Cannock Chase Hospital

Updated 14 February 2020

Cannock chase hospital is part of the Royal Wolverhampton NHS trust and is approximately 10 miles from the New Cross Hospital site. It provides medical care, surgical services and a range of outpatient services, which includes general surgery, orthopaedics, breast surgery, urology, dermatology, and medical day case investigations and treatment (including endoscopy).

There are two main wards located at the Cannock Chase Hospital with 27 inpatient beds on the orthopaedic ward and 27 on the rehabilitation ward including elderly care. There are also facilities for day case surgery and several outpatient clinics.

There was a shuttle bus service provided by the trust for patients and staff travelling between New Cross Hospital and Cannock Chase Hospital.

Updated 14 February 2020

Outpatients has previously been inspected and rated alongside diagnostics. This is the first time this core service has been inspected alone. We rated it as good because:

We rated safe, effective, caring, responsive and well led as good.

Updated 1 October 2018

• We saw improvements in processes to protect patients from harm compared with the previous inspection. There was an improvement in the number of incidents reported and staff told us that they were encouraged to report incidents.

• Staff understood the procedure to raise concerns, reports incidents and near misses and said they were supported to do so.

• Areas were clean and regular hygiene audits were carried out and action plans put in place to make improvements where required.

• Patient notes were multi-disciplinary and had name and date stamps throughout all entries, indicating which member of staff had seen the patient.

• The trust had been working to improve the implementation of the sepsis pathway since the last inspection. we found that management of sepsis had improved.

• The ward carried out various local audits, including auditing their own documentation to check that care plans were being completed correctly. We found that overall results were positive.

• We saw senior service leaders regularly reviewed the effectiveness of care and treatment through local and national audit.

• Staff were supported to undertake professional training to enhance their knowledge and skills and said they felt well supported with their training and development.

• Patient information huddles were held each day on each ward so that information could be shared with all relevant staff involved in the care and treatment of the patient.

• Nursing and medical staff ensured that patients received timely pain relief.

• Patients’ nutritional needs were assessed and care plans developed.

• Staff understood their roles and responsibilities under the Mental Capacity Act 2005 and the deprivation of liberty safeguards (DoLS).

• We observed both nursing and medical staff interacting with patients with dignity and respect.

• Patients told us they felt involved in their care and that they were given enough information.

• Staff supported patients’ emotional needs and responded to their care and treatment in different ways and according to their social, religious and spiritual needs.

• Families were encouraged to be part of the rehabilitation process and could support patients whilst on the ward.

• There was a robust discharge procedure which used a checklist to aid staff in monitoring discharges.

• Relatives of patients were included in the planning of care and the consultant or a senior member of staff would try to see relatives or loved ones, within 48 hours of an admission to the ward.

• Patients told us that the therapy was “brilliant” and that there was a range of activities to suit individual needs.

• Staff told us that the way complaints were managed had improved and they received feedback from complaints across the trust and discussed these at team meetings.

• Training and development for staff was a priority for the trust and we saw examples where staff had been involved in developing training.

• There was a local vision and strategy for the medical service which was linked to the trust’s overall vision.

• There had been an introduction of nursing forums throughout the trust to allow staff to discuss issues openly and offer views on potential solutions.

• Shared governance meetings were held monthly where staff sent a representative from the ward to attend.

• The Fairoak ward team were shortlisted for the “enhancing patient dignity” category at the 2018 nursing times awards.

However:

• The access on Fairoak ward was not always secure and people could enter or leave the ward easily, without being noticed. Staff told us that at busy times there might not be staff monitoring the entrance to the ward, although there was swipe entry access.

• Not all staff were up-to-date with their mandatory training, only 53% of eligible staff had completed level 3 in basic life support and 87% in tissue viability and pressure injury management training.

• There was a high number of incidents of falls recorded which made up 54% of all the recorded incidents on Fairoak ward.

• Some staff said that, on occasions, they still felt disconnected to New Cross Hospital.

Updated 13 December 2016

The Specialist Palliative Care Team (SPCT) provided a safe, effective and responsive service for people with life-limiting illnesses. The palliative team worked across both New Cross Hospital and Cannock Chase Hospital so we found similarities across both sites. On both sites we found staff were well engaged with education and training programs around end of life care and it has taken a priority to ensure the care of patients and families is enhanced.

The palliative team were in the process of embedding the Swan Project at both hospital sites as a care planning tool and guidance for patients in the last few days of life. Staff adopted practices of the Salford Royal NHS Foundation Trust such as: the Swan logo being placed on the curtains or the door of the side room to alert staff to be mindful, relatives were given canvas bags with the Swan logo with their relative’s belongings as oppose to a plastic bag, staff offered families of end of life patients keepsakes such as photographs (of hands) and handprints, locks of hair (taken discreetly from behind the ear and presented in an organza bag not as previously in a brown envelope) and staff returned jewellery in a small box. Literature on both hospital sites had been updated and rebranded such as: the personalised care plan, the ‘practical information leaflet’ and the feedback survey was redesigned to have the Swan logo.

