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The Princess Royal Hospital Inadequate

Inspection Summary


Overall summary & rating

Inadequate

Updated 29 November 2018

Our rating of services went down. We rated them as inadequate because:

  • Our rating of safe was inadequate overall. At times of high operational pressures patients were not always assessed and treated in a safe and suitable environment. Services did not always manage patient safety incidents well. The deteriorating patient was not always recognised within urgent and emergency care services to ensure appropriate and timely care was provided. Not all services had sufficient numbers of permanent staff with the right qualifications, training and experience to keep people safe from avoidable harm and abuse. Staff completion data for mandatory training did not meet the trust targets, including Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards. There was no data available for adult safeguarding training for medical staff.
  • Our rating of effective remained requires improvement overall. Services monitored the effectiveness of care and treatment and used the findings to improve them. However, effective action was not always taken in response to poor audit results to drive improvement.
  • Our rating of caring remained as good overall. Staff delivered compassionate care, however we did see examples where compassionate care was not delivered in a consistent manner. Privacy and dignity was maintained and promoted by most services, however we found the trust’s approach to boarding meant patients’ dignity was not always promoted.
  • Our rating of responsive remained as requires improvement overall. The trust did not always plan and provide services in a way that met the needs of local people. Not all services always took into account the individual needs of patients.
  • Our rating of well-led went down to inadequate overall. Staff reported a disconnect between them and the senior management team and board. There were systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected. However, timely and effective action was not always taken to mitigate risk. The trust did not always use a systematic approach to continually improve the quality of its services or safeguard high standards of care by creating an environment in which excellence in clinical care would flourish.
Inspection areas

Safe

Inadequate

Updated 29 November 2018

Effective

Requires improvement

Updated 29 November 2018

Caring

Good

Updated 29 November 2018

Responsive

Requires improvement

Updated 29 November 2018

Well-led

Inadequate

Updated 29 November 2018

Checks on specific services

Critical care

Requires improvement

Updated 29 November 2018

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

  • Mandatory training compliance levels for medical staff were significantly lower than the trust’s target.
  • Medical staffing levels had not improved since our previous inspection and so were not in line with the required standards which meant that people did not always receive safe care and treatment or experience continuity of care in relation to medical personnel.
  • Arrangements for the ward round did not always include multidisciplinary input.
  • Recommended guidelines relating to allied health professional staffing levels were not met.
  • The critical care outreach service did not operate 24 hours a day.
  • The hospital at night team did not always ensure a safe service.
  • Delivery of people’s care, treatment and support was not always in line with legislation, standards and evidence based guidance.
  • The rehabilitation needs of patients were not always addressed which could lead to less favourable outcomes.
  • The collection and monitoring of information about the outcomes of people’s care and treatment was limited.
  • Participation in quality improvement initiatives was limited and there was little evidence relating to benchmarking, accreditation schemes, peer review, research or trials.
  • There was limited evidence relating to participation in a comprehensive programme of clinical audit which specifically related to critical care.
  • Less than 50% of nursing staff had achieved their post registration qualification in critical care nursing.
  • Services were not always available to patients seven days a week.
  • Staff compliance with Mental Capacity Act (MCA) and Deprivation of Liberty training was extremely low.
  • The service did not always identify how it could be developed or improved when patient needs were not addressed.
  • Timely access to initial assessment, test results, diagnosis and treatment was not always possible.
  • Discharge from the critical care unit was not always in accordance with national standards and did not always take place at appropriate times or place.
  • Patient diaries were not in use on the unit.
  • Patients did not have access to formal counselling services for patients.
  • Managers had the right skills and abilities to provide the service but there was lack of overarching managerial arrangements to ensure a coordinated critical care service across both the trust’s hospitals to provide a safe, high-quality and sustainable care.
  • The challenges to quality and sustainability were known to leaders but the actions needed to address them were not being implemented promptly.
  • There was a lack of clinical leadership and it was unclear as to whether there were priorities for ensuring sustainable and effective leadership within the critical care unit.
  • Limited action was being taken to improve the service and there did not appear to be an immediate vision for the critical care unit.
  • The long-term vision and strategy was known to staff but it was unclear as to whether they had collaborated with leadership in shaping them.
  • Structures, processes and systems of accountability to support the delivery of the strategy and good quality, sustainable services were unclear.
  • Governance and management systems were not functioning effectively or interacting with each other appropriately.
  • It was unclear whether there were comprehensive assurance systems or whether performance issues were escalated appropriately through clear structures and processes.
  • There were not always clear and robust service performance measures which were always reported and monitored.
  • The service’s approach to service delivery and improvement was inconsistent.

