George Eliot NHS Hospital

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We reviewed learning culture, safeguarding, involving people to manage risks, safe environments, safe and effective staffing, infection prevention and control and medicines optimisations for the safe key question. We found safe improved to good. 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.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff told us they received and kept up to date with their mandatory training. The mandatory training was comprehensive and met the needs of patients and staff. Training covered a number of training course, the trusts target of 85% had been met in all training for all staff except for moving and handling for patient landlers Level 2 which scored 84%. The service completed Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS) training which both scored 100%. Staff knew what incidents to report and how to report them. Staff told us they raised concerns and reported incidents and near misses in line with trust policy. Staff told us they received feedback in relation to incidents. Staff told us learning from incidents was shared at their morning safety huddle and team meetings. Staff had a good understanding of duty of candour and gave examples of when they would use this. Staff told us there was a positive culture and feel support by the managers within the department. The service held daily huddles which identified any concerns, relating to incidents, staffing, and any other information that needed to be shared with the team. Staff also told us that they attended staff meetings, where information was shared with the team and for staff to raise any ideas or concerns.

There were processes in place for staff to follow when reporting incidents. Incidents were discussed as part of regular huddles and meetings, and where learning was required, there were processes to follow for staff to ensure this was shared and embedded. Where serious incidents had occurred, staff formally undertook the duty of candour. Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 is a regulation, which was introduced in November 2014. This regulation requires the organisation to be open and transparent with a patient when things go wrong in relation to their care and the patient suffers harm or could suffer harm, which falls into defined thresholds. The duty of candour regulation only applies to incidents where severe or moderate harm to a patient has occurred. We reviewed 2 incidents where the duty of candour had been applied and found no concerns with how the service had completed this. Evidence showed there were processes within the service to ensure staff met to discuss and learn from significant incidents. Due to the directorate which the service was in, they were able to learn from incidents outside of their immediate area which strengthened their learning. There were also processes in place to ensure all relevant safety alerts were shared within the department. Information was shared through emails, huddles, ward meetings, board meetings and clinical governance meetings.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

Staff could give examples of how to protect patients from harassment and discrimination, including those with protected characteristics under the Equality Act. Staff knew how to identify adults and children at risk of, or suffering, significant harm and worked with other agencies to protect them. Staff knew how to make a safeguarding referral and who to inform if they had concerns. Children and young people had a separate outpatient department but were sometimes seen in the main outpatient departments fracture clinic. Children being seen in the main outpatient department had a separate waiting area which could also be used by children who had accompanied their parents to appointments. Staff followed safe procedures for children visiting the department. This included following up missed appointments by ringing parents, alerting the patient’s consultant, and if patients had safeguarding flags reporting this to the onsite safeguarding team. The service had 2 safeguarding concerns raised within the service, these were managed in line with the trusts policy and the patients had been safeguarded.

There were processes in place for staff to follow to ensure patients were safeguarded from the risk of harm and abuse. The trust had a process in place to identify where patients were at risk due to safeguarding concerns. The policies were in date and contained the most recent national guidance and legislation. The service had a process in place to monitor staff training to ensure they were in compliance with the trusts target. Information was provided which demonstrated staff were trained in level 1 and 2 safeguarding for both children and adults, and all nursing staff who required level 3 safeguarding training for children and adults had completed this. However, medical staff were recorded at 88% compliance with this training. The training matrix provided for additional evidence did not identify what training staff completed in relation to learning disability and autism. The service had processes in place to follow up on patients who did not attend their appointments, especially if the appointment was for a child. There were process in place for the staff to follow to ensure those who do not attend appointments are followed up. Where safeguarding concerns were identified, there is a clear process for staff to follow to escalate their concerns.

During our on-site assessment we spoke with 24 patients’, patients told us that they had a good understanding of their care and treatment, and if they did not understand something the doctors would explain their care to them. Patients also told us that appointments were in a timely manner, and waiting times were short. Patients told us that they received reminders via a text message and were able to complete feedback about their appointment. Patients also told us that they received letters from the consultant after each appointment. Patients told us they received enough information after their procedures. We observed post operative instructions were given to patients, both written and verbally, the patient was given a copy of their GP letter. Patients were given enough time to ask questions on any of the information provided. The patient was also given advise relating to pain management and the contact information if the patient needed to recontact the doctor.

