You are here

Provider: St Helens and Knowsley Teaching Hospitals NHS Trust Outstanding

On 20 March 2019, we published a report on how well St Helens and Knowsley Teaching Hospitals NHS Trust uses its resources. The ratings from this report are:

  • Use of resources: Good  
  • Combined rating: Outstanding  

Read more about use of resources ratings

Inspection Summary


Overall summary & rating

Outstanding

Updated 20 March 2019

Our rating of the trust improved. We rated it as outstanding because:

  • We rated safe, effective and responsive as good and caring and well-led as outstanding.
  • We rated six of the trust’s eight services as good, one as outstanding across two sites and one as requiring improvement. In rating the trust, we took into account the current ratings of the five services not inspected this time.
  • Whiston Hospital was rated good overall.
  • St Helens Hospital was rated outstanding overall.
  • Community services were rated as good overall.
  • We rated Marshalls Cross Medical Centre as requiring improvement however this service was only acquired by the trust in April 2018 and therefore these ratings are not aggregated in to the overall ratings.
  • As the community services had been delivered by the trust for less than two years we have agreed not to aggregate the rating for community into the overall trust rating.
  • We have rated well led for the trust as outstanding. There had been significant progress within the maternity services and some upward movement within the ratings although there has been some deterioration in one rating in urgent and emergency care.
  • The Trust retained the outstanding ratings for the Whiston and St Helens Hospital outpatient services, which were rated in 2015.
  • The trust was rated good for Use of Resources.
  • This gives a combined rating of outstanding.

Inspection areas

Safe

Good

Updated 20 March 2019

Our rating of safe stayed the same. We rated it as good because:

  • The safe domain was rated as good at both hospital sites.
  • People were protected from avoidable harm and abuse. When something goes wrong people receive a sincere and timely apology.
  • Openness and transparency about safety is encouraged. Staff understand and fulfil their responsibilities to raise concerns and report incidents and near misses.
  • Performance shows a good track record and steady improvement in safety. In the majority of cases, when something goes wrong, there is appropriate thorough review, investigation and action.
  • There were clearly defined and embedded systems, processes and standard operating procedures to keep people safe and safeguard them from abuse.
  • Staff had received up-to-date training in safety systems.
  • Safeguarding vulnerable adults, children and young people was given sufficient priority.
  • Staffing levels and skill mix were planned, implemented and reviewed to keep people safe.
  • Risks to people using services were assessed, monitored, managed and responded to appropriately.
  • Risks to safety from service developments or changes are planned for and managed appropriately including responding to major incidents.

However;

  • Urgent and emergency care services at Whiston Hospital and Marshalls Cross Medical Centre were rated as requires improvement in safe. Although it should be noted that the rating for Marshalls Cross was not aggregated into the trust ratings as the service had only been provided for a few months at the time of the inspection.
  • In urgent and emergency care we identified areas for improvement around safeguarding training levels. The median time from arrival to initial assessment was worse than the overall England median over the 12-month period from February 2017 to January 2018. During the inspection however, we saw that the trust had taken measures to reduce this and from March 2018 there was a reduction to less than 15 minutes. The number of Ambulance turnaround times over 30 minutes were higher than the national average and the use of both paper and electronic records caused some concern.
  • There were a number of concerns raised at Marshalls Cross Medical Centre however the trust had only been delivering the service for five months at the time of the inspection and actions were being taken.
  • There was an area for improvement in the review and investigation of deaths to ensure that all deaths that require investigation are investigated thoroughly. The trust was made aware during the inspection and assured us that they would look at the concern.

Effective

Good

Updated 20 March 2019

Our rating of effective stayed the same. We rated it as good because:

  • All services apart from the Marshalls Cross Medical Centre were rated as good for effectiveness.
  • People had good outcomes because they received effective care and treatment. The outcomes were monitored and used to improve care.
  • Care and treatment was planned and delivered in line with current evidence-based guidance and legislation.
  • People had comprehensive assessments of their needs including clinical, mental health, wellbeing and nutrition and hydration. These were regularly reviewed and updated.
  • People who were subject to the Mental Health Act had their rights protected.
  • The trust engaged in relevant local and national audits and results were used to internally and externally to improve care and treatment.
  • Staff were qualified and had the skills they needed to carry out their roles effectively.
  • There was timely and meaningful supervision and appraisal for staff. There was a clear and appropriate approach to managing staff when performance was poor or variable.
  • Care was delivered by coordinated, multidisciplinary teams and services who worked collaboratively to meet the range and complexity of people’s needs including at transition between services and at discharge.
  • Consent to care and treatment was gained in line with legislation and guidance.
  • Deprivation of Liberty safeguards were used proportionately and appropriately in the best interest of the person.

