The Care Quality Commission has carried out focused inspections at Epsom and St Helier University Hospitals NHS Trust.
At Epsom General Hospital CQC inspected critical care and services for children and young people. Both were rated Good following the inspection in October 2018.
ED staff identified adults at risk of causing harm to themselves. Patients assessed as being at risk of suicide or self-harm, received early referrals to the mental health liaison team. Policies and procedures were in place for extra observation or supervision of patients with acute mental health needs.
There was a designated room for interviewing patients with mental health needs in the Emergency Department (ED) at Epsom General Hospital. The room had an emergency panic alarm strip and two exit points and there were no ligature points.
The trust managed patient safety incidents well. Staff recognised incidents and reported them appropriately and learning was shared across the tust. Staff gave inspectors clear examples of when learning from incidents had resulted in changes to practice. This was an improvement since CQC’s last inspection.
Managers of the critical care service promoted a positive culture, that supported and valued staff, creating a sense of common purpose based on shared values.
Safeguarding processes had improved since CQC’s last inspection across children and young people services. Staff had instant access to information, which was held electronically. This meant staff were immediately aware if a child was known to social services, was a looked after child, or subject to a child protection plan.
Staff identified and responded appropriately to changing risks to children and young people, including deteriorating health and wellbeing and medical emergencies. Staff were able to seek support from senior staff in these situations.
However, there were also areas of poor practice where the trust needs to make improvements. These included:
The critical care service did not have suitable premises and the design of facilities did not meet the needs of patients. It did not always maintain an effective patient flow through the department. Delayed discharges remained consistently worse than the national average.
In the ED at Epsom General Hospital, people’s individual care records were not always written and managed in line with best practice.
In the children and young people service, medical staff did not meet the completion rate target of 85% for nine out of the 11 mandatory training modules for medical staff. This meant that not all medical staff had received training essential to providing safe patient care.
Staff did not consistently record the temperature of the fridge in the clinical room in the neonatal unit, which was used to store breast milk. This meant that there was a risk that breast milk could be exposed to abnormal temperatures, which could cause the milk to deteriorate.
Locum medical staff did not have access to the full information technology systems and could only use a generic log on to access the trust's systems.
The trust must now:
- Improve the environment and facilities on the critical care unit to reduce the infection control risks to patients.
- Improve systems and processes in critical care so that patients are not delayed from being discharged
CQC inspected the trust after concerns were raised at both Epsom General and St Helier hospitals, in relation to patients being treated for hyponatraemia (low sodium blood levels), and the internal communication of abnormal pathology results.
However, CQC inspectors found recently adapted guidance on quality standards for the treatment of patients with hyponatraemia and these were embedded in practice.
Medical staff across the ED, the acute medical unit and the medical wards, received training in the management of patients with hyponatraemia.
Pathology results needed to deliver safe care and treatment were available to staff in a timely and accessible way. There was a trust wide standard operating procedure for communicating abnormal blood results to appropriate staff.
England’s Chief Inspector of Hospitals, Professor Ted Baker, said: “These focused inspections at Epsom and St Helier University Hospitals NHS Trust, show that while there is good care being provided at the trust there is always room for improvement.
“In particular, the environment and procedures at Epsom General Hospital’s critical care unit need to improve to reduce the infection control risks to patients. There also needs to be an improvement to systems and processes in critical care so that patients are not delayed from being discharged.”
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