All inspections: Queen Elizabeth The Queen Mother Hospital

East Kent University Hospitals NHS Foundation Trust is one of the largest hospital trusts in England, with five hospitals and community clinics serving a local population of around 695,000 people. The Trust provides local services primarily for the people living in Kent.

The Queen Elizabeth the Queen Mother Hospital (QEQM) is one of five hospitals that form part of East Kent University Hospitals NHS Foundation Trust. The maternity service at the QEQM hospital delivers approximately 2,500 to 3,000 babies each year. East Kent University Hospitals NHS Foundation Trust has another acute hospital with inpatient maternity services called the William Harvey Hospital.

We refer to women in this report, but we recognise that some transgender men, non-binary women and women with variations in sex characteristics (VSC) or who are intersex may also use services and experience some of the same issues

The Queen Elizabeth Queen Mother Hospital is operated by East Kent Foundation NHS Trust. The maternity service sits within the maternity and women’s directorate and provides a range of services from pregnancy, birth and postnatal care. Out- patient services include an early pregnancy unit, antenatal clinics, and a fetal medicine unit. In-patient services include antenatal, intrapartum, postnatal beds and a bereavement suite. There is a mixed antenatal and postnatal ward and a triage service which is accessible 24 hours-a-day. The is a midwifery-led unit and the labour ward has 7 labour/birth rooms which include 1 pool for labour and/or birth. There is 1 dedicated obstetric theatre and recovery room with 2 beds. The special care baby unit is close to the labour ward to support quick access when babies needed to transfer. Community maternity services are provided by teams of midwives predominantly commissioned by NHS Kent and Medway Integrated Care Board.

Safe summary:

We assessed 8 quality statements for the key question safe. We rated this key question requires improvement during this review of maternity at Queen Elizabeth Queen Mother Hospital. This is because of the limitations of the estate.

Effective Overall Summary:

We reviewed 6 quality statements for the key question effective. We rated this key question good during this review of maternity at Queen Elizabeth Queen Mother Hospital.

Caring Overall Summary:

We reviewed 5 quality statements for the key question caring. We rated this key question good during this review of maternity at Queen Elizabeth Queen Mother Hospital.

Responsive Overall Summary:

We reviewed 7 quality statements for the key question responsive. We rated this key question good during this review of maternity at Queen Elizabeth Queen Mother Hospital.

Well-Led Overall Summary:

We reviewed 7 quality statements for the key question well-led. We rated this key question good during this review of maternity at Queen Elizabeth Queen Mother Hospital.

Medical care (including older people's care)

Our rating of this location went down. We rated it as requires improvement because:

The service did not ensure staff at all levels completed the necessary mandatory and statutory training to enable them to carry out the duties they are employed to perform.
The service did not always have enough staff to care for patients. Staff did not always make sure equipment, such as resuscitation trolleys, were checked accurately and safe to use.
Staff did not always report near misses or potential harm.
The service did not ensure systems and processes to mitigate risk including fire safety, infection prevention and control and patients’ privacy and dignity; relating to the environment, premises, and equipment, were safe.
The service did not always ensure they followed their Standard Operating Procedure when placing patients in escalation areas.
The service did not provide enough space for allied health professionals to conduct patient assessments. The service did not ensure staff working in escalation areas had easy access to the equipment they needed, to care for patients safely and effectively.
The service did not always ensure chemicals that are hazardous to health were stored safely and securely. The service did not always keep patient records secure.

However:

Staff understood how to protect patients from abuse. Staff acted on risks to patients and kept good care records.
Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Most key services were available 7 days a week.
Staff treated patients with compassion and kindness, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families, and carers.
The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it.
Staff understood the service’s vision and values, and how to apply them in their work. 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.

Services for children and young people

Our rating of this location improved. We rated it as good because:

Staff assessed risks to children and young people, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them.
Staff provided good care and treatment, gave children and young people enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of children and young people, advised them and their families on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
Staff treated children and young people with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to children and young people, families, and carers.
The service planned care to meet the needs of local people, took account of children and young people’s individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
The service had information systems for governance. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported, and valued. They were focused on the needs of children and young people receiving care. Staff were clear about their roles and accountabilities. The service engaged well with children, young people, and the community to plan and manage services and all staff were committed to improving services continually.

However:

The service did not always have enough medical staff to care for children and young people and keep them safe.
Staff did not have training in key skills including the required training to protect children and young people from abuse.
The service did not always have reliable information systems covering risk management processes.

Urgent and emergency services

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

The service did not have enough emergency department (ED) or paediatric emergency medicine (PEM) consultants to safely meet the Royal College of Emergency Medicine (RCEM) or The Royal College of Paediatrics and Child Health (RCPCH) guidelines.
The service did not have an effective handover process of patients who had been in ED for more than 24 hours, which led to a delay in treatment and lack of continuity of care in some cases.
Staff did not always report near misses, including those that had potential for harm.
Staff had varied compliance with training in key skills. Safeguarding training was below trust targets for medical staff. Staff did not always receive appraisals and there was limited clinical supervision was in place for nursing staff.

However:

The service had enough nursing staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service managed infection risks well. Staff assessed risks to patients, acted on them and kept good care records. The service managed safety incidents well and learned lessons from them.
Key services were available 7 days a week.
The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
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. 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.

Our rating of this location stayed the same.

We inspected maternity services. We rated it as inadequate because:

Essential resuscitation equipment was not always placed to enable easy and rapid access. The service did not always control infection risk well and the environment and equipment was not always cleaned effectively. The design, maintenance and use of facilities, premises and equipment did not always keep people safe. Staff did not always complete daily checks of specialist equipment and equipment was overdue safety checks and maintenance. Staff did not always manage clinical waste and sharps well.
The service did not have adequate oversight of the risk of baby abduction. Records were not always stored securely and medicines were not always managed safely. Although the service managed safety incidents appropriately and learned lessons from them, staff could not tell us what these lessons were.
Managers did not always monitor the effectiveness of the service in a timely way. Outcomes for women were not always positive, consistent or met expectations, such as national standards. Milk for babies was not always stored securely.
Leaders did not always understand and manage the priorities and issues the service faced. Staff did not always understand the service’s vision and values, and how to apply them in their work. Not all staff felt there were regular opportunities to meet to discuss risk and governance. Staff did not always know how to speak up if they had concerns. The service’s information systems did not provide sufficient coverage of both quality and sustainability. The service did not have standardised quality improvement methods to drive improvement.

