Mid Cheshire Hospitals NHS Foundation Trust

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment, we rated this key question as requires improvement. At this assessment, the rating has changed to Good.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service had a positive culture of safety. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Staff gave examples of learning and changes made to support and train staff and improve the service. For example, the process for reviewing and reporting X-rays had been improved to ensure they were reviewed by a radiologist within 48 hours of being undertaken.

Staff told us they knew how to raise concerns but did not always feel listened to and confident action would be taken.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Patients who presented with symptoms that required urgent care and treatment were referred onto the trust emergency department. Patients could also be signposted to other health and care services, dependent on need.

Patients’ details were recorded on booking and initial assessment. The visit and treatment were shared with the patients GP including any follow up required.

The service to identify safeguarding concerns for people who attended the service. Safeguarding policies were in place and known to staff, who were appropriately trained in safeguarding procedures. No concerns were identified at the time of our assessment.

Staff had access to safeguarding policies and procedures and had undertaken safeguarding training for adults and children. Staff could access safeguarding advice and guidance from the trust safeguarding lead based at Leighton Hospital.

Staff we spoke to were knowledgeable about safeguarding processes and gave examples of safeguarding issues the service faced. For example, clinicians did not have access to GP records and were reliant on the information the patient gave during the assessment. Safeguarding concerns were escalated and documented and acted upon as necessary. At the time of assessment the service was transitioning across to an electronic record system that would allow all staff to have access to information contained with the GP record system.

The service worked with people to understand and manage risks and take action to mitigate them. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Staff could recognise a deteriorating patient and knew of action to take. Patients booked in at reception and were triaged by a nurse. Patients were assessed and a treatment plan was discussed according to the patient need. For example, an X-ray or transfer to accident and emergency service at Leighton Hospital. Patients were advised on risks related to their condition and actions to take if their condition deteriorated or required follow up.

The service had a process for closing in the evening if there were still patients to review. Patients were triaged and signposted to the local hospital, referred to GP out of hours or advised to attend the following day dependent on their presenting need.

The service detected and controlled potential risks in the care environment. Staff made sure equipment, facilities and technology supported the delivery of safe care. However, the service had a dedicated triage room from 8am to 6pmand then a cubicle from 6pm to 8pm. The provider assured us that this was under review at the time of inspection to provide continuity of care to patients in the same area.

The service was located in a grade II listed building which is owned by the trust. The replacement of the fire alarm system had started with phase one which was expected to take 12 months, followed by phase two. Plans were in place to support this. There was a business continuity plan in place which was monitored and reviewed.

The service had a shared waiting area with other service in the hospital. There was a separate children’s waiting area and fire exits were clearly signposted.
Emergency equipment was available, and checks were completed to ensure the equipment was safe and maintained to manufacturers’ instructions.

There were systems for safely managing healthcare waste.

The service made sure there were enough qualified, skilled and experienced nursing staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

We found training was up to date, learning needs and development of staff was managed appropriately, and staff were working within their agreed areas of competence. Safe recruitment practices were followed. Nursing staff told us medical mentors were assigned to each nurse practitioner.

Staff completed an induction when they started working for the service.

Rotas were planned well in advance and some staff rotated between the minor injuries unit and the local emergency department. A review of the service had not been undertaken in the last four years. Staff had been trained in additional skills to provide care and treatment for some medical conditions. In the absence of a service review, these staff did not have the opportunity to treat patients with some of the conditions they were trained in.

Locum and agency staff were not used. Employed staff were used as bank staff to support the service.

The service assessed and managed the risk of infection.
Nurses had a designated infection, prevention and control lead and support from a microbiologist for antimicrobial prescribing.
All staff had had relevant training and access to personal protective equipment. Policies and procedures were in place.
Cleaning schedules were in place and followed. Hand hygiene audits were completed. No concerns were identified.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences.
The service stored controlled drugs in a locked swipe access cupboard. The medicines stocks and drug registers were monitored by the trust pharmacy team.
We were told the medicines were removed when the service was shut on Christmas Day and New Years Day.
We saw fridge temperatures were recorded and monitored to ensure medicines were stored at the correct temperature.
We reviewed the controlled drug register and prescription process and found medicines were stored as per best practice guidance.