Withington Community Hospital

Updated 19 March 2019

Withington Community Hospital is part of Manchester University Foundation Trust which was formed on 1 October 2017. It provides day surgery and outpatients services. Other services, such as community services, are based there, but are not included as part of this report.

The day surgery service has approximately 350 full time staff and see around 155,000 patients in outpatient clinics and departments every year. Withington Hospital provides elective day case surgery for the following specialties: burns and plastics, urology, general surgery and vascular surgery. Cataract surgery is also undertaken at the Withington site by a team from the Manchester Eye Hospital in a dedicated cataract suite. This is open six days a week.

The main outpatients’ department of the Withington Community Hospital includes clinics for audiology, urology, dermatology, sexual health and other general clinics.

During our announced inspection we spoke with fifteen patients, 31 members of staff and looked at 14 sets of patient records. We observed staff delivering care, looked at four patient records and four prescription charts. We reviewed information from, and about, the trust. We also received comments from patients and members of the public who contacted us directly to tell us about their experiences.

Updated 19 March 2019

We had not previously rated this hospital for this provider. We rated it them as good because:

At this inspection we rated the services as good because:

• The service provided mandatory training in key skills to all staff and made sure most staff completed it.
• The service controlled infection risk well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection.
• The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.
• The service provided care and treatment based on national guidance and evidence of its effectiveness.
• The service made sure staff were competent for their roles. The service followed best practice when prescribing, giving, recording and storing medicines. Patients received the right medication at the right dose at the right time.
• We observed positive, kind and caring interactions between staff and patients on the day units and some clinics.
• The service had systems for reporting, monitoring and learning from incidents. Staff we spoke with knew how to report incidents, learning was disseminated to learn from incidents and prevent recurrence.

However:

• We had concerns about the sexual health clinic held at the hospital. The department had limited space for patients which led to overcrowding.
• Although most staff cared for patients with compassion, we witnessed a lack of care shown to a vulnerable patient in the sexual health clinic.
• In outpatients, there was a lack of overall leadership with no one person with oversight of the entire building and all risks.

Updated 19 March 2019

We had not previously rated this service. We rated this service as requires improvement because:

• We rated safe as good but rated caring, responsive and well-led as requires improvement (effective is not rated for outpatients).
• The service had an adequate number of qualified staff with the relevant qualifications, skills, training, and experience to provide the right care and treatment and prevent avoidable harm.
• The location provided a clean and serviceable environment with private consulting rooms.
• Staff were aware of their obligations towards themselves and their patients and understood duty of candour.
• There were policies and procedures in place to ensure that users were aware of how to manage all activities and to mitigate risk.
• Care and treatment was based on national guidelines and was able to measure performance.
• Staff understood mental capacity and when patients had the capacity to give consent.
• There was a good mix of staffing levels, and managers had the skills and abilities to run the service.
• There were staff who were driving influencing values and vision. for example, in driving forward the need to gain accreditation for the outpatients’ department.
• The trust had effective systems in place to identify risk and to share learning where applicable.

However,

• There was a witnessed occasion when there was a lack of care shown to a vulnerable patient.
• There were discrepancies with effective use of space; some departments had spare capacity and other departments had limited space for patients which led to some overcrowding of waiting areas.
• Not all staff seeing children in the outpatients’ clinics had received level 3 safeguarding training, although plans were in place to address this.
• The service did not have a holistic view of the location and no one person with oversight of the entire building and all risks.
• Care was only provided Monday to Friday, with no out of hours provision.

Updated 19 March 2019

We had not previously inspected surgical care services at this site under this trust.

We rated it as good because:

• The service provided mandatory training in key skills to all staff and made sure everyone completed it. The services were safe because there were systems to ensure staff who were non-compliant were given opportunities to undertake mandatory training and safeguarding training.
• The service controlled infection risk well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection.
• Nurse staffing was managed using recognised tools and professional judgment. To maintain safe staffing levels, the service monitored staffing levels and reviewed these daily using nationally recognised tools alongside clinical judgment.
• The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment. Nurse staffing was managed using recognised tools and professional judgment.
• The service provided care and treatment based on national guidance and evidence of its effectiveness. The services were effective because processes were in place to ensure that guidance used by staff complied with national guidance, such as that issued by National Institute for Health and Care Excellence.
• The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and monitor the effectiveness of the service. Staff were given opportunities to develop their competencies.
• The service followed best practice when prescribing, giving, recording and storing medicines. Patients received the right medication at the right dose at the right time.

• Staff identified patients at risk of nutritional and dehydration risk or requiring extra assistance at pre- assessment stage. Patients were offered support when required

• Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness. We observed positive, kind and caring interactions on the day units and between staff and patients.

• The service had systems for reporting, monitoring and learning from incidents. Staff we spoke with knew how to report incidents, learning was disseminated to learn from incidents and prevent recurrence.
• Patients we spoke to felt involved in their care and had been provided with information to allow them to make informed decisions.
• The trust had systems and processes in place to ensure that the needs of local people were considered when planning the service delivery.
• Managers at all levels in the trust had the right skills and abilities to run a service providing high-quality sustainable care.
• 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.