George Eliot NHS Hospital

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We reviewed the person-centred care, care provision Integration, and continuity, care provision, Integration, and continuity, providing Information, listening to and involving people, equity in access, equity in experiences and outcomes and planning for the future as part of the responsive key question. We found responsive improved to good. 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.

This service scored 79 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Patients told us they were involved in their care and treatment and felt listen to when they had to make decisions relating to their care and the next steps. Speaking directly with patients during the assessment they told us clinics were on time, and they did not have to wait long to see the consultant. Patients also told us they had appointments cancelled before; however, these were always rescheduled. Information received after the assessment identified appointments sometimes got cancelled at short notice.

Staff told us patients with a learning disability used hospital passports and some patients with dementia used a similar tool to help them communicate their preferences and other useful information. Staff knew how to use these tools, and they knew how to support patients to develop one of these documents if they did not have one. These tools helped ensure patients received person centred care. The department had a variety of link nurses. Link nurses have additional training in specific areas to help them support patients or support their colleagues to support their patients better. This included a learning disability link nurse and a dementia link nurse. There was also a diabetes link nurse. The service also employed paediatric nurses to support children’s clinics, and specific days were identified to support children’s clinics. The service completed a back to health pathways (BTHP). Staff told us this was a volunteer-based programme at the trust, which was introduced in the last year to support patients on their journey to and from hospital. The programme plays key part in the trust working more effectively within the local communities to address health inequalities. This identified the number of patients that's received additional support to help manage their care needs and with this support, patients returning to hospital had reduced and identified better outcomes for patients returning home or back into the community, on the report this also identified some positive feedback from patients.

We observed patients attending their appointments and we observed that care was person-centred, and the focus was of the patient's needs, care and treatment, and future treatment. During our assessment we observed patient's clinics where there was a person-centred approach to patient care and treatment.

The service gained patients feedback once their appointments had concluded, also this information had been gathered to be able to identify themes and trends, so the service is able to make any changes to improve patients care and treatment. During the assessment we observed staff of all levels working well to meet the needs of patients and responding to any requests in relation to the patients care and treatment.

Staff told us that they aimed to ensure appointments ran on time and that patients still had the time they needed within the appointment to ask questions to understand their treatment options. Once referred by their GP patients could choose which hospital they had their appointment at, this included hospitals from other trusts. Patients could choose from a range of appointment dates and times. In some specialities this meant they could choose a weekend appointment. Once they had chosen their appointment slot the hospital would write to them to confirm their appointment and send additional information, for example, on what they could expect to happen at their appointment especially if this involved having an examination or test. The trust had commenced a project to standardise appointment letters and update the additional information that may need to be sent to patients. On the back of letters there was information in 5 different languages explaining how people could get support to understand the content of the letter. The service completes an action plan to monitor and to meet the referral to treatment (RTT) national targets which is broken down by specialism. These identify the areas that need actioning and what the action have been completed, this was identified by Red, amber, and green (RAG) ratings. The service provided data in relation to cancelled appointments, between January and March 2024 there were a total of 3806 appointments cancelled, 2073 were cancelled by patients and 1733 were cancelled by the service. The service uses a system to help communicate with patients, this covers simple and instant communication with patients, better tools for appointments and waiting list management, this also identifies patient and clinic lists, and where staff can communicate with each other. The service us the app for referral to treatment patient tracking list to communicate with patients, to check if they still require an appointment and this enab

There were processes in place to ensure care provision took into account the diverse health and social care needs of the local population. The service was involved in the programme which aimed to support patients on their journey to and from hospital. The programme took account of the diverse needs of those patients who were on this journey and aimed to address the health inequalities they may be faced with. The programme had other partners involved to offer holistic support to patients. Workstreams on this pathway also addressed ways to reduce readmission into hospital by enhancing the support available to them in the community. The team who worked on this process had identified all different communities within the local population and were now looking further in what additional needs those populations required to ensure they received the care which addressed their needs. This trust has a process that applies to all patients who breach the 52 weeks referral to treatment (RTT) pathway time frame. However, post assessment the service told us they currently do not have any long waiters. The 52 weeks was relaxed due to backlog following covid and is currently 65 weeks not 52. The service provided evidence of where they have brought patients appointment forward to ensure they are meeting the waiting times for their appointments. The trust policy and process are currently under review.