However;

  • Regular updates and training in the systems and processes were provided to staff which helped to keep people safe and Mandatory training compliance was in line with trust targets.
  • People were protected from abuse, neglect, harassment and breaches of their dignity and respect due to the services safety and safeguarding systems.
  • The service maintained high standards of cleanliness and hygiene.
  • The premises and facilities of the critical care unit were generally designed, maintained and used to keep people safe.
  • Maintenance and use of equipped appeared safe.
  • Risk assessments carried out on people who used services were comprehensive.
  • The planning and review of nursing staffing and skill mix usually ensured people received safe care and treatment.
  • People’s individual care records, including clinical data, were written and managed in a way that kept people safe.
  • Medicine management arrangements kept people safe as they were recorded, administered and stored appropriately.
  • There was a low number of serious incidents.
  • Prevalence of patient harm was recorded using the Safety Thermometer and it was also used to provide immediate information and analysis for frontline teams to monitor their performance in delivering harm free care.
  • Physical, mental health and social needs of patients were holistically assessed.
  • Good patient outcomes in relation to mortality and unplanned readmissions to the unit were being achieved.
  • The National Organ Donation programme was in operation within the trust.
  • Nutrition and hydration needs were identified, monitored and met.
  • Pain was effectively assessed and managed.
  • The critical care unit was involved in the local critical care network.
  • The assessment, planning and delivery of care involved necessary staff, including those in different teams, services and organisations.
  • The relevant consent and decision-making requirements of legislation and guidance, including the Mental Capacity Act 2005, was understood by staff.
  • The personal, cultural, social and religious needs of patients were understood and respected by staff and were considered when delivering care.
  • Staff took time to interact with patients and those close to them, in a respectful and considerate manner.
  • Patients’ privacy and dignity was always respected, including during physical and intimate care.
  • Patient confidentiality was respected by ensuring conversations took place in private or when at the bedside.
  • Care, treatment and condition was understood by patients.
  • The impact a patient’s care, treatment and condition had on their wellbeing and on those close to them was understood by staff.
  • Carers were treated as important partners in the delivery of patient care.
  • A sensitive approach to relatives was taken when a patient might be a possible eligible organ donor.
  • Patients’ health needs could be addressed on the unit as appropriate equipment was available.
  • Services were delivered, made accessible and coordinated to take account of the needs of different people.
  • Some action was being taken to minimise the length of time people had to wait for care, treatment and advice.
  • Complaints were handled effectively and confidentially, with regular updates provided and a formal record being kept.
  • Local leaders were visible and approachable.
  • The trust had a clear set of values, with quality and sustainability as the top priorities.
  • Staff felt supported, respected, valued and proud to work in the organisation.
  • Arrangements for identifying and recording risks were in place and there was an alignment between recorded risks and what staff say is on their worry list.
  • The service gathered people’s views and experiences to shape and improve the service and culture.

Outpatients and diagnostic imaging

Good

Updated 20 January 2015

Overall, we rated this service as good. During the inspection we did identify a small number of areas where the trust could improve. Outpatients and diagnostic services were safe; the trust had prioritised statutory training; however, refresher mandatory training had not been completed by the majority of staff. Staffing levels were in line with national guidance.

We saw good practice and effective, compassionate care. Patients were very complimentary about all the staff they had come into contact with. We found that clinics followed national guidance and good practice relative to their individual specialities.

Diagnostic services at the Princess Royal Hospital did not have access to a screening room which was suitable for paediatric services. We saw how a patient who might have benefited from appropriate screening equipment had to undergo an alternative treatment. Whilst the alternative had been safe and appropriate, staff told us that the method used would not have been their first choice had they had an option.

