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Amersham Hospital Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 20 June 2014

Amersham Hospital was part of Buckinghamshire Healthcare NHS Trust. This hospital was a community hospital and provided medical care and outpatients services. These were two of the core services always inspected by the Care Quality Commission (CQC) as part of its new approach to hospital inspection.

This hospital had a total of 75 beds and specifically provided care for older people. It also offered inpatient services in dermatology and the Buckinghamshire Neurorehabilitation Unit (BNRU) for people with neurological and rehabilitation needs. There were outpatient clinics and these saw more than 47,000 outpatients a year.

We carried out this inspection because the Buckinghamshire Healthcare NHS Trust had been flagged as a potential risk on CQC’s intelligent monitoring system. The announced inspection took place between 18 to 21 March 2014 and an unannounced inspection visit took place between 6pm and 10pm on Saturday 29 March 2014.

Overall we rated this hospital as ‘Requires improvement’. We rated it ‘Good’ for caring for patients but it required improvement in providing safe and effective care, being responsive to patients’ needs and being well led.

Our key findings were as follows:

  • Staff were caring towards patients, and patients were treated with dignity and respect.
  • Staff followed infection control practices and infection rates in the hospital were similar to those of other trusts.
  • Patients were supported to eat and drink, where appropriate, and standards to ensure that patients were properly hydrated had improved.
  • Patients whose condition was deteriorating were identified and escalated appropriately and mortality rates were now within expected range.
  • Staffing levels were a concern because there were not always sufficient numbers of suitably qualified, skilled and experienced staff to meet the needs of older patients and medical emergencies out of hours were managed by 999 calls. Medical staffing for patients who required emergency care needed to improve. The trust was working to improve this situation.
  • There were not enough bath and shower facilities for patients on the older people’s wards.
  • There were security and safety concerns in the wards areas because fire cupboards and exits did not close properly.
  • Patients were treated according to national guidelines but these were not always properly reviewed or monitored.
  • Older patients living with dementia or a learning disability were not supported appropriately.
  • Outpatients services were safe and changes were being made to speed treatment for patients and bring care closer to people’s homes.
  • Outpatient clinic appointments were frequently cancelled at short notice and patients could wait a long time for consultations in busy clinic environments.

We saw areas of good practice including:

  • There was a multidisciplinary team approach in the Buckinghamshire Neurorehabilitation Unit to coordinate care. This included involving patients in setting their own treatment goals and outcomes for their care and rehabilitation.

There were areas of poor practice where the trust needed to make significant improvements.

Importantly, the trust MUST take the following actions:

  • Care plans need to be developed for all patients.

There were also areas of practice where the trust should take action which are identified in the report.

Professor Sir Mike Richards

Chief Inspector of Hospitals

- 12 June 2014

Inspection areas

Safe

Requires improvement

Updated 20 June 2014

Effective

Requires improvement

Updated 20 June 2014

Caring

Good

Updated 20 June 2014

Responsive

Requires improvement

Updated 20 June 2014

Well-led

Requires improvement

Updated 20 June 2014

Checks on specific services

Medical care (including older people’s care)

Requires improvement

Updated 20 June 2014

Patients received compassionate care and we saw that patients were treated with dignity and respect. There was regular monitoring of key safety measures, and ward areas and equipment were clean. However, staff vacancies meant that there were delays in patients receiving personal care. There was a lack of patient care plans, and there was a risk that patients could have inconsistent care due to staff, especially temporary staff, not being aware of individual care plans for their care. Risks were being managed but there was no procedure for sharing learning about incidents among the medical staff. Medical staffing for patients who required emergency care needed to improve.

Patients living with dementia had inconsistent support and there were discharge delays for patients with complex needs.

Outpatients

Requires improvement

Updated 20 June 2014

Patients received compassionate care and were treated with dignity and respect. Patients told us that staff were kind and supportive, and they felt fully involved in making decisions about their care. Medicines and prescription pads were securely stored. The outpatient areas we visited were clean.

However, many clinic appointments were cancelled at short notice. Clinics were busy and patients had to wait a long time. Patients and staff told us one of the biggest challenges was clinics running late. Outpatient clinics were over-booked; there was not enough time to see patients, so clinics often over-ran. Although there had been recent improvements, many staff, particularly in the general outpatient area, said they had not been listened to on key service changes and that outpatients had not been a priority for the trust.

Other CQC inspections of services

Community & mental health inspection reports for Amersham Hospital can be found at Buckinghamshire Healthcare NHS Trust.