However:

The service had enough staff to care for women and other pregnant people. Staff understood how to protect women and other pregnant people from abuse. Staff assessed risks to women and other pregnant people, acted on them and kept good care records. Staff were mostly up-to-date with required safety training.
Staff worked well together for the benefit of women and other pregnant people, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
Staff treated women and other pregnant people with compassion and kindness. They provided emotional support to women and other pregnant people, families and carers.
The service planned care to meet the needs of local people, took account of women and other pregnant people’s individual needs. People could access the service when they needed it and did not have to wait too long for treatment.
Leaders supported staff to develop their skills. Most staff felt respected, supported and valued. They were focused on the needs of women and other pregnant people receiving care. The service engaged well with women and other pregnant people and the community to plan and manage services and all staff were committed to improving services continually.

We carried out an unannounced focused inspection of the maternity services at East Kent Hospitals University NHS Foundation Trust because we received information giving us concerns about the safety and quality of maternity services.

To get to the heart of patient care, we visited the maternity units at the Queen Elizabeth the Queen Mother Hospital on 21 July 2021. We also visited the community midwifery services at Buckland Hospital on the 22 July 2021.

As this was a focused inspection, we only inspected three of the key questions in maternity services (safe, effective and well led).  

Focused inspections can result in an updated rating for any key questions that were inspected if we have inspected the key questions in full across the service and/or we have identified a breach of regulation and issued a requirement notice, or taken action under our enforcement powers. In these cases, the ratings will be limited to requires improvement or inadequate.

We inspected maternity care throughout the unit so we could get to the heart of the patient experience. During the inspection, we needed to understand the patient journey and make sure that women and babies were kept safe from harm and that staff were supported with their training and decision making.

How we carried out the inspection

One CQC inspector led the inspection supported by an experienced obstetric specialist advisor and a midwifery specialist advisor.

On the day of the inspection, we visited five key areas of the maternity unit; the delivery suite, antenatal triage, maternity day care the antenatal/postnatal Kingsgate ward and the community midwifery teams in Dover.

We spoke with over 27 staff including executive staff, service leads, midwives, medical staff and maternity support workers, consultants, registrars, junior doctors and student midwives.

Our inspection was unannounced (staff did not know we were coming) to enable us to observe routine activities. We carried out a focused inspection related to the concerns raised, this does not include all our key lines of enquiry (KLOEs). As a result of this inspection ratings for this service remain unchanged. The rating stays as requires improvement.

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.

We carried out this unannounced focused inspection because at our last inspection we rated the service overall as inadequate and we received information giving us concerns about the safety and quality of the services. We focused our inspection on the key questions that were rate inadequate at our last inspection. We also looked at those parts of the service that did not meet legal requirements at the time of the last inspection.

Queen Elizabeth The Queen Mother Hospital provides; medical care (including older people’s care), services for children and young people, critical care, end of life care, outpatients and diagnostic imaging, surgery, and urgent and emergency services.

We did not rerate the hospital at this inspection. The previous rating of requires improvement remains. See the children and young people section for what we found.

During the inspection, we visited Rainbow ward, the special care baby unit, theatres, recovery, radiology, fracture clinic, and the children’s outpatient department at Queen Elizabeth The Queen Mother Hospital. We spoke with five parents, two children and 29 staff including; nurses, doctors, managers, allied health professionals and support staff. During our inspection, we looked at six sets of patient records.

How we carried out the inspection

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.

We carried out an unannounced focused inspection of the emergency department at Queen Elizabeth The Queen Mother Hospital following the ‘Resilience 5 Plus’ process. The ‘Resilience 5 Plus’ process is used to support focused inspections of urgent and emergency care services which may be under pressure due to winter demands or concerns in relation to patient flow and COVID-19.

We did not inspect any other services as this was a focused inspection in relation to urgent and emergency care. We did not enter any areas designated as high risk due to COVID-19. The inspection framework focused on five key lines of enquiry relating to critical care, infection prevention and control, patient flow, workforce and leadership and culture.

We previously inspected the emergency department at Queen Elizabeth The Queen Mother in March 2020 as part of our comprehensive inspection methodology. We rated it as Requires Improvement overall.

We spoke with 20 staff across a range of disciplines including lead nurses, senior nurses, healthcare assistants, department consultants, trust grade doctors, junior doctors, matrons, ambulance crews, the care group head of nursing, and the care group clinical director. We attended department safety huddles and a patient flow meeting.

As part of the inspection, we observed care and treatment and looked at eight care records. We analysed information about the service which was provided by the trust.

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.

Queen Elizabeth The Queen Mother Hospital is operated by East Kent Hospitals University NHS Foundation Trust. It provides surgery, medical care, services for children and young people and outpatients and diagnostic imaging, surgery, maternity and a minor injuries unit with an emergency care centre. We inspected the urgent and emergency care service.

The trust became an NHS foundation trust in 2009. It has five hospitals serving the local population of around 695,000 people throughout Dover, Canterbury, Thanet, Shepway and Ashford.

The trust has 1,111 inpatient beds across 54 wards. This includes 31 critical care beds, 48 children's beds and 49 day-case beds. The trust receives over 200,000 emergency attendances, 158,000 inpatient spells and one million outpatient attendances between December 2018 and December 2019.

NHS Improvement put the trust in financial special measures in March 2017 because it was forecast to be in significant financial deficit and was not meeting its control total (the trusts year-end target against its budget). The trust was still in financial special measures at the time of the inspection.

We inspected this service using our focused inspection methodology. However, we inspected all areas that we would inspect on a comprehensive inspection. We carried out an announced inspection on 3 and 4 March 2020.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

Services we rate

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

Not all staff had completed mandatory training.
The service generally used systems and processes to safely prescribe, administer, record and store medicines. However, not all medications had been given as prescribed.
Staff could not be assured that processes ensured patients received the correct medicines in a timely manner, as pharmacy staff could not always review all patients’ medicines.
Staff did not always use monitoring information to assess and improve effectiveness of care and treatment.
Not all people could access the service when they needed it and received the right care promptly. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were not in line with national standards but had improved since our last inspection.