Patients told us that they felt that information had been shared with them in their appointments and felt that staff explained the information in a way they were able to understand, patients felt that when they asked questions, that these were communicated in a way they understood. We observed patients receiving leaflets with information to help and support them to make decisions about care and treatment. We observed that staff explained information to patients, also in a way the patients were able to understand, which enabled them to have control of their care and treatment.

Staff told us there was a service, staffed by volunteers, that contacted patients on the waiting list to see if they required support. These welfare calls helped establish if patient needs required additional support to stay well in the community or if, for example they need support from a social prescriber, or access to transport to get to the appointment. Different specialities provided written information along with appointments letters, so patients knew what to expect at their consultation. Staff told us the service was in the process of standardising appointment letters and reviewing supplementary information to ensure they met accessibility standards. Staff told us the department was almost ready to go live with a new project that involved providing a range of information to patients in waiting areas through a bespoke presentation shown on tv screens. The information included details of how to cancel or rearrange appointments as well as health promotion information. In partnership with 2 local trusts staff told us the service provided face to face health sessions to patients. For example, a 4-session course on diabetes to help people understand what diabetes is and how to manage it. There were also similar sessions that provided support and educational groups for patients with cancer/cancer survivors.

The service had policies and processes in place to ensure the information which patients received met their needs and where adjustments were required, these were made. We saw information during our onsite assessment which confirmed staff implemented these policies and processes where patients need identified it was required (for example patients requiring translation and interpretation services, information provided to patients which met the Accessible Information Standard.

Patients told us that they feel listened to by staff, and if they had any concerns with the care provided and all patients stated they were happy with the care received. Patients told us that staff were supportive and if they had any worries or concerns, they could raise this with staff at the time. The service provided evidence that in the last 3 months there were no complaints received within the service. The service also asks patients for feedback once they have had their appointment. All patients were offered the opportunity to have a chaperone with them if they required an examination. Reception staff had received chaperone training to increase the number of staff available to provide this service.

Staff told us they were actively trying to engage hard to reach communities to improve their access healthcare and specifically to cancer and diabetes screening. In the past 12 months they had made connections with over 100 communities including people from itinerant communities and a range of faith and cultural groups. They tried to engage with each group at least bi-monthly and held health education sessions, provided screening and advice, and worked with the groups to uncover their reluctance to engaging with local primary and secondary health services. For example, with travelling communities they wanted to understand why they were more likely to present at an ED than a GP surgery so they could improve traditional access routes for this group. To help build trust as well as health education they provided dental hygiene products, sanitary items, contraception, and baby formula. Staff told us they used interpreters to help engage faith groups and cultural groups and, for example, took consultants to meetings to give detailed health advice and hold some consultations. Staff gave us examples of changes they had made based on feedback from patients. Self-service check in kiosks had been removed as patients said they preferred to speak to a member of staff rather than use a computer to book in. Patients had requested better signposting for people living with dementia and so purple footprints had been added to the floor to improve navigation for those who did not respond well to traditional signage. Staff told us that they receive feedback form managers in relation to complaints that have been received from patients. The service post assessment data stated that the service did not have any complains for the last 3 months. Senior leaders told us the trust had a patient forum and members of the team are invited to participate in a number of trust meetings to ensure patients were well represented.

There were policies and processes in place to support patients who wanted to raise concerns and complaints about their care and treatment. The policy in place was comprehensive and in date until January 2025. During the onsite assessment, evidence was seen of posters and leaflets which informed patients on how they could raise their concerns. There was also information available on how patients could provide their feedback outside of formal complaints (for example the Friends and Family Test). Processes were in place where complaints were reviewed themes identified and lessons from the complaints identified and shared with others. The report for the Quality and Safety Governance Report evidenced where complaints and learning were identified. The report provided identified there had been not complaints for the service in December 2023.

Patients could book OPD appointments through an online web platform. The platform allowed them to see what appointments were available over a range of dates and times. This system also enabled them to look at appointments offered by their speciality at other trusts. This meant that patients who lived outside the hospital’s ‘catchment’ area could also book OPD appointments at the hospital. This meant the patients waiting to be seen were not specifically local patients and that demand on the service was sometimes as a result of their shorter waiting times than neighbouring trusts. If patients wanted to cancel or rearrange their appointments, they could phone or email the booking team to do this.

