  • The service had improved compliance against 18-week referral to treatment standards and at this inspection referral to treatment time was similar to the England average.
  • We saw positive examples of the service engaging with the wider community including people with additional needs.

However:

  • The average length of stay from February 2017 to January 2018 for all non-elective and all elective patients was higher than the England average.
  • The service cancelled elective orthopaedic surgery for two weeks in April 2018.

Urgent and emergency services

Good

Updated 7 November 2019

Our rating of this service improved. 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. Most people could access the service when they needed it and received the right care promptly. Waiting times from referral to treatment were in line with national expectations for paediatric patients.
  • 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.

However;

  • The service did not meet national guidelines for the recommended number of trained paediatric trained nurses on each shift. The service had put in place additional processes and staff training to mitigate the risks to paediatric patients.
  • Waiting times for all patient groups were not always in line with national expectations, although the service performed better than the national average. The arrangements for triage of patients were not always in line with national expectations but the service demonstrated an improving trend in triage times in recent months.

Maternity

Good

Updated 17 October 2018

We previously inspected maternity jointly with gynaecology so we cannot compare our new ratings directly with previous ratings.

We rated it as good because:

  • All managers and staff displayed a caring approach to patients. All staff treated patients with compassion, dignity and respect.
  • Staff involved patients in decisions about their care and treatment including their emotional, physical and social wellbeing,
  • Patients and carers, we spoke with all gave positive feedback about the care they received from all staff.
  • Staff morale was good and staff reported feeling supported by their immediate line managers and colleagues.
  • Joint working between hospital and community services had improved since our last inspection.
  • Safeguarding systems were in place and guidelines followed well by staff. There was a system in place for protecting babies from abduction.
  • There were clear systems in place for reporting incidents and managing identified risks within the service.
  • Processes were in place for ordering and recording medications. Medicines were stored and dispensed correctly.
  • Infection control rates were better than the national average.

However:

  • Women’s postnatal records were not always kept in a secure way. This meant that patient confidentiality could not always be assured.
  • Hazardous substances were not always stored securely a way which protected patients from possible harm.
  • Not all resuscitation equipment used by community midwives was within the manufacturer’s expiry dates. This meant that the effectiveness of this equipment could not be assured when it was needed.
  • There were significant staffing vacancies and sickness and absence rates due mainly to staff on maternity leave. Managers were aware of midwifery vacancy rates and a programme of recruitment was underway. Measures had been put into place to mitigate risk and manage staffing shortfalls.
  • Current processes for reviewing trust policies did not ensure they were reviewed in a timely way. A third of all trust policies were past their review date. The policies we saw which were over their review date remained relevant.

Outpatients

Good

Updated 17 October 2018

We previously inspected outpatients jointly with diagnostic imaging in September 2016, so we cannot compare our new ratings directly with previous ratings.

We rated the service as good because:

  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
  • Care and treatment was delivered in line with best practice guidance. Patient outcomes were reviewed during clinic appointments to make sure patients were receiving appropriate care and treatment.
  • Staff demonstrated a consistently caring attitude to supporting patients that was compassionate and kind. Patients’ dignity was always maintained.
  • Staff of different kinds worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.
  • The service had managers at all levels with the right skills and abilities to run a service providing high-quality sustainable care.
  • Patients could access care and treatment in a timely manner.
  • Staffing numbers and skills were flexibly managed to make sure there was sufficient staff to support the clinics as needed.
  • There was a clear strategy based on best practice and values that assisted the service in developing quality care and treatment.
  • The service had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected.

However:

  • The assessment and recording of a patient’s mental capacity and staff understanding of the Mental Capacity Act 2005 was not always consistent.
  • Systems designed to flag patients needing extra support were not consistently used.
  • Information for patients was not always available in formats that met their needs
  • Patient records were variable not all records were clear and up to date.