You are here

Provider: Hampshire Hospitals NHS Foundation Trust Requires improvement

On 19 September 2018 , we published a report on how well Hampshire Hospitals NHS Foundation Trust uses its resources. The ratings from this report are:

  • Use of resources: Requires improvement  
  • Combined rating: Requires improvement  

Read more about use of resources ratings

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

Requires improvement

Updated 26 September 2018

  • Our rating of the trust went down. We rated it as requires improvement because:
  • We rated well led for the trust overall as requires improvement.
  • Safe, effective, caring, responsive and well led were requiring improvement overall. We rated surgery and medicine as requires improvement and urgent and emergency as inadequate. We identified that improvements to safety were required in all three of the services we inspected.
  • The trust had a clear overarching vision which was ‘to provide outstanding care for every patient’, The trust’s strategic framework stated four organisational goals, which together aimed to deliver the vision.
  • We were not assured that the trust’s leadership team fully understood the current challenges to quality and sustainability. We identified issues that if not addressed in a timely manner would negatively impact on the quality and safety of care received by patients, that the senior leadership team were not aware of.
  • There was a lack of compliance by the trust with meeting the Fit and Proper Person Requirement (FPPR) (Regulation 5, HSCA, 2014). We found on this inspection that there was a lack of an effective system to review fit and proper persons being employed.
  • The trust had engaged with patients and the local population including hard to reach groups, to inform service development.
  • Whilst the national staff survey reported that the percentage of staff experiencing harassment, bullying or abuse in the last 12 months was the same as other acute trust, we heard from a range of sources including staff groups and whistle blowers that there was a culture of bullying and harassment. The trust had recognised this and the board were reported to be committed to addressing.

Our full Inspection report summarising what we found and the supporting Evidence appendix containing detailed evidence and data about the trust is available on our website www.cqc.org.uk/provider/RN5/reports

Inspection areas

Safe

Requires improvement

Updated 26 September 2018

Our rating of safe went down. We rated it as requires improvement because:

  • Patients were not always protected from avoidable harm. There were limited effective system(s) in place to assess and monitor the ongoing care and treatment to patients, including monitoring patients for signs of clinical deterioration.
  • Mandatory training completion rates were not compliant with the trust’s targets for the majority of courses. Managers reported that this was due to an inability to release staff from their clinical duties to complete this training. However, this meant that some staff may not have the necessary knowledge and skills to deliver safe and effective care.
  • Whilst the trust reported they were in the top quartile for infection rates, during the inspection, we found episodes of poor infection control practice on some wards and in theatres and known infection controlled risks were not always mitigated.
  • Equipment including emergency equipment was not always appropriately maintained or checked. We were not assured that in the event of an emergency this equipment would be readily available and fit for use.
  • Risks to patients were not always assessed, monitored or managed. The national early warning system was not always used correctly to identify and escalate patient’s needs appropriately. Therefore, deteriorating patients may not be identified and timely treatment provided.
  • Resuscitation equipment was not always safe and ready for use in an emergency. Gaps in records suggested equipment had not been checked in line with trust policy.
  • Medicines were not always stored, administered and disposed of in line with best practice.
  • Duty of candour (DoC) was not part of mandatory training. The majority of nursing staff we spoke with lacked knowledge of this area and considered it to be the responsibility of medical staff. The trust had acknowledged that this was an area that required more work to ensure all staff were aware of their responsibilities in relation to DoC.
  • Planned nurse staffing numbers were not always achieved. The fill rate for registered nurses and healthcare assistants was below the trust’s target in many areas we inspected. This meant that patients may not receive care and treatment in a timely manner and to the standard the trust aimed to deliver.
  • The layout of the emergency department was not suitable for the number, or age, of admissions the service received. There was significant overcrowding and, at times, patients were being cared for on trolleys in the central area of the department as there were no free cubicles to use.
  • There was a lack of consideration given to ligature points and other environmental factors which could allow patients with suicidal tendencies to come to harm.
  • In some areas there were not enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and abuse and to provide the right care and treatment.

However,

  • Safeguarding systems, processes and practices protected people from abuse and neglect.
  • Most staff employed by the trust had qualifications, skills, training and experience to provide the right care and treatment to patients.
  • Staff understood their responsibilities to raise and report safety incidents and near misses. Lessons were learnt and some improvements were made when things went wrong.
  • Safety information was collected, analysed and used to monitor performance and focus front line staff on areas for improvement to reduce patient harm.

Effective

Requires improvement

Updated 26 September 2018

Our rating of effective went down. We rated it as requires improvement because:

  • Not all staff had the opportunity to participate in an annual appraisal, therefore their development needs were not identified and responded to.
  • Supervision meetings were not provided to all staff to support and monitor the effectiveness of the service they provided.
  • The trust collected performance data against clinical standards for seven-day working but did not have a strategy for implementing the standards.
  • Not all staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005 and did not always effectively support patients who lacked the capacity to make decisions about their care.
  • Not all policies and procedures had been reviewed to ensure they reflected current best practice and national guidance. Some policies and procedures were past their review date and therefore may not have reflected the latest guidance.
  • There was a lack of consideration given to ligature points and other environmental factors which could allow patients with suicidal tendencies to come to harm.
  • Staff were not always skilled or competent to undertake their role effectively. This included cases whereby staff had not received any additional competency training to care for or recognise the deteriorating child. The number of staff who had completed a post-graduate qualification in emergency care nursing was low. A lack of oversight meant the department did not know which staff members had completed competency frameworks.
  • There was limited access to health promotion information.

