Epsom General Hospital Quality Report

Epsom and St Helier University Hospitals NHS Trust Epsom General Hospital Quality Report Epsom General Hospital Dorking Road Epsom Date of inspection visit: Announced visit 10 and 13 Surrey November 2015. We also undertook unannounced KT18 7EG visits to the hospital on 21, 23 and 27 November Tel: 01372 735735 2015. Website: : www.epsom-sthelier.nhs.uk Date of publication: 27/05/2016 This report describes our judgement of the quality of care at this hospital. It is based on a combination of what we found when we inspected, information from our ‘Intelligent Monitoring’ system, and information given to us from patients, the public and other organisations. Ratings Overall rating for this hospital Requires improvement ––– Urgent and emergency services Requires improvement ––– Medical care (including older people’s care) Good ––– Surgery Requires improvement ––– Critical care Requires improvement ––– Maternity and gynaecology Requires improvement ––– Services for children and young people Requires improvement ––– End of life care Good ––– Outpatients and diagnostic imaging Good ––– Elective orthopaedic centre Outstanding – 1 Epsom General Hospital Quality Report 27/05/2016 Summary of findings Letter from the Chief Inspector of Hospitals Epsom General Hospital is part of Epsom and St Helier University Hospitals NHS Trust. The trust provides local acute services for people living in the southwest London and northeast Surrey. Epsom General Hospital provides acute hospital services to population of around 180,000. Epsom General Hospital is home to the South West Elective Orthopaedic Centre (SWLEOC), which is one of the largest hip and knee joint replacement centers in the UK. Most of the trust’s elective surgery is undertaken at Epsom General Hospital and the majority of emergency surgery is carried at the trust’s other location, St Helier Hospital and Queen Mary's Hospital for Children. Epsom and St Helier University Hospitals NHS Trust employs around 5024.8 whole time equivalent (WTE) members of staff with approximately 705 staff working at Epsom General Hospital. We carried out an announced inspection of Epsom General Hospital between 10 and 13 November 2015. We also undertook unannounced visits to the hospital on 21, 23, 25 and 27 November 2015. Overall, this hospital is rated as requires improvement. We found urgent and emergency care, surgery, critical care, maternity and gynaecology, services for children and young people required improvement. We found medical care, outpatients and diagnostic services and end of life care were good. We have rated the South a West London Elective Orthopaedic Centre as outstanding. We found the care of patients was good, but the safety, effectiveness, responsiveness and leadership and management required improvement. Our key findings were as follows: Safe • Systems and processes were in place for reporting and investigating incidents but learning from incidents and complaints was inconsistent. • Low nurse staffing levels on some surgical and children wards meant there was a risk to the quality of patient care. There was also a large number of vacant medical staff posts and high use of locum doctors in paediatrics. However, the hospital had recently undergone a recruitment drive which had enabled it to fill some of its nursing and medical vacancies. • Cardiac monitors used in the majors area in ED were not fit for use and this had been an ongoing risk for over a year, without an adequate solution. Major incident equipment we observed was out of date and not ready for use in the event of a major incident. • Mandatory training completion rates were low. • The hospital was visibly clean. However data supplied by the trust indicated that wards repeatedly fell short of the infection prevention control compliance threshold. Staff reviewing patients on the unit did not always comply with infection control practices such as being bare below the elbow and hand washing. • Appropriate procedures and staffing were in place to prevent harm. • We identified gaps in record keeping and safe storage of medicines management in some areas. Effective • Patient outcomes were good across most specialties and the trust performed well in national surgical audits. In the SWLEOC, patient outcomes and patient satisfaction consistently exceeded national averages. • We found staff appraisal completion rates were low. • There was a lack of clarity amongst some staff with regard to how the Deprivation of Liberty Safeguards should be used 2 Epsom General Hospital Quality Report 27/05/2016 Summary of findings • There was a lack of agreed guidelines specific to the critical care unit and no system to ensure consistency of care, even though three different consultants cared for patients in one day. The unit had a larger number of delayed discharges compared to similar units. • There was good multidisciplinary teamwork and collaborative care. Caring • Patients and their relatives commented positively about the care they received and the attitude of the staff. Staff provided care in a compassionate and kind way that preserved patients’ dignity. Patients felt supported and involved in their care and treatment. • Whilst Family and Friend Test feedback was positive, the response rate was notably low. • Patients were kept informed of their treatment, given detailed information about their diagnosis, and given time to ask further questions. Responsive • At Epsom ED for the 12 months between November 2014 and October 2015, 94% of patients were seen, admitted, transferred or discharged within four hours. • In all but neurology and dermatology, the medical directorate achieved the 18 week referral to treatment standard. The average length of stay at Epsom was slightly longer for non-elective care than the England average. • The medical directorate was slow to respond to complaints, achieving an 8% response rate within designated timescales. • Not all women received one to one care in labour. • National waiting times were met for outpatient appointments and access to diagnostic imaging although the wait for MRI services had increased. • A higher percentage of patients were seen within two weeks for all cancers than the national average, but the cancer waiting times for people waiting less than 31 days from diagnosis to first definitive treatment and the proportion of people waiting less than 62 days from urgent GP referral to first definitive treatment were both below the national average. Well-led • Vision and strategy within departments were not well developed or known by all staff. • There were good local governance structures and reporting mechanisms in place, however we found a lack of responsiveness to some known challenges and concerns. • In critical care, the strategy for the unit had not been agreed due to difficulties in reaching an agreement among the critical care workforce across the two sites and staff were not aware of the vision for the unit. Not all risk had been identified on the risk register and some risk had been on the register for some time and senior staff were still unclear on the timescale to address these risks. • The trust monitored maternity services based on merged data from both maternity units. This was misleading because the units were very different, with different staff and serving different populations. • The hospital had a number of innovative projects underway, including some related to patients living with dementia. We saw several areas of outstanding practice including: • The leadership of the outpatients and diagnostic imaging teams was outstanding with staff inspired to provide an excellent service, with the patient at the centre. • The diagnostic imaging department worked hard to reduce the patient radiation doses and had presented this work at national and international conferences. However, there were also areas of poor practice where the trust needs to make improvements. We saw several areas of outstanding practice, including: 3 Epsom General Hospital Quality Report 27/05/2016 Summary of findings • The leadership of the outpatients and diagnostic imaging teams was outstanding with staff inspired to provide an excellent service, with the patient at the centre. • The diagnostic imaging department worked hard to reduce the patient radiation doses and had presented this work at national and international conferences. • The safety and leadership of the SWLEOC, where outcomes for patients were consistently excellent and based on national guidelines. However, there were also areas of poor practice where the trust needs to make improvements. Importantly, the trust must: • Ensure there are adequate numbers of nurses and midwives to deliver safe and quality care. • Implement agreed guidelines specific to the critical care units. • Ensure the management, governance and culture in the critical care units, supports the delivery of high quality care. • Obtain feedback from patients/relatives in the critical care units, so as to improve the quality of the service. • Identify, analyse and manage all risks of harm to women in maternity services • Ensure identified risks in maternity services are always reflected on the risk register and timely action is taken to manage these risks. • Improve the quality and accuracy of performance data and increase its use in identifying poor performance and areas for improvement. In addition the trust should: • Ensure cardiac monitors used in the majors area in ED and major incident equipment are fit and ready for use in the event of a major incident. • Ensure the target

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