However:

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. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. Most people could access the service when they needed it.
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.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.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should take action either because it was not doing something required by a regulation, but it would be disproportionate to find a breach of the regulation overall, to help the service improve. We also issued the provider with two requirement notices that affected urgent and emergency services. These requirement notices tell the trust to produce a plan, within 28 days, for how it will comply with regulation 12 (safe care and treatment) and regulation 17 (good governance). Details are at the end of the report.

The Queen Elizabeth The Queen Mother Hospital is operated by East Kent Hospitals University NHS Foundation Trust. The maternity service provides services for women within the local area of Thanet and the South Kent coast area. The service has 50 maternity beds across two sites at Queen Elizabeth The Queen Mother Hospital at Margate and William Harvey Hospital in Ashford.

Facilities at Queen Elizabeth The Queen Mother Hospital include one obstetric operating theatre, a consultant led labour ward (with eight labour rooms), an induction bay and a 22-bedded antenatal and postnatal bay. The maternity unit includes a midwifery led unit, which has four rooms, an antenatal triage, antenatal day-care, foetal medicine service and a bereavement room. The service works closely with the level one special care baby unit. However, the special care baby unit was not inspected during this inspection.

There were 2,631 births at Queen Elizabeth The Queen Mother Hospital during the period of January 2019 to December 2019.

We inspected this service using our comprehensive inspection methodology. We carried out an unannounced part of the inspection on 22 January and 23 January 2020, along with an announced visit to the hospital on 4 February and 5 February 2020.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

Services we rate

Our rating of this service stayed the same. We rated it as Requires improvement overall.

New maternity triage guidelines and risk assessments were not yet embedded within the service and we found concerns with the documenting of risk and escalation.
The service did not have pathways of care for specific conditions which triage midwives could follow. This meant women were at risk of not being seen when potentially they could be scoring high on the ‘red, amber, green’ (RAG) rating risk assessment.
The risk rating score was not used when triaging women on telephone consultations. Midwives were relied on to use their professional judgment when determining whether women should be seen within triage, go to the labour ward or to stay at home.
Staff were not using the Modified Early Obstetric Warning Score (MEOWS) in triage. MEOWS is a nationally recognised, competency-based tool to trigger escalation. Staff were completing observations but not following the MEOWS process.
Safeguarding training rates for doctors did not meet trust targets. The trust set a target of 85% completion for safeguarding training. Data we reviewed showed medical staff were only 75% compliant in level three safeguarding training.
There was limited space in labour ward rooms for both resuscitaires and medical and midwifery teams, if an emergency were to occur.
Documentation was not always clear, up-to-date, or in chronological order because 50% of records were stored digitally and 50% were hand written. Staff told us risk assessments were completed on electronic records and printed off to add to the paper records, but this did not always happen and was not evident on the records we reviewed.
There were long waits for women within the antenatal day care with one only midwife on duty during each clinic. The trust had just started to audit waiting times to be able to assess the impact and to respond to improve waiting times, but during our inspection we found one woman had waited up to seven hours for a medical review.
There was not always sufficient senior doctor cover in the day care clinic. Midwives reviewed and assessed woman and women would only see a doctor if the midwife assessed that there was a concern or risk. Midwives told us that a senior doctor was sometimes available in clinic. However, it was usually a junior doctor with limited experience within obstetrics that would review and discharge.
From January 2019 to December 2019, the unit did not meet the national target of 95% for venous thromboembolism (VTE) risk assessments. The maternity dashboard showed 92.1% were completed.

However:

The service provided mandatory training in key skills to all staff. Mandatory training figures which showed that mandatory training figures for midwifery staff had improved and were meeting the trust target of 85%.
The service provided care and treatment based on national guidance and evidence-based practice. Managers checked to make sure staff followed guidance. Staff protected the rights of women subject to the Mental Health Act 1983.
We spoke with newly qualified midwives, who told us they were well-supported by the midwifery team and senior midwives. Newly qualified midwives received up to 18-months of preceptorship period dependant on their competence and confidence within their role.
Staff understood and respected the personal, cultural, social and religious needs of women. Women could ask for a female doctor or midwife during procedures or appointments. The hospital had a multi-faith chapel and there were leaflets around the unit.
The service was inclusive and took account of women’s individual needs and preferences. Staff made reasonable adjustments to help women access services. They coordinated care with other services and providers.
People’s individual needs and preferences were central to the planning and delivery of tailored services. The maternity unit offered a consultant led and midwifery led birthing unit. The services were flexible, provided choice and ensured continuity of care. The service provided a team of specialist home birth community midwives.
Staff worked well together for the benefit of women, advised them on how to lead healthier lives, supported them to make decisions about their care and had access to good information. All women were routinely monitored antenatally as part of the ‘saving lives’ care bundle.
The trust had recently introduced scanning all women at 36 weeks of pregnancy to reduce the incidence of birth complications, caesarean sections, breech birth and pre-term babies.
The service had strengthened its clinical leadership since our previous inspection. The obstetrics team had a new clinical lead and two new site leads. The head of midwifery had been in post since 2018. Staff told us the maternity unit had gone through a number of positive changes since the head of midwifery’s appointment and the maternity service was continuing with an improvement plan. Staff told us they felt the head of midwifery was visible and approachable to all staff.
Leaders had recently improved the governance processes throughout the service with support from partner organisations. However, the new governance processes were not yet fully embedded.
Staff felt respected, supported and valued. They were focused on the needs of women receiving care. The service promoted equality and diversity in daily work and provided opportunities for career development. The service had an open culture where women, their families and staff could raise concerns without fear.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with a requirement notice for a breach of regulation/s. Details are at the end of the report.

We inspected services for children and young people at Queen Elizabeth the Queen Mother Hospital on 24 and 25 October 2018. The inspection visit on 24 October was unannounced and began at approximately 8.30pm.

This responsive inspection was undertaken because we had received concerning information from members of the public and staff about the Emergency department and children’s inpatient wards. We had also identified concerns about the care of children during our May 2018 inspection when we inspected the emergency department and operating theatres but did not review services for children and young people as a separate core service.

As part of this inspection, we reviewed the care and treatment of children and young people from birth to 18 years in the two acute hospital sites with children’s inpatient units. Some outpatient services for children are provided at the Kent and Canterbury Hospital site and from Buckland Hospital in Dover, but there are no inpatient services there. We did not inspect clinics or community services as the inspection was focused on the areas of concern.

