Chase Farm Hospital

Updated 10 May 2019

Chase Farm Hospital is situated in the borough of Enfield which has a population of around 321,000. The hospital has a total of 74 beds. The hospital provides a range of adult, elderly and children’s services across medical and surgical specialties as well as an urgent care centre providing GP and nurse practitioner led treatment for urgent, but non-life threatening, illnesses and injuries.

Shortly before this current inspection the hospital had re-located into a new purpose-built hospital building.

Our inspection was announced (staff knew we were coming) to ensure that everyone we needed to talk to was available and took place between 11 and 13 December 2018.

During the inspection we spoke with 30 patients and their relatives, and over 75 members of staff including doctors, nurses, allied health professionals, managers, support staff and administrative staff. We looked at over 30 sets of patient records and observed a range of meetings including multidisciplinary meetings, safety huddles, ward rounds and patient handovers.

Updated 10 May 2019

• We rated effective, caring, responsive and well-led at this hospital as good and safe as requires improvement.
• We rated all services inspected at this hospital as good overall.
• Staff worked together as a team to deliver effective, patient-centred care and improve patient outcomes. Treatment was planned and delivered in line with current evidence-based guidance and patients were supported by staff to take ownership of their own recovery.
• Staff treated patients with kindness, dignity and respect. Patients were involved as partners in their care and were supported by staff to make decisions about their treatment. Feedback from patients confirmed that staff treated them well and with kindness.
• There was a strong culture of openness, transparency and teamwork within the organisation. Staff felt well supported by managers and told us that they encouraged effective team working across the hospital. Senior staff were visible, approachable and supportive.
• The needs and preferences of different people, including the local population, were taken into account when designing and delivering services. There was a proactive approach to delivering care in a way that met the needs of older people and people living with dementia.
• The hospital had a vision for what it wanted to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community.
• The service had suitable premises and equipment and looked after them well. Staff kept themselves, equipment and the premises clean. They used effective control measures to prevent the spread of infection.
• The trust had implemented a number of innovative services and developed these to meet patient needs. The trust was committed to improving services by learning, promoting training and innovation.

However:

• The trust needed to take action to ensure that patients were protected from the risk of avoidable harm. We were not assured that there were effective systems and processes in place to prevent avoidable patient safety incidents from reoccurring. For example evidence of completed actions in response to serious incidents, was not always robust.
• Opportunities to share key safety information relating to patient risk were sometimes missed. For example, there was no system in place for staff to escalate to the safeguarding team and risk assesses patients that left the Urgent Care Centre before being assessed.
• Staff told us they reported incidents infrequently and therefore opportunities to learn from near-misses were lost. We were not assured that there was a robust culture of incident reporting.
• Although records were clear, up-to-date and easily available to all staff providing care, in the Urgent Care Centre, patient records were not always stored securely and appropriately.
• Although the trust provided mandatory training in key skills to all staff, not all staff had completed it. Many staff told us they did not get time to complete training and had to do it in their own time.
• Although the staff generally followed best practice when prescribing, giving and recording medicines, we found some medicines were not stored in line with trust policy.
• Patients sometimes experienced delays in accessing care and treatment. Waiting times from referral to treatment was not in line with national standards for the endoscopy unit. Theatre lists often started late meaning patients sometimes had to wait a long time on the day of their surgical procedure. The service did not have oversight of the number of patients who left the Urgent Care Centre before being seen, including vulnerable children and adults.

Updated 10 May 2019

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

• Staff kept records of patients’ care and treatment. Staff completed comprehensive risk assessments and followed escalation protocols for deteriorating patients.
• There were effective systems in place to protect people from harm. Learning from incidents were discussed in departmental and governance meetings and action was taken to follow up on the results of investigations.
• Medicines were stored and administered safely.
• Staff provided evidence based care and treatment in line with national guidelines and local policies. There was a program of local audits to improve patient care.
• The service made sure staff were competent for their roles. Managers appraised staff’s work performance.
• Staff were aware of their responsibilities under the mental capacity act and we saw appropriate records in patient’s notes.
• There was effective multidisciplinary working, including liaison with community teams, to facilitate timely discharge planning.
• Feedback for the services inspected were mostly positive. Staff respected confidentiality, dignity and privacy of patients.
• Services were developed to meet the needs of patients. There was a proactive approach to delivering care in a way that met the needs of older people and people living with dementia.
• The leadership team had a clear vision and strategy and there were action plans in place to achieve this.
• The trust had implemented a number of innovative services and developed these to meet patient needs. The trust was committed to improving services by learning, promoting training and innovation.

