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Queen Charlottes and Chelsea Hospital Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 23 July 2019

Our rating of services improved. We rated it as outstanding because caring and responsive was outstanding and safe, effective and well-led were good.

  • The ratings for safe, caring, responsive and well-led had improved since our last inspection in 2014. The ratings for effective had remained the same.
  • We inspected Maternity services as part of this inspection in March 2019 to check if improvements had been made. We had previously inspected this service as part of the Maternity and Gynaecology services, so this was the first time we rated this service as a standalone Maternity service. We rated the service as outstanding because caring and responsive was outstanding, with safe, effective and well-led being good.
  • We inspected Neonatal services as part of this inspection in March 2019 to check if improvements had been made. Our rating of the service had improved. We rated the service as good because caring was outstanding, with safe, effective, responsive and well-led being good.
Inspection areas

Safe

Good

Updated 23 July 2019

Effective

Good

Updated 23 July 2019

Caring

Outstanding

Updated 23 July 2019

Responsive

Outstanding

Updated 23 July 2019

Well-led

Good

Updated 23 July 2019

Checks on specific services

Neonatal services

Good

Updated 23 July 2019

We previously inspected maternity jointly with gynaecology, so we cannot compare our new ratings directly with previous ratings. Our rating of maternity services was outstanding because:

  • The service provided mandatory and maternity specific training in key skills to all staff. The majority of staff received up-to-date mandatory training. Compliance with core maternity specific mandatory training and skills, such as cardiotocography interpretation, was 98.6%.

  • The trust had clear systems, processes and practices in place to safeguard adults and children from avoidable harm, abuse and neglect that reflected relevant legislation and local requirements. Staff understood how to protect patients from abuse and the service worked collaboratively with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

  • There was an effective system in place to assess, respond to and manage risks to patients. Staff could recognise and respond to signs of deterioration and emergencies. Staff completed and updated risk assessments for each patient.
  • 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. This was an improvement from the last inspection.

  • The service followed best practice when prescribing, giving, recording and storing medicines.

  • 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. The service performed better than the national recommendations and standards on the waiting time for epidurals and the average on women receiving obstetric anaesthesia during caesarean sections.

  • Managers monitored the effectiveness of care and treatment and used the findings to improve them. The service performed better than average on all outcomes in the 2017 National Neonatal Audit.

  • The service made sure staff were competent for their roles. Managers appraised staff’s work performance and meetings with them to provide support and monitor the effectiveness of the service.

  • The midwifery and medical staff supported women that accessed the maternity service to live healthier lives and manage their own health, care and wellbeing.
  • Staff treated and cared for women with compassion, patience, dignity and respect. Feedback from people who used the service and their relatives was continually positive about the care they received and the way staff treated them.

  • There was a strong, visible person-centred culture in the service and relationship between staff and patients was strong and supportive.
  • The hospital planned and provided services in a way that met the needs of local people. Between April 2018 and January 2019, 100% women had a named midwife whom they saw at their first appointment. Women might not see that midwife at every appointment but would see one of a small team at that clinic.

  • People could access the service when they needed it. Women were given a choice of times and dates for antenatal clinic appointments. There were clear pathways for all pregnant women to access the right services for their needs, with excellent access to specialist midwives.

  • Patient needs and preferences were considered and acted on to ensure services were delivered to meet those needs. Staff tried to arrange patient antenatal appointments together for the same day to meet patients’ commitments such as work.

  • The service was responsive to parents who had suffered a loss, such as miscarriage, stillbirth or neonatal death. The services provided extensive support and resources to bereaved women and were committed to continually improving the care and services they provided for bereaved parents.
  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, which were shared with all staff. Action plans were developed and monitored in response to complaints to prevent similar problems recurring.

  • There was a high level of staff satisfaction across all disciplines and equality groups. Staff were proud of working in the service, spoke highly of the culture and the improvement they had made to the service since the last inspection.
  • The service had a vision for what it wanted to achieve and workable plans to turn it into action, which it developed with staff, patients, and local community groups.

However;

  • There were inconsistencies in the monitoring of emergency equipment to ensure it was safe and effective for patient use.
  • The midwife to birth ratio was 1:28 which was below national recommendation of 1:26.

Maternity

Outstanding

Updated 23 July 2019

We previously inspected maternity jointly with gynaecology, so we cannot compare our new ratings directly with previous ratings. Our rating of maternity services was outstanding because:

  • The service provided mandatory and maternity specific training in key skills to all staff. The majority of staff received up-to-date mandatory training. Compliance with core maternity specific mandatory training and skills, such as cardiotocography interpretation, was 98.6%.

  • The trust had clear systems, processes and practices in place to safeguard adults and children from avoidable harm, abuse and neglect that reflected relevant legislation and local requirements. Staff understood how to protect patients from abuse and the service worked collaboratively with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

  • There was an effective system in place to assess, respond to and manage risks to patients. Staff could recognise and respond to signs of deterioration and emergencies. Staff completed and updated risk assessments for each patient.
  • 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. This was an improvement from the last inspection.

  • The service followed best practice when prescribing, giving, recording and storing medicines.

  • 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. The service performed better than the national recommendations and standards on the waiting time for epidurals and the average on women receiving obstetric anaesthesia during caesarean sections.

  • Managers monitored the effectiveness of care and treatment and used the findings to improve them. The service performed better than average on all outcomes in the 2017 National Neonatal Audit.

  • The service made sure staff were competent for their roles. Managers appraised staff’s work performance and meetings with them to provide support and monitor the effectiveness of the service.

  • The midwifery and medical staff supported women that accessed the maternity service to live healthier lives and manage their own health, care and wellbeing.
  • Staff treated and cared for women with compassion, patience, dignity and respect. Feedback from people who used the service and their relatives was continually positive about the care they received and the way staff treated them.

  • There was a strong, visible person-centred culture in the service and relationship between staff and patients was strong and supportive.
  • The hospital planned and provided services in a way that met the needs of local people. Between April 2018 and January 2019, 100% women had a named midwife whom they saw at their first appointment. Women might not see that midwife at every appointment but would see one of a small team at that clinic.

  • People could access the service when they needed it. Women were given a choice of times and dates for antenatal clinic appointments. There were clear pathways for all pregnant women to access the right services for their needs, with excellent access to specialist midwives.

  • Patient needs and preferences were considered and acted on to ensure services were delivered to meet those needs. Staff tried to arrange patient antenatal appointments together for the same day to meet patients’ commitments such as work.

  • The service was responsive to parents who had suffered a loss, such as miscarriage, stillbirth or neonatal death. The services provided extensive support and resources to bereaved women and were committed to continually improving the care and services they provided for bereaved parents.
  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, which were shared with all staff. Action plans were developed and monitored in response to complaints to prevent similar problems recurring.

  • There was a high level of staff satisfaction across all disciplines and equality groups. Staff were proud of working in the service, spoke highly of the culture and the improvement they had made to the service since the last inspection.
  • The service had a vision for what it wanted to achieve and workable plans to turn it into action, which it developed with staff, patients, and local community groups.

However;

  • There were inconsistencies in the monitoring of emergency equipment to ensure it was safe and effective for patient use.
  • The midwife to birth ratio was 1:28 which was below national recommendation of 1:26.