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Archived provider: Ipswich Hospital NHS Trust Good

On 11 July 2018, we published a report on how well Ipswich Hospital NHS Trust uses its resources. The rating from this report is:

  • Use of resources: Requires Improvement  

Read more about use of resources ratings

Inspection Summary


Overall summary & rating

Good

Updated 18 January 2018

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

Safe was requires improvement, effective, caring, responsive and well led were good.

Our inspection of the core services covered Ipswich hospital and Community In patient services at Aldeburgh Community Hospital, Bluebird Lodge Community Hospital and Felixstowe Community Hospital. Our decisions on overall ratings take into account, for example, the relative size of services and we use our professional judgement to reach a fair and balanced rating.

Ipswich hospital

  • Urgent and emergency care went down from outstanding to good overall. The question of safety went down from good to requires improvement. Responsive and Well Led went down from outstanding to good. There were concerns with safety aspects relating to equipment monitoring, maintenance, and risk assessment processes for the environment. Service performances against national standards were variable and the department was in the process of transition and was introducing a new model of nursing leadership.
  • Medicine services remained rated as good overall, with all five questions remaining good. Safety and delivery of the service and outcomes for patients remained good, with some innovative developments in older people’s services. Patients’ needs were met and treatment delivered by well-trained competent caring staff. However there were some improvements required with ensuring the accuracy of venous thromboembolism (VTE) assessments.
  • Services for children and young people had improved from requires improvement to good overall. The question of safety remained requires improvement, effective and well led had improved to good with caring and responsive retaining a good rating. There were concerns around medication storage, documentation completion by medical staff and safeguarding training to level three. However the trust had taken steps to improve the critical care pathway for children, with clarity now around patient flow and competent staffing to provide care to seriously ill children. A change in leadership had resulted in a more visible cohesive team.
  • End of life care remained rated as good overall, with the effective rating improved from requires improvement to good. The documentation was now in line with National guidance, individualised care planning had been introduced and discussions with patients and families regarding end of life care planning decisions had improved. However there were shortfalls in monitoring of incidents specifically relating to EoLC and how many patients achieved their preferred place of care and preferred place of death.
  • On this inspection we did not inspect surgery, critical care, maternity, and outpatients. The ratings we gave to these services on the previous inspection in January 2015 are part of the overall rating awarded to the trust this time.

Community Inpatient service

  • Community inpatient services had not been inspected and rated previously. Safe, effective, caring, responsive and well led were all rated as good. Care was provided in line with national and best practice guidelines. Patients’ needs were met and there was clarity regarding management responsibility with engaged local leadership. However we also found that IT systems, at the time of inspection, did not allow staff to access the trust intranet. In some locations the vacancy rate was high and not all risk management processes were embedded.
  • On this inspection we did not inspect community health services for adults or urgent care. These services had not been inspected previously therefore there is no rating provided.
Inspection areas

Safe

Requires improvement

Updated 18 January 2018

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

  • Urgent and emergency care had gone down for safety from a good rating at out last inspection to requires improvement. There was a lack of effective process to monitor equipment servicing to ensure items were safe for use, and there were gaps in checking of resuscitation equipment. Risk assessments to ensure the environment utilised for patients suffering mental health conditions were not in place and had not been identified as an area of risk. Mandatory training and safeguarding training completion rates did not meet the trust’s completion target and prompts to lead staff to explore potential types of abuse were limited to only physical signs.
  • Services for children and young people remained rated as requires improvement. There was ineffective process to ensure medications were stored at appropriate temperatures to maintain efficacy. Compliance with mandatory training for nursing staff across the service was lower than the trust target of 95%, and safeguarding level three training was at 79% which for childrens service was particularly low. Medical stall were not completing the ‘First hour of care’ documentation on the neonatal unit.
  • At our last inspection in January 2015, surgical services were rated as requires improvement for safe. The action plan and ongoing monitoring and engagement with the trust gave us a good degree of confidence that the trust had taken the right action to improve the safety of this service. This will be inspected at a later date.

Effective

Good

Updated 18 January 2018

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

  • Urgent and emergency care remained good for effectiveness. Evidence-based guidance was used to provide care and treatment and staff were competent in their skills and knowledge. There was good multidisciplinary working. However the department did not continue to measure their performance against the Royal College of Emergency Medicine (RCEM) clinical standards for emergency departments in relation to sepsis.
  • Medicine services remained good for effectiveness. Care and treatment was based on national guidance the service monitored the effectiveness of care and treatment and used the findings to improve them.
  • Services for children and young people improved for effectiveness from requires improvement to good. Effectiveness of care and treatment was monitored through local and national audits and actions identified to improve. Working relationships with other providers of specialist care and regional networks were established. However we did find areas for improvement with regard to ensuring policies were updated in a timely manner, monitoring of fasting times in day surgery and consent process in respect of Gillick competence. Transition for adolescents was yet to be established in all areas.
  • Services for end of life care remained requires improvement for effectiveness. There remained areas for improvement such as utilising local audit to monitor specialist palliative care response times and preferred place of death or preferred place of care. However care provided was in line with national guidance, documentation had been revised and individualised care plans introduced. Consultation was underway to increase the specialist palliative care team (SPCT) service to seven days and introduce an electronic system to co-ordinate care.
  • Community Inpatient service was rated as good for effectiveness. Patients care, pain relief and nutrition were planned and delivered in line with national and best practice guidelines. There was established multidisciplinary working across all three community hospitals and staff were competent and encouraged to develop.

