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Provider: University Hospitals Plymouth NHS Trust Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 18 December 2019

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

  • We rated safe, effective, responsive and well-led as requires improvement. Caring was rated as outstanding.
  • Medical care remained the same and was rated as requires improvement. Safe, effective and responsive all remained the same and were rated as requires improvement. Well-led went down one rating and was rated as requires improvement. Caring stayed the same and was rated as good.
  • Surgery went down one rating to requires improvement. Safe, effective and well-led went down one rating to requires improvement. Responsive stayed the same and was rated requires improvement. Caring stayed the same and was rated as good.
  • Maternity went up one rating to good. Safe and well-led went up one rating to good. Effective and responsive stayed the same and were rated as good. Caring went up one rating and was rated outstanding.
  • Diagnostic imaging went up one rating to requires improvement. Responsive and well-led went up one rating to requires improvement. Safe stayed the same and was rated as requires improvement. Caring stayed the same and was rated as good. Effective was not rated.
  • The remaining core services were not inspected at this inspection and their previous ratings are therefore unchanged.
Inspection areas

Safe

Requires improvement

Updated 18 December 2019

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

  • In medical care, staff were not always up-to-date with mandatory and safeguarding training. Cleaning records were not always up-to-date, equipment safety checks were not always completed and there were not always enough staff to keep patients safe. However, detailed records of patients’ care and treatment were available, patient safety incidents were managed well, and medicines were safely prescribed, administered, recorded and stored.

  • In surgery, there were not always enough staff to keep patients safe, staff were not up-to-date with mandatory training, VTE risk assessments were not always completed and checks of equipment were not always being carried out. However, staff understood how to protect patients from abuse, patient’s records were detailed and up-to-date, and there was a positive incident reporting culture.

  • In maternity, staff understood how to protect women and babies from abuse, infection risk was well-controlled, staffing levels were regularly reviewed and there were safe processes for prescribing, administering, recording and storing medicines. However, staff were not all up-to-date with mandatory training, processes to identify changing risks and deteriorating health were not always followed, and safety thermometer results were not displayed.

  • In diagnostic imaging, not all staff had completed mandatory training, infection prevention and control policies were not always followed, emergency equipment was not always checked, there was ageing equipment and there were not enough staff to keep patients safe. However, staff understood how to protect patients from abuse, risk assessments were completed, patient records were clear and up-to-date, and safety incidents were well-managed.

Effective

Requires improvement

Updated 18 December 2019

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

  • In medical care, appraisals were not always completed, patients were not always reviewed by a consultant in a timely way at weekend and consent was not always recorded in line with guidance and legislation. However, care and treatment were provided in accordance with evidence-based practice, pain was well-managed, and staff worked well together.

  • In surgery, many of the audits showed a deterioration and yearly appraisals were not being completed. However, care and treatment were provided in accordance with evidence-based practice, pain was well-managed, and patients were supported to make informed decisions about their care and treatment.

  • In maternity, care and treatment was provided in accordance with evidence-based practice, pain was well-managed, there was strong multidisciplinary working and women were supported to make informed decisions about their care and treatment. However, there was variable understanding of the Mental Capacity Act and Deprivation of Liberty Safeguards.

  • In diagnostic imaging, trust policies and local rules were not always reviewed, accreditation was not maintained, and seven-day services were not available due to staff shortages. However, staff ensured patients were comfortable, the effectiveness of care and treatment was monitored, and staff worked well together.

Caring

Outstanding

Updated 18 December 2019

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

  • In medical care, staff treated patients with compassion and kindness, respecting their privacy and dignity and taking account of their needs. Staff gave emotional support to patients and helped patients and those close to them understand and be involved in decisions about their care.
  • In surgery, staff treated patients with compassion and kindness, respecting their privacy and dignity and taking account of their needs. Staff gave emotional support to patients and helped patients and those close to them understand and be involved in decisions about their care.
  • In maternity, women were treated consistently with compassion and kindness, respected and valued, and emotionally supported. Feedback from women was consistently positive and staff supported women to be involved in their care and treatment.
  • In diagnostic imaging, staff treated patients with compassion and kindness, provided emotional support to patients and helped patients and those close to them understand and be involved in decisions about their care.

Responsive

Requires improvement

Updated 18 December 2019

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

  • In medical care, demand was outstripping capacity for beds and medical outliers were not always being well-managed. However, the service worked well with the wider system to plan care and took account of patients’ individual needs.
  • In surgery, people could not always access services when they needed them, there were high numbers of cancelled elective operations, and premises did not always ensure dignity and confidentiality for patients. However, the service was inclusive and took account of patients’ individual needs and complaints were responded to in a timely way.
  • In maternity, services were planned and provided to meet the needs of local people, mental health support was available 24 hours a day, seven days a week, and care was coordinated with other services and providers.
  • In diagnostic imaging, the needs of the community were not always met, routine audits were not always being completed, national standards for diagnostic tests were not being met and learning from complaints was not always shared with staff. However, the service was inclusive and took account of patients’ individual needs.

Well-led

Requires improvement

Updated 18 December 2019

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

  • In medical care, leaders were not always visible, and staff did not always feel valued. Governance and risk management processes did not operate effectively. However, leaders had the integrity, skills and abilities to run the service, collected reliable information and used it to improve services, and had a good understanding of quality improvement methods.
  • In surgery, governance processes were not always effective, and staff were not always clear about their roles and accountabilities. The service did not always collect reliable data and analyse it. Data or notifications were not always consistently submitted to external organisations as required. There was not always effective participation in and learning from internal and external reviews. Operational pressures adversely affected staff well-being and development. Minutes of mortality and morbidity meetings were not standardised. However, staff felt respected, supported and valued. Leaders and staff actively engaged with the public, staff, patients and stakeholders.
  • In maternity, leaders had the integrity, skills and abilities to run the service. There was a clear vision and a strategy to deliver it. Staff felt respected, valued and supported. Leaders operated effective governance systems and used information systems to manage performance.
  • In diagnostic imaging, there was no clinical lead or senior clinical support for radiologists in one modality. There were several vacancies in middle management, there was no vision and strategy for the service, and there was limited evidence of learning from incidents and complaints. However, staff reported a slowly improving culture and good teamwork.
Assessment of the use of resources

Use of resources summary

Requires improvement

Updated 18 December 2019

Our rating of use of resources stayed the same. We rated it as requires improvement.

NHS England and NHS Improvement undertake the Use of Resources assessments. The report is available on our website.

Combined rating

Combined rating summary

Requires improvement

Updated 18 December 2019

Our rating of combined quality and resources stayed the same. We rated it as requires improvement.

Please see the use of resources report on our website.