30 June 2020
The Great Western Hospitals NHS Trust provides acute hospital services at the Great Western Hospital, which has 23 inpatient wards (around 480 beds), 18 operating theatres, an emergency department and an urgent care centre. The trust employs approximately 5,000 staff and has around 1.2 million patient contacts a year.
The trust also provides community services to support people to manage long-term conditions. Services are provided in local community facilities and in people’s own homes across Swindon. Services include inpatient rehabilitation and community nursing and therapy services.
Since November 2019, the trust has provided primary care services at two main practices in Swindon – Moredon and Abbey Meads, which together serve around 30,000 people.
The trust does not provide services for people with mental health needs. There is a service level agreement with a local mental health trust, which includes mental health liaison services, out of hours crisis resolution and application of the Mental Health Act.
21 December 2018
We rated safe, effective, caring, responsive and well-led as good, because:
- We were assured the service was consistently meeting the requirements to provide safe care in all areas. Staff protected patients from abuse and maintained infection prevention and control standards. Staff were reporting incidents and lessons were learned from these. Safety information was collected and actions taken to improve services.
- The service was providing effective care, with patients receiving evidence-based care and treatment. Staff from different services, both internal and external, worked well together. Staff were competent in meeting the assessed needs of patients.
- Staff took the time to interact with patients and those close to them in a respectful, compassionate and considerate way. Patients and their relatives/carers were actively involved in their treatment and care.
- Services provided reflected the needs of the population served and ensured flexibility, choice and continuity of care. Services were reviewed and improved when they were identified as not meeting the needs of patients. Complaints feedback was used to improve services provided and learning was shared amongst staff.
- Leaders had the right skills and commitment to improve the quality of the service. The culture was centred around the needs and experience of patients. There were structures, processes and systems of accountability to support the delivery of the strategy and good quality services.
- Not all staff within community health services for adults were compliant with the trust’s mandatory training programme. There were shortfalls in some areas, including manual handling and adult basic life support.
- The safety electrical checks on some equipment, including some medical devices, were out of date. However, the trust was aware of this and was taking action to address this risk.
- Whilst there were systems for monitoring performance, waiting times were not being formally scrutinised until after our inspection.
- Complaints were not always responded to within the target time frames set by the trust.
19 January 2016
Overall rating for this core service
We found that services were safe, effective, caring, responsive and well led. The staff were competent, compassionate, enthusiastic and well supervised in their role. During the inspection, we met with managers, staff, children, young people and parents in a variety of community settings. We observed staff delivering care being in schools, outpatient clinics and in the child’s own home. There was an open reporting culture for any incidents that took place. Staff were encouraged to raise incidents and managers gave them feedback when appropriate. Staff were aware of their responsibilities to safeguard children and young people from abuse and worked closely with different agencies where appropriate. Recruitment had been a concern within the health visiting service, but we did not see any evidence that this had a negative effect on the care provided.
Care provided to children and young people was evidence based, using NICE guidance, Department of Health research and from advice from specialist centres. Local, regional and national audits were undertaken. Managers shared the outcomes with staff and, where services needed to improve, we saw action plans in place and plans to re-audit. Multidisciplinary and multi-agency working was embedded across the teams. We saw evidence that staff received regular supervision and appraisals.
We received excellent feedback from children, young people and their parents/carers about the care and treatment they received and the staff who provided it. Staff were skilled at communicating with children and young people and treated them with respect and dignity. Staff were friendly, warm, caring and professional. Staff always put the children and young people at the heart of everything they did and always involved them in their care and treatment. Specially trained health visitors and school nurses took part in a rapid response team to support parents in Wiltshire who had experienced the unexpected death of their child. We saw staff were responsive to the needs of children, young people and their families. Interpreting services were used for families where their first language was not English. Robust clinical governance structures were in place. Staff felt supported by their team leaders and managers within the community services.
21 December 2018
We rated this service as good overall, with all key questions rated good. The service had not been inspected before under our current methodology, so we were unable to provide a comparison of ratings. We rated it as good because:
- Staff were trained in, and followed safe systems and processes to protect people from avoidable harm.
- Patients’ holistic needs were assessed and care and treatment provided by multidisciplinary teams, using evidence-based care pathways.
- Staff acted as patients advocates and promoted choice. Staff provided emotional support to patients and their relatives to help them come to terms with their situation.
- There was coordinated care, with close links with acute and community-based services.
- The service was well led; leaders had appropriate skills and experience and supported staff well. There were effective governance arrangements.
- Nurse vacancies, resulted in reliance on temporary staff.
- Documentation of best interest decisions needed to improve.
- There was limited therapy provision at weekends.
- Complaints were not always responded to within target timescales.
- Some staff felt they had not been engaged early enough in the service’s improvement journey.
19 January 2016
Overall rating for this core service GOOD
We judged the overall service provision of end of life care as good. We found the service to be safe, effective, caring, responsive and well-led.
There were systems in place to keep patients safe. There was a good provision of equipment, including syringe drivers and mattresses for patient use in the community. We saw pre-emptive prescribing of anticipatory medications and availability of the ‘just in case’ medications.
End of life care was delivered through evidence based research and guidance. Education programmes had been developed and delivered, new documentation had been successfully introduced to the trust improving the pathway for patients
Patients and relatives spoke highly of the teams of nurses in the community; they were seen as very responsive to their needs. Out of hours there were good resources for staff to access including a 24 hour advice line managed by specialist palliative care nurses at a local hospice.
End of life care was seen as a priority for the trust. There was a clear overarching strategy for the service and plans to improve the delivery of care had already begun to take place with good results. The staff were able to collate evidence and influence change to improve services for patients.