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Provider: Royal Surrey NHS Foundation Trust Good

On 20 August 2018, we published a report on how well Royal Surrey County Hospital NHS Foundation Trust uses its resources. The ratings from this report are:

  • Use of resources: Good  

Read more about use of resources ratings

Reports


Inspection carried out on 24 January to 22 February 2018

During a routine inspection

We found there had been a number of improvements throughout the trust, which had accelerated in the past year. Performance was good. During our unannounced visit in January, we observed the trust benefiting from extensive preparations made for ‘winter pressures’ and they were responding well to the seasonal demand on services.

Overall, our rating for the trust stayed the same:

  • The trust was rated as good for safe, effective, caring, and responsive. Outpatients improved from requires improvement to good and maternity was rated as outstanding.
  • We did not inspect urgent and emergency care, surgery, services for children and young children or end of life care.

We are monitoring the progress of improvements to these services and will re-inspect them as required.


CQC inspections of services

Inspection carried out on 17-18 and 23 October 2013

During a routine inspection

The Royal Surrey County Hospitals NHS Foundation Trust is based at the Royal Surrey County Hospital. It is a leading general hospital and specialist tertiary centre for cancer, oral and maxillofacial surgery and pathology. The trust also has a very strong reputation for minimally invasive and laparoscopic surgery, which are used widely across the surgical specialties. It runs outpatient clinics at Cranleigh, Haslemere and Woking hospitals.

The trust has over 520 beds, 14 operating theatres, two MRI scanners, four CT scanners, interventional radiology equipment and a gamma camera. 

It serves a population of 320,000 for emergency and general hospital services and employs 3,100 staff, making it the second largest employer in Guildford. Every year, the trust sees 240,000 outpatients, 58,000 inpatients, and 72,000 patients in accident and emergency. It delivers more than 3,200 babies every year.

Overall, the trust was providing services that were safe, effective, responsive, caring and well-led. However, there were some areas for improvement.

The culture throughout the trust was very open, and staff were very enthusiastic, positive and knowledgeable about the trust’s overall vision and strategy.

The Board structure and portfolio structure is relatively new and there is still some embedding required. The CEO is well respected and popular with the staff and he and board members were visible throughout the trust. There was evidence of good leadership at the majority of department levels and a lot of innovation by staff to continually improve the patient’s experience. There are a number of processes for communication flow from and to the Board and departments. However, priorities at the departmental level had not been captured at trust level, and there is some lack of connection to the Board. This led to the executive team being unclear on its understanding ofsome of the issues in departments, and there was a general perception throughout the trust that the executive team and local teams are progressing at different paces and priorities were not always aligned.

The quality strategy focused on national targets and future developments without defining some key quality and safety priorities of the organisation. Thus members of the Board were not able to articulate all of the quality strategy for some basic quality issues specific to the trust.

Operational management was not fully connected from Board to departmental level and not all middle management had a clear understanding of the range of risks across the trust. There is a risk register that looks at risks highlighted by the specialist business units, but it was not evident that the Board reflects a trust-wide perspective.

The trust was working to full capacity in most departments with cancellations of elective surgery on one of the days of the visit, and this was providing a challenge for them. The trust recognised this problem, and it had a number of plans to improve the capacity of the hospital in the long term. The full alignment of capacity issues and the impact of patient experience could not be fully articulated by the trust. Although capacity was being created within theatres and critical care to support cancer services, the impact of this in pressure on ward beds could not be evidenced within the business planning. The trust had paid less attention to how it would manage the current capacity issues, and the impact they were having on the experience of patients, until it implemented the long-term plans. These capacity issues included:

  • Staffing levels for support/administration staff.
  • Staffing on some wards, particularly care of the elderly. 
  • Managing capacity issues in outpatients, particularly in ophthalmology. 
  • Managing issues such as discharge letters and GP correspondence.

The trust had plans for the development of its cancer services to meet the needs of patients. This will inevitably put further challenges on capacity and staffing requirements. The trust will need to address these before it puts its plans to expand cancer services into action.

Patients were generally very positive about the care they received at the hospital. They were very supportive of the trust and keen to be involved in the improvement at the hospital. The vast majority of patients that contacted us and those we spoke with commended the care they received at the trust. However some patients we spoke to at the listening event and who had contacted us directly had not had good experiences and some reported delays in their complaints being dealt with a timely fashion. They had little opportunity to engage with the trust other than through the complaints system. The trust was developing more ways to engage with patients and the community, but it had not fully implemented its ideas. However, there was some innovative work taking place at departmental level.

Cancer services were safe, effective, responsive and well-led. They were at full capacity, and staffing in some areas left little allowance for contingency planning and unplanned absences. On occasions this did impact on the effectiveness of services and their ability to be caring. The staff themselves were caring, but not all patients had their expectations met, and the cancer patients experience survey identified a number of areas where the trust needs to make improvements. 

Staff were positive and engaged, and nursing staff levels were being managed well at departmental level, despite staff shortages in some areas.

Use of resources

These reports look at how NHS hospital trusts use resources, and give recommendations for improvement where needed. They are based on assessments carried out by NHS Improvement, alongside scheduled inspections led by CQC. We’re currently piloting how we work together to confirm the findings of these assessments and present the reports and ratings alongside our other inspection information. The Use of Resources reports include a ‘shadow’ (indicative) rating for the trust’s use of resources.


Intelligent Monitoring

We use our system of intelligent monitoring of indicators to direct our resources to where they are most needed. Our analysts have developed this monitoring to give our inspectors a clear picture of the areas of care that need to be followed up.

Together with local information from partners and the public, this monitoring helps us to decide when, where and what to inspect.


Joint inspection reports with Ofsted

We carry out joint inspections with Ofsted. As part of each inspection, we look at the way health services provide care and treatment to people.