We rated the children and young people’s services at Queen Elizabeth the Queen Mother Hospital as Inadequate overall. We fed back our immediate concerns to the chief executive officer, the director of nursing and quality, the medical director and the quality improvement programme lead.

The services for children and young people were not safe.

Resources for children and young people with mental health problems were not sufficient to ensure they, other children and staff remained safe.
The recognition and management of deteriorating patients was inconsistent and senior clinicians did not follow the trust protocols or national guidance on the management of sepsis.
People were at risk of cross infection of communicable diseases because of poor facilities and poor practice.
Staffing levels were insufficient to meet the needs of children and young people.
There was insufficient attention paid to safe medicines management.
Incidents were not identified, nor reported and there was very limited learning from incidents.

The services for children and young people were not effective.

The trust could not identify shortfalls in care nor benchmark their performance against other trusts as there was limited participation in national audits.
Local audit results were inaccurate and there were conflicting results from different audits. An example of this was a report of sepsis that gave falsely positive information and which could not have been accurate based on the early warning scores contained within the report.
Pain was not always managed in a timely manner.
Fasting times before surgery did not follow current best practice and put the needs of the service before the needs of the children.
Staff had no training in de-escalation techniques or managing children with mental health problems.
Staff reported that staff shortages were such that they could not attend planned training.
The trust did not resource children’s services at Queen Elizabeth the Queen Mother Hospital in line with the current intercollegiate guidance.
There were gaps in the seven-day service provision that meant children had to be treated in adult environments by adult staff.
Out of Hours consultant cover did not meet the intercollegiate standards.

Improvements were needed in the care and compassion shown to children and families.

Receptionists in the main accident and emergency department were sometimes offhand with parents of children. We observed that staff did not make eye contact nor smile at parents who were very anxious and needed reassurance.
One receptionist told a mother of a visibly unwell child that she was lying about not being triaged.
Senior staff used unfavourable stereotypes when describing parents, particularly those from specific areas.

The services for children and young people were not responsive.

The flow of children and young people through the accident and emergency department was confused and not understood by staff.
Senior staff and operational staff argued in front of the inspection team about which was the correct pathway for children to move through the department.
Children were required to wait in the adult waiting area. This included at night when it was crowded and when some adults were likely to be drunk or volatile.
The service for children with mental health problems was insufficient and failed to protect the children, other children or staff. Whilst this service was commissioned by the Clinical Commissioning Group from a third party, the inadequacy should have been addressed by the trust.
There was limited provision for and a lack of understanding of the needs of children and young people with learning disabilities or autism.
There were frequent breaches of the four-hour emergency department target.
Urgent referrals were not always seen within the expected referral to treatment times.
The journey to theatres had not been adapted to be child friendly.
A lack of overnight accommodation for mothers of babies on the Special Care Baby Unit meant that establishing breastfeeding was more difficult, increased the risk of maternal mental ill health and was likely to impact negatively on mother and baby bonding.
There was very limited consideration of the needs of young people aged 16 years to 18 years.

The services for children and young people were not well led.

There was not a clear, well understood vision and strategy for the service.
Governance and risk management processes were ineffective and provided false assurance to the board.
Leadership was confused with a lack of oversight of all the children using trust services.
Staff reports of the culture within the service were variable with some reporting bullying, oppression and not being listened to.
The NHS Staff Survey results for 2017 showed that overall the trust was in the worst 20% of trusts nationally for staff engagement. The results had worsened for many key findings since 2016.

We saw several areas of good practice including:

Parents reported very positively about the care and support the staff on the Special Care Baby Unit offered them.
Child bereavement boxes had been purchased by the hospital charity for use in the emergency department when a child had died.
The routine use of heel warming made heel prick blood testing less painful and more effective.
Staff who were exceptionally busy dealing with a high demand and very sick children remained kind and gentle towards the children.
Staff had a clear understanding of their safeguarding role and responsibilities and there was an effective system to provide prompt child protection medicals when needed.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

Provide suitable accommodation for children and young people with mental health problems.
Review their booking and triage processes to ensure all staff are clear about the pathway children take through the emergency department and to minimise the time before they are assessed by a qualified children’s nurse.
Ensure that equipment checks required by trust policies are carried-out.
Ensure the safe management of medicines.
Ensure that clinicians are aware and follow trust policy and national guidance on the safe management of deteriorating children, testicular torsion and sepsis identification and management.
Ensure that children wait in the children’s waiting area at all times. They must not be exposed to volatile behaviour, inappropriate television programmes and unpleasant sights and sounds in the adult waiting area.
Review the care of children aged 16 years to 18 years and ensure that their needs are fully considered.
Ensure submission of data to national audit programmes to allow benchmarking against other children’s services and to drive improvements.
Ensure that they adhere to a local audit plan and use the results to drive service improvements.
Carry out a learning needs analysis for nursing staff working with children and young people to assist in identifying what training is necessary and where there are gaps in staff skills and knowledge.
Ensure that staff are provided with the necessary training and support to ensure they can carry out their work competently.
Ensure compliance with the Health and Social Care Act 2008: code of practice on the prevention and control of infections. To include ensuring there are appropriate isolation facilities in the children’s emergency department for children with communicable diseases.
Review their policy and usual practice on pre-operative fasting for children to ensure it is aligned to national guidance.
Ensure that up to date policies and protocols are available to staff.
Ensure that the needs of children and young people presenting in mental health crisis are considered and met.
Ensure the views of children and young people are taken into consideration to aid service provision and make sure the care and treatment meets their needs and reflects their preferences.
Ensure that there are no breaches of the four-hour admission to treatment target for children attending the emergency department.
Develop a clear vision for children’s services that is recognised and shared by all staff caring for children and young people.
Ensure that data and information provided to the board is an accurate reflection of the services being provided to avoid the risk of false assurance.
Undertake an assurance review of their children’s service to identify gaps in their assurance and governance processes.
Ensure that there is clear, accountable leadership of services for all children from birth to 18 years (and beyond 18 years for looked after children and children in need).

Additionally, the trust should;

Provide staff with training in the care of children and young people with autism and learning disabilities.
Ensure that the pathway for providing care when a child dies is known and understood by all staff likely to be affected.
Provide all staff including senior leaders with training in equality and diversity.
Consider providing customer service training for reception staff in the emergency department.

