George Eliot NHS Hospital

Updated 15 November 2023

Pages 1 and 2 of this report relate to the hospital and the ratings of that location, from page 3 the ratings and information relate to maternity services based at George Eliot NHS Hospital.

We inspected the maternity service at George Eliot NHS Hospital as part of our national maternity inspection programme. The programme aims to give an up-to-date view of hospital maternity care across the country and help us understand what is working well to support learning and improvement at a local and national level.

George Eliot NHS Hospital provides maternity services to the population of over 300,000.

Maternity services include an early pregnancy unit, outpatient department, maternity assessment unit, combined antenatal and postnatal ward (Drayton Ward), delivery suite and two maternity theatres. Between April 2022 and March 2023 2,153 babies were born at George Eliot NHS Hospital. We will publish a report of our overall findings when we have completed the national inspection programme.

We carried out an announced focused inspection of the maternity service, looking only at the safe and well-led key questions.

Our rating of this hospital stayed the same. We rated it as Requires Improvement because:

• Our rating of Good for maternity services did not change ratings for the hospital overall. We rated safe as Good and well-led as Good.

Our reports are here: www.cqc.org.uk/location/RLT01

How we carried out the inspection

We provided the service with 2 working days’ notice of our inspection.

We visited the maternity day assessment unit, maternity assessment unit (triage), delivery suite and the antenatal / postnatal (Drayton) ward.

We spoke with 9 midwives, 3 support workers, 9 medical staff, 5 women and birthing people and 1 birthing partner and or relative. We reviewed 5 patient care records, 4 Observation and escalation charts and 10 medicines records. We did not receive any responses to our give feedback on care posters which were in place during the inspection.

Following our onsite inspection, we spoke with senior leaders within the service; we also looked at a wide range of documents including standard operating procedures, guidelines, meeting minutes, risk assessments, recent reported incidents as well as audits and action plans. We then used this information to form our judgements.

You can find further information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

Updated 26 February 2019

Our rating of this service went down. We rated it it as requires improvement because:

• Whilst the service provided mandatory training in key skills to all staff, not all staff had completed it in accordance with the service’s targets. During this inspection, we found deterioration in that the trust compliance target was not met in 50% of subjects, as at July 2018.
• Whilst staff assessed risks to patients and monitored their safety, they were not always completed for every patient when required. Although assessments were in place to alert staff when a patient’s condition deteriorated, reviews were not always completed within recommended timescales.
• The service did not collectively monitor the percentage of staff that had completed sepsis training, or set a target for compliance.
• The service made sure most, but not all staff, were competent for their roles. Not all eligible staff had completed blood transfusion training. Training compliance was significantly below the trust target for eligible staff on six out of eight wards and units. Furthermore, a TACO (transfusion associated circulatory overload) audit completed in April 2018, found that 28% of patients had not received a TACO assessment to support the minimisation of risks for those patients who required a blood transfusion.
• Malnutrition and Screening Tool (MUST) assessments were not always completed within 12 hours of admission, or reassessments completed in line with a patient’s care plan or policy.
• Most, but not all people, could not always access the service when they needed to; there were delays at times in admitting patients from the acute areas to appropriate inpatient medical wards.
• There was insufficient resource in the leadership for it to consistently run a service providing high-quality sustainable care. A vacancy in the senior management team meant there was reduced support provided within the division.
• Governance processes were not consistently embedded across the service.
• Ward staff meetings were not held consistently across the service and agendas differed which did not support the cascading of information from board to ward level.

However;

• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Most staff had training on how to recognise and report abuse and they knew how to apply it.
• The service controlled infection risk well. Staff kept themselves, equipment and the premises clean and used control measures to prevent the spread of infection.
• Patients had their needs assessed and their care was planned and delivered in line with evidence-based guidance, standards and best practice.
• The endoscopy department had their Joint Advisory Group (JAG) accreditation confirmed following a recent inspection.
• Patients’ pain was assessed on admission to hospital and repeated at intervals throughout their stay.
• Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.
• The service took account of patients’ individual needs. The service identified and met the information and communication needs of people with a disability or sensory loss.
• The service had a vision based on the trust’s overall vision for what it wanted to achieve.
• 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 proud to work at the trust and felt valued for the contribution they made to patient care.

