Chief Inspector of Hospitals publishes his findings on the Royal Surrey County Hospital, Guildford

18 December 2013

England's Chief Inspector of Hospitals has today published his first report on the quality of care provided by The Royal Surrey County Hospitals NHS Foundation Trust at the Royal Surrey County Hospital, Guildford.

The trust was one of the first to be inspected under radical changes introduced by the Care Quality Commission which are designed to provide a much more detailed picture of care in hospitals than ever before.

An inspection team which included doctors, nurses, hospital managers, trained members of the public, CQC inspectors and analysts, visited the trust announced in October.

The team examined the care provided in accident and emergency (A&E), medical care (including older people’s care), surgery, intensive/critical care, maternity, children’s care, end of life care and outpatients.

Overall, the report concludes that the trust was providing services that were safe, effective, responsive, caring and well-led; however, there were some areas for improvement.

Positive findings included a modern and well equipped children’s unit that reflects the ideas and contributions of children and young adults who use the service. The unit is a testament to how the organisation has used staff and patient suggestions to develop a state-of-the-art environment that provided high levels of care in a calm and relaxed atmosphere. Parents told us that the facilities were outstanding and that staff paid great care and attention to the needs of the children and their families.

The maternity service had good and effective leadership, and an open and supportive culture. Positive leadership had led to high levels of staff morale and a service that met the needs and expectations of the people who used the maternity services. Patients were mostly very complimentary about the care and dedication of the staff looking after them. They said that communication was good, staff referred to individual birth plans and women felt supported, listened to and had confidence in the quality and safety of their care.

However, the eye outpatient service was overcrowded. Patients said they had been waiting for up to four hours, and data that we received before and during the inspection confirmed that this was a regular occurrence. The trust was aware of this and had plans to expand the service to address its capacityissue. However, it had not taken sufficient action to minimise the impact of this issue on patients while the service was expanded.

Inspectors also visited the hospital unannounced as part of the inspection, held focus groups with staff, and held a public listening event.

The report, based on a combination of their findings, information from CQC’s Intelligent Monitoring system, and information provided by patients, the public and other organisations, is available below.

Read the full report on the Royal Surrey County Hospital page.

The Chief Inspector of Hospitals for CQC, Professor Sir Mike Richards, said: "We found that the Royal Surrey County Hospital was providing services that were safe, effective, responsive, caring and well-led. Staff we spoke to were positive and engaged, and patients we spoke to were generally very positive about the care that they had received at the hospital.

"When we inspected the hospital, we found that most departments were operating at full capacity – and that this was, at times, having a negative impact on patient experience. There are improvements that could be made here to improve the care delivered to local people, but overall we judge this to be a good hospital."

Whenever CQC inspects it will always ask the following five questions of every service: Is it safe? Is it effective? Is it caring? Is it responsive to people’s needs? Is it well-led?

ENDS

For media enquiries, call the CQC press office on 020 7448 9401 during office hours or out of hours on 07917 232 143. For general enquiries, call 03000 61 61 61.

Notes to editors

Is it safe?

Overall, services were safe, but some improvements were needed in medical services. Patients’ needs were assessed and staff provided care to meet those needs, and systems were in place to minimise risks to patients. In some wards and outpatient departments we found that the level and mix of staffing might create a risk to the safety of patient care, particularly in areas of care for frail elderly patients and administration support services.

Is it effective?

Overall, the trust is effective, but needs to make some improvements to ensure that all services are effective at all times, particularly in outpatients and A&E. Some clinical pathways needed improvement and patients not always offered pain relief in a timely manner. Staffing levels were impacting on the effectiveness of some services.

Is it caring?

Overall, services were caring, but there were some areas for improvement. Generally, staff treated people with compassion, respect and dignity. Most patients felt cared for and listened to by staff, although some patients we spoke to at the listening event and who had contacted us directly had not had good experiences.

Is it responsive to people’s needs?

Overall, services were responsive, although there were some areas for improvement particularly in outpatients. Overcapacity issues had led to delayed appointments and long waits in some outpatient departments, particularly ophthalmology. Maternity services were particularly good at responding to patients’ needs.

Is it well-led?

Overall, there were some areas for improvement. The trust was well-led at departmental level, with the exception of outpatients, and there was a transparent, open, supportive culture. Everyone was clear on trust priorities, but priorities at departmental level had not always been captured at trust level.

The Care Quality Commission has already presented its findings to a local Quality Summit, including NHS commissioners, providers, regulators and other public bodies. The purpose of the Quality Summit is to develop a plan of action and recommendations based on the inspection team’s findings.

CQC inspectors will continue to monitor the Royal Surrey County Hospital and will return in due course to carry out further inspections as part of its regulatory programme.

The Chief Inspector of Hospitals for CQC, Professor Sir Mike Richards, announced in July that he will lead significantly larger inspection teams than before, headed up by clinical and other experts including trained members of the public. Sir Mike identified 18 NHS trusts representing the variation of care in hospitals in England. These will be the first hospitals to test the new inspection regime.