Services were managed well at a local level.

Urgent and emergency services

Inadequate

Updated 29 November 2018

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

The Emergency Department (ED) at Princess Royal Hospital had not fully addressed breaches of the Health and Social Care Act identified at the last CQC inspection in 2016. These included ensuring the room used for psychiatric patients was compliant with the Mental Health Act requirements, and ensuring the department achieved the Department of Health’s (DoH) standard of 95% patients being discharged, admitted or transferred within four hours of arrival.

Both medical and nurse staffing was not adequate to keep patients safe. The hospital was understaffed; with regular reliance on agency and locum staff. This meant that not all staff were equipped with the specific training and competencies to support patients; particularly overnight when staffing numbers were reduced. In addition, there was not an adequate provision of paediatric trained nurses as per national guidelines.

We found that infection prevention and control practices to be variable; particularly with regards to hand hygiene. In addition, aspects of the ED environment did not support safe care.

Both medical and nursing staff had not achieved mandatory training targets. In addition; safeguarding training levels did not meet the trust target.

Identifying and responding to deteriorating patients was variable. Whilst we observed good practice using nationally validated tools; we also observed cases where deteriorating patients had not been identified or treated in line with national guidance.

We observed staff who were not appropriately trained or competent were co-ordinating the department without local management support during times of staff shortages.

Royal College of Emergency Medicine (RCEM) Audit results for 2016 were poor. However, action plans had been produced and completed in order to improve these.

National targets around patient waiting times in ED were not achieved. For example, the target highlighted above of 95% of patients being discharged, admitted or transferred within four hours of arrival were consistently not achieved.

Complaints were not investigated in line with the trust policy with regards to the length of time to respond.

Morale amongst staff was low; the hospital had a high turnover of nursing staff and a higher sickness rate than the trust target.

The executive team were not consistently sighted on the department in terms of risks and changes. The risk register did reflect concerns we identified during the inspection; and actions were set against each risk. However, many of these risks were actively ongoing and had potential to affect patient safety at the time of our inspection.

Maternity

Requires improvement

Updated 29 November 2018

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

We rated it as requires improvement because:

  • Staff had not completed mandatory training in accordance with the trust’s target.
  • Staff had not completed adult safeguarding training in accordance with the trust’s target.
  • Staff had not completed Cardiotocograph training in accordance with the service’s target.
  • Community staff did not have all of the equipment needed to do their work in accordance with best practice.
  • Maternity Early Obstetric Warning Score (MEOWS) were not always fully completed.
  • High risk women in labour were not always reviewed regularly and by the appropriate member of staff.
  • The SBAR (situation, background, assessment, recommendation) forms were not always fully completed when midwives handed over care.
  • Prescription and observation charts were not stored confidentially they were left unattended at the midwives’ desk on the ward area.
  • The service did not meet national guidance for the number of anaesthetists recommended by the Obstetric Anaesthetists’ Association/Association of Anaesthetists of Great Britain & Ireland 2013 guidelines for obstetric anaesthesia.
  • Outcomes on the maternity dashboard were not clearly colour coded and we did not observe this on meeting minutes as a standing item for MDT discussion.
  • Midwives were not aware of the service plan to implement a new process to replace statutory supervision of midwives which ceased in April 2017.
  • Women were not receiving carbon monoxide screening in line with national guidance.
  • Staff told us that leaflets were accessible to print off but were limited in alternative languages or easy read versions.
  • There were no displays to inform people how to complain to the service and women we spoke to did not know how to complain.
  • Not all women were booked before ten weeks of pregnancy, the service did not meet the trust target.
  • Staff were not able to describe any complaint the service had received of if the service had any changes in practice following a complaint.
  • The head of midwifery did not have direct access to the board.
  • Action plans developed following external reviews were not fully embedded in practice.
  • The executive team were not visible and staff did not feel supported by them in challenging times.
  • There was a lack of defined strategy for the service and staff did not know the vision for their service.
  • Staff were not able to explain what happened to risks and concerns shared at governance meetings and felt that they escalated concerns, but did not see actions or feedback responses from the executive leadership team.
  • Not all risks we encountered during the inspection were added to the maternity risk register. For example, the number of women booked before ten weeks of pregnancy was poor. This had not been identified as a risk by the service.
  • Staff described not being actively involved or engaged in changes within the service, with decisions made at care group level without their involvement.
  • Staff were not able to give examples of new initiatives within the unit, although staff were committed to making improvements for women and babies.
  • The maternity staff survey results showed a decline from 2015 to 2017, with regard to recommending the trust as a place to work and the extent staff were motivated and engaged in their work.