Updated 26 February 2019

• The service provided mandatory training in key skills to all staff and nursing staff were mainly compliant.
• Staff understood how to protect patients from abuse and the service worked well with other agencies. The trust target of 85% compliance was met for the majority of safeguarding training courses.
• The service controlled infection risk well.
• The service had suitable premises and equipment and looked after them well. Equipment was checked at regular intervals to ensure it was safe for use.
• Staff completed and updated risk assessments for each patient. They kept clear records and asked for support when necessary.
• The service had sufficient nursing staff with the right qualifications, skills, training and experience. Staffing levels were safe at the time of the inspection and we saw evidence of this in all the areas we visited.
• At the time of the inspection there were sufficient medical staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.
• Staff kept detailed records of patient’s care and treatment and individual records were managed in a way that mainly kept patient’s safe. Records were stored securely in all the areas we visited.
• Staff prescribed gave and recorded medicines well. Patients received the right medication and the right dose at the right time.
• Staff recognised incidents and reported them appropriately. Managers investigated incidents and provided feedback to staff. When things went wrong, staff apologised and gave patients honest information and suitable support.
• The service 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.
• Pain was assessed and managed well.
• 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. Outcomes were generally better than the national average. Action plans were in place to address any shortcomings.
• The service made sure staff were competent in their roles.
• Staff worked together as a team to benefit patients.
• Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. They followed trust policy and procedures when a child or young person could not give consent. The majority of staff in children’s services had undertaken training in the Mental Capacity Act (MCA).
• Staff cared for babies, children and young people with compassion. Feedback from children and parents confirmed that staff treated them well and with kindness.
• Staff provided emotional support to patients to minimise their distress.
• Staff involved patients and those close to them in decisions about their treatment. Parents were encouraged to be actively involved in their children’s care.
• The trust planned and delivered services to meet the needs of local people.
• The service took account of children and young people’s needs.
• The service treated concerns and complaints seriously, investigated them and learned lessons from the results and shared these with staff.
• Senior managers in children’s services had the right skills and abilities to address risks identified in sustaining paediatrics at the hospital. Performance issues across clinical teams in children’s and urgent care services continued to be addressed and we saw improvements in the local leadership and management of children’s services starting to emerge.
• The service had a vision of 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.
• Senior managers were continuing to promote a positive culture to help address the challenges raised at the previous inspection. Improvements in behaviours and staff morale were observed and a sense of common purpose across CAU and ED was starting to emerge.
• The service used a systematic approach to continually improve the quality of its services and safeguarding high standards of care by creating an environment in which excellent care would flourish.
• The service had effective systems for identifying risks, planning to eliminate or reduce them, coping with both the expected and unexpected.
• The service collected, analysed, managed and used information well to support all its activities, using secure electronic systems with security safeguards.
• The service engaged with patient’s, staff and the public to plan and manage appropriate services for children, young people and their families.
• The service was committed to improving services by learning from when things went well and when things went wrong in promoting training, research and innovation.

However

• There were four patients who had been referred to the child and adolescent mental health service (CAMHS) that were in the CAU for over 12 hours awaiting admission to the nearby NHS acute trust for assessment. This then affected the flow of other patients through CAU. We raised this with the service at the time of the inspection who were taking the appropriate actions to address current concerns and a multi-agency action plan was in place with Coventry and Warwickshire.
• Children’s services had identified paediatrics as a risk to the organisation due to the inability to recruit a substantive medical workforce and financial sustainability. However, the trust was taking the appropriate actions to address the service shortfalls.
• Although the service prior to the inspection had not identified the risks associated with CYP waiting for an acute paediatric bed for mental health assessment, additional data demonstrated the service was working closely with Coventry and Warwickshire on a multi-agency action plan which included reviewing the risks posed to CYP.
• Medical staff were not meeting the 85% trust standard for mandatory training.

Updated 16 July 2014

There were effective procedures to protect patients and support safe care. Visitors we spoke with were pleased with the care their relatives had received in the intensive therapy unit (ITU) and spoke highly of the staff. Clinical outcomes for patients in the unit were good. Staff worked well together as a team and were enthusiastic about their work. Patients we spoke with gave us examples of the good care they had received in the unit. Staff built up trusting relationships with patients and their relatives by working in an open, honest and supportive way.

The unit had an annual clinical audit programme to monitor how guidance was adhered to. Information was collected for the Intensive Care National Audit and Research Centre (ICNARC) database. There was good multidisciplinary team working although specific therapy support was not available over seven days. There was strong local leadership of the unit. Openness and honesty was encouraged at all levels, and staff were encouraged to learn new skills and develop the service.

Updated 26 February 2019

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

• The last inspection in 2017 identified the trust did not always ensure there were sufficient quantities of equipment to maintain the safety of patients. This had improved during this inspection. No incidents concerning delays in patient care due to the lack of availability of syringe drivers had been reported in a 12-month period.
• The service now had sufficient numbers of suitably qualified, competent, skilled and experienced persons in end of life care services. There was palliative care consultant in post within the specialist palliative care team (SPCT) at the time of our inspection.
• The trust did not consistently assess, monitor and improve the quality and safety of the services it provided during our last inspection. This had improved during this inspection. The service now completed audits to identify if evidence-based, end of life documentation was consistently completed and reviewed. For example, staff had carried out an audit on preferred place of death for patients known to SPCT and used the audit to evaluate the quality of the information collated in the care plans.
• The trust had appointed end of life care champions in various ward areas and ensured the delivery of end of life care training was sufficient throughout the hospital.
• Staff were caring and compassionate and end of life care services provided a flexible service to meet the needs of local people.

Updated 15 November 2023

Updated 25 January 2018

We previously inspected outpatients jointly with diagnostic imaging so we cannot compare our new ratings directly with previous ratings.

We rated it as requires improvement because:

• We rated safe, responsive and well led as requires improvement and rated caring as good. We do not currently rate effective for outpatients.
• Mandatory training was low and did not meet the trusts target of 85%.
• Staff did not have the appropriate level of children’s safeguarding training.
• The trust did not complete regular audits of infection prevention and control practices.
• Patients were unable to access services for assessment, diagnosis and treatment in a timely way due to waiting times, delays and cancellations. Action to address this was not robustly managed and timescales were unclear. Overbooking of fracture clinics resulted in long waiting times for patients.
• The service did not take full account of people’s individual needs. Facilities for children and adjustments for people living with dementia or a learning disability were not in place.
• Governance and management processes did not function effectively. Roles and processes for managing issues and performance were unclear. The flow of information from the departments within the directorate to the directorate governance committees and vice versa was limited and there was no evidence of cross directorate learning. Data and information was not collected and managed effectively to inform improvement initiatives and challenge practice.

However:

• Patients were treated with kindness, dignity and respect and staff were attentive to their needs. They were involved in decision making about their care and treatment and were supported in this.
• Staff and teams worked well together to deliver effective care and treatment and overcome operational issues. We saw examples of good multi-disciplinary working and staff had opportunities to develop their skills and roles to improve patient experience.

Updated 19 May 2020

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

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• People could not always access the service when they needed it and had to wait too long for treatment.

However,

• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

Updated 7 July 2023