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Inspection Summary


Overall summary & rating

Good

Updated 18 June 2019

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

  • The services had enough staff with the right skills and training with managers who supported and monitored their performance.
  • The services managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learnt. When things went wrong, staff apologised and gave patients honest information and suitable support.
  • There was good multidisciplinary working. When people received care from a range staff, teams or services, it was co-ordinated.
  • People were supported, treated with dignity and respect and were involved as partners in their care. People were treated with kindness during all interactions with staff and relationships with staff were positive.
  • Most leaders were visible and approachable. Leaders modelled and encouraged compassionate, inclusive and supportive relationships among staff so that they felt respected, valued and supported.
  • The trust engaged well with patients, staff, the public and local organisations to plan and manage appropriate services.

However:

  • Staff did not always store patients care records in a way which protected patient confidentiality.
  • In the surgical wards and theatres, medicines were not stored safely or managed at all times.
  • The use of the five steps to surgery safety checks were not completed in line with practice guidelines.
  • For patients undergoing surgical procedures, risk assessments were not always completed, and actions were not taken to mitigate potential risks.
  • Not all equipment for providing care and treatment across the services was maintained and therefore safe for use.
  • The emergency department did not always provide a suitable, safe, risk assessed environment for patients with acute mental health needs.
Inspection areas

Safe

Good

Updated 18 June 2019

Effective

Good

Updated 18 June 2019

Caring

Good

Updated 18 June 2019

Responsive

Good

Updated 18 June 2019

Well-led

Good

Updated 18 June 2019

Checks on specific services

Medical care (including older people’s care)

Good

Updated 18 June 2019

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

The hospital delivered safe care in an environment that was suitable and looked after well.

  • Leaders on the wards had the skills, knowledge, experience and integrity they needed to fulfil their roles.
  • We could see how nurse led roles, rota changes, and adaptations and recruitment were planned and discussed to combat nurse staffing shortfalls.
  • The service provided care and treatment based on national guidance and monitored evidence of its effectiveness.
  • Overall outcomes were positive for those patients accessing the hospital. Managers monitored the effectiveness of care and treatment and used the findings to improve them.
  • The trust had processes to ensure care and treatment was aligned with current evidence-based practice.
  • Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.
  • The trust planned and provided services in a way that met the needs of local people and took account of patients’ individual needs.
  • People could access the service when they needed it. Average length of stay for patients at the hospital and waiting times from referral to treatment were in line with in line with national targets.
  • Leaders across the wards at had the skills, knowledge, experience and integrity they needed to fulfil their roles. Local nursing leaders at ward level were experienced and were knowledgeable about the needs of the patients they treated.
  • Staff told us the leadership on their wards and departments was supportive. Staff were complimentary about their ward leaders and senior executive teams and said they visible and approachable.
  • The trust had a clear vision and a credible strategy to deliver good quality care. Staff on the wards and departments were aware of the trust values.

However

  • The service provided mandatory training in key skills to all staff but not everyone had completed it.
  • On occasion we saw that staff did not always wear the appropriate personal protective equipment and wash their hands in line with national standards.
  • Not all staff had received their appraisal.
  • The average length of stay for medical elective patients was significantly higher than the national average but the trust recognised this and had opened a therapy/nurse led unit which focused on rehabilitation.
  • Not all complaints were closed in line with trust’s expected time frame.

Services for children & young people

Good

Updated 20 June 2014

Services for children and young people were good throughout. Most parents told us the staff were caring, and we saw that children and their parents and carers were treated with dignity, respect and compassion. Ward areas and equipment were clean. There were enough trained staff on duty to ensure that safe care could be delivered. There were thorough nursing and medical handovers that took place between shifts to ensure continuity of care and knowledge of patient needs.

The services were responsive to the needs of children and young people and their families and carers. The ward sisters communicated well with staff, and staff were positive about the service and quality. Children’s experiences were seen as the main priority. Staff felt supported by their managers and were encouraged to be involved in discussing their ideas for improvements.

Critical care

Good

Updated 20 June 2014

Patients we spoke with gave us examples of the outstanding care they had received in the unit. Staff built up trusting relationships with patients and their relatives by working in an open, honest and supportive way. There was strong local leadership of the units. Openness and honesty was encouraged at all levels.

The unit had an annual clinical audit programme to monitor how guidance was adhered to. All staff, including student nurses, were involved in quality improvement projects and audit. There was good multidisciplinary team working. Patients underwent an assessment of their rehabilitation needs within 24 hours of admission to the unit, and the subsequent plan for their rehabilitation needs was clearly documented in the notes.

End of life care

Outstanding

Updated 18 June 2019

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

  • The service protected patients with a strong comprehensive safety system with a focus on openness, transparency and learning when things went wrong.

