You are here

Provider: The Princess Alexandra Hospital NHS Trust Requires improvement

On 31 July 2019, we published a report on how well The Princess Alexandra Hospital NHS Trust uses its resources. The ratings from this report are:

  • Use of resources: Good  
  • 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 31 July 2019

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

  • We rated safe, effective, responsive and well led as requires improvement.
  • We rated three of the six core services we inspected as requires improvement. Our ratings took into account the previous ratings of services not inspected this time. Our decisions on overall ratings take into account factors including the relative size of services and we use our professional judgement to reach a fair and balanced rating.
  • The rating of the key question of effective had gone down to requires improvement since our last inspection in December 2017.
  • The rating for maternity services at this inspection was requires improvement in safe, effective, responsive and well led.
  • The requires improvement rating remained the same for urgent and emergency services and medical care (including older people’s care).
  • Some issues that contributed to a breach of regulation at our last inspection in December 2017, had not been fully resolved at this inspection; in some services patient records were not always maintained in a timely or consistent manner. Mandatory training compliance remained an area of concern and nurse vacancies were high in some areas.
  • Safety incidents were not always managed in a timely manner and at the time of our inspection, the trust had recently identified significant number of incidents that had not been appropriately dealt with on its electronic reporting system. Some of which dated back to 2013.
  • Governance systems were not fully established or embedded to assess, monitor and improve the quality and safety of services and manage risk across all services within the trust.

However:

  • We rated the trust as good in caring overall. Our rating for the trust took into account the previous rating of services not inspected this time.
  • The rating for children and young people’s services had improved from requires improvement to good overall with outstanding for caring since our last inspection in 2017.
  • The effective key question in end of life care services had improved from requires improvement to good since our last inspection in December 2017.
  • The key question of well led had improved from requires improvement to good in urgent and emergency services and services for children and young people since our last inspection in December 2017.
  • The key question of responsive had improved from requires improvement to good in medical care (including older people’s care), surgery and services for children and young people’s service since our last inspection in December 2017.
Inspection areas

Safe

Requires improvement

Updated 31 July 2019

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

  • The trust provided mandatory training in key skills but did not always ensure everyone completed it.
  • The trust did not have enough nursing staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment.
  • Staff did not always keep detailed records of patients care and treatment.
  • The use of facilities and the environment did not always keep patients safe.
  • Through our inspection of surgery and maternity services, safety incidents were not always managed in a timely manner. Although staff mostly recognised incidents and reported them in line with trust policy, there were incidents where the trust had not responded to safety concerns in a timely manner.

However:

  • Staff reported safety incidents well, staff recognised them and reported them appropriately.
  • Staff understood how to protect patients from abuse and worked well with the trust’s safeguarding team and other agencies to do so.
  • Services mostly controlled infection risk well. Staff kept themselves, equipment and premises clean. They used control measures to prevent the spread of infection.
  • Services mostly used systems and processes to safely prescribe, administer, record and store medicines.

Effective

Requires improvement

Updated 31 July 2019

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

  • The key question of effective had gone down from good to requires improvement for medical care (including older people’s care) and maternity services.
  • Care and treatment within maternity services were not always based on national guidance and evidence of its effectiveness was not always monitored. Managers did not always check to make sure staff followed guidance.
  • Within maternity services, staff were not always competent for their roles. Managers did not always appraise staff’s work performance to provide support and monitor the effectiveness of the service. Not all staff had the skills and competencies for their roles.
  • Within medical services, there was a limited local audit programme with only four internal clinical audits being undertaken in the last year.
  • The trust did not provide action plans for three of the four national audits in medical care.

However:

  • Staff gave patients enough food and drink to meet their needs and improve their health.
  • Staff assessed and monitored patients regularly to see if they were in pain.
  • Staff of different kinds worked together as a team to benefit patients.
  • Staff supported patients to make informed decisions about their care and treatments. They followed national guidance to gain patient consent.

Caring

Good

Updated 31 July 2019

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

  • The key question of caring had improved to outstanding in services for children and young people since our last inspection in December 2017. Caring was rated as good in all other core services.
  • Staff cared for 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.
  • Patients were positive about the care and treatment they received and felt involved in decision making.
  • Patients and carers were given opportunities to provide feedback about the care and treatment they had received.

Responsive

Requires improvement

Updated 31 July 2019

  • Within urgent and emergency services, people could not always access the service when they needed it.
  • 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. From February 2018 to January 2019 the trust consistently failed to meet the standard and consistently performed worse than the England average.
  • From February 2018 to January 2019 the trust’s monthly percentage of patients waiting in the urgent and emergency department more than four hours from the decision to admit until being admitted was worse than the England average in 10 out of 12 months.
  • From February 2018 to January 2019 the trust’s monthly median total time in ED for all patients was higher than the England average for eight of the nine months for which data were available.

However:

  • The trust planned and provided services in a way that met the needs of local people and the communities it served. It also worked with others in the wider system and local organisations to plan care.
  • Services were inclusive and took into account patients’ individual needs and preferences.
  • People could mostly access services when they needed it and received the right care promptly.
  • It was easy for people to give feedback and raise concerns about care they received. Services treated complaints seriously, investigated them and learned lessons from results, and shared these with all staff.
  • The trust treated complaints and concerns seriously and supported patients and those close to them to understand how to make complaints. They investigated complaints appropriately and cascaded relevant learning.

Well-led

Good

Updated 31 July 2019

  • The trust leadership and local service leadership teams responded slowly to issues of risk and performance that had been identified and that affected the safe delivery of patient care.
  • Within medical care, we were not assured that leaders had the right skills and abilities in some of the wards we visited.
  • Within maternity services, the key question of well led was rated as requires improvement.
  • Within maternity services, managers had not fully implemented, and embedded changes required to reduce risks and improve the safety of the service provision.
  • The maternity service did not have effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected.
  • The maternity service did not have robust systems in place to improve safety and quality of care, despite monitoring the quality and standards of its services and care.

However:

  • The trust had a vision for what it wanted to achieve and a strategy to turn it into action, developed with relevant stakeholders. The vision and strategy were focused on the sustainability of services and aligned to local plans within the wider health economy.
  • Staff felt respected, supported and valued. The trust promoted equality and diversity in daily work and provided opportunities for career development. There was an open culture where patients, their families and staff could raise concerns without fear.
  • 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.
  • The trust encouraged staff to develop and implement ideas for service delivery, improvement and innovation. We heard many examples of innovation projects and work that groups had done which impacted on and improved patient care.

Assessment of the use of resources

Use of resources summary

Good

Updated 31 July 2019

Combined rating

Combined rating summary

Requires improvement