Staff told us any risks relating to the patient were highlighted on the outside or inside cover of patient’s paper records. For example, discreet stickers were used to flag patients with dementia or alert staff that a patient was a high risk for sepsis (neutropenic septicaemia). This meant staff were able to put extra support or precautions in place. Staff told us they used separate waiting areas (unused consultations rooms or the children’s waiting room if not in use) for patients with additional needs, for example, patients living with dementia or people with autism) who required a quieter waiting space. The service had doctors on site during clinic hours who provided support in the case of patients who deteriorated. The service completed Resuscitation Level 1 Basic Life Support and recorded 100% compliance with this. The service also completed Resuscitation Level 2 Adult Basic Life Support for clinical staff with a 97% compliance rate.

There was a trust wide process in place which the service were aware of for managing and escalation of a deteriorating patient. This provided staff with the information they required to ensure the situation was managed well regardless of where the emergency occurred. In addition to the deteriorating patient policy, there was also a process in place for staff to follow if risk was identified whilst the patient was in the outpatient's service and the patient required admission into the hospital as an inpatient. This complimented the deteriorating patient policy and required staff to contact the site management team. There were processes in place to risk assess patients undergoing a procedure within the department. WHO checklists and Local Safety Standards for Invasive Procedures (LocSSIPs) were completed at each procedure and this information were used within the department and audits completed for compliance purposes. The results showed 100% compliance with the audits for the service. We requested further evidence around the notes which staff completed when reviewing patients in the outpatient service. At the time of the assessment, there was no process in place to review the quality of notes completed as the service were reviewing the previous process in place. We were therefore not able to gain assurance that the quality of the notes kept were compliant with required professional standards.

Patients told us that they felt cared for and safe whilst they were visiting the service. Patients told us they felt that any information that had been shared with them in relation to their care and treatment had been explained in a manner that they could understand, also if they had any questions they felt that the doctor had answered these, which helped the patient understand their care and any treatment that was required.

Staff told us that patients could bring a carer or family member with them if they felt like they needed support. The service also provided and could provide a chaperone to go into their appointments if they felt additional support was needed. Staff told us that safety alerts were communicated to them via email, huddles, and ward meetings. Staff were able to tell us what the most recent safety alerts were and there the explanation of what the changes were. Safety alerts were also discussed and shared with board regularly updated with relevant information shared at Clinical support service (CSS) governance meeting. The service provided data to evidence that all electrical equipment had been tested and this also identified what equipment had failed. Staff told us the service had a Patient Led Assessments of the Care Environment (PLACE), this covered cleanliness, food, privacy, condition, appearance and maintenance, dementia and disability. Each area was scored, the scores for the service ranged between 85.71% and 100%.

he outpatient department was split over 2 floors, there was a lift between the floors to improve accessibility for patients with mobility problems. The service had suitable facilities to meet the needs of patients' families. The waiting area was spacious and there were enough seats for patients to bring their family or carers. There were purple footprints on the floor to help guide patients with dementia to different areas of the department. The signs for toilets were on a bright yellow background to make it easier for people living with dementia to locate them. Each clinic room had the correct equipment, and all clinic rooms had hand washing facilities. There were fire evacuations plans located on the walls within the waiting area, so in case of a fire staff and patients knew where and how to exit the building, and where the fire evacuation point was located. The service had enough suitable equipment to safely care for patients. However, we saw a blood pressure machine which was in use that had not had an electrical safety test within a specified timeframe. Staff disposed of clinical waste safely. We saw evidence clinical waste bins were emptied regularly. The service had enough resuscitation trolleys, these were all clean and tagged, regular daily and weekly checks were all completed. The glucose rescue box and the paediatrics emergency equipment grab bag checks were all completed and documented. The service had vending machines and water dispensers which patient could access. The service had a sluice room which was clean and tidy, however they did not have any spill kits available. Fire extinguishers and oxygen cylinders were secured and tagged where required. Sharps boxes were in the clinic rooms and were dated and close, once they were full, they were moved to the sluice room, and then clinical staff arranged collection.

