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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 service 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.
  • The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance and ensured patients were offered nutritional support and adequate pain relief.
  • 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:

  • 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.
  • Staff did not always store patients care records in a way which protected patient confidentiality within the surgery department.
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.
  • 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.

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 annual appraisal.

Services for children & young people

Good

Updated 20 June 2014

Services for children and young people were good. Parents told us the staff were caring, and we saw that children and their parents and carers were treated with dignity, respect and compassion. The ward areas and equipment were clean. There were enough trained staff on duty to ensure that safe care could be delivered. Children were appropriately prepared for surgery and treatment and clinical outcomes were good.

The service was responsive to the needs of children and young people and their families and carers. Staff were positive the service and children’s experiences were seen as the main priority. The service did not have a strategy but there were actions around improving the service. The trust long term plans for the service were not clear to staff.

Critical care

Good

Updated 20 June 2014

Patients we spoke with gave us examples of the good care they had received. 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 units 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 were effectively monitored and clinical outcomes were good.

End of life care

Outstanding

Updated 18 June 2019

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

  • People are protected by a strong comprehensive safety system and a focus on openness, transparency and learning when things go wrong.
  • People are able to transition seamlessly between services because there is advance planning and information sharing between teams.
  • There is a genuine open culture in which all safety concerns raised by staff and people who use the service are highly valued as being integral to learning and improvement.
  • The continuing development of the staff’s skills and knowledge is recognised as being integral to ensuring high quality care. Staff are proactively supported and encouraged to acquire new skills, use their transferable skills and share best practice. Chaplaincy volunteers re proactively recruited and supported in their role.
  • There is a strong, visible person-centred culture. Staff are highly motivated and inspired to offer care that is kind and promotes peoples’ dignity. Relationships between people in the service, those close to them and staff are strong, caring respectful and supportive. These relationships are highly valued by staff and promoted by leaders.
  • There is a proactive approach to understanding the needs and preferences of different groups of people and to delivering care in a way that meets these needs, which is accessible and promotes equality. This includes people with protected characteristics under the equality act, people who are approaching end of life and people in vulnerable circumstances who have complex needs.

There is compassionate inclusive and effective leadership at all levels. Leaders at all levels demonstrate the high levels of experience, capacity and capability needed to deliver excellent and sustainable care. There is a deeply embedded system of leadership development and succession planning, which aims to ensure that the leadership represents 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. Midwifery staffing levels were appropriate and there were always experienced staff on every shift to women and provide one to one care.

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 head of midwifery and her team were well focused and fully engaged. The service did not have a strategy to develop its services and there were concerns about underused services at Wycombe Hospital and potential delays to transfer women who required urgent care to Stoke Mandeville Hospital. The service did have a strategy to manage operational and performance risks and risks were appropriately managed.

Surgery

Good

Updated 18 June 2019

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

The surgical services at Wycombe Hospital were divided into care groups, according to speciality. Each care group was managed by a clinical director, general manager and matron. 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 (staff knew we were coming) 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 improved. We rated it as good because:

  • Staff followed the trust’s internal procedures for reporting incidents. Incidents were investigated, and lessons learnt were shared with staff across surgical services and the directorates.
  • Staff had clear understanding about their safeguarding responsibilities and were confident about actions they would take if they had any concern about a patient’s wellbeing.
  • Actions were taken to improve service provision in response to feedback, incidents investigations.
  • 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 the local 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 managed 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 trust’s vision and strategy was understood by staff and staff said they were supported by their managers.

However;

  • The service did not manage medicines safely in line with regulations and guidance. Staff did not follow processes to keep patients safe and minimise the risks of medicines misappropriation when dispensing patients’ medicines in the day surgery unit.
  • Patients’ records were not always kept securely which may pose risks of unauthorised access to confidential information.
  • All necessary checks such as World Health Organisation surgical safety checklists, the five steps to safer surgery were not always adhered to and may pose risks to patients’ safety. The service did not use the Local Safety Standards for Invasive Procedure checklists.
  • Risk assessments were not consistently completed such venous thrombo- embolism VTE (blood clots). This may pose risks to patients as preventative measures may not be in place.
  • The service was not meeting their referral to treatment time which may impact on patients care, welfare and well- being.

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.