However,

  • Patients nutrition and hydration needs were assessed and met. All patients were offered food or drink unless they were nil by mouth. Patients’ religious, cultural and other preferences were met.
  • Staff regularly assessed and monitored patients to see if they were in pain. They supported those unable to communicate using suitable assessment tools and gave pain relief as necessary.
  • The trust participated in a range of national audits to benchmark their performance with other trusts and identify areas for improvement.
  • The trust’s unplanned re-attendance rate within seven days was generally better than the England average.

Caring

Good

Updated 26 September 2018

  • Feedback from patients was consistently positive about the way staff treated them, we saw many compliments and ‘thank you’ cards displayed in the ward areas.
  • Staff provided emotional support to patients to minimise their distress.
  • Staff involved most patients and their families in decisions about their care and treatment and ensured they understood their treatment plan.
  • Whilst the trust’s performance against friends and family is generally better than the England average, there is a downward trend in relation to the number of patients who would recommend the service.

However,

  • The privacy and dignity of patients was not always protected. We saw a number of patients being treated on corridors; these patients did not have access to a patient call bell and as such, found it difficult to get help from the nursing staff when they needed assistance. Staff did not routinely use screens, close doors, or use curtains when providing care or treatment to patients.
  • Staff frequently held clinical conversations about patients in public areas that could be overheard by visitors and other patients.
  • Patients were not always treated with compassion, kindness, dignity and respect.

Responsive

Requires improvement

Updated 26 September 2018

Our rating of responsive went down. We rated it as requires improvement because:

  • Medical non-elective patients, average length of stay was 8.6 days, which is higher than the England average of 6.4 days.
  • Some areas of the trust did not have single sex accommodation. There was no standard operating policy or monitoring for the management of mixed sex breaches. The trust had not reported any breaches to NHS England (NHSE). During our inspection we observed mixed sexed breaches, this meant the trust had not interpreted the national mixed sex guidance correctly and failed to report breaches to NHSE.
  • The ED did not always consider patients’ individual needs; the department had not taken action to address the accessible information standard. There was limited support or environmental adaptations for vulnerable or agitated patients
  • The needs of patients living with dementia were not always met. Dementia training was mandatory but compliance with this training was below the trust target. The care plans for these patients were not always completed to reflect their individual needs and there we were not assured these needs were met.
  • Complaints were not always responded to in a timely way.
  • Theatre utilisation rates were poor, staff thought this was due to various factors including the way theatre lists were organised, lack of equipment, last-minute patient cancellations and staff availability.
  • The Department of Health’s standard for emergency departments is that 95% of patients should be admitted, transferred or discharged within four hours of arrival in the emergency department (ED). The trust was not meeting this four-hour standard and patients therefore were not always receiving treatment in a timely manner.

However,

  • The trust had winter plans in place and worked with local partners to manage demand and improve patient flow through the hospital.
  • The trust planned and provided services in a way that met the needs of local people.
  • The trust had introduced a frailty and dementia team based in the ED who assessed these patients once they were admitted to ED and worked with staff internally and in the community to avoid these patients being admitted to the hospital.
  • Concerns and complaints were taken seriously and investigated. Lessons were learnt and shared with staff to improve care and treatment.

Well-led

Requires improvement

Updated 26 September 2018

Our rating of well-led went down. We rated it as requires improvement because:

  • Senior leaders were not always aware of the risks, issues and challenges in the service that had not been entered on the risk register. This meant that they could not proactively implement actions to mitigate or address these and reduce the risk of patient harm.
  • There were not effective systems in place for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected. Front line staff raised risks but action was not always taken to mitigate the risk. We were not assured senior leaders were taking action to address known risks.
  • Concerns identified by the inspection team such as the competency of the workforce and environmental risk factors were not managed appropriately leading to poor patient experience and the risk of avoidable harm to patients.
  • While the national staff survey reported positively in many areas about how staff felt about working at the trust, during and following our inspection staff told us that managers did not always take action to address behaviour and performance that was inconsistent with the trust’s vison and values. This made staff feel there was not a fair and just culture in the trust and not all staff were treated equally.
  • Divisional risk registers were in place that fed into the trust register but these did not include the date the risk was added or review dates therefore there was no evidence that risks were reviewed regularly.
  • The trust acknowledged that the quality of reports produced needed to be improved. This improvement included more analysis of data to explain spikes and changes. There was also a need to clarify which reports were presented at other committees and groups to facilitate sharing of information.
  • While the trust had a quality improvement (QI) strategy dated 2018-20, that identified the principles for QI and was had recently launched a quality improvement academy. There was no trust wide methodology that all projects used. There were not effective structures, processes and systems of accountability in place to support the delivery of the trust’s strategy and quality, sustainable services. We were not assured that patients were sufficiently protected from avoidable harm.

However,

  • The trust had a clear overarching vision which was ‘to provide outstanding care for every patient’. Some services had developed local strategies that contributed to achieving the trust’s overall vision for the organisation.
  • A range of data on areas such as staffing, quality and safety was prepared monthly and used by the divisions to review their performance and take appropriate action. This information was scrutinised at divisional level before being presented for inclusion in the monthly governance report that was reviewed at board meetings.
  • The trust had an active staff recognition scheme that recognised staff who had gone the extra mile for patients or their families, called the Wow! Awards. Staff were very positive about these and felt that they hada positive impact on staff morale.
  • There was a quality improvement (QI) strategy and the aim was to increase the number of staff who were trained and participated in QI projects. There were already a number of QI in progress with others at the consideration stage. While this was a relatively new development it did demonstrate that the trust were committed to focusing on continuous learning and improvement.
  • Managers across the trust tried to promote a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
Assessment of the use of resources

Use of resources summary

Requires improvement

Updated 26 September 2018

Combined rating