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Archived provider: The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust Good

Inspection Summary


Overall summary & rating

Good

Updated 18 June 2018

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

  • Across the trust, we found the services we inspected to be safe, effective, caring, responsive and well led. We rated safe, effective, caring and responsive as good overall and well led to be outstanding.
  • The trust had made significant improvements in all the areas we inspected. Trust leaders had taken a cultural approach to improving services, ensuring that quality improvement and continuous improvement were integral to the everyday workings of the trust.
  • Patient safety was afforded sufficient priority. Staff kept patients safe from avoidable harm and abuse. When patient safety incidents occurred, the trust took a robust and systematic approach to ensuring that learning was identified and practices improved where appropriate.
  • Staff followed best practice and evidence based guidance to ensure patient outcomes were good. Patient outcomes were mostly better or similar to other acute trusts when compared nationally.
  • There were sufficient numbers of suitably skilled and trained staff to deliver effective care and treatment.
  • Equipment and premises were fit for purpose, clean and managed well. Medicines were safely managed.
  • Staff, including senior leaders, worked together and followed clear escalation protocols when the hospital was reaching capacity to ensure patient care was not unduly compromised.
  • Patients were treated with dignity and respect throughout the trust and trust leaders promoted a person centred culture. Patients and their relatives gave consistently positive feedback about the care they received.
  • The trust was responsive to individual needs and made good provision for patients with mental health conditions and/or a learning disability.
  • Services were planned in a way that ensured patients could access care and treatment in a timely way.
  • The trust was ranked first (highest performing) when compared against acute trusts nationally in the NHS staff survey of 2017.
  • Senior leaders at the trust provided exemplary leadership to staff, ensuring staff had the right tools in place to drive improvements and innovate in their everyday work.
  • Trust leaders had developed a clear mission, strategy, vision for the trust underpinned by clearly understood strategic objectives and key priorities.
  • Robust governance arrangements and risk management ensured the trust could deliver against its strategic objectives.
  • The trust were working collaboratively with system partners towards the transformation of services across Dorset.
  • The relationship between the board and the Council of Governors had improved and board members were more responsive to challenges and concerns raised by governors.

Inspection areas

Safe

Good

Updated 18 June 2018

Our rating of safe improved. We rated it as good because:

  • The trust provided mandatory training in key skills to all staff and monitored compliance levels.
  • Staff across the trust demonstrated clear understanding of how to protect people from abuse and worked well with other agencies to do so.
  • The trust controlled infection risk well. Staff kept themselves, equipment and premises clean. The trust had a consistently low rate of hospital-acquired infections.
  • The trust had suitable premises and equipment and looked after them well.
  • There were sufficient numbers of staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.
  • Records were mostly well managed, clear and up to date.
  • The trust followed best practice when giving, recording and storing medicines.
  • The trust had an exemplary reporting system, which allowed staff to report incidents, share good practice, share an improvement idea or share a concern. Staff were positively encouraged to report incidents.
  • Incidents, including deaths, were investigated thoroughly and learning was shared and used to improve patient safety and experience.
  • The trust recognised and responded appropriately to patients whose condition was deteriorating.

However,

  • Whilst the trust overall was providing safe care, there was inconsistency in some areas with measures to control and prevent infection, medicines management, the completion of patient risk assessments in a timely way and storage of patient records in medicine and surgical services.
  • Despite a robust approach to patient safety and learning from incidents, the trust continued to report never events.

Effective

Good

Updated 18 June 2018

Our rating of effective improved. We rated it as good because:

  • The trust provided care and treatment based on national guidance and evidence of its effectiveness.
  • Staff gave patients enough food and drink to meet their needs and improve their health. Staff used special feeding and hydration techniques when necessary.
  • Patients had good access a range of pain relief when required.
  • The trust ensured staff were competent for their roles through the investment of additional training, values based appraisals and staff development initiatives.
  • Staff across the trust understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. Staff sought consent from patients appropriately, before procedures took place.
  • Managers monitored the effectiveness of care and treatment and used the findings to improve them. Patient outcomes were mostly positive. Where appropriate, the trust had action plans in place where needed to improve patient outcomes.
  • Staff worked well together within and across teams to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.
  • The trust provided services across seven days a week, there were consultants either on call or on site over the 24-hour period.
  • People who used services were empowered and supported to manage their own health, care and wellbeing to maximise their independence.

However

  • There was some variability in staff approach to assessing capacity in the medicine service.
  • There were some gaps in completion of nutritional assessments and food and fluid charts across the medical and surgical services.

Caring

Good

Updated 18 June 2018

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

  • Caring in the medicine service had improved significantly since our last inspection when we rated it as requiring improvement.
  • We observed a deeply positive and embedded culture of caring, which was clearly demonstrated by all staff groups in all areas. This internal culture supported patients and relatives and encouraged families to become equal partners in care.
  • We observed kind and compassionate care in all areas we inspected. It was of note that the trust was at the highest level of escalation due to increased demand for hospital care at that time.
  • Staff ensured that patients were treated with dignity and respect and took action to ensure their emotional needs were met.
  • Patients and their loved ones consistently provided positive feedback about the care they had received from staff at the trust.
  • The trust had introduced Schwartz rounds to support reflection and promote kindness and compassion in practice.

Responsive

Good

Updated 18 June 2018

Our rating of responsive improved. We rated it as good because:

  • The trust planned and provided services in liaison with the wider health economy to meet the needs of local people.
  • The service took account of patients’ individual and/or complex needs. The trust had a clear dementia strategy and working group, which had improved care for patients living with dementia.
  • Most people could access the hospital when they needed it. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were mostly in line with good practice.
  • Staff and managers worked hard to ensure that patient flow was managed effectively. Patients were mostly treated in a timely way in and discharged home at the earliest clinically safe opportunity.
  • The trust treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with all staff.

However

  • A minority of patients stayed in hospital for longer than clinically necessary. Whilst the majority of these patients were awaiting social care provision, the trust was working with system partners to address this.
  • Whilst the trust benchmarked in the top 16% of type 1 providers in 2017/18, it breached the national standard of 95% for emergency departments for patient admission, transfer or discharge within four hours of arrival for eight out of 12 months in 2017.
  • Not all complaints were investigated within the trust’s internally agreed timescales. The trust were reviewing their complaints procedure to allow a longer timescale for particularly complex or challenging complaints to address this.

Well-led

Outstanding

Updated 18 June 2018

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

  • We were impressed with the leadership across all of the services we inspected. We rated surgery and medicine as good for well led and maternity and urgent and emergency care as outstanding.
  • Service managers had the skills, expertise and knowledge to lead teams to deliver safe and quality care.
  • Staff at all levels in all services understood the trust values in relation to their daily roles and the values were used as a common language by staff when challenging poor practice.
  • Local leaders were empowered to lead effective and high functioning teams.
  • Staff at all levels across the services had appropriate tools to drive improvement and innovation in their everyday work. Staff were motivated and inspired to improve patient care in every way possible.
  • Staff had access to timely and accurate information that was used to monitor and improve performance.
  • Each service had clearly identified governance leads and clear reporting lines to and from the board.
  • Service managers took financial ownership of the services they were responsible for and understood the trust’s overall financial position.
  • In maternity, service leaders were working in a highly collaborative way with system partners to best support the needs of local women and babies.
  • In the emergency department, service leads followed effective escalation protocols and led by example during times of maximum capacity to reduce the impact on patients. The culture within the department remained exceptionally positive, even at times of peak escalation.