Professor Edward Baker

Chief Inspector of Hospitals

Our rating of services stayed the same. We rated it them as requires improvement because:

We rated safe, effective, responsive and well-led as requires improvement, and caring as good. We rated four of four core services as requires improvement.

The Queen Elizabeth the Queen Mother Hospital (QEQM) is one of five hospitals that form part of East Kent University Hospitals NHS Foundation Trust (EKUFT). The Trust provides local services primarily for the people living in Kent. EKUHFT serves a population of approximately 759,000 and employs approximately 6,779 whole time equivalent staff.

The QEQM hospital has a total of 388 beds, providing a range of emergency and elective services and comprehensive trauma, orthopaedic, obstetrics, general surgery and paediatric services.

Following our last inspection of the Trust in August 2015, we carried out an announced inspection between 5th and 7th September 2016, and an unannounced insection on 21st September 2016.

This is the third inspection of this hospital. This inspection was specifically designed to test the

requirement for the continued application of special measures to the trust. Prior to inspection we risk

assessed all services provided by the trust using national and local data and intelligence we received from a number of sources. That assessment has led us to include four services (emergency care, medical services, maternity and gynaecology and end of life care) in this inspection.

Overall we rated the Queen Elizabeth, the Queen Mother Hospital as Requires improvement

Our key findings were as follows:

Safe

We rated The Queen Elizabeth, Queen Mother Hospital as Requiring improvement for safe because:

There was a shortage of junior grade doctors and consultants across the medical services at the hospital. This meant that consultants and junior staff were under pressure to deliver a safe and effective service, particularly out of hours and at night.

The trust did not use a recognised acuity tool to assess the number of staff needed on a day-to-day-basis.

In Maternity, a lack of staffing affected many areas of service planning and the care and treatment of women. This included not meeting national safe staffing guidelines, meaning 1 in 5 women did not receive 1:1 care in labour.

We found poor records management in some areas. Staff did not always complete care records according to the best practice guidance.
The trust did not have adequate maintenance arrangements in place for all of the medical devices in clinical use. This was a risk to patient safety and did not meet MHRA (Medicines & Healthcare products Regulatory Agency) guidance. The trust did not have adequate maintenance arrangements in place for the 483 medical devices used in maternity and gynaecology.
Mandatory training rates for topics such as adult safeguarding and information governance were low.

However

We saw robust systems in place for reporting and learning from incidents both locally and trust-wide.

Ward and departmental staff wore clean uniforms and observed the trust’s ‘bare below the elbows’ policy. Personal protective equipment (PPE) was available for use by staff in all clinical areas.

The hospital was clean and met infection control standards.

Effective

We rated The Queen Elizabeth, Queen Mother Hospital as Requiring improvement for effective because:

Documents and records supporting the learning needs of staff were not always competed and there were gaps in the records of training achieved.

The trust had not completed its audit programme. This meant the hospital was not robustly monitoring the quality of service provision

Appraisial rates across the hospital needed to be improved.

There was poor compliance in the use of the end of life documentation across the wards we visited which was reflected in the May 2016 documentation audit undertaken by the SPC team.

However,

Care and treatment was planned and delivered in line with current evidence-based guidance, standards, best practice and legislation.
Comfort rounds had been performed and audited. These provided good assurance that pain assessments had been performed, analgesia administered.

Caring

We rated The Queen Elizabeth, Queen Mother Hospital as Good for caring because:

Staff treated patients with kindness and compassion.
Patients and relatives we spoke with were complimentary about the nursing and medical staff.
Patients were given appropriate information and support regarding their care or treatment and understood the choices available to them.

Responsive

We rated The Queen Elizabeth, Queen Mother Hospital as requires improvement for responsive because:

Performance indicators such as patients being seen within four hours in A&E remained below trust target and national averages.

Delayed discharges remained a concern. However, as part of this response we observed an operational communications meeting, which showed the trust was addressing patient flow through the hospital.

The hospital was not offering a full seven-day service. Constraints with capacity and staffing limited the responsiveness and effectiveness of the service the hospital was able to offer.

Patients’ access to prompt care and treatment was worse than the England average for a number of specialities. The trust had not met the 62-day cancer referral to treatment time since December 2014. Referral to treatment within 18 weeks was below the 90% standard as set out in the NHS Constitution and England average for six of the eight specialties from June 2015 to May 2016.
Services did not always meet people’s needs, for example, women had to divert to another hospital on 22 dates between January 2015 and June 2016. Also, the trust did not monitor the percentage of women seen by a midwife within 30 minutes and a consultant within 60 minutes during labour.

However,

The trust employed specialist nurses to support the ward staff. This included dementia nurses and learning difficulty link nurses who provided support, training and had developed resource files for staff to reference. Wards also had ‘champions’ who acted as additional resources to promote best practice.

Well led

We rated The Queen Elizabeth, Queen Mother Hospital as requires improvement for well led because:

In some areas risk management and quality measurement were not always dealt with appropriately or in a timely way. Risks and issues described by staff did not correspond to those
Where changes were made, appropriate processes were not always followed and the impact was not fully monitored in maternity and gynaecology services
No separate risk register was available for palliative /end of life care. A separate risk register would allow the risks to this patient group be discussed regularly at the end of life board, and allow plans to be made to alleviate any identified risks.
Changes in leadership in end of life care and maternity services had only recently been realised and as a result had yet to fully
address the issues relating to these services

However

The hospital had well-documented and publicised vision and values. Their vision was to provide ‘Great healthcare from great people’, with the mission statement ‘together we care: Improving health and lives’. These were readily available for staff, patients and the public on the trust’s internet pages, posters around the hospitals and on the trust’s internal intranet.

We saw some outstanding practice including:

Improvement and Innovation Hubs were an established forum to give staff the opportunity to learn about and to contribute to the trust’s improvement journey.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

Ensure the number of staff appraisals increase to meet the trust target. So that the hospital can assure itself that staff performance and development is being monitored and managed.

Ensure the trust’s agreed audit programme is completed and where audits identify deficiencies that clear action plans are developed that are subsequently managed within the trust governance framework. To have assurance that best practice is being followed.

The trust must ensure that there are sufficient numbers of staff with the right competencies, knowledge, qualifications, skills and experience to meet the needs of patients using the service at all times. This includes medical, nursing and therapy staff.

