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Provider: Chelsea and Westminster Hospital NHS Foundation Trust Good

Inspection Summary


Overall summary & rating

Good

Updated 31 January 2020

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

  • We rated safe, effective, caring, responsive and well led as good.
  • We rated well-led at the trust level as outstanding. The trust had successfully merged the two former trusts and this merger had been undertaken sensitively to ensure cohesion acknowledging and adopting the best practice from both. At the same time the trust maintained financial surplus as well as achieving major targets such as the national access standards for A&E 4 hour waits, most Referral to Treatment (RTT) and Cancer.
  • Having established a clear base of good performance the trust was engaging with the wider health and social care economy of North West London.
  • Our decisions on overall ratings take into account, for example, the relative size of services and we use our professional judgement to reach a fair and balanced rating.

Inspection areas

Safe

Good

Updated 31 January 2020

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

  • The trust continued to manage patient safety incidents well. Incident reporting was embedded into the culture of the services and there was evidence of learning from incidents across services.
  • There were fully embedded ward accreditation schemes to monitor quality and safety performance in each area of the hospital including inpatient wards, outpatients and clinical service areas. The results were used to identify areas of good practice and areas for improvement. This was monitored via the trusts quality committee and board.
  • Staff had a thorough understanding of safeguarding and made appropriate referrals to the safeguarding team.
  • The trust controlled infection risk well. We observed consistent standards of hand hygiene and infection control measures amongst clinical and ward-based staff.
  • The trust had improved overall compliance with mandatory training since the last inspection.
  • There were good medicines management processes in place and this kept patients safe.
  • The trust had introduced a new electronic patient record system two weeks prior to our inspection. Senior leaders had suitably prepared and supported staff throughout this process.
  • The trust had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and abuse and to provide the right care and treatment. Vacancy rates were a challenge to the trust in common with most London NHS trusts. Skills were maintained by supplementing regular agency staff from approved agencies as well as initiatives to give extensive support to nursing staff recruited from overseas and a recognition of promoting flexible working to attract and retain staff.

However:

  • The trust needed to improve mandatory training of medical staffing.
  • We found maternity services were not always using appropriate risk assessment tools during triage. This was highlighted during the inspection and the trust put an audit in place to ensure this was done going forward.
  • We found some issues with checks of resuscitation equipment in maternity at the Chelsea and Westminster hospital site.

Effective

Good

Updated 31 January 2020

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

  • The trust provided care and treatment based on national guidance and evidence of its effectiveness.
  • The trust monitored the effectiveness of care and treatment through participation in national and local audits, research and national, regional and local innovation projects and used the findings to improve them.
  • We found trust policies were in date and updated with relevant national guidance.
  • Staff assessed and monitored patients’ pain regularly to see if they were in pain and gave pain relief in a timely way. Recording of patients’ pain was good.
  • Patients were given enough food and drink to meet their needs and improve their health.
  • There was a positive multidisciplinary working culture within services. We found there was still evidence of good team working at all levels of the trust from the board downwards. There were examples of good divisional, ward and multi-disciplinary team working to enhance patient care.
  • The trust made sure staff were competent for their roles through access to training, support from practice development staff, mentoring and appraisal.
  • Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.

Caring

Good

Updated 31 January 2020

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

  • All managers and staff treated patients with compassion, dignity and respect.
  • We found examples of outstanding care such as arranging marriages for patients in critical care.
  • All patients and carers said staff did everything they could to support them and were attentive to their needs. Staff displayed the trust ethos of being unfailingly kind.
  • Staff involved patients in decisions about their care and treatment. Staff considered all aspects of a patient’s wellbeing, including the emotional, psychological and social.
  • There was good support from the trust chaplaincy and religious support services.
  • Staff reflected the trust values of putting the patient first.

Responsive

Good

Updated 31 January 2020

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

  • The trust engaged closely with commissioners and other external bodies to make sure it planned and delivered services according to the needs of the populations it served.
  • People could access the service when they needed it.
  • The trust took account of patients’ individual needs.
  • Both maternity and critical care services were under renovation and patients’ needs had been taken into account when planning the services. The rooms on the labour ward had pull down double beds available to patients’ partners so they could stay with the patient if required.
  • There was good signage for critical care and maternity services.
  • The trust treated concerns and complaints seriously, investigated them and learned lessons from the results, which were shared with all staff.

Well-led

Outstanding

Updated 31 January 2020

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

  • The trust had an experienced leadership team with the skills, abilities and commitment to provide high-quality services led by a highly regarded chief executive.
  • The trust demonstrated a good grip on its business with a strong board.
  • The trust had a vision for what it wanted to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community.
  • Having improved the quality of its core services the trust had changed from an inward focus to a more outward focus. The trust was now playing a leading part in the development of the wider strategy for north west London.
  • The trust had an open culture which was cohesive, supportive and innovative. While managers addressed poor performance where necessary, there was a no blame culture and mistakes were regarded as opportunities for learning and improvement. The trust recognised different cultures at its two sites and had maintained this while combining the best from both sites in terms of practice and in forming its PROUD values.
  • The trust had a clear governance structure for overseeing performance, quality and risk with board members represented across the divisions.
  • The trust adopted a structured approach when addressing issues or problems that arose.
  • The trust had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected.
  • The trust collected, analysed, managed and used information well to support all its activities, using secure electronic systems with security safeguards.
  • The trust engaged well with patients from diverse backgrounds and patient groups, staff, the public and local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively.
  • The trust was committed to improving services by an extensive programme of research and innovation, holding annual innovation awards for the best innovations.

  • In addition to our inspection, a team from NHS Improvement England and Improvement (NHSE/I) conducted a Use of Resources assessment of the trust.
  • The aim of Use of Resources assessments is to understand how effectively providers are using their resources to provide high quality, efficient and sustainable care for patients. The team from NHSE/I examined the trust’s performance against a set of initial metrics alongside local intelligence from NHSE/I day-to-day interactions with the trust, and the trust’s own commentary on its performance. The team conducted a dedicated site visit to engage with key staff using agreed key lines of enquiry (KLOEs) and prompts in the areas of clinical services; people; clinical support services; corporate services, procurement, estates and facilities; and finance.
  • NHSE/I rated use of resources at the trust as outstanding because the trust was achieving excellent use of resources, enabling it to provide high quality, efficient and sustainable care for patients.

Assessment of the use of resources

Use of resources summary

Outstanding

Updated 31 January 2020

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

NHSE/I conducted a use of resources inspection in August 2019. NHSE/I rated use of resources as outstanding because the trust is achieving excellent use of resources, enabling it to provide high quality, efficient and sustainable care for patients. The trust continues to show outstanding practice in its approach to improvement and its reductions in agency use.

Combined rating

Combined rating summary

Good

Updated 31 January 2020

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