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Provider: Ashford and St. Peter’s Hospitals NHS Foundation Trust Good

On 04 October 2018 , we published a report on how well Ashford and St. Peter’s Hospitals NHS Foundation Trust uses its resources. The ratings from this report are:

  • Use of resources: Good  
  • Combined rating: Good  

Read more about use of resources ratings

Inspection Summary


Overall summary & rating

Good

Updated 4 October 2018

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

We rated effective, caring responsive and well-led as good. We rated safe as requires improvement overall.

In outpatients at Ashford Hospital we rated safe and well-led as requires improvement and caring and responsive as good. We did not rate effective. We rated the service as requires improvement overall

In urgent and emergency care we rated safe, responsive and well-led as requires improvement and caring and effective as good. We rated the service as requires improvement overall.

In critical care we rated safety, responsive, effective as good and caring and well-led as outstanding. We rated the service as outstanding overall.

In medicine at St Peters we rated safe as requires improvement and effective, caring, responsive and well-led as good. We rated the service as good overall.

In children and young people’s services we rated safe, effective, caring, responsive and well-led as good, and the service as good overall.

We did not inspect all core services. The previous ratings for those services we did not inspect were taken into account when working out the overall trust ratings for this inspection.

We rated well-led for the trust overall as good.

The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately and could discuss the processes involved.

The service used safety monitoring results well and participated in the national safety thermometer scheme. Staff collected safety information and shared it with staff, patients and visitors. The trust used information to improve the service.

The service controlled infection risk well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection. Standards of hygiene and infection rates were monitored to identify any risks and infection rates were low.

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

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. Specialist teams support ward staff and patients in vulnerable circumstances.

The service 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. Recruitment, especially of nursing staff was a major challenge to the trust. However, there were systems, including the use of a flexible workforce that ensured there was a match between staff on duty and patients’ needs.

The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance through programmes of audit.

The trust made sure staff were competent for their roles. There was a programme of mandatory training and staff had opportunities to develop their skills and gain experience and qualifications to help them do their jobs effectively.

Staff always had access to up-to-date, accurate and comprehensive information on patients’ care and treatment. Electronic records were used effectively and there were electronic systems to ensure patients’ conditions were monitored

Inspection areas

Safe

Requires improvement

Updated 4 October 2018

Medicines were not always stored well in line with manufacturers’ guidance which meant the effectiveness of medicines could not be guaranteed. However, patients received the right medication at the right dose at the right time.

The service had suitable premises and equipment but did not always look after them well. Fire safety was compromised through the blocking of fire exists and the poor state of repair of fire doors. Clinical and domestic waste was not segregated in line with national guidance. Substances hazardous to health were not always stored securely. Emergency equipment was not always checked to ensure it was ready for immediate use.

The service provided mandatory training in key skills to all staff but not everyone completed this.

However:

The trust managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Staff showed awareness of incident management and could demonstrate systems to us.

Managers investigated incidents and shared lessons learned with the whole team and the wider service through staff meetings newsletters. This included wider learning across the organisation especially if incidents were serious. When things went wrong, staff apologised and gave patients honest information and suitable support. The trust applied the duty of candour when required.

The service used safety monitoring results well. Staff collected safety information using the safety thermometer tool, and shared it with staff, patients and visitors. Performance was monitored and actions taken if themes were identified, for example in the management of pressure ulcers of the heel.

The service controlled infection risk well. Staff kept themselves, equipment and the premises clean and carried out checks and audits to ensure standards of hygiene were maintained and rates of infection were low. They used recognised control measures to prevent the spread of infection such as isolation procedures and screening programmes.

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. Specialist teams supported ward staff and those in vulnerable circumstances.

The service 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. The trust experienced severe recruitment problems, especially with nurses. It used its flexible workforce to ensure staff numbers were safe. There were systems to ensure staffing met the needs of patients on a short and long-term basis. The trust was creative in exploring new ways of recruiting and retaining staff.

Effective

Good

Updated 4 October 2018

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

The service provided care and treatment based on national guidance and evidence of its effectiveness. There were systems to check policies reflected national guidance and to ensure any new guidance was evaluated and changes to practice made if required, Managers checked to make sure staff followed guidance using audits and other checks.

Staff gave patients enough food and drink to meet their needs and improve their health. Patients were assessed using nationally recognised tools. Dietitians provided specialist advice and treatment when indicated. Staff used special feeding and hydration techniques when necessary.

The trust monitored the effectiveness of care and treatment and used the findings to improve them. They participated in all relevant national audits and compared local results with those of other services so they could learn from them.

The service made sure staff were competent for their roles. Managers appraised staff’s work performance and staff found this helpful. There were opportunities for staff to develop their skills and experience and to gain additional qualifications. Staff had their competency formally assessed for specified tasks or to use certain medical equipment.

Staff of different kinds worked together as a team to benefit patients. They worked as a multi- disciplinary team meeting regularly to agree treatment plans with patients and to monitor progress. Patients had access to the full range of therapists many on a seven day basis. The team supported each other to provide good care and spoke favourably of each other.

Staff always had access to up-to-date, accurate and comprehensive information on patients’ care and treatment via an electronic records system. All staff contributed to this record so could see what care was being provided by other health care professionals.

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. Patients and staff had access to specialist teams such as psychiatric liaison services to support them with complex issues.

Caring

Good

Updated 4 October 2018

Staff involved patients and those close to them in decisions about their care and treatment. Patients and their loved ones reported that felt involved in making decisions about their treatment and care options and were provided with the necessary information to enable them to make an informed choice.

Staff cared for patients with kindness and compassion. Feedback from patients, and our observations confirmed that staff treated them well and with kindness. We found many examples where staff made considerable efforts to ensure patients were treated well. Generally, patients were cared for in single sex facilities.

Staff provided emotional support to patients to minimise their distress and we observed this in practice. Patients could access chaplaincy services to meet their spiritual needs.

However:

The discharge lounge had limited facilities for sex segregation which could negatively impact on patients’ privacy and dignity.

Responsive

Good

Updated 4 October 2018

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

Well-led

Good

Updated 4 October 2018

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

Generally he trust had managers at all levels with the right skills and abilities to run a service providing high-quality sustainable care. However, there were lapses in the local monitoring of services in urgent care and medicine resulting in breaches of regulations.

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. The trust had reset its vision and strategic objectives in collaboration with all stakeholders. Although a recent innovation, understanding of these objectives was well understood at all levels of staff.

Managers across the trust promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values. The organisational values were well publicised and embedded within the trust with staff able to examples of the informed their work. Staff were committed to upholding the primacy of the patients in all the trust’s dealings.

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 culture of identifying and solving problems using a quality improvement methodology. There was a commitment to research activity with many active projects and published papers. The trust was the highest ranked general hospital in this field.

The trust had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected. There were systems to ensure risk registers were current, that risks were escalated and their management monitored. The board assurance framework ensured strategic risks were understood. However, the risk register in out-patients at Ashford hospital was not current.

The trust collected, analysed, managed and used information well to support all its activities, using secure electronic systems with security safeguards. The trust invested in IT and had robust security systems which had been resilience tested. The trust had systems to ensure that its data sources were reliable and produced comprehensive performance dashboards to monitor performance over time.

The trust engaged well with patients, staff, the public and local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively. There were numerous example of collaborative working with other organisations, for example the seconding of senior staff to set up new primary care services, and of changes made as result of engagement with the public, for example the naming of the Senior Adults Medial Service.

Assessment of the use of resources

Use of resources summary

Good

Updated 4 October 2018

Combined rating