However:

  • Staff had completed children safeguarding training in line with the trust’s target.
  • The service reported patient safety incidents well. Staff recognised incidents and reported them appropriately.
  • Resuscitation equipment was checked and recorded daily in all areas.
  • Staff could describe their responsibilities regarding the duty of candour (DoC) regulation and when this needed to be implemented.
  • Care and treatment was in the main managed in accordance with national guidance.
  • Antenatal screening for blood born infections was offered to women and the service was compliant with national key performance indicators.
  • Staff with different roles worked together as a team to provide holistic care to women. We observed that staff were respectful of one another and all staff we spoke with said that they worked well together as a team.
  • The service provided seven-day services to women to enable them to be seen when they needed to access care and/or advice.
  • Staff understood and respected the personal, cultural, social and religious needs of women and those important to them.
  • All women we spoke with within the unit told us that their confidentiality, privacy and dignity was maintained.
  • Bereavement services and staff knowledge on supporting bereaved families ensured people received the care physical and emotional care required.
  • Although some services were closed the service continued to provide choice for women. There were a range of clinics and high and low risk services at the unit.
  • The service provided a range of specialist clinics and specialist midwives to meet the needs of women using the service.
  • Medical staff without exception felt supported by their managers and were complimentary regarding the experiences and training they received.
  • There were good working relationships between the senior leadership team of the maternity service and the managers of the departments.
  • The trust had appointed a maternity safety champion, in line with national recommendations (Department of Health ‘Safer Maternity Care: Next steps towards the national maternity ambition’, October 2016). They were the director of nursing, midwifery and quality and the medical director.

Maternity and gynaecology

Requires improvement

Updated 16 August 2017

The maternity service was in a transition period of change and although new senior leaders had begun to make positive changes, we had concerns as to whether this service had an embedded safety and learning culture.

Communication of incident learning was not consistently service wide or fed down to all staff. Service-wide sharing of learning from serious incidents was not evident across the maternity service and not always timely. The maternity service chose not to use the maternity specific safety thermometer. Medicines management was poor in several maternity wards despite pharmacy audits raising concerns. There was poor compliance with the checking of resuscitation equipment. We observed poor handovers between both midwifery and obstetric staff; they lacked leadership, organisation and consistency.

Governance processes were under review at the time of our inspection. We saw evidence that although processes were in place, they were not fully embedded in the culture of the service.

However, we saw there was a positive incident reporting culture. Staff understood the importance of reporting and learning from incidents. Serious incident investigations had improved and involved families in the process.

Staff were kind and professional and attentive to patients’ needs. Patients felt informed and involved in their care.

Policies and procedures were based on up-to-date, evidence-based guidance. Risk registers were up-to-date, showed clear ownership and actions completed or in progress. Senior managers recognised areas for improvement and engaged with staff to drive improvement.

Medical care (including older people’s care)

Requires improvement

Updated 29 November 2018

Our rating of this service went down. We rated all five domains as requires improvement because:

  • The service had suitable premises with the exception of the areas on wards used for escalation at times of high operational pressures and the discharge lounge environment. At times of high operational pressures patients were not always assessed and treated in a safe and suitable environment.
  • The trust did not always plan and provide services in a way that met the needs of local people. A significant number of patients were ‘boarded’ on wards during periods of high capacity and demand and seven-day rehabilitation was not available for stroke survivors.
  • The trust’s approach to boarding, handovers and managing patient information meant patients’ dignity was not always promoted.
  • We saw that one person which the ability to make decisions about their care was unlawfully detained on a ward.
  • The service did not have sufficient numbers of permanent staff with the right qualifications, training and experience to keep people safe from avoidable harm and abuse.
  • The service provided mandatory training in key skills to all staff but did not ensure everyone completed it.
  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. However, not all staff had received safeguarding training on how to recognise and report abuse.
  • The service did not always manage patient safety incidents well. Staff did not always recognise and report incidents appropriately. Managers investigated incidents and made recommendations. However, effective action to prevent future incidents was not always taken.
  • Patient records did not always contain the information required to enable staff to provide safe and consistent care. Medical records were not always stored securely.
  • The service did not always take into account the individual needs of patients. Person centred care plans were not devised to plan for patients’ individual needs.
  • 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. However, the risks associated with malnutrition and dehydration were not always assessed and planned for effectively.
  • Compassionate care was not always delivered in a consistent manner as some staff were observed to be task focussed at times, meaning they did not always have the time to consistently treat people in a compassionate manner.
  • Medical services had managers at all levels with the right skills and abilities to run a service providing high-quality sustainable care. However, staff working on the wards and units we visited reported a disconnect between them and the senior management team and board.
  • The trust had systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected. However, timely and effective action was not always taken to mitigate risk.
  • The service was continuing to work towards seven-day services although yet to achieve it.

However:

  • The service controlled infection risk well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection.
  • An effective early warning system was in place to identify deteriorating patients and appropriate action was taken in response to this.
  • When things went wrong, staff apologised and gave patients honest information and suitable support.
  • On the whole pain relief on wards was well managed. 
  • 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.
  • Patients were supported to live healthier lives and manage their own care and wellbeing needs where appropriate.
  • Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. They knew how to support patients experiencing mental ill health and those who lacked the capacity to make decisions about their care.
  • Most staff involved patients and those close to them in decisions about their care and treatment. Most patients felt that staff communicated with them in a way which they could understand their care, treatment and condition.
  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, which were shared with all staff.
  • The trust had a vision for what it wanted to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community.
  • The trust engaged well with patients, staff, the public and local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively.

Surgery

Requires improvement

Updated 29 November 2018

Our overall rating stayed the same. We rated it as requires improvement because:

  • Managers investigated incidents but there were no clear procedures in place to share lessons learned with the whole team and the wider service.
  • The service provided mandatory training in key skills but did not ensure all nursing and medical staff completed it. However, there was an action plan in place to address this.
  • The service had enough staff with the right qualifications and skills but not all staff had completed training in sepsis management.
  • The service monitored the effectiveness of care and treatment but did not consistently use the findings to improve patient outcomes.
  • Records were not always stored appropriately or securely to maintain patient confidentiality.
  • The service did not present an embedded consistent systematic approach to continually monitor the quality of its services.
  • The service controlled infections but not all staff followed the trust’s infection prevention and control guidance to ensure patients were kept safe from the spread of infection.
  • Most staff had not received training in the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards. Although staff generally understood their roles and responsibilities under the Mental Health Act 1983 and the MCA.
  • Staff informed us senior executives were not visible and there was poor engagement with surgical staff.
  • The tracheostomy pathway had been developed but the policy remained on the trust intranet page in draft form dated 2014.
  • We saw additional policies that were out of date or not ratified on the trust intranet page for staff to access.

However:

  • Staff kept appropriate records of patients’ care and treatment. Records were clear, up-to-date and available to all staff providing care.
  • Staff involved patients and those close to them in decisions about their care and treatment.
  • Senior staff across the service promoted a positive culture that supported and valued staff, based on shared values.
  • The trust generally planned and provided services in a way that met the needs of local people.
  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
  • Pain was managed effectively and staff provided or offered pain relief regularly.
  • Staff provided patients with enough food and drink to meet their needs and improve their health.
  • Staff worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.
  • All clinical staff we spoke with demonstrated a good understanding and knowledge of the principles of patient consent.
  • Nursing staff used national early warning scores (NEWS) to assess and monitor a patient’s condition electronically and in paper format.
  • Lessons learned from complaints were shared with all staff members effectively.
  • 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.
  • Patient feedback was positive about care and compassion, they felt safe.