However:

• There was insufficient occupational therapy cover to support patients with cognitive issues.
• Waiting times from referral to treatment was not in line with national standards for the endoscopy unit.
• Staff within the endoscopy unit felt they were not always involved in the decision-making process by the executive team.
• Not all risks identified during our inspection were on the risk register.

Updated 15 August 2016

They was a dedicated team providing holistic care for patients with palliative and end of life care (EOLC) needs in line with national guidance.

The hospital provided mandatory EOLC training for staff which was attended, a current EOLC policy was evident and a steering group met regularly to ensure that a multidisciplinary approach was maintained.

The hospital and its staff recognised that provision of high quality, compassionate end of life care to its patients was the responsibility of all clinical staff that looked after patients at the end of life. They were supported by the palliative care team, end of life care guidelines and an education programme.

The palliative care team was highly thought of throughout the hospital and provided support and education to clinical staff. The team worked closely with the practice educators, and link nurses, at the hospital to provide education to nurses and health care assistants. Medical education was led by the medical consultants and all team members contributed to the education of the allied healthcare professionals.

Medical records and care plans were completed and contained individualised end of life care plans. Most contained discussions with families and recorded cultural assessments. The ‘do not attempt cardio-pulmonary resuscitation’ (DNACPR) forms were all completed as per national guidance. However there were inconsistencies in the documentation in the recording of Mental Capacity Act assessments.

The EOLC service had supportive management and visible and effective board representation. This had resulted in a well led trust wide service that had a clear vision and strategy to provide a streamlined service for EOLC patients.

Updated 15 August 2016

The outpatient and radiology departments followed best practice guidelines and there were regular audits taking place to maintain quality.

Staff contributed positively to patient care and worked hard to deliver improvements in their departments.

The trust had consistently not met the referral to treatment time standard or England average since April 2015.

The hospital cancelled 35% of outpatient appointments in the last year. From October to January, 34% of short notice cancellations were due to annual leave, which was not in line with trust policy.

Staff felt supported by their managers and stated their managers were visible and provided clear leadership

Updated 10 May 2019

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

• Staff worked together as a team to deliver effective, patient-centred care and improve patient outcomes. Treatment was planned and delivered in line with current evidence-based guidance and patients were supported by staff to take ownership of their own recovery.
• Staff treated patients with kindness, dignity and respect. Patients were involved as partners in their care and were supported by staff to make decisions about their treatment.
• There was a strong culture of openness, transparency and teamwork within the organisation. Staff felt well supported by managers and told us that they encouraged effective team working across the hospital. Senior staff were visible, approachable and supportive.
• The needs and preferences of different people, including the local population, were taken into account when designing and delivering services. People could access the service when they needed it. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were in line with good practice.

However:

• The trust needed to take action to ensure that patients were protected from the risk of avoidable harm. We were not assured that there were effective systems and processes in place to prevent avoidable patient safety incidents from reoccurring.

Updated 10 May 2019

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

• The service had suitable premises and equipment and looked after them well.
• The majority of staff had received up-to-date mandatory training. The overall compliance for all nursing and medical staff was 94% which was better than the trust target (85%).
• There was an effective system in place to assess, respond to and manage risks to patients. Staff could recognise and respond to signs of deterioration and emergencies.
• Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date and easily available to all staff providing care.
• There was effective internal multidisciplinary team working within the service and across other discipline. Doctors, nursing staff, receptionist, radiographer and other healthcare professionals supported each other to provide good care.
• The service made sure staff were competent for their roles. Patients were cared for by staff with the right qualifications, skills and knowledge to provide safe care.
• Managers appraised staff’s work performance and held supervision meetings with them to provide support and monitor the effectiveness of the service.
• Staff cared for patients with compassion, respect, dignity and kindness. However, patients’ confidentiality was not managed appropriately due to the service environment. Feedback from patients confirmed that staff treated them well and with kindness.
• The trust and service had a vision for what it wanted to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community.
• Managers across the trust promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.

However, we also found areas for improvement:

• There was no system in place for staff to escalate to the safeguarding team and risk assesses patients that left the service before been assessed after booking in.
• Records were not always stored securely and appropriately.
• There was no formal regular teaching for medical and nursing staff in the service.
• Reasonable adjustment had not been made to the service so that people with visual or hearing impairment could access the service on an equal basis as others.
• We received mixed response mixed response from staff on the access to the translation services.
• There were no leaflets or posters on health promotion or condition in the service or displayed on the television. The service did not display information on how patients could provide feedback and make complaints.
• Paediatric patients waiting in the paediatric patients did not have urgent care centre staff oversight during and out of hours.