West Hertfordshire Hospitals NHS Trust Evidence appendix Trust Headquaters Date of inspection visit: Vicarage Road 15 October to 30 November 2018 Watford Hertfordshire Date of publication: WD18 0HB 28 February 2019 Tel: 01923436228 www.westhertshospitals.nhs.uk This evidence appendix provides the supporting evidence that enabled us to come to our judgements of the quality of service provided by this trust. It is based on a combination of information provided to us by the trust, nationally available data, what we found when we inspected, and information given to us from patients, the public and other organisations. For a summary of our inspection findings, see the inspection report for this trust. Facts and data about this trust Acute hospital sites at the trust A list of the acute hospitals at the trust is below. Name of acute Details of any specialist services Geographical area Address hospital site provided at the site served Acute emergency services - the core Hertfordshire location for inpatient emergency care, and for all patients who need the specialist emergency facilities (such as intensive care) of a major Vicarage Rd Watford General district general hospital. It also Watford, Hospital provides elective care for higher risk Hertfordshire patients together with a full range of outpatient and diagnostic services. Also, the focus of the Trust's Women's and Children's services, including neonatal care. Healthcare facilities such as Hertfordshire Hemel Hillfield Road, diagnostic services, including MRI Hempstead Hemel and cold pathology, as well as an Hospital Hempstead outpatient service as well as a urgent care centre. 20190110 West Hertfordshire Hospitals NHS Trust – DRAFT Combined evidence appendix - WGH Page 1 Trust's elective care centre. It Hertfordshire provides a wide range of elective Waverley care (both inpatient low risk surgery St Albans City Road, St and day-case) and a wide range of Hospital Albans, outpatient and diagnostic services Hertfordshire and a Minor Injuries Unit (MIU), open every day of the week from 9am to 8pm. (Source: http://www.westhertshospitals.nhs.uk/default.asp) West Hertfordshire Hospitals NHS Trust has approximately 676 beds, of which 72 are maternity, 19 are critical care and high dependency beds located across Watford General, Hemel Hempstead and St Albans City Hospital. The trust serves a population of approximately 388,500 people in West Hertfordshire, and neighboring populations in North London, Bedfordshire, Buckinghamshire and East Hertfordshire. The number of staff employed by the trust as of June 2018 was 4,313. The trust’s services are commissioned mainly by Herts Valley Clinical Commissioning Group. (Sources: Routine Provider Information Request (RPIR) – Beds and Total staffing tabs; trust website) Background to the trust West Hertfordshire Hospitals NHS Trust provides acute healthcare services to a core catchment population of approximately half a million people living in West Hertfordshire and the surrounding area. The trust also provides a range of more specialist services to a wider population, serving residents of North London, Bedfordshire, Buckinghamshire and East Hertfordshire. West Hertfordshire Hospitals NHS Trust provides services from three sites, Watford General, Hemel Hempstead and St Albans City Hospital. The majority of acute services are delivered at Watford General Hospital, which provides a full range of district general hospital services. Hemel Hempstead Hospital provides an urgent care centre and outpatients and diagnostic services. St Albans City Hospital is the trust’s elective care centre. It provides inpatient low risk surgery, both on an inpatient and day case basis as well as outpatient and diagnostic services. It also has a minor injuries unit. This was the fourth comprehensive inspection of the trust and the first inspection of the trust using a new methodology, whereby we inspected core services, and included an inspection of the well- led element of the trust overall and took place between 15 October and 30 November 2018. The first inspection took place in April and May 2015. The trust was rated as inadequate overall and was placed into special measures in September 2015. The hospital was inspected again in September 2016 and was rated requires improvement overall. It remained in special measures The third inspection took place between 30 August and 1 September 2017, which was announced, during which time Watford Hospital, St Albans Hospital and Hemel Hempstead Hospital were all inspected. Unannounced inspections of all three hospitals were undertaken on the 12 September 2017. The key questions for safe, effective, responsive and well led were rated as requires improvement. Caring was rated as good. Four services were rated as requiring improvement overall and eight rated as good. One was rated inadequate. 