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Provider: The Hillingdon Hospitals NHS Foundation Trust Requires improvement

On 24th July 2018, we published a report on how well The Hillingdon Hospitals NHS Foundation Trust uses its resources. The ratings from this report are:

  • Use of resources: Requires improvement  
  • Combined rating: Requires improvement  

Read more about use of resources ratings

Inspection Summary


Overall summary & rating

Requires improvement

Updated 24 July 2018

Our rating of the trust stayed the same. We rated it as requires improvement because:

  • We rated safe and well-led at Hillingdon Hospital as inadequate; effective and responsive as requires improvement, and caring as good. We rated three of the trust’s 12 core services as good, three as requires improvement and two service as inadequate. In rating the trust, we took into account the current ratings of the four services at Mount Vernon Hospital not inspected this time.
  • We rated well-led for the trust overall as requires improvement.
Inspection areas

Safe

Inadequate

Updated 24 July 2018

Our rating of safe went down. We rated safe as inadequate.

  • There was deterioration in infection prevention and control since the time of the last inspection. We found inconsistencies in hand hygiene practice amongst staff, during ward rounds.
  • Medicines were not always appropriately stored or checked in the ED.
  • There was poor recognition of sepsis.
  • There had been some improvement to safe levels of staffing. However some services within the trust did not have enough permanent nursing and medical staff to ensure the provision of safe care and treatment. However, they used bank and agency staff to cover gaps in the staff provision.
  • We found out of date copies of the major incident plan on some wards and this was against the trust’s own policy.
  • The trust had not improved in relation to the testing of portable electrical equipment. We found that not all portable appliances had been tested.
  • We were not assured that high-risk patient groups were screened for MRSA at pre-admission.
  • Staff did not always maintain appropriate records of patients’ care and treatment. Records were not always clear, up-to-date and available to all staff providing care.
  • We were not assured that the laser service met the Medicines and Healthcare Products Regulatory Agency safety standards.

However:

  • Staff were confident about how to record incidents. Staff recognised incidents and near misses and reported them appropriately. Senior staff investigated incidents and shared lessons learnt with staff. There was an open and constructive culture of sharing and learning from incidents.
  • There had been an improvement in relation to safety monitoring and the collection and display of safety information on the wards.
  • There was consistent and effective use of National Early Warning Scores (NEWS) including appropriate escalation.
  • Staff demonstrated an awareness of safeguarding procedures and how to recognise if someone was at risk, or had been exposed to abuse. There was a clear and effective process to ensure that potential safeguarding concerns were escalated.

Effective

Requires improvement

Updated 24 July 2018

Our rating of effective stayed the same. We rated effective as requires improvement.

  • There was low participation in clinical audits and the trust performed poorly in some.
  • Appraisal rates were low in some areas.
  • Staff did not always understand their roles and responsibilities in relation to the Mental Capacity Act 2005, in particular in relation to Deprivation of Liberty Safeguards (DoLS).
  • The trust did not audit the World Health Organisation (WHO) five steps to safer surgery in 2017.
  • There were no pre-operative fasting audits for patients fasting before surgery.
  • The trust did not always actively monitor the effectiveness of care and treatment and use this information to improve services.

However:

  • There was a multidisciplinary approach to patient care and staff worked well together to deliver an effective service.
  • The trust provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.
  • All staff had access to an electronic records system that they could all update.
  • The hospital had a dedicated pain team. There was good documentation for recording pain. Patients we spoke with told us that there was good pain management.

Caring

Good

Updated 24 July 2018

Our rating of caring stayed the same. We rated caring as good.

  • Staff cared for patients with compassion. Staff treated patients and their families with dignity, kindness and respect. We observed positive and compassionate interactions between staff and patients.
  • Staff involved patients and those close to them in decisions about their care and treatment. Patients and their relatives were kept informed of ongoing plans and treatment. They told us that they felt involved in the decision-making process and were given clear information about their treatment.
  • Relatives were happy with the communication and information given to them from staff.
  • Staff provided emotional support to patients to minimise their distress.

Responsive

Requires improvement

Updated 24 July 2018

Our rating of responsive stayed the same. We rated responsive as requires improvement.

  • The trust did not meet the target to admit, discharge, or transfer and did not meet the standard that patients should wait no more than one hour for initial treatment.
  • The A&E waiting area for patients who attended by their own means was very crowded with insufficient seating.
  • We found that staff had poor awareness of the needs of people with learning disabilities.
  • Translation services were not always offered to patients.
  • The trust provided a range of information leaflets including support groups. However, similarly to the last inspection we did not see any information printed in any other language.
  • Space within the surgery division was not suitable for inpatients due to the lack of essential equipment and washing facilities.
  • The trust’s investigation and closure of complaints was not in line with their complaints policy which states complaints should be completed in 30 days.
  • Since the last inspection, there had been limited improvement in the facilities on the ITU for relatives and visitors.
  • There were limited examples of departments supporting patients to manage their own health.
  • The bereavement service had limited opening hours and inappropriate waiting areas for bereaved family members
  • There was a large backlog of estates maintenance.

However:

  • The trust planned and provided services in a way that met the needs of local people The trust had a frailty pathway, supported by specialists, to safely reduce admissions and length of stay for elderly patients and ambulatory care pathways.
  • The trust delivered a broad range of services including speciality and one-stop clinics.
  • There was a mental health matron seconded from a local trust who supported staff to offer a better patient experience to those with mental health issues.
  • We observed patient’s dietary needs and fluid restrictions clearly displayed above patients beds.
  • The trust treated concerns and complaints seriously, investigated them and learned lessons from the results, which were shared with all staff.

Well-led

Requires improvement

Updated 24 July 2018

Our rating of well led went down. We rated well led as inadequate.

  • Local risk registers did not always reflect risks described by staff in some areas.
  • Matrons and managers within the trust did not have the capacity to effectively lead their teams due to pressures faced operationally.
  • The senior management team had not taken note of all of the concerns raised at the previous inspection.
  • We found that divisional and executive team were not visible in some areas and rarely visited some departments.
  • Staff struggled to locate clinical guidelines quickly as the trust intranet search engine was not user friendly.
  • The department had managers with the right skills to run the service; however senior nurses felt that their managerial duties were at times excessive of their role.
  • We were not assured that there were adequate governance procedures for the laser service as set by the Medicines and Healthcare Products Regulatory Agency safety standards.

However:

  • Staff told us they enjoyed good local teamwork.
  • The values of the trust were embedded and staff at all levels were able to tell us what the trust values were and how they applied to their roles.
  • There was a culture of honesty, openness and transparency.
  • Managers across the service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
  • Quality and safety received sufficient coverage in board meetings, and in other relevant meetings below board level.
Assessment of the use of resources

Use of resources summary

Requires improvement

Updated 24 July 2018

Combined rating

Combined rating summary

Requires improvement