Ensure there are systems established to ensure there are accurate, complete and contemporaneous records are kept and held securely in respect of each patient.

The trust must ensure that all staff have attended mandatory training.

The trust must ensure that there are adequate maintenance arrangements in place for all of the medical devices in clinical use.
The trust must take steps to ensure the 62-day referral to treatment times for cancer patients is addressed so patients are treated in a timely manner and their outcomes are improved.
Ensure there are sufficient numbers of midwives to meet national safe staffing guidelines of 1:1 care in labour.
Ensure maternity data is correctly collated and monitored to ensure that the department’s governance is robust.

In addition the trust should:

Review the physical environment within maternity services to ensure it meets the needs of the patients. Specifically temperature control
Ensure that the trust programme to improve overall culture also focuses on individual cases of bullying and harassment.
Continue to reduce the number of bed moves patients experienced during their stay.
Monitor ambient room temperatures where medication is stored.
Review the maintenance of medical devises.
Include venous thromboembolism data on the department dashboard.

There is no doubt that further improvements in the quality and safety of care have been made since our last inspection in July 2015. At that inspection there had been significant improvement since the inspection in March 2014 which led to the trust entering special measures. In addition, leadership is now stronger and there is a higher level of staff engagement in change. My assessment is that the trust is now ready to exit special measures on grounds of quality, However, significant further improvement is needed for the trust to achieve an overall rating of good.

Professor Sir Mike Richards Chief Inspector of Hospitals

The Queen Elizabeth the Queen Mother Hospital (QEQM) is one of five hospitals that form part of East Kent University Hospitals NHS Foundation Trust (EKUFT). The Trust provides local services primarily for the people living in Kent.

EKUHFT serves a population of approximately 759,000 and employs approximately 6,779 whole time equivalent staff.

The QEQM hospital has a total of 388 beds, providing a range of emergency and elective services and comprehensive trauma, orthopaedic, obstetrics, general surgery and paediatric services.

Following our last inspection of the Trust in March 2014 when we found many of the services provided to be inadequate, EKUHFT was placed into special measures by the regulator Monitor. This announced inspection was undertaken to monitor and assess what progress the Trust had made in addressing our concerns.

We carried out an announced inspection of EKUHFT between 13- 17 July 2015. We also undertook unannounced visits the following week on 29 July 2015.

At this inspection although we found the hospital overall to require improvement we noted there had been improvements made in the majority of services we inspected.

Our key findings were as follows:

Safe

At the last inspection we told the Trust they must ensure there were appropriate levels and skills mix of staffing to meet the needs of all patients. At this inspection we found that although staffing overall had improved through a sustained recruitment initiative and the use of agency and bank staff, recruitment continued to be a problem for the hospital. The numbers, skills and qualifications of staff did not always reflect the needs of patients.
Although the Trust had revised the adverse incident and serious incident policy and had trained more staff in incident investigation and Root Cause Analysis, patients were not always protected from inappropriate or unsafe care because staff were not always reporting incidents. Where incidents were reported there was good evidence that learning was shared and actions taken to prevent reoccurrence.
The environment was not always a safe place to care for patients. For example there was only one obstetric operating theatre for both emergency and elective procedures; the flooring in the corridor areas on St. Augustine’s ward was uneven, dirty and badly worn with tears in the covering. The toilets did not always conform to requirements under the Disability Discrimination Act (DDA) and were unable to accommodate patients with walking aids. Shower and bathrooms were used as storage facilities and cluttered making them unfit for patient use. The layout of the day care unit did not meet best practice in infection control and presented a contamination risk; Fire safety concerns were raised in both the midwifery wards, theatres and on St Augustine Ward. The poor state of the environment was an issue raised at the previous inspection.
Access to and availability of equipment had improved since our last inspection through the implementation of an equipment library. However equipment was not always cleaned and checked in line with trust policy and there areas in the hospital where appropriate equipment was not readily available. For example there were insufficient fetal monitoring machines in the maternity department, a weighing machine and stand aid on St Augustine Ward had not been serviced and decommissioned autoclaves remained in theatres.
We found that the theatres did not comply with national guidance in relation to risk assessment; the environment, and staff training.
Staff were aware of the policies for infection prevention and control and adhered to them. The majority of clinical areas we visited were visibly clean and tidy.
We found that attendance at mandatory training had improved along with the system for recording and monitoring attendance although the mandatory training targets and agreed actions had not been achieved.
The recording of patient assessments and the documentation and monitoring of patients’ treatment, needs and observations had improved since our last inspection. Patient observations were undertaken electronically and regular audits were undertaken to check that information was recorded appropriately.

Effective

Most of the services we inspected provided effective care. National guidance was used to inform the care and treatment of patients and services participated in national and local audits.
At the last inspection we found that the paper and electronic policies, procedures and guidance that staff referred to when providing care and treatment to patients were out of date. The Trust had undertaken a major review of the Trusts policies and procedures and apart from the emergency department and medication policies, the majority were now current and reflected best practice.
We found that although the wards and consultants offered a seven day service they were not always supported by other services. This limited the responsiveness and effectiveness of the service the hospital was able to offer and on occasions delayed discharge. For example there was no access to therapy staff, dieticians or speech and language therapists (SALT) at weekends on the stroke ward. Pharmacy services only available until midday at weekends, which impeded timely discharge for patients who were unable to obtain their discharge medication.
We found that patients were always asked for their consent before any intervention and this was always appropriately recorded.
There was good multidisciplinary working throughout the hospital.
In general patients received timely effective pain relief and their nutritional needs were being met.

Caring

Patients throughout the hospital commented positively on their experiences. They told us they received kind and compassionate care, which maintained their dignity and respected them as individuals.
We saw caring and compassionate care being delivered throughout the hospital but in particular we observed staff in the outpatients and diagnostic and imaging department treating patients, relatives and visitors with respect and thoughtfulness.

