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Provider: Epsom and St Helier University Hospitals NHS Trust Good

On 19 September 2019, we published a report on how well Epsom and St Helier University Hospitals NHS 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 19 September 2019

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

  • We rated safe as requires improvement; and effective, caring, responsive and well-led as good. We rated eight of the trust’s nine services as good. Only the emergency departments were rated as requires improvement. In rating the trust, we took into account the current ratings of the six services not inspected this time.
  • We rated well-led for the trust overall as good.

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/RVR/reports

Inspection areas

Safe

Requires improvement

Updated 19 September 2019

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

  • There was not a suitable and safe environment for children and young people presenting with mental ill health to be assessed.
  • There were not effective systems for identifying risks to children and young people presenting with mental ill health; and planning to eliminate or reduce them.
  • In the emergency department at Epsom General Hospital, some patients waited on trolleys between 30 – 50 minutes, to be handed over to the emergency department staff by the ambulance crew.
  • In the emergency department at Epsom General Hospital, intra venous fluids in resuscitation area was stored openly on shelves and the floor under a hand wash basin.
  • Staff did not monitor fridge and room temperatures on several areas, which could impact on the potency of some medicines.
  • Staff completion of mandatory training remains below the target, particularly for medical staff.
  • Actual number of nurses on some shifts, were below the planned number in some surgical wards at St Helier Hospital.

However:

  • There was a good incident reporting culture and staff shared learning from incidents.
  • Staff kept themselves, equipment and the premises clean. They mostly used control measures to prevent the spread of infection.
  • Staff had training on how to recognise and report abuse and they knew how to apply it.

Effective

Good

Updated 19 September 2019

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

  • Guidelines were in place to support staff to provide effective treatment, and these were up-to-date with national guidance and standards and regularly reviewed and audited.
  • There was very good multidisciplinary team working in all areas, including with external partners.
  • 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.
  • Staff gave patients enough food and drink to meet their needs and improve their health. The trust introduced a range of initiatives to improve nutrition and hydration standards.
  • Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely manner.

However:

  • Completion of staff appraisal of their performance continue to be below the trust target of 95% in many areas.
  • Regular bank and agency staff could not access support such as relevant competency training or appraisals and supervision.

Caring

Good

Updated 19 September 2019

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

  • Staff treated patients with compassion and kindness. They respected patients’ privacy and dignity and supported their individual needs.
  • Staff provided emotional support to patients to minimise their distress.
  • Staff involved patients and those close to them in decisions about their care, treatment and changes to the service.
  • Patients, families and carers gave positive feedback about their care and the kindness of staff.
  • Staff communicated clearly with patients to help them understand what was happening to them. They kept relatives and people accompanying patients informed.

However:

  • The response rate for the friends and family test had declined since our previous inspection.

Responsive

Good

Updated 19 September 2019

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

  • The trust planned and provided services in a way that met the needs of local people. The trust had a transition agenda and were rolling out new ways of working including a model of integrated care.
  • At Epsom General Hospital, the hospital had an ‘At Home’ team. This was an integrated community-based team that could support patients when they were discharged into the community.
  • The trust treated concerns and complaints seriously, investigated them, learned lessons from the results, and shared these with staff, in most cases.
  • In maternity, the service introduced a ‘Green Armband’ initiative on both sites, whereby women who were suitable for midwife-led discharge were given a green armband. This meant staff could recognise and prioritise women who were ready to go home and facilitate a speedier discharge.

However:

  • People living with dementia were not always highlighted to ensure they were cared for in an individualised way.
  • The responsiveness of the emergency departments, were not in line with good practice in relation to waiting times and arrangements to admit, treat and discharge patients.
  • Over a period of two years, the percentage of cancelled operations at the trust had generally been higher than the England average.

Well-led

Good

Updated 19 September 2019

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

  • Managers had the right skills and abilities to run a service providing sustainable care.
  • Managers across the service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values. Staff were committed to improving the quality of care and patient experience and worked together to do so.
  • Staff used a systematic approach to continually improve the quality of its services and safeguard high standards of care. Staff understood their roles and accountabilities.
  • The trust engaged well with patients, staff, the public and local organisations to plan and manage appropriate services and collaborated with partner organisations effectively.

However:

  • Structured board development was currently not taking place, but we were told was scheduled to start in September 2019.
  • Board assurance about the trust’s capture of dementia diagnoses, needed to improve.
  • Oversight, governance and leadership of safeguarding needed to improve.
  • There was a lack of oversight, governance and control of risks associated with medicines management.
Assessment of the use of resources

Use of resources summary

Good

Updated 19 September 2019

Combined rating