You are here

Worthing Hospital Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 22 October 2019

Our rating of services stayed the same. We rated them as outstanding because:

Western Sussex Hospitals NHS Foundation Trust became a foundation trust on 1 July 2013.

Worthing Hospital, West Sussex is one of three hospitals provided by the trust.

Worthing Hospital provides a full range of general acute hospital services including A&E, maternity, outpatients, day surgery and intensive care. It is also home to the West Sussex Breast Screening service.

Inspection areas

Safe

Outstanding

Updated 22 October 2019

Effective

Outstanding

Updated 22 October 2019

Caring

Outstanding

Updated 22 October 2019

Responsive

Outstanding

Updated 22 October 2019

Well-led

Outstanding

Updated 22 October 2019

Checks on specific services

Medical care (including older people’s care)

Outstanding

Updated 20 April 2016

Patients at risk of deteriorating were monitored and systems were in place to ensure a doctor or specialist nurse was called to provide additional support. The trust had an open culture and was prepared to learn from clinical incidents.

Across the Medicines Division there were enough medical and nursing staff to keep patients safe. However, on the day of our inspection, the number of chemotherapy qualified staff on the Medical Day Care Unit was less than the established amount. The trust found it difficult to recruit new nursing staff; but was able to effectively fill gaps across the division using bank and agency staff.

Staff across the Medicines Division reported problems with the trust’s electronic prescribing system when prescribing and transcribing. Actions to mitigate the risks posed by e-prescribing were not recorded on the divisions risk register.

The environment at the Medical Day Care unit had led to a four week wait for patients requiring chemotherapy.

Attendance at mandatory training, as well as staff receiving an annual appraisal was below the 90% trust target. We found care was provided in line with national and local best practice guidelines. Clinical audit was undertaken and there was good participation in national and local audit that demonstrated good outcomes for patients. We observed good clinical practice by clinicians during our inspection. Patient morbidity and mortality outcomes were broadly within what would be expected for a hospital of this size and complexity and no mortality outliers had been identified. There was a good knowledge of the issues around capacity and consent among staff. We found two deprivation of liberty safeguard (DoLS) assessment applications did not contain capacity assessments.

Patients received compassionate care and were treated with dignity and respect. Most patients and relatives we spoke with said they felt involved in their care and were complimentary about staff. One person told us: “The staff have been very nice and have always responded when I have called them.” The Medicines division had good results in patient surveys with results indicating an improvement in the views of patients over the last 12 months.

The Medicines Division were effective at responding to the needs of the community. The trust’s performance management team understood the status of the hospital at any given time. Bed availability was well managed. Elderly care pathways had been well designed to ensure that elderly patients were assessed and supported with all their medical and social needs. Patients living with dementia were accommodated on two specific department of elderly medicine (DOME) wards. The AMU provided effective alternate pathways for GP's and other referrers.

Medical services were well led; divisional senior managers had a clear understanding of key risks and issues in their area. The medical areas had an effective meeting structure for managing the key clinical and non-clinical operational issues on a day to day basis. The hospital had a risk register which covered most key risks. Staff spoke positively about the high quality care and services they provided for patients. They described the hospital as a good place to work and as having an open culture. The most consistent comment we received was that the hospital was a “nice” place to work and staff enjoyed working in their teams.

Services for children & young people

Outstanding

Updated 20 April 2016

The children and young people’s service was rated 'Outstanding' because it had a strong, open culture of safety developed through the reporting and learning from incidents and complaints. Strong governance and an effective assurance framework resulted in a cycle of monitoring and improvement. 

The children and young people who used the serviced experienced good care that resulted in outcomes generally above national benchmarks. Where there was underperformance, it was recognised and addressed through robust action. Staff knew how the service was performing in specific areas and were motivated to make improvements.

Innovation and ownership of the service was strongly encouraged. There was a culture of joint working and learning from others. This worked across the trust with examples such as 'Harvey’s Gang' (which the trust is justifiably proud of) and with other local providers and children’s agencies. The result of this was children and families had a seamless journey through separate services, both internally and externally.

