The Care Quality Commission (CQC) has published two reports following inspections of surgical services at Ashford Hospital and surgery and medical care services St. Peter’s Hospital, run by Ashford and St. Peter’s Hospitals NHS Foundation Trust.
CQC carried out an unannounced focused inspection of Ashford Hospital in November to look at how safe and well-led surgical services were, after receiving information of concern about the service.
Following the inspection, the overall rating for Ashford Hospital is unchanged and remains as requires improvement. The overall rating for surgery at the hospital did not change and remains good. The rating for safe improved from requires improvement to good. The rating for well-led remains good.
Inspectors also carried out an unannounced focused inspection at St. Peter’s Hospital at the same time. This was to look at how safe and well-led medical care and surgical services were, after receiving information of concern about the quality and safety of the service. Some aspects of the effective and responsive domains were also inspected but were not rated.
Following the inspection, the overall rating for St. Peter’s Hospital has gone down from good to requires improvement. The rating for overall rating for surgery also went down from good to requires improvement and the rating for how well-led the surgical services division was also dropped from good to requires improvement. Safe remains requires improvement. The overall rating for medical care at St. Peter’s Hospital remains good. The rating for being safe has improved from requires improvement to good. The rating for being well-led did not change and remains good.
Because this was a focused inspection, the overall rating for the trust is unaffected and remains good.
Amanda Williams, CQC’s head of hospital inspection, said
“When we inspected surgical services at Ashford Hospital and St Peter’s Hospital, we found the leadership team understood the challenges the service faced and was taking action to address these. When staffing was previously identified as an issue, leaders adopted innovative strategies to improve staffing levels, such as ‘grow your own’ apprenticeship opportunities. As a result, staffing was no longer an issue. A number of other initiatives had been developed to give staff a voice, address concerns, and improve communication and learning from incidents. Leaders also supported staff to upskill and develop so they could take on more senior roles.
“In both hospitals, we found that staff knew what incidents should be reported and raised concerns in line with trust policy. Managers investigated incidents thoroughly and staff received feedback from incidents they reported. It was evident that changes had been made as a result of learning from incidents.
“At Ashford Hospital, most staff said that morale was good, and they felt happy and supported, both by managers and their colleagues. At St Peter’s Hospital, staff on the surgical wards said they felt valued, included and respected, and proud to work there. However, this was not the case for all staff in the theatre and recovery areas, where a significant number of staff told us they felt they had not been consulted on changes to the way in which the service ran, or ways of working in a way that was meaningful to them. Although trust leaders had introduced a number of ways to improve the culture and give staff the opportunity to speak out and share their experiences, these had not been effective for all. The trust has now brought in an external company to help address the issues, and it is continuing to implement an action plan focused on supporting the theatre teams to manage change, as well as team building and leadership development.
“In St. Peter’s, we were also concerned to find that some patients with complex mental health remained on the medical wards when they no longer needed to be there, due to a lack of beds in social care services. During the inspection, there were 63 patients who were still on the ward when they should have been discharged, and some of them had been there for 30 days. This was affecting the trust’s ability to manage patient flow, and it also meant these patients were not in the best place to meet their needs. However, the trust is working to address this issue and recently opened a 19-bed ward for medically fit patients to move to while they are waiting for community placements.
“We have pointed out a number of areas for improvement in both hospitals and we will continue to monitor the situation to check that these have been made.”
At Ashford Hospital, inspectors found the following:
- Leaders ran services well using reliable information systems and supported staff to develop their skills
- 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
- 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 controlled infection risk well and managed medicines well
- Staff assessed risks to patients, acted on them and kept good care records. They also managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service
- The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.
There were also notable areas of outstanding practice, namely:
- The service had introduced a number of different innovations to reduce patient falls
- A system had been implemented to ensure that all patients received a follow up call the day after their surgery to check they had everything they needed, and their pain was controlled, and to discuss any concerns they had
- Theatres and day surgery had implemented systems to enable staff to respond effectively to emergency situations
- Inspectors saw examples of staff responding to patients’ individual needs and beliefs whilst mitigating any risks to the patient
- The service had developed an effective support package for newly recruited international staff that enabled them to gain UK registration.
However:
- A minority of staff did not feel respected, supported and valued
- Staff said that divisional leaders were visible, but members of the trust executive team were not
- A minority of staff were not bare below the elbows in clinical areas
- Not all staff were up to date with mandatory training including safeguarding training.
At St. Peter’s Hospital, inspectors found the following:
- Leaders ran the service 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. They were clear about their roles and accountabilities and focused on the needs of patients receiving care. They treated patients with compassion and kindness, respected their privacy and dignity and took account of their individual needs
- Staff understood how to protect patients from abuse and harm most of the time, and managed safety well. They also controlled infection risks and managed medicines well
- Staff assessed risks to patients, acted on them and kept good care records
- Staff managed safety incidents well and learned lessons from them. They collected safety information and used it to make improvements. They were committed to continuous improvement
- The service engaged well with patients and the community to plan and manage services.
They also found an example of outstanding practice:
- The Healing Arts steering group created a project called a ‘Time Garden’, a place within the hospital where people could go to find peace. The project recognised the importance of our environment in supporting healing, both physical, psychological and spiritual.
However:
- Nursing staff numbers were consistently below planned levels
- Staff did not always feel respected, supported and valued. The culture in the theatres was unhappy, staff felt that they weren’t being listened to and felt disengaged
- Staff were not always up to date with mandatory safeguarding training
- There were times when managers lacked oversight around safeguarding and flow
- The theatre had damage to the walls, floors and fittings, which was an infection control risk
- Several items of medical equipment were out of date for servicing, meaning staff could not be sure they were safe to use
- In medical care, not all records were clear, correctly updated or filed in order.
Read the reports published on the CQC website:
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