  • Patients could transition seamlessly between services because there was good advance care planning and information sharing between teams.
  • There was a genuine open culture in which all safety concerns raised by staff and patients were highly valued as being integral to learning and improvement.
  • The continuing development of the staff’s skills and knowledge was recognised as being integral to ensuring high quality care. Staff were proactively supported and encouraged to acquire new skills, use their transferable skills and share best practice. Chaplaincy volunteers were proactively recruited and supported in their role.
  • There was a strong, visible person-centred culture. Staff were highly motivated and inspired to offer care that was kind and promoted peoples’ dignity. Relationships between people in the service, those close to them and staff were strong, caring respectful and supportive. These relationships were highly valued by staff and promoted by leaders.
  • There was a proactive approach to understanding the needs and preferences of different groups of people and to delivering care in a way that met these needs, which was accessible and promoted equality. This included people with protected characteristics under the equality act, people who are approaching end of life and people in vulnerable circumstances who had complex needs.
  • There was compassionate inclusive and effective leadership at all levels. Leaders at all levels demonstrated high levels of experience, capacity and capability needed to deliver excellent and sustainable care. There was a deeply embedded system of leadership development and succession planning, which aimed to ensure that the leadership represented the diversity of the workforce.

Maternity and gynaecology

Good

Updated 20 June 2014

The ward areas were modern and clean. Women and their partners said that the staff were caring and friendly. Women were encouraged to discuss their plans and choices with their midwife and to be actively involved in the planning and decision making. The average ratio of births to midwives was higher than the national average, but this had improved recently. There were, however, some comments from women on the postnatal ward about insufficient staff and staff being under pressure.

There was good multidisciplinary team working and learning throughout the service. Staff development and continuing professional development in general was a priority within the service.  The leadership of the service was described as strong and effective. The head of midwifery and her team were well focused and fully engaged.   Reporting arrangements to the board and within the division required improvement and the service did not have a strategy to develop its services. There was a risk management strategy to manage operational and performance risks.  Risks were appropriately managed although the the lack of available postnatal care beds was not identified as a risk. Staff were good at implementing innovations in care.

Spinal injuries

Good

Updated 20 June 2014

The NSIC is a national centre for spinal injuries and develops guidelines for other units in the UK to follow. It has been internationally accredited. Staff built up trusting relationships with patients and their relatives through their interactions. Patients and relatives told us that they received considerable support. There was a sense of belonging for them. Care plans for patients with spinal injury identified goals set by the patients and these were monitored by them in partnership with the staff. There was support for current patients from former patients of the unit.

Staff within the Centre spoke positively about the service they provided for patients. There was enthusiasm and energy for providing a high quality of care for patients with spinal injury. The drive to recruit more nurses and healthcare assistants was seen as an example of positively and making a difference to the culture within the service.

Surgery

Good

Updated 18 June 2019

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

The surgical services at Stoke Mandeville Hospital were divided into care groups, according to speciality. A clinical director, general manager and matron managed each care group. The surgical service included the operating theatres, the surgical wards, recovery units and pre-operative assessment unit.

The Care Quality Commission (CQC) carried out an announced inspection of the trust between 19 to 21 February 2019.

We observed care and treatment and we spoke with 17 patients, carers and their relatives. We also spoke with approximately 35 staff members including senior managers, matrons, ward managers, theatre managers, consultants, doctors, nurse practitioners, registered nurses, agency staff health care assistants, physiotherapists, occupational therapists, pharmacy staff, ward clerks, housekeepers, porters and domestic staff.

We reviewed 19 patients’ records, including risk assessments, elective surgery care pathways, care plans, medicines charts and other records pertaining to the service.

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

  • Staff followed their internal procedures for reporting incidents. These were investigated, and lessons learnt were shared with the staff across the other directorates.
  • Staff had clear understanding about their safeguarding responsibilities and were confident about actions they would take if they had any concern about a woman’s wellbeing
  • Actions were taken to improve service provision in response to feedback, incidents investigations and complaints received.
  • The service provided care and treatment that was based on national guidance and monitored its application in practice.
  • Arrangements were in place for the prevention and control of infection. The service carried out regular audits and outcomes were shared with the staff. Action plans were developed to address any shortfalls in infection control management.
  • Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
  • Patients were treated with care and compassion; carers and relatives were involved as appropriate in the care and treatment. Feedback we received in relation to patients’ care was consistently positive.
  • The service planned and delivered care based on the identified needs of both the immediate community and wider community it served.
  • Information on how to raise concerns and complaints was available. Complaints were investigated and learning from them was shared with staff.
  • Patients told us their pain was manged effectively and they received pain control as needed.
  • Managers at local levels in the trust had the skills to manage the service providing quality and sustainable care.
  • The service worked with the trust’s vision and strategy was understood by staff and staff said they were supported by their managers.

However:

  • Medicines including emergency medications were not always stored in line with manufacturer’s guidance and regulations.
  • The service did not manage control drugs effectively in one of the operating theatres. This was not in line with regulations and guidelines.
  • All necessary checks such as World Health Organisation surgical safety checklists, the five steps to safer surgery were not always adhered to which may pose risks to patients’ safety. The service did not use the Local Safety Standards for Invasive Procedure checklists.
  • Equipment checks were not consistently undertaken which may pose a risk as it may not be fit for use when needed in an emergency.

Records were not fully completed, missing information included assessments for blood clots and malnutrition risk assessments.