Outcomes for very young children living in challenging circumstances benefited from this joint working. Most importantly staff and leaders of the service were self-aware, knew the limits of care they could provide safely, understood areas they needed to improve on and were working on these. They were very proud of their work and felt sufficiently comfortable in their position to share their pride widely and loudly to build on their strengths.

Critical care

Outstanding

Updated 22 October 2019

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

  • Leadership was compassionate, inclusive and effective. Leaders at all levels demonstrated the high levels of experience, capacity and capability needed to deliver excellent and sustainable care. Leaders had the skills, knowledge and experience to perform their roles.
  • Leaders and staff had a deep understanding of issues, challenges, priorities and vision for their service. The strategy places patients’ safety and individual needs at the core of its strategy.
  • There was strong collaboration, team-working and support across all functions and a common focus on improving the quality, safety and sustainability of care. Staff are proud of the organisation as a place to work and speak highly of the culture. Staff at all levels are actively encouraged to speak up and raise concerns.
  • There was a strong visible person-centred culture to providing care in the critical care unit. Patients were treated with dignity and respect at all times. All staff we spoke with were very passionate about their roles and were dedicated to making sure patients received the best individualised patient-centred care possible.
  • Staff understood the impact that a person’s care, treatment or condition had on their wellbeing and on those close to them, both emotionally and socially. People's emotional and social needs were seen as being as important as their physical needs.
  • Staff involved patients and those close to them in decisions about their care and treatment. Relatives of patients told us they felt involved in decisions. We observed staff communicated with patients and their relatives in a way which they could understand, and they asked patients if they understood what had been discussed.
  • All staff were actively engaged in activities to monitor and improve quality and outcomes (including, where appropriate, monitoring outcomes for people once they have transferred to other services). Opportunities to participate in benchmarking and peer review are proactively pursued, including participation in approved accreditation schemes. Outcomes for people who use services are positive, consistent and regularly exceed expectations.
  • The continuing development of the staff's skills, competence and knowledge was recognised as being integral to ensuring high-quality care. Staff were proactively supported and encouraged to acquire new skills, use their transferable skills, and share best practice. Managers made sure staff received any specialist training for their role.
  • Staff, teams and services were committed to working collaboratively and had found innovative and efficient ways to deliver more joined-up care to people who use services.
  • The service was inclusive and took account of patients’ individual needs and preferences. There was 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 included people with protected characteristics under the Equality Act, people who may be approaching the end of their life, and people who are in vulnerable circumstances or who have complex needs.
  • Governance arrangements were proactively reviewed and reflected best practice. A systematic approach was taken to working with other organisations to improve care outcomes.
  • There was a fully embedded and systematic approach to improvement which made consistent use of a recognised improvement methodology. Improvement was seen as a way to deal with performance and for the organisation to lean. Improvement methods and skills were available and used across the service and staff were empowered to lead and deliver change.
  • The service managed patient safety incidents well. Staff recognised incidents and near misses 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. Managers ensured that actions from patient safety alerts were implemented and monitored.
  • The service had enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed and adjusted staffing levels and skill mix.
  • The service had enough medical staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed staffing levels and skill mix.
  • The service had enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed and adjusted staffing levels and skill mix.
  • Staff understood how to protect patients from abuse. Staff understood their responsibilities and the steps to take in the event of a safeguarding concern. Staff had training on how to recognise and report abuse, and they knew how to apply it.

However:

  • The high dependency unit did not meet the minimum bed space dimensions as recommended in national guidance
  • Safety thermometer data was not displayed. to keep patients and visitors informed about the units performance.

End of life care

Outstanding

Updated 20 April 2016

Staff provided an end-of-life care service that was outstanding. The specialist palliative care team, mortuary and chaplaincy team worked effectively and cohesively to provide a seamless service. Most audits performed by Worthing Hospital scored above England averages, which underpinned the rating given for this service.

The management structure, staff involvement and culture of the service were good. Patient and staff feedback was consistently positive throughout the inspection. There was a positive vision for the future sustainability of the service.

Maternity and gynaecology

Outstanding

Updated 20 April 2016

Overall we rated maternity and gynaecology services as 'Outstanding'.

This was because of the excellent work being done to engage with women and their partners through innovative and award winning use of social media and other routes. The trust was actively working to engage with harder to reach groups and had adapted services to the needs of a changing local community.

Multi-disciplinary work internally at the trust and with external partners had resulted in improved outcomes for woman and babies, particularly the most vulnerable or those in challenging circumstances.

The service provided effective care in accordance with recommended practices. Outcomes for women in the service were continuously monitored and incidents and complaints were used as opportunities for learning and for the improvement of services.

The service at one of the main sites was sometimes unable to cope with the demand and this resulted in the closure and women were diverted to the other site. This also resulted in some delay for women waiting for the induction of their labour and for elective caesarean sections.

Compliance with training was good and staff were offered additional opportunities for learning and development. The care was compassionate and supportive and women and their families were treated with respect and dignity.

Surgery

Good

Updated 20 April 2016

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

Patients were protected from avoidable harm because there were robust systems 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 evidence 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 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 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 Worthing Hospital and spoke enthusiastically about their role and responsibilities. We found staff attendance at mandatory training was good and staff were knowledgeable in how to safeguard and protect vulnerable patients.

The patients we spoke with during the inspection told us they were treated with dignity and respect and had their 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 Family and Friends feedback and patient survey results.

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, musculo-skeletal and ENT specialties were of particular concern at the current time.

We found there were some environmental challenges where lack of facilities such as adequate storage presented a potential risk to patients and impacted on their care and treatment.

Staff were not monitoring ambient room temperatures in rooms where drugs were stored. There is a risk that certain medicines become less effective if stored at incorrect temperatures.

The availability of junior doctors out of hours was raised as a concern as inexperienced medical staff were often working unsupported.

There was a lack of surgical beds with the admissions ward, day care ward and theatre recovery frequently used to accommodate overnight stays because of bed shortages. This affected patients being admitted for surgery. Patients were sometimes recovered from anaesthesia in the operating theatre because the recovery bays were full of patients waiting to be discharged home or to a ward. Surgery was sometimes cancelled because there were often no beds for them to be admitted to.

Urgent and emergency services

Outstanding

Updated 20 April 2016

Overall, we rated the emergency department as 'Outstanding'. It wasn't perfect but the staff and trust executive knew where any shortfalls and risks were and were constantly reviewing the provision to ensure it was meeting the needs of the people using the service.

Departmental leaders and staff had implemented systems to maintain flow and escalate problems as soon as there were indications of delays in patient flow. The trust had programmes of work to improve patient flow through the hospital. The hospital met the national target of seeing, treating, admitting or discharging 95% of patients within four hours, ending the year in the top 20 trusts in the country.

We saw examples of a service that responded in an extremely compassionate way to meet the needs of a patient whose spouse had died the previous day in the same department. The service was very busy but the patient and their relatives were made to feel as though staff had all the time in the world to support and care for them.

Patients were asked about their wishes and were supported to make decisions about their care and treatment. We saw staff consistently offered care that was kind, respectful and considerate whilst promoting their privacy and dignity at all times. Staff supported patients promptly in managing pain and anxiety and we observed staff discussing treatment and pain management with patients in ways they could understand.

The ED had a strongly embedded culture of learning from incidents. There were clear and effective processes for incident reporting, investigation and learning from incidents. Staff we spoke with knew how to escalate concerns in relation to patient safety and safeguarding. They were aware of Duty of Candour and could describe how they met this requirement.

The leaders of the service were well respected by the staff. Staff of all grades and disciplines talked positively about working in the department and for the trust.

Outpatients

Good

Updated 22 October 2019

Our overall rating of this service stayed the same. We rated it as good because: