You are here

Provider: Royal Brompton and Harefield NHS Foundation Trust Good

Inspection Summary


Overall summary & rating

Good

Updated 22 February 2019

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

  • We rated safe, effective, caring and responsive as good.
  • We rated well-led for the trust overall as good.
  • We rated three of the four core services inspected as good and one service as outstanding. In rating the trust, we also took into account the current ratings of the services not inspected this time.

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/RT3/reports

Inspection areas

Safe

Good

Updated 22 February 2019

  • The service had suitable premises and equipment and looked after them well.

  • Staff completed and updated risk assessments for each patient. They kept clear records and asked for support when necessary.

  • The hospital had enough staff with the right qualifications, skills, experience and training to keep patients safe from avoidable harm and abuse, and to provide them with the care and treatment they needed. Ward managers matched staffing levels to patient need and could increase staffing when care demands rose. All staff understood their responsibilities to safeguard patients from abuse and neglect, and had appropriate training and support.

  • Staff kept appropriate records of patients’ care and treatment. Records were clear, up-to-date and available to all staff providing care.

  • The service prescribed, gave, recorded and stored medicines well. Patients received the right medication at the right dose at the right time.

  • The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. 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.

  • The service used safety monitoring results well. Staff collected safety information and shared it with staff, patients and visitors. Managers used this to improve the service.

However,

  • The rate of mandatory training in key skills to all staff was low. The trust target was set at a comparatively low 70% or 80% depending on the mandatory training module and the compliance rates for mandatory training for some staff groups were below these trust targets.
  • Although staff had training on safeguarding children and adults, the trust target was set at a comparatively low 75%. The compliance rates for mandatory training for some staff groups were below trust targets.
  • We observed lapses in strict adherence to infection control procedures within critical care. Although the trust controlled infection risk well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection.
  • There was no standardised procedure at Harefield hospital to ensure medicines and equipment used for organ retrieval were checked and re stocked. Although staff told us this was a task completed at the beginning of every shift there was no assurance and no way of knowing if the bag had been tampered with.

Effective

Good

Updated 22 February 2019

Our rating of effective stayed the same. We took into account the current ratings of services not inspected this time. We rated it as good because:

  • The trust provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.

  • Staff gave patients enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary. The trust made adjustments for patients’ religious, cultural and other preferences.

  • Staff assessed and monitored patients regularly to see if they were in pain. They supported those unable to communicate using suitable assessment tools and gave additional pain relief to ease pain.

  • The service monitored the effectiveness of care and treatment and used the findings to improve them. They compared local results with those of other services to learn from them.

  • Staff of different kinds worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.

  • Staff always had access to up-to-date, accurate and comprehensive information on patients’ care and treatment. All staff had access to an electronic records system that they could all update.

  • Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. They knew how to support patients experiencing mental ill health and those who lacked the capacity to make decisions about their care.

However,

  • Although the service made sure staff were competent for their roles. Managers did not always effectively appraise staff’s work performance.

Caring

Good

Updated 22 February 2019

Our rating of caring stayed the same. We took into account the current ratings of services not inspected this time. We rated it as good because:

  • Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness. We found a good example of this in critical care unit, where they had since last inspection introduced an animal therapy policy to enable dogs to be safely allowed on the unit for patients who wished to have them visit.

  • Staff involved patients and those close to them in decisions about their care and treatment.

  • Staff provided emotional support to patients to minimise their distress.

Responsive

Good

Updated 22 February 2019

Our rating of responsive improved. We took into account the current ratings of services not inspected this time. We rated it as good because:

  • The trust planned and provided services in a way that met the needs of local people.

  • People could access the service when they needed it. Waiting times from referral to treatment were and arrangements to admit, treat and discharge patients were in line with good practice.

  • The service took account of patients’ individual needs.

  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, which were shared with all staff.

Well-led

Good

Updated 22 February 2019

Our rating of well-led stayed the same. We rated it as good because: