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Provider: Hampshire Hospitals NHS Foundation Trust Good

Inspection Summary


Overall summary & rating

Good

Updated 7 April 2020

Inspection areas

Safe

Good

Updated 7 April 2020

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

  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
  • The service controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. Generally, staff kept equipment and the premises visibly clean.
  • The design, maintenance and use of facilities, premises and equipment kept people safe. Staff were trained to use them. Staff managed clinical waste well.
  • The environment on the elderly care wards was dementia friendly. 
  • Staff completed and updated risk assessments for each patient and removed or minimised risks. Staff identified and quickly acted upon patients at risk of deterioration.
  • Despite high vacancy rates, the trust had enough staff using bank and agency. Staff had 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 and agency 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 service managed patient safety incidents well. Staff recognised and reported incidents and near misses. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support. Managers ensured that actions from patient safety alerts were implemented and monitored.
  • The service used monitoring results well to improve safety. Staff collected safety information and shared it with staff, patients and visitors.

However:

  • Although, mandatory training compliance rates had improved since our last inspection, they did not always meet the trust target.
  • Staff had access to safeguarding training, however not everyone had completed this. Compliance rates for medical staff were particularly low.
  • The service did not always have efficient systems and processes to safely prescribe, administer, record and store medicines. FP10 prescriptions were not always managed safely. In some areas, there was limited pharmacy oversight. Up to date patient group directive paperwork was not always available on the intranet
  • On two surgical wards, emergency equipment was not consistently checked to ensure they were safe to use and in line with guidance.
  • The urgent and emergency department at Basingstoke was tired in appearance. There was damage to the walls, chips in some wooden door frames and some chairs were dusty and torn.
  • The service did not always use the World Health Organisation Checklist for Safer Surgery.
  • Signage was poor in the urgent and emergency department at Basingstoke.
  • Seating in the main waiting room did not accommodate those who require a higher seat or for bariatric patients. 
  • The risk assessment for developing blood clots was not always recorded or completed in line with national guidance.
  • Recording risk assessments in all notes where patients might have been at risk in the urgent and emergency department at Basingstoke.

Effective

Good

Updated 7 April 2020

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

  • The service provided care and treatment based on national guidance and evidence-based practice. Managers checked to make sure staff followed guidance. Staff protected the rights of patients subject to the Mental Health Act 1983.
  • Staff gave patients enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary.
  • Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way. They supported those unable to communicate using suitable assessment tools and gave additional pain relief to ease pain.
  • The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and development.
  • 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 practical support and advice to lead healthier lives.
  • Staff supported patients to make informed decisions about their care and treatment. They knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health.

However:

  • Staff did not body maps to record the location of transdermal patches
  • Patient outcomes were variable and did not always meet expectations. National audits showed the hospital did not always meet national standards. 
  • Staff did not always keep up-to-date with training in the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff did not consistently record consent in patient records.
  • Although, compliance rates for appraisals had improved since our last inspection, they did not always meet the trust target.
  • Patients food and fluid records were not fully completed, and fasting processes were not always in line with national guidance.

Caring

Outstanding

Updated 7 April 2020

Our rating of caring improved. We rated it as outstanding because:

  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
  • Staff provided emotional support to patients, families and carers to minimise their distress. They understood patients’ personal, cultural and religious needs.
  • Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.

However:

  • Staff did not always record patient’s personal, cultural, social and religious needs.

Responsive

Good

Updated 7 April 2020

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

  • The service planned and provided care in a way that met 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.
  • 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:

  • People could not always access services when they needed it and did not always receive the right care promptly.
  • The service was restricted by the challenges faced with capacity and flow. Demand was outweighing capacity, and escalation areas were being used frequently.  
  • There were no information leaflets available in other languages or print sizes and no signs to advertise chaperones the urgent and emergency department in Basingstoke

Well-led

Good

Updated 7 April 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 service faced. They were visible and approachable in the service for patients and staff. They supported staff to develop their skills and take on more senior roles.
  • The service had a vision for what it wanted to achieve and a strategy to turn it into action, developed with all relevant stakeholders. The vision and strategy were focused on sustainability of services and aligned to local plans within the wider health economy. Leaders and staff understood and knew how to apply them and monitor progress.
  • Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service promoted equality and diversity in daily work and provided opportunities for career development. The service had an open culture where patients, their families and staff could raise concerns without fear.
  • Leaders operated effective governance processes, throughout the service and with partner organisations. Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service.
  • Leaders and teams used systems to manage performance effectively. They identified and escalated relevant risks and issues and identified actions to reduce their impact. They had plans to cope with unexpected events. Staff contributed to decision-making to help avoid financial pressures compromising the quality of care.
  • The service collected reliable data and analysed it. Staff could find the data they needed, in easily accessible formats, to understand performance, make decisions and improvements. The information systems were integrated and secure. Data or notifications were consistently submitted to external organisations as required.
  • 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.
  • All staff were committed to continually learning and improving services. They had a good understanding of quality improvement methods and the skills to use them. Leaders encouraged innovation and participation in research.

However:

  • Minutes from mortality and morbidity meetings across the service were not standardised across the medicine division.
  • The medicine division’s quarterly performance report lacked detail in many areas such as the division’s performance in audits.
  • There was no formal process for staff and senior managers to discuss and manage risk, issues and performance. There was limited opportunities for wider learning within the surgical division. 
  • Senior oversight and visibility had improved since our last inspection at Andover but this still required building upon.
  • Staff told us there was no vision or strategy for the development of the surgical service at Andover.
Assessment of the use of resources

Use of resources summary

Requires improvement

Updated 7 April 2020

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

  • The trust had seen a material increase in its unscheduled care activity which had impacted its ability to improve its productivity and it had not progressed significantly on the areas we had identified in our previous assessment in 2018.
  • Although the trust showed some areas of good productivity, for example on pathology, imaging and procurement, it needed to further progress, on workforce productivity.
  • The trust continued to be challenged to deliver against operational standards.
  • The trust’s financial performance had markedly deteriorated during 2019/20 and it still needed to finalise its financial recovery plan at the time of our assessment.

Combined rating

Combined rating summary

Good

Updated 7 April 2020

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