20190110 West Hertfordshire Hospitals NHS Trust – DRAFT Combined evidence appendix - WGH Page 2 This was an improvement on the inspection we carried out in September 2017, where five services were rated as requiring improvement, five rated as good and two were rated inadequate, although one of these services is no longer run by this trust. Due to the improvements seen at this inspection, special measures were lifted in January 2018. Facts and data about the trust There are 676 beds, of which 72 are maternity, 19 are critical care and high dependency beds. The trust has nine operating theatres, providing elective (planned) and emergency surgical facilities for general surgery, trauma and orthopaedics, vascular, breast, urology, oral maxillofacial and plastic surgery. The trust holds around 544,786 outpatient attendances annually across most specialities, such as trauma and orthopaedics, cardiology, dermatology, diabetes, and obstetrics. There are six surgical inpatient wards and approximately 25 general medical and care of the elderly wards including specialist stroke, cardiology, respiratory and frailty wards. The surgical teams have an emergency surgical admissions unit (ESAU) and an admissions area combined with a day surgery unit (Surgical Admission Unit/Surgical day case area). For women and children, the hospital has a level 2 neonatal intensive care unit, alongside a delivery suite, two dedicated obstetric theatres, one dedicated elective gynaecology theatre and two maternity wards. As of June 2018, the trust employed 4,313 (headcount) staff, including 588 WTE medical and dental and 1,096 WTE nursing and midwifery staff. Patient numbers Trust activity (June 2017 to May 2018): • 137,787 A&E attendances (increase of 3% compared to the same time 2016/17) • 89,790 inpatient admissions (increase of 3% compared to the same time 2016/17) • 544,786 outpatient attendances (increase of 3% compared to the same time 2016/17) • 4,653 deliveries (decrease of 2% compared to the same time 2016/17) • 1,541 deaths (increase of 6% compared to the same time 2016/17) (Source: Hospital Episode Statistics – HES – Facts and Figures) 20190110 West Hertfordshire Hospitals NHS Trust – DRAFT Combined evidence appendix - WGH Page 3 Is this organisation well-led? Leadership The trust had managers at all levels with the right skills and abilities to run the service. There was a mix of experience within the executive directors with some new to the executive role and others with considerable experience. In order to assess if the organisation was well-led, we interviewed the members of the board, both the executive and non-executive directors, and held focus groups with a range of senior staff across the hospital. We met and talked with a wide range of staff to ask their views on the leadership and governance of the trust. Over the previous 12 months, we have observed board meetings, patient panel meetings, and serious incident panel meetings. We looked at a range of performance and quality reports, audits and action plans, board meeting minutes and papers, annual reports, investigations, and received feedback from patients, staff, and stakeholders. Board members Since our last comprehensive inspection, which was published in January 2018 there had been some changes to the trust board. The members of the trust board generally had the appropriate range of skills, knowledge, and experience. Its members had an appropriate level of operational and financial experience and expertise across both non-executive directors (NEDs) and executives. Two people were acting into their roles; the chief executive officer (CEO) and chief information officer (CIO) and were both interim at the time of the inspection. This reflected a level of turnover, which provided a degree of stability but also the opportunity for new ideas for be brought into the organisation. However, during our inspection, an offer of employment had been made to a CEO, and accepted. This was a substantive post. The trust was managed overall by a trust board consisting of non-executive (NED) and executive directors. • The chair, appointed 2014. • Chief executive officer (CEO), acting into this role since January 2018 but working in the trust as a director since 2014, most recently as deputy chief executive. • Chief nursing officer, appointed in 2014. • Chief operating officer (COO), appointed on April 2016, but has worked in the trust at director level since 2015. • Chief finance officer, appointed 2014. • Medical director/director of patient safety, appointed in 2013 but has worked in the trust since 2005. • Director of human resources and organisational development, workforce and information development appointed