Caring

Good

Updated 18 January 2018

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

  • Urgent and emergency care remained good for caring. Staff provided compassionate care and ensured privacy and dignity for patients at all times. Patients and those close to them were involved in decisions about their care and treatment, with explanations being given in terms the patient could understand. The chaplain for the emergency department carried a trauma bleep and offered emotional support to the relatives of critically ill patients. However friends and family test results needed to improve.
  • Medicine services remained good for caring. The evidence was universally positive about the way patients and relatives were treated by staff. Staff displayed kind and gentle behaviour and offered positive support to patients that were uncomfortable or needed reassurance. Situated in the oncology and haematology department was the cancer information centre which meant patients and relatives had immediate access for information and support.
  • Services for children and young people remained good for caring. Patients spoke of being treated with kindness and explanations were provided to the children as well as the parents. There were several specialist nurses, such as the bereavement midwife, that provided additional support. There were parent care plans in place in the neonatal unit, however despite this, inclusion of parents in discussions with medical staff was not always good with babies being removed from parents for medical ward rounds.
  • Services for end of life remained good for caring. Both medical and nursing staff were aware of treating patients receiving end of life care, and their families, in a sensitive manner. Dignity and respect was embedded across all disciplines of staff including nurses, doctors, chaplains and porters. Individualised care plans included psychological and spiritual needs and there were a range of clinical nurse specialists in place to provide support and information.

  • Community Inpatient services were rated good for caring. All staff were observed to be courteous, professional and kind when interacting with patients. Patient feedback was consistently positive. There were examples of special events, such as wedding ceremonies, being organised. Information for a range of support groups was available at all three community hospitals.

Responsive

Good

Updated 18 January 2018

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

  • Urgent and emergency care went down for responsiveness from outstanding to good. The department had seen a downward trend against some national performance targets in the last 18 months. However the service continued to provide to the needs of the local people and had undertaken an external review to identify areas to enable improvement. There was a proactive approach to managing flow through the department.
  • Medicine services remained good for responsiveness. Processes for admissions, discharges and peaks of capacity worked well. The Frailty Assessment Base (FAB) provided an alternative to acute admission provided liaison between local GPs, community teams and provided multidisciplinary team assessment. Health passports provided continuity in care with the community. Processes were in place for sharing and learning from complaints.
  • Services for children and young people remained good for responsiveness. There was clear evidence that the service involved children and young people in design and development of the service. More age appropriate toys and materials had been introduced and a portable sensory unit meant availability across all wards. There were however areas for improvement such as the paediatric recovery area and reducing the need to treat children under the age of 16 in adult inpatient areas.
  • Services for end of life remained good for responsiveness. Staff were aware of patients’ individual spiritual and religious needs. Visiting hours were flexible to ensure relatives could spend as much time as needed with their loved ones. There was a compassionate approach from all staff including the chaplaincy and mortuary service. However there was recognition that delays with completion of death certificates and cremation documentation needed to improve.
  • Community Inpatient services were rated good for responsiveness. There was evidence that the trust worked with other providers to plan and deliver services, providing both step up services (admission from primary care) and step down services (admission from acute beds). Patient admissions were pre-planned to allow for appropriate individual assessment and there were several specialist staff, such as dementia champions, provided support in the community setting. However there was no discharge co-ordinator to support community inpatients and there was evidence that delayed discharges could be improved.

Well-led

Good

Updated 18 January 2018

Our rating of well-led stayed the same. We rated it as good because:

  • Urgent and emergency care went down for well led from outstanding to good. The department was in a transition period with regard to nursing leadership. Staff continued to work well together and described an open and supportive culture. Staff were encouraged to share ideas about how to improve services and recent examples of this included a proposed pilot to trial out of hours cover for phlebotomy and ECG monitoring.
  • Medicine services remained good for well led. Nursing and medical leadership at a local level was established and visible. There was a defined strategy with focus on alternative ways of working to manage capacity pressures with new developments such as pathway to support frail older patients both in the acute setting and in the community. Culture was positive with strong multidisciplinary working, with clear lines of accountability for risk management and performance.
  • Services for children and young people improved for well led from requires improvement to good. Following some team-changes staff told us local leaders were more visible. A strategy had been drafted with a focus on high standards of care. There was a clear sense of pride amongst staff with clear lines of responsibility aligned to the accountability framework and staff felt communication was good.
  • Services for end of life remained good for well led. A named non-executive director (NED) was now in place for end of life care. Staff had been engaged in developing the strategy for the service to ensure it met patient’s needs. There were formalised quality assurance processes in place and a member of the mortuary now attended the end of life programme board meetings. However we found that there was limited oversight of incidents relating to end of life care and no formal bereavement survey, to gather the views and experiences of bereaved relatives.

  • Community Inpatient services were rated good for well led. There were clear lines of management responsibility and accountability that linked into the accountability framework. At each hospital, we found knowledgeable, enthusiastic local leaders and staff stated they felt valued and supported. The united aim was to provide integrated services to provide seamless transition from acute care to community and primary care settings. At the time of inspection the community inpatient services were just preparing to adopt the trusts risk management processes and therefore these need to be fully embedded.

Assessment of the use of resources

Use of resources summary

Requires improvement

Updated 18 January 2018

Checks on specific services

Community health inpatient services

Good

Updated 18 January 2018

We had not rated community services before. We rated community services as good because:

•We rated safe, effective, caring, responsive and well led as good

A summary of our findings about this service appears in the Overall summary