Urgent and emergency services

Good

Updated 18 June 2019

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

  • The service effectively controlled all infection risks.
  • The service had a good approach to anticipating and managing risks to people who used the service, and they managed patient related safety incidents well.
  • There were enough staff with the right qualifications and skills. The training they received helped them to protect patients form avoidable harm and to keep people safe.
  • The service provided care and treatment based on national guidance and could evidence its effectiveness.
  • There was a multidisciplinaryapproach to working in the service. Staff of different roles worked together as a team to benefit patients and supported each other to provide good care.
  • Staff cared for patients with compassion. Feedback from patients, and those close to them, was positive and confirmed that staff treated them with kindness.
  • The services provided reflected the needs of the local population and considered patients’ individual preferences and choices.
  • Most patients were able to access the service in a timely way.
  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with staff.
  • There was strong leadership in the emergency department with leaders having an inspiring shared purpose and strove to deliver and motivate staff to succeed.
  • The governance processes enabled the service to monitor its standards and performance.
  • The department was forward looking, promoting training and research and encouraging innovations to ensure improvement and sustainability of the service.

However,

  • The service did not provide consultant presence 16 hours a day in line with the Royal College of Emergency Medicine’s recommendations.
  • There was lack of a dedicated safe space for assessing patients with mental health needs.
  • Patient’s records were not always completed fully or stored securely.

Hospice services for adults

Good

Updated 18 June 2019

We previously inspected the Florence Nightingale Hospice within the acute End of Life Care core service, so we cannot compare our new ratings directly with previous ratings.

We rated it as good because:

  • The service provided mandatory training in key skills to all staff and made sure everyone completed it.
  • 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 controlled infection risk well. Staff kept themselves, equipment and the premises clean.
  • Staff completed and updated risk assessments for each patient. They kept clear records and asked for support when necessary.
  • The service had enough nursing staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.
  • The service had enough medical staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.
  • Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date and easily available to all staff providing care.
  • Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date and easily available to all staff providing care.
  • The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.
  • The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.
  • Staff gave patients enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary. The service made adjustments for patients’ religious, cultural and other preferences.
  • Staff assessed and monitored patients regularly to see if they were in pain. They supported those unable to communicate using suitable assessment tools and gave additional pain relief to ease pain.
  • 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 made sure staff were competent for their roles. Managers appraised staff’s work performance and clinical supervision meetings were available to staff to provide support and monitor the effectiveness of the service.
  • Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. They followed the trust policy and procedures when a patient could not give consent.
  • Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness. All the patients and relatives we spoke with told us they were very happy with their treatment all saying the doctors and nurses all contribute to their care and wellbeing in an outstanding way.
  • Staff provided emotional support to patients to minimise their distress. Patient’s individual concerns were identified and responded to in a positive and reassuring way. A patient and their relative described the hospice as an “Oasis of calm”.
  • Staff involved patients and those close to them in decisions about their care and treatment. It was clear from observing that interactions between patients and relatives they trusted the medical and nursing staff. Patients told us they were treated as individuals and that they felt listen too.
  • The trust planned and provided services in a way that met the needs of local people.
  • The service took account of patients’ individual needs. Patients who were receiving EoLC where identified by a ‘Purple Rose.
  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with all staff.
  • Managers at all levels in the service had the right skills and abilities to run a service providing high-quality sustainable care.
  • The service had a vision for what it wanted to achieve and workable plans to turn it into action.
  • The service used a systematic approach to continually improve the quality of its services.
  • The service had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected.
  • Managers across the service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.

However

  • The service had suitable premises and equipment and looked after them well. However, the hospice did not record temperatures of the chilled room, which meant the service could not be assured the deceased appearance, condition and dignity was preserve or what actions they would need to take if the chilled room temperature became out of range.
  • Managers monitored the effectiveness of care and treatment, through national audits, and used the findings to improve them. However, they were not undertaking local audits which meant they could not compare local results to learn from them.
  • The service could not be assured people could access the service when they needed it as the service did not record when they were not able to admit a patient when there were no beds available.

Outpatients

Good

Updated 18 June 2019

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

  • People were protected from avoidable harm and abuse. The department was sufficiently staffed and most of the team had received up-to-date mandatory training, including safeguarding. Premises were visibly clean and tidy. Staff were pro-active in managing risk, and patient records were completed appropriately. Incidents were reported and investigated.
  • Patients received effective care and treatment that met their needs. The trust had participated in a national benchmarking programme and was using the findings to make improvements to the service. Staff development was encouraged, and appraisals were up to date.
  • People were supported, treated with dignity and respect, and were involved as partners in their care. Patient survey results were good, and patients we spoke with were happy with their care. Staff were compassionate and helpful in their interactions with patients.
  • People’s needs were met through the way services were organised and delivered. The trust recognised where the service needed improving and was taking action to do so. People with particular needs were prioritised for appointment times and patients were told when appointment delays were longer than expected.
  • The leadership, governance and culture promote the delivery of high-quality person-centred care. The team felt supported by managers and were supportive of each other. Systems were in place with appropriate escalation processes for governance, quality and performance. There was a focus on continuous learning and improvement throughout the service.

However:

  • Confidential patient records were not always locked away or kept secure.