Responsive

We found that the hospital did not always have sufficient bed capacity to meet the needs of the patients admitted. This meant that patients were often moved between wards during their stay, they were admitted to non-specialty beds where their own doctors were difficult to contact and consultant reviews less likely to occur. The lack of capacity had negative implications for the safe care and treatment patients.
Patient flow through the surgical services was limited by availability of beds at times, caused by delayed discharges. In turn delayed discharges associated with provision of on-going support, rehabilitation and delays in take home medication adversely impacted on the hospital’s bed capacity. This was raised as a concern at the last inspection.
In the emergency department there was no emergency assessment room for patients with acute mental health needs.
Surgical referral to treatment times were not being met over consecutive months for surgical specialties. Theatres were not always effectively utilised and this affected performance.
Improvements were needed for the day-care environment, as this did not provide sufficient privacy.
Arrangements were in place to support people with disabilities and cognitive impairments, such as dementia. Translation services were available and information in alternative languages could be provided on request.
The complaints process was understood by staff and patients had access to information to support them in raising concerns. Where complaints were raised, these were investigated and responded to. Where improvements were identified, these were communicated to staff through a range of methods.

Well Led

The Trust had implemented a Special Measures Action plan following our last inspection. The action plan identified where issues had been raised during inspection and outlined actions to be taken by the Trust along with an agreed timescale. This action plan had been RAG rated on delivery of objectives.
We found that the Trust had taken action to refocus its vision and mission strategy. Staff at QEQM were articulate in understanding the Trust’s vision and described how the organisation’s mission to provide safe, patient focussed and sustainable health services with and for the people of Kent was simple but something they felt committed to.
There was a clear direction of focus underpinned by the values of providing effective care, respecting one another, people feeling safe and involved and able to contribute to change. Work was in progress to develop the directorate strategic aims and principles. Although there was now a clear direction of focus in many of the services, others such as the midwifery unit lacked a clear strategy and strategic direction.
However many of the leadership, organisational and developmental changes were in their infancy and had not had time to deliver the necessary changes to the patient experience.
Some services such as the midwifery service had been through a period of instability of leadership which led to a great deal of staff dissatisfaction and unrest. Although progress was being made to stabilise the midwifery service with appointments to a number of interim, acting and substantive posts, a number of staff remained unhappy.
The Trust had identified there had been a culture of bullying and harassment within the trust. We found at QEQM there were still pockets where staff felt intimidated and were not confident to speak out. The Trust told us of the actions and initiatives that were taking place to address these concerns.
Governance arrangements throughout the hospital had been strengthened and were starting to provide more robust information to staff at all levels and to the Trust Board.

We saw several areas of outstanding practice including:

Outpatients where substantial changes had taken place since our last inspection and the service offered was focused on ensuring that patients received a positive experience when attending the hospital.
The pre-operative joint clinic is recognised as enhancing patient outcomes.
The Nurse leadership in outpatients was outstanding with staff inspired to provide a good service to patients. The main outpatient’s matron provided knowledgeable and inspiring support to staff working hard to maintain and improve the service.
The care pathway for patient discharged with ridged cervical collar in place is acknowledged for contributing to on-going response care to individuals.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

The trust must take action to ensure that HTM 05-01 is complied with in operating theatres, particularly with respect to; risk assessment; the environment, and staff training.
The trust must take action to remove the decommissioned autoclave from theatres.
There must be sufficient numbers of suitably qualified, skilled, and experienced midwifery staff available to deliver safe patient care in a timely manner.
The environment and facilities in which patients are cared for must be safe, well maintained, fit for purpose and meet with current best practice standards.
There must be sufficient equipment in place to enable the safe delivery of care and treatment, that the equipment is regularly maintained and fit for purpose to reduce the risk to patients and staff.
The Trust must ensure the hospital has sufficient capacity to cope with the number of women in labour and new born babies on a day to day basis.
The wards must be supported in providing a full seven day service by appropriate numbers of support services such as radiology, physiotherapy and pharmacy.
There must be robust systems in place to monitor the safe management of medicines to ensure that national guidelines are reviewed appropriately and their implementation monitored.
Ensure that required signatures are included in CD registers.
Ensure that temperature checks are monitored and recorded on fridges used to store medicines and food supplements.

In addition the trust should:

The trust should ensure that the mandatory training targets and agreed actions are achieved.
Consider how it can address staffs knowledge and understanding with respect to the Mental Capacity Act (2005) and deprivation of liberty safeguards.
Ensure that all safety checks on equipment are carried out.
Consider how it may improve the environment in the day surgical unit.
The trust should consider how it may move forward with the implementation of the dementia care work to bring it to fruition.
The trust should continue to improve referral to treatment times across all specialities to ensure that patients are treated in an acceptable timeframe following referral to the service.
Standardising inotropic infusions to avoid the risk of potential drug errors when staff engage in cross site working.
There should be a formal vision and strategy for women’s health services to enable the development of a modern maternity service which is woman centred, underpinned by a sound evidence base and benchmarked against best practice standards.
Methods of maintaining the stability of leadership within the maternity department should be established.
The routine administrative burden on maternity staff at weekends and out of hours should be reduced in order to free midwifery staff to look after patients.
Staff should be encouraged to report non-clinical incidents in order that action can be taken to protect patients from avoidable harm.
The electronic system for allocating NHS numbers to new born babies should be functioning, in order to avoid the risk of babies missing screening tests through a manual process with insufficient printers available.
There should be a robust system in place to measure, monitor and analyse common causes of harm to women during pregnancy and childbirth.
Continue to work with commissioners to ensure there is adequate funding and resources for the End of Life service.

Professor Sir Mike Richards

Chief Inspector of Hospitals

The Queen Elizabeth The Queen Mother Hospital in Margate is an acute hospital. It is one of three hospitals that form the East Kent University NHS Foundation trust. It has a total of 388 beds, providing a range of emergency and elective services and comprehensive trauma, orthopaedic, obstetrics, general surgery and paediatric services. The hospital dates back to the 1930s when the original building was constructed. Between 1996 and 1998 most services were relocated and expanded into a new main hospital building linked to the original facilities. The hospital has a specialist centre for gynaecological cancer and modern operating theatres, Intensive Therapy Unit (ITU) facilities, children’s inpatient and outpatient facilities, a new Cardiac Catheter Laboratory and Cancer Unit.

We inspected services at The Queen Elizabeth The Queen Mother Hospital, namely the accident and emergency, medical care, surgery, critical care, maternity and family planning, children and young people, end of life care and outpatients.

Overall this hospital was rated as ‘requires improvement’. The hospital was rated as ‘requires improvement’ for safety, effectiveness and responsiveness. Caring was ‘good’ and well-led was ‘inadequate’. The Accident and Emergency services were rated as ‘inadequate’.

