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Provider: Portsmouth Hospitals NHS Trust Good

We are carrying out checks on locations registered by this provider. We will publish the reports when our checks are complete.

Inspection Summary


Overall summary & rating

Good

Updated 29 January 2020

Inspection areas

Safe

Requires improvement

Updated 29 January 2020

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

  • Overall there was some improvement with regards to safety across the trust. However there were still significant concerns about safety in some areas that we inspected.

  • The services provided mandatory training in key skills to all staff but did not make sure everyone completed it. Some areas met the mandatory training targets but there were still significant deficiencies in compliance throughout the trust. Medical staff compliance with mandatory training targets was particularly poor.

  • Some services did not always control infection risk well. Staff did not always use control measures effectively to protect patients, themselves and others from infection.

  • The design, maintenance and use of facilities, equipment and premises did not keep all people safe. There were areas throughout the hospital that did not have capacity for the patients it served. The hospital was often close to its bed capacity causing flow issues and outliers and some spaces were cramped.

  • The emergency department was frequently crowded. Lack of capacity within the department led to patients being accommodated in non-clinical areas, including in corridors, and being held for long periods in ambulances outside the emergency department.

  • There were no side rooms for isolation of infectious patients on the Surgical High Care Unit.

  • Staff did not always use or check emergency equipment according to guidance or the trust’s policy.

  • It was not always clear that all staff recognised and reported all incidents and near misses and there were delays to incident reviews in some areas.

  • The triage processes were not always managed safely and effectively and in line with guidance.

  • There were significant numbers of patients waiting in ambulances over an hour before being handed over to the emergency department staff.

However,

  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.

  • Some services did control infection risk well. In these areas, staff used control measures effectively to protect patients, themselves and others from infection.

  • The services had staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed and adjusted staffing levels and skill mix, and gave bank, agency and locum staff a full induction.

  • Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date, stored securely and easily available to all staff providing care.

  • The services used systems and processes to safely prescribe, administer, record and store medicines.

Effective

Good

Updated 29 January 2020

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

  • The services provided care and treatment based on national guidance and evidence-based practice.

  • Staff generally gave patients food and drinks and considered the needs of patients who needed special feeding and hydration techniques.

  • Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way.

  • The services made sure staff were competent for their roles.

  • Doctors, nurses and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care.

  • Key services were available seven days a week to support timely patient care.

  • Staff gave patients support and advice to lead healthier lives.

  • Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent. They knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health.

However,

  • Some departments did not have regular team meetings and there was no consistent approach to sharing information across teams.

  • Not all staff had a recent appraisal recorded. The trust was meeting its overall target appraisal rate, but there were areas which were not meeting the target.

  • Some services were outliers for some national audits.

Caring

Good

Updated 29 January 2020

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

  • Staff generally treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.

  • Staff generally provided emotional support to patients, families and carers to minimise their distress. They understood patients’ personal, cultural and religious needs.

  • Staff generally supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.

Responsive

Good

Updated 29 January 2020

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

  • The services planned and provided care to meet the needs of local people and the communities served. It also worked with others in the wider system and local organisations to plan care.
  • The service was inclusive and took account of patients’ individual needs and preferences. Staff made reasonable adjustments to help patients access services. They coordinated care with other services and providers.
  • People could access the service when they needed it and received the right care promptly. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were in line with national standards.
  • It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff. The service included patients in the investigation of their complaint.

However,

  • Patients were not always able to access care and treatment in a timely way and in the right setting, particularly in the emergency department.
  • Patients were still waiting extended periods for appointments in some clinics.
  • The trust only met its target to respond to complaints within 30 days in 47% of cases.
  • There was not a consistent approach to providing patients with accessible information, for instance letters in large print.
  • Signage in the hospital could be confusing. We observed, and patients reported, that they were not always able to navigate the hospital easily.

Well-led

Good

Updated 29 January 2020

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

  • Leaders had the integrity, skills and abilities to run the service. They understood and managed the priorities and issues the services faced. They were visible and approachable and supported staff to develop their skills and take on more senior roles.

  • The culture across the trust had improved since out last visits. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The trust promoted equality and diversity in daily work and provided opportunities for career development. It had an open culture where patients, their families and staff could raise concerns without fear.

  • Leaders operated effective governance processes. Staff at all levels had regular opportunities to meet, discuss and learn from the performance of the service.

  • The trust had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected. They used a systematic approach to improve the quality of the service. Managers we spoke with at all levels understood the risks to the services and could describe action to reduce risks.

  • The services collected reliable data and analysed it to understand performance and make decisions and improvements.

  • Leaders and staff actively and openly engaged with patients, staff, equality groups, the public and local organisations to plan and manage services. They collaborated with partner organisations to help improve services for patients.

Staff were committed to continually learning and improving services. Leaders encouraged innovation and participation in research.

However,

  • IT systems did not support comprehensive recording and analysis of data and not all services had the information to monitor performance in all areas.

  • Not all risks were identified, or there was not assurance that all risk was identified, and included in the risk management process.

  • There was no vision and strategy for some services.

  • There was lack of pace with plans to improve performance of the service.

Assessment of the use of resources

Use of resources summary

Good

Updated 29 January 2020

We award the Use of Resources rating based on an assessment carried out by NHS Improvement.

Our combined rating for Quality and Use of Resources summarises the performance of the trust taking into account the quality of services as well as the trust’s productivity and sustainability. This rating combines our five trust-level quality ratings of safe, effective, caring, responsive and well-led with the Use of Resources rating.

Combined rating

Combined rating summary

Good

Updated 29 January 2020

Our rating of use of resources was good because:

  • The trust had a past record of delivering financial deficits but had strengthened its financial governance, was delivering against its financial recovery plan and was on track to improve its financial position in 2019/20. The trust benchmarked overall well on workforce productivity, clinical support services, corporate services and clinical services metrics. It had a total cost per weighted activity unit which benchmarked in the second-best quartile nationally for 2017/18.
  • However, we noted a few areas where the trust could improve particularly around operational performance, agency staff spend, delivery of financial efficiencies and specific areas in clinical support services, estates and procurement.