Caring

Outstanding

Updated 20 March 2019

Our rating of caring stayed the same. We rated it as outstanding because:

  • Two services that we previously rated as outstanding and were not inspected remained outstanding and the community inpatient service at Newton Hospital was rated outstanding for caring. The other core services we inspected rated caring as good.
  • Throughout the inspection we saw that individuals were supported and treated with dignity and respect and were involved as active partners in the planning and delivery of their care.
  • People who used the services were continually positive about the way staff treated them. Some people felt that staff went the extra mile and the care exceeded their expectations.
  • There was a strong, visible person centres culture, the staff we met were highly motivated and driven. The relationships between people who use the service, their families and staff were highly valued and promoted by leaders.
  • Staff respected the totality of peoples’ needs and took in to account personal, cultural, social and religious needs when planning and arranging care.
  • We saw examples of how staff had been creative to overcome obstacles to delivering care and peoples personal preferences were reflected in how care was delivered.
  • Peoples emotional needs were highly valued by staff and embedded in their care and treatment.

Responsive

Good

Updated 20 March 2019

Our rating of responsive stayed the same. We rated it as good because:

  • All care services except for urgent and emergency services were rated as good for being responsive.
  • Peoples needs were met through the way services were organised and delivered.
  • Services were planned and delivered to meet the needs of local people, including taking in to account the various needs of people based on equality characteristics. Reasonable adjustments were made were required.
  • Care was coordinated with other services and providers.
  • Facilities and premises were appropriate and in some areas, were being adjusted for example in the urgent and emergency department.
  • The appointments system supported people to get appropriate appointments.
  • Waiting times, delays and cancellations were minimal and managed appropriately.
  • The complaints process was easy to access, and all complaints were taken seriously and dealt with in an open and transparent way. Improvements were made based on the findings from complaints.

Well-led

Outstanding

Updated 20 March 2019

Our rating of well-led improved. We rated it as outstanding because:

  • All the core services were rated good for well-led except one which was rated outstanding across both hospital sites.
  • There was clear statement of vision and values driven by quality and safety. There were credible service level strategies.
  • Strategic objectives were cascaded through the organisation and staff knew and understood the vision, values and strategic goals. Values were held as underpinning the delivery of the strategies.
  • Governance within the organisation functioned effectively with clear structures of accountability which were understood and effective.
  • Quality and finance received comparable coverage in corporate meetings including the Board.
  • Performance information was accurate, valid and reliable and the integrated performance reports supported effective decision making.
  • Risk management processes were comprehensive and identified, monitored and addressed risks which were escalated appropriately.
  • Leaders were knowledgeable and understood the risks in their areas. They prioritised safe, high quality care through supportive relationships with staff who felt respected, valued and supported.
  • Candour and honesty amongst staff promoted challenge to poor practice and staff wellbeing was promoted.
  • Engagement with staff and people who used services was seen and was held in high importance to effective change management.
  • Safe innovation was supported and there was a strong focus on learning an improvement.
Checks on specific services

Community health inpatient services

Good

Updated 20 March 2019

We did not previously rate this service. We rated it as good because:

  • The service controlled infection risk well. The areas we visited were exceptionally clean and tidy.
  • All relevant staff, teams and services were involved in the assessing, planning and delivering of patients’ care and treatment and there was excellent multi-disciplinary working to ensure holistic and effective patient care and evidence of close partnership working with community services and other outside areas.
  • Accurate and up-to-date information about the effectiveness of care and treatment was shared internally and externally. Positive changes had been implemented based on findings from previous Intermediate Care Audits, to improve patient outcomes and patients had access to seven-day therapy services.
  • Staff responded compassionately when patients or their relatives needed help. Support was always given by caring staff, in order to meet the needs of the patients and their families.
  • Staff ensured that patients and those close to them were partners in decisions about their care and treatment, including decision making processes.
  • We saw examples of outstanding care and staff going to great lengths to ensure the needs of the patients were met.
  • The service planned and provided services in a way that met the needs of local people, often admitting patients on the same day when they were able. The service provided a 24-hour service for intermediate care delivered to the local population.

However:

  • There were no robust records of cleaning schedules being completed.
  • There were some gaps in effective documentation, as we saw evidence of signatures that were missed in three out of the 13 records we examined.
  • There were 46 medication errors in the last 12 months, which included issues with the doses of medication given.

Community health services for adults

Good

Updated 20 March 2019

We did not previously rate this service. We rated it as good because:

  • The trust took responsibility for delivering the services provided by the Healthy Hearts team, chronic obstructive pulmonary disease team and tissue viability nursing in April 2018. We were impressed by how quickly these services had integrated into the trust. They were performing well and staff told us they felt valued by the trust.
  • We saw community based services worked closely with inpatient services to provide integrated pathways for patients and coordinated care and treatment for patients moving out of hospital and into community services.
  • Overall, staff told us they felt positive about their work and we saw they worked in cohesive teams that delivered person-centred care and treatment.
  • We saw strong local leadership of community teams at line management and senior management level.
  • We saw several examples of outstanding practice and excellent examples of services working with the public and local agencies in innovative ways that supported the care and treatment of vulnerable patients.
  • The service had some characteristics that, when teams are embedded into the trust, could be defined as outstanding.

However,

  • Each team or service worked as part of the division it aligned to professionally such as surgery or care of older persons. There was no identity, vision or strategy for community services as a whole.
  • We saw that policies and guidelines for staff working alone in the community and secure storage of patient records were not applied consistently across all the teams within community services for adults.