The rationale for the Swan logo was to trigger a compassionate response and kind communication. All staff at New Cross Hospital and Cannock Chase Hospital were aware of the project and had recently started the project for the past few end of life patients. During the inspection we found the scheme to be in its infancy stages although all staff were fully aware of the project, what to do and how to implement it should they be caring for a dying patient.

The Specialist Palliative Care Team worked closely with Cannock Chase Hospital to support patient pathways through the hospital.

The staff knew how to make referrals and people were appropriately referred to and assessed by the SPCT in a timely fashion. Seven day working was not in place but staff had access to specialist advice and support 24 hours a day from SPCT.

We reviewed five DNACPR forms, they were completed according to the National Guidelines.

The chaplaincy service supported families’ emotional needs when people were at the end of life.

We found leadership of the end of life service to be good. The SPCT promoted a culture of sharing knowledge and developing the skills of others.

Staff were unaware of the major incident plan and actions to take in the event of a major incident.

Updated 13 December 2016

We found that the safety of the service to be good overall but with some improvement required. Staff reported, investigated and learned from incidents. There were systems in use to control infection, safely manage medicines, maintain records and safeguard children and vulnerable adults. Staffing levels were not sufficiently robust to provide the service although this was being addressed by the trust. Some risks to patients were not being properly addressed by the trust such as the lack of access to x ray. Nurses were emergency medicine practitioners (ENP) and this meant they could prescribe drugs. The lead nurse was qualified to care for sick children. No staff however had advanced paediatrics life support training.

We found services required improvements. There was a lack of audit undertaken. The MIU was using nationally agreed protocols to ensure quality of care although there was no system in place to monitor the outcomes for patients. Staff were qualified and had the skills and support they needed to carry out their roles effectively and in line with best practice. The MIU had good joint working with other trust services They referred patients directly to Ear, Nose and Throat, Paediatric and Maternity services.

We found the service was caring. Feedback from people who used the service, those who are close to them and other stakeholders was positive about the way staff treated people. People were treated with dignity, respect and kindness. The MIU could access a range of emotional support services provided by the trust for patients. The size and layout of the reception area however meant that patients had no privacy in their conversation with the receptionist.

We found services were responsive. The MIU was open seven days a week from 10.30 am to 6.30pm. People could access the right care at the right time except for x ray imaging. Access to care was managed to take account of people’s needs, including those with urgent needs or complex conditions such as living with a learning disability. There was no performance information regularly collected to show whether the MIU was performing well or badly on key performance indicators, including waiting times, and other access and flow patient’s indicators. Complaints were dealt with in an open and transparent way.

We found leadership of the service to be good but required some improvements. In its Annual Report for 2014/15 the trust said emergency and urgent care (ED) was its first priority for 2015/16. There was little information about how the MIU was to fit into the vision and strategy. ED directorate leaders were visible and available to the MIU and local leaders showed a firm leadership and there was a friendly, open culture of teamwork and concern for patients. The trust and MIU had started to work well on quality issues. However there had been no recent review of the governance arrangements, the strategy, plans or the information used to monitor performance. The trust had not undertaken any comprehensive risk assessment and management plan for the service before or immediately after it had taken it over in March 2015.

We visited the MIU on 4 and 5 June 2015 and spent a total of four hours there. We spoke with two nurses, the lead nurse and the administrator and followed the care and treatment of one patient.

Updated 14 February 2020

Outpatients has previously been inspected and rated alongside diagnostics. This is the first time this core service has been inspected alone.

Our rating of this service was good because:

• The service had enough 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 controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. 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. Managers monitored the effectiveness of the service and 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 five 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. People could access the service when they needed it and did not have to wait too long for treatment. The service was experiencing delays in the ophthalmology pathway and had a plan to improve this.
• 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.

Updated 27 June 2018

• The service had enough staff to provide the right level of care and treatment. Staff were up to date with mandatory training and had a good understanding of safeguarding procedures.
• Patients care and treatment was in line with best practice guidelines. Patients were kept well hydrated and told us their pain was managed appropriately. All staff told us they worked well as part of multidisciplinary team.
• Patients we spoke with confirmed that all members of staff treated them in a caring manner, displaying compassion and professionalism at all times.
• The ward managers told us how they initially investigated concerns and complaints at a local level. The outcomes were discussed with the staff at ward meetings and wider trust quality meetings. Compliments were displayed on the ward notice board there were also discussed at ward meetings.
• Staff we spoke with told us they felt valued and supported by their managers. They told us they were proud to work as part of the team and described a positive culture promoted by their matrons and leadership teams. All levels of staff understood how they were beginning to contribute to the trust values.

However:

• We identified environmental issue in the recently re-opened theatre four that meant it was immediately closed until action was taken. The ceiling tiles visibly lifted and the exit door opened whenever any doors into the theatre opened which created a risk of patient infection.
• Systems and processes for keeping patients safe in theatres were not always observed. In all three surgical cases we observed in theatre, staff were not verbalising the ‘sign in’ process of the World Health Organisation (WHO) safer surgery checklist but were signing that they had done it. There was non-compliance with the ‘time out’ processes observed. On one occasion, not all staff were present and on the other occasion loud music was playing.
• Staff were wearing scrubs outside of the operating theatre which contravened the trust’s ‘professional standards of dress at work’ policy.