  • Staff offered emotional support to relieve patient anxiety.

  • Staff had good knowledge to raise safeguarding alerts.

  • Staff were knowledgeable about escalation of deteriorating patients.

  • Agency staff received a trust induction and ward based competencies.

  • There was good pastoral care.

  • Staff were knowledgeable about how to support patients with complex needs such as dementia or a learning disability

Services for children & young people

Good

Updated 20 January 2015

Services for children and young people were found to be good. Children received good care from dedicated, caring and well trained staff, who were skilled in working and communicating with children, young people and their families. There were processes in place for children’s safeguarding, and concerns were identified and referred to the relevant authorities.

The trust had provided good flexible staffing levels, an adequate skill mix, and had encouraged proactive teamwork to support a safe environment. There were arrangements in place to implement good practice, learning from any untoward incidents, and an open culture to encourage a strong focus on patient safety and risk management practices.

Outcomes for patients were good, and treatment was in line with national guidelines. There were clear strengths in specialist areas in treating children. Staff felt valued, and had clear lines of communication though the trust. Staff felt confident in raising concerns, and felt listened to regarding ideas to improve services.

End of life care

Requires improvement

Updated 29 November 2018

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

  • The mortuary environment was visibly aged and arrangements for viewing deceased children was not ideal due to the low temperatures in the viewing area.
  • The service did not provide a seven-day week 24 hour a day end of life or specialist palliative care team. Nurse and medical staffing was not in line with national guidance.
  • Staff did not routinely complete the end of life care plan for patient’s in their last days of life.
  • The trust end of life care strategy did not link to national or local objectives in relation to improving end of life care or definitive timescales or commitments to achieve service improvements and none of the staff we spoke with, knew what the vision or strategy was for end of life or palliative care patients.
  • There was a lack of psychological support for patients and a psychology service was no longer funded by the service.
  • Patients could not access the specialist palliative care team (SPCT) directly. Patients needed to be admitted via the emergency department (ED) for a referral to the SPCT to be triggered, this posed a potential risk to patients receiving appropriate care in a timely way.
  • Except for the emergency department, the wards we visited used the SWAN rooms for escalation when patient capacity was high or if a patient needed to be isolated due to an infection. Ward staff said that infection control always superseded the needs of end of life patients.
  • The trust did not consistently collect, analyse, and use information to support all its activities. Internal audit processes across the service were inconsistent and audit outcomes were not always used to improve quality and performance of the service. End of life performance measurements were not part of the trusts dashboards, this had not changed since our last inspection.
  • The SWAN scheme was not fully embedded, leaders did not ensure that SWAN resources were allocated in an appropriate fashion to support end of life patients.
  • The trust identified there was inadequate coverage for end of life and palliative care at the Princes Royal Hospital within end of life care, due to only having one staff member in post and additional limited access to a clinical lead for the service.

However:

  • Staff knew how to recognise incidents and report them appropriately. From May 2017 to April 2018, the trust reported no incidents classified as never events within end of life care.
  • The service had suitable premises and equipment and controlled infection risk well. Staff kept themselves, equipment and the premises clean.
  • The service prescribed, gave, recorded and stored medicines well. Patients received the right medication at the right dose at the right time and staff kept clear, up to date and appropriate records of patients’ care and treatment.
  • Staff understood how to protect patients from abuse and knew their roles and responsibilities under the Mental Capacity Act 2005 to support patients that lacked the capacity to make decisions about their care.
  • The service took account of patients’ individual needs. Nursing staff could access translation services for patients who did not speak English as a first language. The trust had facilities for family members to stay with their relative overnight and the mortuary had facilities for bariatric patients.
  • The service treated concerns and complaints seriously, investigated them in line with trust policy.
  • Portering staff transported deceased patients to the mortuary in a timely manner.
  • The SPCT were proud of the organisation as a place to work and spoke highly of a culture of working together to meet the needs of the patients and their families.
  • The hospital had end of life link staff on the wards. The link staff linked in with the end of life care facilitator around end of life care and shared advice and support to other ward staff.