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Provider: Chelsea and Westminster Hospital NHS Foundation Trust Good

On 15 June 2018, we published a report on how well Chelsea and Westminster NHS Foundation Trust uses its resources. The ratings from this report are:

  • Use of resources: Outstanding  

Read more about use of resources ratings

Inspection Summary


Overall summary & rating

Good

Updated 10 April 2018

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

  • We rated safe effective, caring, responsive and well-led as good. We rated both Hospitals – Chelsea and Westminster and West Middlesex as good.
  • We found that the trust had learned from our previous inspections at the two sites and had put in place improvements in the domains that had been rated previously as requires improvement.
  • We rated well-led at the trust level as good. 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 all major targets such as the national access standards for A&E 4 hour waits, most Referral to Treatment (RTT) and Cancer.
  • Staff were proud to work for the organisation and engaged with managers and senior leaders. The trust had consulted with staff and patients at both sites in developing its PROUD set of values.
  • The trust leadership team was stable and, with a clear example from the chief executive, were highly visible at both sites and took part in a regular programme of ward and departmental visits. The trust board and senior leaders had offices at both sites, and trust board meetings rotated between the sites.
  • We noted the openness and honesty displayed by the trust at all levels, not seeking to hide areas where development and improvement were still needed but acknowledging them and making clear remedial plans.
  • Having established a clear base of good performance the trust was engaging with the wider health and social care economy of North West London.
  • There were clear examples of innovation and research across services and in individual cases. We found a genuine no blame, learning culture and a continued determination to improve.
  • Patients and carers all gave positive feedback about the care they received. They said they were involved in decisions about their care and that staff considered their emotional well-being, not just their physical condition.

Inspection areas

Safe

Good

Updated 10 April 2018

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

  • The trust managed patient safety incidents well. Incident reporting was embedded into the culture of the services and there was evidence of learning from incidents.
  • The trust used safety monitoring results well. There were ward accreditation schemes to monitor quality and safety performance in each inpatient ward. The results were used to identify areas of good practice and areas for improvement.
  • 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 suitable premises and equipment and looked after them well. Staff had ready access to medical, IT and personal protective equipment to carry out their duties. Equipment was checked in date. The trust had recently refurbished, extended and improved the urgent and emergency departments (ED) at both locations to a high standard.

  • Overall, staff used effective and embedded medicines management processes.
  • Staff kept appropriate records of patients’ care and treatment. We found an overall improvement in patient risk assessments and accessibility of care plans in comparison to the previous inspections.
  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.
  • The trust provided mandatory training in key skills to all staff. Mandatory training completion rates varied across the trust. In response to this the trust launched a new learning platform in October 2017 which allowed staff to access training from home and before they start employment with the trust. The trust aimed to reach the 90% standard by end of March 2018 and as of February 2018 achieved an 87% completion rate against the 90% target by the end of March.
  • 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.

  • The trust planned for emergencies and staff understood their roles if one should happen. The most recent real life example of this was treating people involved in the Grenfell fire disaster in June 2017.

Effective

Good

Updated 10 April 2018

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

  • The trust provided care and treatment based on national guidance and evidence of its effectiveness.
  • Staff gave patients enough food and drink to meet their needs and improve their health.
  • 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.
  • The trust made sure staff were competent for their roles through access to training, support from practice development staff and mentoring and appraisal. The trust implemented a new PDR system in April 2017 which identified staff who wanted to progress and also linked the appraisal process to the trust values and strategic aims. The trust aimed to complete 90% of PDRs by March 2018. As of February 2018, 89.6% of all staff had a new appraisal completed.
  • We found 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.
  • Staff had access to up-to-date, accurate and comprehensive information on patients’ care and treatment. Staff had access to trust policies and treatment protocols via the trust intranet.
  • Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
  • The trust’s mortality and morbidity were below the national average following work undertaken to scrutinise and learn from every death and not just unexpected deaths.

Caring

Good

Updated 10 April 2018

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

  • All managers and staff treated patients with compassion, dignity and respect.
  • 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 10 April 2018

Our rating of responsive improved. 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.
  • The trust was achieving the national access standards for A&E 4 hour waits, most Referral to Treatment (RTT) and Cancer. For example the trust was ranked first in the country for 62 day cancer waits in October 2017 and third in November 2017.
  • Between June 2016 and July 2017 the trust reported no mixed sex accommodation breaches.
  • People could access the service when they needed it.
  • The trust took account of patients’ individual needs.
  • The trust treated concerns and complaints seriously, investigated them and learned lessons from the results, which were shared with all staff. The trust was reviewing its local response target of 25 days which it was not achieving. It was taking steps to improve its response performance and response rates were now at 78% of target.

Well-led

Good

Updated 10 April 2018

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

  • The trust had managers at all levels with the right skills and abilities to run a service providing high-quality sustainable care.
  • 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.
  • Managers across the trust promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values. The trust had recognised different cultures at its two sites and had maintained while combining the best from both sites in terms of practice and in forming its PROUD values.
  • The trust used a systematic approach to continually improving the quality of its services and safeguarding high standards of care by creating an environment in which excellence in clinical care would flourish. There was a distinct emphasis on learning from mistakes in a no blame culture.
  • The trust had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected. The governance structure drawing together the two sites was maturing if not yet completely mature.
  • 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. It had trialled a consultant led Learning from Excellence programme in ED which it was intending next to roll out to Anaesthetics.