Managers monitored waiting times and tried to make sure patients could access services when needed to receive treatment within agreed timeframes and national targets. However, the trust had a significant backlog of patients waiting to be seen by some of the different specialities. The backlog of patients waiting to be seen across the service was partly due to the COVID-19 pandemic and associated social distancing requirements when patients could either not be seen at all or could only be invited to attend in small numbers. Staff told us they had worked hard to try and reduce the number of patients waiting extensively as well as risk assessing patients who had been waiting for an appointment for a substantial period of time. In addition to this, the service had introduced the patient initiated follow up (PIFU) system. PIFU is when a patient initiates an appointment when they need one, based on their symptoms and individual circumstances. Managers and staff worked to make sure patients did not have to attend OPD more often than they needed to. If they were required to see multiple practitioners’ staff would try and ensure all appointments were scheduled for the same day. For example, staff would try and arrange for a patient to see a doctor, dietician, and phlebotomist on the same day.

There were process and policies in place to ensure that people were able to access care and treatment when they needed it and in a way that promoted equality. Despite difficulties in the build-up of waiting lists during the pandemic, the service had no excessive waits for appointments. Performance meetings monitored the RTT and other key indicators such as cancer KPIs and the backlog reduction to ensure the service were ensuring patients could access the service in a timely manner. An action plan remained in place to ensure backlog and delays did not form again. There was a team in place for patient pathways tracking, however information had noted there had been difficulties maintaining an oversight of the tracker due to no team leader being in place. Where patients had been waiting for long periods for an appointment or follow up, there was a process in place to complete a risk review and escalate patients where the need was identified. The service monitored them did not attend rates and their cancellation of clinics. There was a policy in place which staff followed when they had to cancel clinics. They ensured the process was followed to ensure patients received a new appointment which was as soon as possible, but at a time which was suitable to them. Work had been completed to understand the patients who were likely to not attend their appointments and to work with them to reduce the amount of wasted clinic appointments. This was run by volunteers and included running an algorithm which predicted who was likely to not attend, allowing them to maximise the appointments and availability within the clinics in the service. When patients failed to attend their appointments, there were processes in place for staff to follow to ensure any additional appointments or measures were put in place, but also completing welfare checks on patients. Where patients repeated to fail to attend their appointments, they would be escalated to their original healthcare practitioner.

Staff told us they ensured they tailored the care and treatment they provided to meet the experience of patients. They had listened to feedback from the local communities and had engaged with programmes which looked to improve the experiences of patients who were more likely to experience health inequality.

There were processes in place to engage with the local population and to ensure care was tailored to their needs. This included the Back to Health pathway looking to identify the communities which put most pressure on the service. The engagement officers from this are therefore aiming to specifically target the deprived communities as well as other hard to reach communities. In addition to this there was the process in place to maximise outpatient clinics by using an algorithm to identify patients who were most likely to not attend their appointments and to work with them to find ways which would meet their needs. The processes and policies in place within the service ensured patients were treated in line with requirements under legal and human rights. The trust met the needs of patients where reasonable adjustments were required. Policies and processes in place had an equality impact assessment completed on them to ensure they met the needs of people.

Patients told us they were happy with how consultants share information and in a way patients understood. We observed in clinics that there were discussions with patient’s relating to their care and treatment and what was happening now and what were the next steps, staff held honest conversations with patients and ensured they were aware of the options of their next steps. We also observed staff having difficult conversations with patients relating to future treatment and plans, staff listened to patients and family members thoughts and choices.

Staff told us that they spend as much time as a patient requires to ensure the patient had a good understanding of their future care and treatment. We observed staff ensuring that patients records were updated after each appointment, this was to ensure that any discussions between the patient and staff were recorded and any actions that had been agreed were all logged. We observed that patients were given the choice of future treatment and were given information to take away and have time to read this, to be able to have an understanding, then it was agreed that there were to have discussions at the patients next appointment.

There were pathways in place to follow for patients who attended the service. Where planning for the future was required, additional staff were invited to attend appointments to support staff. Examples of this was in relation to patients attending for suspected or confirmed cancer appointments. Staff were able to discuss all requirements in relation to their care and treatment and plan with the patient for the future. This included at times when discussing a terminal diagnosis and discussing treatment plans for palliative care and elements of care under the ReSPECT form including ceilings of care and resuscitation decisions. During our onsite assessment, we observed staff following these processes and making decisions together with patients about their future plans.