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Inspection Summary


Overall summary & rating

Good

Updated 20 April 2016

We carried out an announced inspection visits across all trust sites from 9 to 11 December 2015. We held focus groups with a range of staff in the hospital, including nurses of all grades, junior doctors, consultants, midwives, student nurses, administrative and clerical staff, physiotherapists, occupational therapists, pharmacists, domestic staff, porters and volunteers. We also spoke with staff individually.

We talked with patients and staff from all the ward areas and outpatient services. We observed how people were being cared for, talked with carers and/or family members, and reviewed patient records of personal care and treatment.

We carried out an unannounced inspection on 21 December 2015 at Worthing Hospital.

Overall we found that Western Sussex Hospitals Foundation NHS Trust was providing good care and treatment from Southlands Hospital. This site provides a limited service with the focus on ambulatory care. There are no overnight beds at Southlands hospital but outpatient and day surgery services are provided. A new eye centre is being opened in the hospital in 2017. The main inpatient services and emergency care are provided from the two other trust hospitals in Chichester and Worthing.

Our report only considers two core services at Southlands Hospital (Outpatients and Surgery) as other core services that we usually report on were not provided from this site. Both these core services are rated good overall.  The responsiveness of the outpatient service was judged to be requiring improvement because the trust Referral to Treatment Time for some specialities was worse than the 18 week target.

We saw examples of good practice across the hospital. Where we identified shortcomings, the trust was aware of them and was already addressing the issues. The trust is one of the 16 members of NHS Quest, a member-convened network for Foundation Trusts who wish to focus on improving quality and safety within their organisations and across the wider NHS. NHS QUEST members work together, share challenges and design innovative solutions to provide the best care possible for patients.

Our key findings were –

  • The executive team provided an exemplar of good team working and leadership. They had a real grasp of how their hospital was performing and knew their strengths and areas for improvement. They were able to motivate and enthuse staff to ‘buy in’ to their vision and strategy for service development. Middle managers adopted the senior manager’s example in creating a culture of respect and enthusiasm for continuous improvement.

  • Innovation was encouraged and supported. We saw examples that, when raised directly with the Chief Executive and her team, had been allowed to flourish and spread across the services. At Southlands hospital, the creation of the new eye centre was an example of innovative solutions to improve patient care and experiences.

  • We saw respectful and warm relationships internally amongst staff teams, the wider hospital team and outwards to external stakeholders and the local community.

  • Across the hospital there was an embedded culture of learning from incidents. Staff were encouraged to have an open and honest attitude towards reporting mistakes and incidents that were then thoroughly investigated. There was strong evidence of learning from incidents both locally and across the organisation.

  • The hospital was performing better, and sometimes much better than comparable trusts across England on many measures. Where this was not the case, the trust had clear action plans and investigations on-going to bring about improvements.

  • In 2014/15 the trust improved their infection control ratings for the sixth successive year.

  • We found a good knowledge and understanding of the policies and guidance relating to safeguarding vulnerable adults and children. Staff at Southlands hospital had completed safeguarding training.

  • Staff of all grades talked with great pride about the services they provided and all agreed they would be happy for their family members to be treated there

We observed good practice at Southlands Hospital that included –

Staff knowledge of vulnerable adult and safeguarding children and how they should proceed if concerns arose was a significant strength. There was very good joint and interagency working.

The culture of safety and learning from incidents and complaints was well embedded. All staff felt responsibility for reporting mistakes and incidents and there was good dissemination of learning following investigation or review.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection areas

Safe

Good

Updated 20 April 2016

Effective

Good

Updated 20 April 2016

Caring

Good

Updated 20 April 2016

Responsive

Good

Updated 20 April 2016

Well-led

Good

Updated 20 April 2016

Checks on specific services

Outpatients and diagnostic imaging

Good

Updated 20 April 2016

Overall, we rated this core service as 'Good'. There was a good incident reporting culture throughout outpatients and diagnostics and screening departments. Infection control practices and processes were good.

Team work was effective. There was evidence of some audit activity and staff shared learning across teams.

Staff treated patients with dignity and respect and responded to patients individual and emotional needs.

The trust consistently met its cancer waiting times. There was timely access to tests and results. The hospital provided one stop clinics for several specialities which reduced the number of appointments a patient needed.

Staff engagement was good and

the senior management team were approachable to staff at all levels.

Surgery

Good

Updated 20 April 2016

Overall we found that surgical services at Southland’s Hospital were 'Good'. This was because;

Patients were protected from avoidable harm as systems were in place to report, monitor, investigate and take action on any incident that occurred. There were effective governance arrangements to facilitate monitoring, evaluation and reporting and learning. Risks were identified and acknowledged and action plans were put into place to address them.

We saw patients’ care needs were assessed, planned and delivered in a way that protected their rights and maintained their safety. Surgical care was evidenced based and adhered to national and best practice guidance. The trust’s policies and guidance were readily available to staff through the trust’s intranet. The care delivered was routinely measured to ensure quality and adherence to national guidance and to improve quality and patient outcomes. The trust was able to demonstrate that it continuously met the majority of national quality indicators. Patient surgical outcomes were monitored and reviewed through formal national and local audits.

There was clear local leadership, and staff knew their reporting responsibilities and took ownership of their areas of influence. All staff spoke with passion and pride about working at Southland’s Hospital and spoke enthusiastically about their role and responsibilities. Staff attendance at mandatory training was good and staff were knowledgeable in how to safeguard and protect vulnerable patients.

Information from patients confirmed they were treated with dignity and respect and had their care needs met by caring and compassionate staff. During our inspection we observed patients being treated with kindness, respect, professionalism and courtesy. This positive feedback was reflected in the general Family and Friends feedback and patient survey results for the trust.

However, we found some areas that had scope for improvement. We considered that existing mitigating strategies and the expertise of clinical staff meant that risks to patients were minimised:

The trust did not meet the referral to treatment (RTT) times for a number of surgical specialties. The ophthalmology and urology specialties were of particular concern at the current time.

We found that surgical activity at Southland’s Hospital was often included with that of Worthing Hospital making it difficult to gain a true understanding of the levels of surgical activity, incident or complaints at the hospital.

Southlands Hospital was isolated geographically and organisationally, with staff needing to actively engage with the two main hospitals to stay informed and involved rather than being an integral part of their core business.