Our key findings were as follows:

The A&E department did not have sufficient levels of staffing to ensure a safe service was provided. There was an over-reliance on locum staff which created risks to safety.
Safety in the A&E department was not a sufficient priority.
The hospital was not well-led.
Many patients experienced delays in leaving hospital because they were waiting for their medications. One patient we met had waited five hours.
We were told that staff were reluctant to fill in the staff surveys as they did not believe it was confidential and did not trust the organisation not to penalise them for making adverse comments.
Patients who attended pre-assessment before undergoing surgery experienced long waits before seeing the doctor. We met two patients who had waited over two hours and staff told us this was not unusual.
There was not enough staff to provide a safe service to women during their pregnancy. The midwife to birth ratio was up to beyond 1:33. This was above the national recommended ratio of midwives to births of 1:28.
Services for children and young people were not effective.
Not all ‘Do Not Attempt Cardiopulmonary Resuscitation’ (DNA CPR) forms documented the involvement of patients and their relatives. Some were not signed by a senior health professional.
Staff were disempowered to make changes in the outpatients service. They were aware of the issues but they felt unable to make improvements to the service.

We saw several areas of outstanding practice including:

Staff were caring
There were good clinical outcomes for patients who had a stroke. The length of stay for stroke patients was 13.2 days with an expected rate of 17.5 days compared to similar trust’s (January to December 2013 data).
The critical care unit monitored its performance and data from Intensive Care National Audit and Research Centre (ICNARC) and showed that patient outcomes were good.
Staff had learnt and changed practices as the result of ‘Never Events’ in the maternity services.
Incident reporting was leading to learning and changes in the outpatients’ service.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

Ensure there are appropriate levels and skills mix of staffing to meet the needs of all patients.
Ensure safety is a priority in A&E.
Ensure patients leave hospital when they are well enough with their medications.
Ensure that maintaining flow through the hospital and discharge planning is effective and responsive. Patients must not be moved numerous times, and not during the night. When patients are well enough they must leave hospital.
Ensure that staff are aware that at a board level there is an identified lead with the responsibility for services for children and young people.
Ensure staff are fulfilling their roles in accordance with current clinical guidance.
Ensure medications are stored safely.
Ensure the administration of all controlled drugs is recorded.
Ensure that procedures for documenting the involvement of patients, relatives and the multi-disciplinary team ‘Do Not Attempt Cardiopulmonary Resuscitation’ (DNA CPR) forms are followed at all times. All forms must be signed by a senior health professional.
Ensure patients are not experiencing unnecessary waits for follow up appointments at outpatients and when waiting in outpatients for appointments.
Ensure there is adequate administrative support for outpatients. On the day of our inspection one medical secretary was responsible for sending out 1,660 GP appointment letters and had not met the within 72 hour target.

In addition the trust should:

Ensure quicker response time to prevent escalation of Grade 2 pressure ulcers to Grade 3.

Professor Sir Mike Richards

Chief Inspector of Hospitals

We spoke with 10 patients, 14 staff and four relatives across the four wards we visited at the hospital.

All the patients we spoke to told us they were treated with dignity and respect. However, some patients told us that doctors did not always pull the curtains when discussing care or examining them, but the nurses always did.

One patient said 'The nurses are great. There are some people here that need help to eat and they get the help they need'. One relative said 'The care has been really good and any minor complaints I have had, have been sorted out by the ward manager'.

Patients said the wards were kept clean and nurses always washed their hands.

We spoke with 70 people across the six wards we visited at the hospital.

All the people we spoke to told us they were treated with dignity and respect.

They said: "The staff are doing a wonderful job, they are polite and respectful". "I can't fault any of the staff; I have received a first class service." "This ward is brilliant, not like other wards I have been on."

People said the staff took time to discuss with them how things were going. One person said, "They always tell me what is happening like when the consultant is due to do his rounds ". Another person told us, 'It is good that they discuss everything in the open. You don't feel that they are hiding things from you'.

On all the wards most people said that they were satisfied with the food provided. One person said, 'You couldn't wish for a better service I reckon'. Another person said that they had wanted more gravy and that it was 'no trouble at all'.

People said the wards were kept clean and nurses always washed their hands but they did comment that they did not see the doctors wash their hands.

People spoke positively about the staff. They said the staff were polite and nice but they were busy. A person on Cheerful Sparrows Male said, "They're very kind and polite to me. They take their time and treat me well."

All of the people spoken with did not have any complaints about the service but did say they would speak to a member of staff or a relative if they had any concerns. "I would definitely say something if things went wrong, but I have no complaints".

We did not speak to people who used this service as part of this review. We looked at a random sample of medical records. This was to check that current practice ensured that no treatment for the termination of pregnancy was commenced unless two certificated opinions from doctors had been obtained.

People told us they were involved in their treatment and support. "I was given some leaflets when I first came here. I don't think there is any room for improvement. I think my privacy and dignity has been maintained when I need privacy I've had it".

People felt safe using the service and that there were usually enough staff on duty. "The staff are so careful about looking after you they make sure you do not fall". 'The staff are all so kind and friendly and the care they provide is second to none'. "It is a very open culture here we can ask each other anything or go to the management about any concerns".

They said that staff were well trained, polite, kind and caring. "Staff are very polite indeed I can not fault them". "Staff really understand what I need' they take great pains to explain things."

In some cases people said that they were given opportunities to say what they thought about the service. "I have not given my opinion about the service but feel at home and I know exactly what is going to happen. I could not have been better treated."

Most people were happy with their care and treatment. Some people said they were pleasantly surprised. They said that staff treated them with respect and were particularly complementary of the male staff who they said were extremely polite. People said that their treatment was clearly explained to them and they were involved in making decisions about what they wanted. People felt their dignity was respected. Some people felt that the curtains were insufficient to maintain their privacy when having conversations about their care and treatment.

Most people liked the food and said there was enough and there were choices on the menu. Some people who were on special diets did not feel that these were well catered for and did not think that the staff were always aware of the foods they could not tolerate. They said there were not always suitable alternatives. People liked the peaceful mealtimes.

All Inspections

Professor Edward Baker

Safe

Effective

Caring

Responsive

Well Led

Professor Sir Mike Richards

Professor Sir Mike Richards