Archived: Essex County Hospital

Updated 17 July 2014

Essex County Hospital is part of the Colchester University Hospital NHS Foundation Trust. This is a much smaller hospital than the main Colchester hospital, with only two oncology wards. This site provides day surgical services for ophthalmology and orthodontic services with minor operations only for other services and outpatients. As part of the CQC new inspection regime, we inspected both the surgical and outpatients services.

We carried out this comprehensive inspection as a follow up to the inspection that was undertaken last year as part of the Keogh Mortality Review.

The team of included CQC inspectors and analysts, doctors, nurses, patients and public representatives, experts by experience and senior NHS managers. The inspection took place between 6 and 8 May 2014, with an unannounced visit on 16 and 19 May.

Overall, we rated this hospital as ‘requires improvement’. We rated it ‘good’ for providing caring and effective care, but it required improvement for safe, responsive and well-led care. We rated surgery services as ‘good’ but outpatient services ‘required improvement. There were areas of poor practice where the trust needs to make improvements.

Importantly, the hospital must:

• Review the decontamination procedures within the orthodontic clinic to ensure that these comply with the required national standards.
• Ensure that the use of the World Health Organisation (WHO) checklist is fully embedded in surgical practice, including the ‘sign out’ and debrief.
• Ensure that all staff have appropriate supervision and appraisal.
• Ensure that staff have access to training and development opportunities to ensure that they maintain the necessary skill for their role, this is to include management, leadership and professional development training.
• Ensure that there is a robust incident and accident reporting system in place and that lessons learnt from investigations of reports are shared with staff to improve patient safety and experience.
• Ensure that there are appropriate waste disposal procedures in place and these are implemented, particularly in the outpatients department.
• Ensure that all cleaning products are stored in accordance with manufacturing guidance and complies with legislative requirements.
• Ensure that all sterile equipment and products are appropriately stored to ensure that there sterility is maintained, including an adherence to expiry dates.
• Review the numbers and skill mix in the outpatients department to ensure that there are sufficient qualified and skilled staff to meet patient needs.
• Review the cancellation of outpatient appointments and take the necessary steps to ensure that issues identified are addressed and cancellations are kept to a minimum.
• Review waiting times in outpatients’ clinics and take the necessary steps to ensure that issues identified are addressed.
• Review access into clinics to ensure that they are suitable for people with mobility problems.
• Ensure that information on how to complain is accessible to patients in all patient areas within the hospital.
• Review the involvement of staff in trust-wide issues to ensure that staff are fully conversant with the trust vision, strategies and objectives and can contribute to the development of services.
• Review the information provided to staff regarding future development of services and how staff can be involved and engaged in this process.

We would normally take enforcement action in these instances, however, as the trust is already in special measures we have informed Monitor of these breaches, who will make sure they are appropriately addressed and that progress is monitored through the special measures action plan.

In addition, the hospital should:

• Review the waste disposal bins in toilets designated for people with disabilities.
• Review issues identified and associated with transport problems when accessing outpatient appointments.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Updated 17 July 2014

Although the outpatient environment was clean, we found poorly stored waste bins and lack of clarity regarding clinical waste disposal. We also found disposable equipment, such as needles and swabs, which had passed their expiry date. Staff were noted to be busy. There were no vacancies in the service and agency staff were rarely used. Staff told us their mandatory training was up to date.

Outpatient services were caring and most patients spoke positively about the care and treatment they received and felt they were involved in their care plan. We witnessed staff being polite and welcoming.

Although the trust had a work stream to monitor outpatient efficiency and to improve do not attend (DNA) rates, we were concerned to find a large number of cancelled outpatient appointments. Up to 9% of these occurred within one week of the original appointment time.

We saw written information about the complaints procedure and the Patient Advice and Liaison Service, but none of the patients we asked had been given any information about complaints or knew how to make a complaint. We received consistently negative feedback from patients and staff about the patient transport service and patient parking.

We found senior staff each had visions for the service at local-level, yet there seemed to be a lack of combined objectives and strategy to achieve an improved service. Issues had been identified within the service, but there were delays in resolving these. We were provided with minutes from divisional governance meetings which appeared to demonstrate that outpatient services were discussed in relevant speciality meetings rather than as a separate service and within these outpatients was discussed at any length. There was no discussions minuted relating to delays in appointments or cancellations. Staff we spoke with were not aware of key performance indicator targets or results for the service and therefore were not proactively managing the situation at clinic-level.

Updated 17 July 2014

The environment on the surgical wards and theatres was clean and there was evidence of learning from incidents in most areas. There was adequate equipment to ensure safe care. However, we witnessed that the ‘five steps to safer surgery’ was not undertaken consistently and that not all patients were seen daily by a consultant at weekends.

Surgical services at this hospital used evidence-based care and treatment and had a clinical audit programme in place. There was evidence of multidisciplinary working.

Effective pain relief and nutritional arrangements were in place. Patients received care and treatment from competent staff.

The surgical services provided at this hospital were caring. All patients and relatives, the results of the NHS Family and Friends Test and patient surveys supported our observations that patients received care and treatment given by staff with dignity and respect.

Staff reported good leadership at all levels within the directorate and improvements in staffing levels. Governance, risk and quality systems were in place.