Ashford Hospital

Updated 27 January 2022

Ashford Hospital is in Surrey and is situated to the West of London and close to Heathrow Airport.

The hospital provides a wide range of medical and mainly day surgical services, outpatients services, ophthalmology, inpatient rehabilitation, and includes the Ashford Walk-in Centre (run by a different provider). The majority of planned care, like day surgery is provided at Ashford Hospital.

Services include:

• Day-case surgery
• Elective Surgery
• Ophthalmology
• Outpatients (including pediatrics) and diagnostics; X ray, ultrasound, and MRI scans
• Inpatient Rehabilitation

We carried out this unannounced focused inspection of surgery because we received information of concern about the surgery service across the hospital from staff whistleblowing to the CQC.

We inspected surgery and focused on the safety and well led key questions as the information we received related to these key questions.

We rated surgery as good in both key questions.

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

• The service had enough staff to care for patients and keep them safe. Staff 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.
• 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.
• The majority of 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.

However:

• A minority of staff did not feel respected, supported and valued.
• A minority of staff were not bare below the elbows in clinical areas.
• Staff told us that divisional leaders were visible. However, staff perceived that the trust’s executive team were not visible.
• Not all staff were up to date with mandatory training including safeguarding training.

How we carried out the inspection

We spoke to over 40 members of staff including; doctors in training, consultants, nurses, health care assistants, a student nurse, and allied health professionals. We reviewed a variety of data, meeting minutes and nine patient records.

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 10 March 2015

Patients received compassionate care. We witnessed positive interactions between staff and patients.

All staff we spoke with were positive about working at Ashford Hospital.

Safety in medicine was compromised because staff were not clear about the monitoring of risks to patients and staff. There were shortfalls in the number of staff attending basic life support and manual handling training. There were risks to patient confidentiality as care records were not consistently securely stored.

The trust monitored the effectiveness of care delivered at divisional level. We were not able to view data which was specific to Ashford Hospital and, therefore, could not be assured how the trust measured the performance of the hospital. The medical wards and the rapid access centre did not reach the trust’s targets for appraisals.

There was confusion from ward staff on two wards about the changes to the level of care provided on their wards.

The clinical nurse leader for the medical wards was seen as a good role model and passionate about patient care, however, there was a lack of clarity about their other management duties.

Updated 10 March 2015

<Summary here>

Updated 4 October 2018

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

• Standards of cleanliness and hygiene were maintained in some areas; however cleaning schedules were not in use in all clinic areas such as the ophthalmology clinic.
• Emergency equipment in general outpatients and the ophthalmology clinic was not always checked in line with trust policy. Some items of clinical equipment in the ophthalmology clinic were seen to be overdue for maintenance.
• Medicines and medicines-related stationary were not always managed in a way that kept people safe in relation to the storage temperatures of medicines and the tracking of prescription forms.
• Not all staff had received feedback on incidents reported and outpatient team meetings did not include safety incidents as a standing agenda item.
• The trust had not participated in the national benchmarking programme for outpatient departments in 2017.
• Services did not always run on time, although patients were informed of delays. There was evidence of some overbooking in clinics which staff reported had caused delays. Managers told us that action was being taken to address the overbooking of clinics.
• Senior trust and divisional leaders were not visible within the outpatient department. Staff in general outpatients were uncertain about who to report to outside of their immediate line managers.
• There was no outpatient strategy recorded in line with the trust wide strategy. Staff felt uncertain about the future of Ashford Hospital and did not feel engaged with the wider organisation.
• Governance structures were not consistently in place to support the delivery and development of outpatient services.
• Arrangements for identifying, recording and managing risks, issues and mitigating actions were not consistent or comprehensive.

However:

• Safeguarding training attendance for nurses was above trust target.
• People’s individual care records, including clinical data was written and managed in a way that kept people safe.
• Lessons were learned and improvements made when things went wrong.
• Patient’s physical, mental health and social needs were holistically assessed and staff delivered patient care in line with evidence based care and best practice guidelines.
• Information about patient outcomes were recorded after each clinic appointment and there were processes to audit these to promote quality improvements. This supported efforts to reduce the volume of patients potentially lost to follow up. The follow-up to new rate for Ashford Hospital was consistently better than the England average.
• There was evidence of multidisciplinary working with all necessary staff, including those in different teams, services and organisations, involved in assessing, planning and delivering care and treatment.
• People were treated with compassion, kindness, dignity and respect, when receiving care. Feedback from people who used the service, those who are close to them and stakeholders was positive about the way staff treated people.
• Outpatient services ensured people’s needs were met through the way services were organised and developed. Patients with dementia were identified through the use of a symbol on their patient record and there was a dedicated dementia waiting area.
• The facilities and premises were appropriate for the services delivered. There were facilities for patients in wheelchairs in the outpatient department including disabled toilets and a ‘changing places’ toilet.
• People had timely access to initial assessment, test results and diagnosis and treatment. Referral to treatment times were monitored and performance for non-admitted and incomplete pathways was better than the national average.
• Trust performance for cancer waiting times was better than the operational standard and the national average.
• Action was taken to minimise the length of time people have to wait for care, treatment of advice. There was close monitoring of waiting lists and patient follow ups.
• Delays and cancellations were explained to people and the trust closely monitored cancellations in fewer than six weeks. Data showed a reduction in cancellations in fewer than six weeks.
• Complaints were reviewed at the bi-monthly outpatient clinical governance meetings and lessons identified to improve practice.
• There was a clear vision and set of values with quality of care and meeting patients’ needs as the top priority.
• Staff we spoke with during our inspection were focused on the needs of patients and the culture was centred on the needs and experience of people who use the services.
• There were processes to manage current and future performance which were regularly reviewed and improved. There were clear and robust service performance measures, which were reported and monitored.

Updated 27 January 2022