Resultados de la evaluación

Inadequate

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We rated responsive asinadequate:

The service was not responsive to the needs of patients requiring admission. The hospital performed worse than the expected national average for cancelled operations. The trust overall performed worse than the expected average. The trust did not have a recovery plan in place to address this. The referral to treatment times within 18 weeks were broadly in line with the national average until October 2014, and then there was a steep decline in performance which has continued till April 2015. Since January 2015 fewer than 70% of patients requiring admitted treatment received treatment within 18 weeks. The trust stated that they were experiencing increased demand for beds and the implementation of the IT system EPIC had led to a declining referral to treatment time performance. However the trust has a recovery

mobilisation plan in place to improve the speed at which patients can access care.

The bed occupancy rates for the hospital were higher than target ranges and we saw that bed occupancy within urology was at 100%.

Surgery

We saw that adult patients would be cared for in the same area as children in recovery. Neither group of patients had their privacy or dignity protected. There was no controlled access within the ophthalmic day surgery unit within recovery whereby we found children and adults shared the same recovery area and bays next to each other.

Within surgery we found that between October 2014 and April 2015, 129 patients who had their procedure cancelled on the day of surgery had not had the 28 days required to receive a new offer. During our inspection we observed that surgery had all non-urgent surgery cancelled for the 24 April 2015 due to no ability to deliver this service.

Cancelled surgery was endemic within surgery with 8 – 20 cancellations per day. Cancelled orthopaedic surgery resulted in two surgeons not operating since October 2014. We saw that the ophthalmic eye surgery theatre was not carrying out any waiting list cases.

Service planning and delivery to meet the needs of local people

• The service had a day surgery unit, which enabled people to have minor procedures without having overnight stays in hospital.

• On the day of their surgery, patients with elective (planned) surgery were admitted to the surgical

admissions lounge. There nurses processed patients for surgery and the post-operative ward. However, we spoke with one nurse who informed us that within the ophthalmic day surgery unit, two days a week, patients are asked to be at the unit for 07:30am in the morning and have to wait for a 1:30pm start due to the

consultant wishing to work this way. It is unnecessary for patients to arrive this early because they have already had their pre-assessment completed.

• It is expected that 90% of elective surgery patients should wait under 18 weeks from referral to treatment. The trust was not meeting this national waiting time target. However the trust has a recovery mobilisation plan in place to improve the speed at which patients can access care.

• Length of stay was longer than the national average for non-elective surgical admissions, which was 26% higher than the England average. However the hospital is a specialist centre and a major trauma unit and this could impact upon the demand for surgery.

• We looked at nine records and identified that discharge

patients. For many patients their delayed discharge revolved around their package of care from the local authority. The trust was working with partners to improve this.

Access and flow

• We observed that the trust followed the National Institute for Care and Excellence (NICE) guidance for fractured neck of femur. However, the hip fracture audit showed this clinical pathway was performing less well and not working as efficiently as should be expected, 67.2% of patients received surgery on the day of or after day of admission compared to the England average of 73.8%.

• The service was under considerable and sustained pressure to meet the competing demands of emergency and elective surgery in a hospital with limited capacity. They had made no progress in clearing the backlog of delayed operations. The trust stated that it has a recovery mobilisation plan in place to improve the speed at which patients can access care. The trust intended to further improve the time of patients waiting by the addition of a further two new theatres to the current 35 theatres.

• From October 2014 to April 2015 129 patients had their operation cancelled and their treatment was not

rescheduled within 28 days. This was above the England average of 5% of patients, and showed no improvement over time.

• Cancelled surgery was endemic within surgery with 8 – 20 cancellations per day. Cancelled orthopaedic surgery resulted in two surgeons not operating since October 2014. We saw that the ophthalmic eye surgery theatre was not carrying out any operations on patients on the waiting list.

• Following surgery patients were often held in recovery because there were no beds available within the speciality service required due to a lack of realisation of discharge plans on the wards. Theatre staff told us it was not unusual for them to stay and look after patients’ recovery in theatre, which had a 'knock-on' effect on surgery time.

• We did see within colorectal surgery that there was an enhanced recovery plan which reduced the length of patient stay from eight to six days which supported the achievement of the divisions Commissioning for Quality and Innovation (CQUIN) programme.

Surgery

Meeting people’s individual needs

• There were dementia care and learning disability champions within surgery. We spoke with staff who understood who to contact for support.

• Staff were familiar with the hospital’s procedures for translation services. Staff could print leaflets in different languages when the need arose and they could request a translator for more complex cases.

• There was information available, in all of the main areas, for many different surgical procedures and conditions. The reception area of the day surgery unit had posters and information available, which sign posted people to other appropriate care pathways and contact

information for other services.

• The patients said they were given choices for food and snacks. However, they provided mixed views regarding the quality of the food available. We noted at one meal time that food on a tray was placed in front of a patient on the neuro surgery ward, who required assistance, and it was 15 minutes before anyone came. We bought this to the attention of the ward manager who

addressed it immediately and ensured that fresh hot food was obtained for the patient.

Learning from complaints and concerns

• Complaints were handled in line with the trust’s policy. Staff directed patients to the patient advice liaison services (PALS) if they could not deal with concerns directly.

• Wards displayed literature and posters, advising patients and their relatives how they could raise a concern or complaint, both formally and informally. • Staff we spoke with told us that ward managers

investigated complaints, and there was feedback on complaints in which they were involved.

• Patients we spoke with felt they would know how to complain or compliment about care and or treatment they received to the hospital if they needed to.