There was a process in place locally to ensure all equipment was safely managed. Evidence provided after the assessment showed details of equipment used within the outpatient department and details of services and electrical testing. Where any items were identified as broken and required repairs, there was a process in place to ensure this was managed safely and swiftly to ensure patients were not impacted by this.

Staff told us there were high vacancy rates within the service. The booking team had a vacancy of almost 50% vacancy rates as did the domestic team. There were also some nurse vacancies, however there were some staff at interview stage. There was recognition from leaders that more needed to be done to improve retention as well as recruit more staff. Managers told us they had a large-scale recruitment campaign underway, and they were looking at ways they could make the employment package more attractive. They were also looking at how to make the recruitment process quicker as they had identified lots of potential new recruits to the service disengaged with the recruitment process because it took so long. The service had a good skill mix of trained staff; however, the service had vacancy for a senior sister, the service mitigated this management gap by ensuring other senior managers were available to give support and advice. Staff told us that they were supported to learn and develop, also competencies were completed where required. The service had support from volunteers, who were able to guide patients to the correct areas and offer support where needed. The service had paediatric nurses on duty for the diabetes speciality clinic every Thursday, also a nurse led BCG clinic, twice a month for a full day on a Friday. The service did not have any vacancies for paediatric nurses. Data had been requested from the trust in relation to staff vacancies and staff sickness, which they have stated nursing staff data were held within the outpatient's department, and medical staff vacancies and sickness rates were held in specific directorates and this information is within whole directorates, this information could not be broken down to the outpatient's department, which meant no data had been shared by the trust.

We spent time observing staffing levels and how staff interacted with patients, there appeared to be enough staffing of all levels and experience, the department had very busy times which the staffed seemed to manage well. We observed staff seeking support from the sisters in the department when they required support or advice.

There were processes in place to ensure there was enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. The service made sure staff were competent for their roles. Where necessary and where staff had identified areas for further training, staff underwent further competency assessments. Evidence provided after the assessment demonstrated evidence of relevant competency assessments for staff relevant to their needs. Managers ensured staff had the opportunity to complete supervision within their roles and to also ensure they had access to professional nurse advocates for any additional support they required. The service had processes in place to monitor staff sickness, vacancies and turnover. Managers reviewed the staffing numbers according to the clinics which were running each day. Evidence was provided for the average numbers of staff and the skill mix on shift each day. The service used bank staff to ensure clinics were full staffed. In the 3 months before our assessment the service had used 701 hours usage of bank staff to support the vacant nursing shifts. The service did not use agency staff.

Staff told us they completed Infection Prevention Control (IPC) Level 1 training compliance remains above target at 97.73%. The service provided hand hygiene audits for November 2023 and January 2024, and these scored 100%. Staff told us the service complete 3 monthly audits for IPC within the outpatient's department, However, February audits showed a drop in compliance in section c. There were also drops in compliance with hand hygiene and uniform audit in March. As a result in the reduction in compliance, the matron and leadership team were now monitoring the service closely. Staff, including IPC leads, told us that the machines used to clean the floors were not currently in use due to a problem that had been identified by NHS England in 2023 which meant the machines may have been emitting harmful spores into the environment. The trust had a plan to ensure that the machines would be able to be used again later in the year which would improve the cleanliness of the floors across the hospital.

Clinical areas were not consistently visibly clean however, all rooms had suitable furnishings which were clean and well-maintained. We saw some areas of the outpatient department that had visibly dirty floors and doors with adhesive residue which meant they were not easy to clean. We raised both infection risks with staff onsite. The adhesive residue was removed the same day. During our onsite assessment we spoke with staff and leader, including domestic staff and IPC staff. We discussed hourly cleaning rotas and them not being completed by staff, also this identified that staff were using the wrong cleaning rota. We also request the cleaning rota’s which the domestic staff completed every evening once the department was closed to patient. However, these were not provided, and the service did not evidence that cleaning had been completed. Staff followed infection control principles including the use of personal protective equipment. Staff cleaned consulting rooms at the start and end of each day. They used labels to show the rooms were clean. Staff cleaned equipment after each patient contact.

There were policies and processes in place for staff to follow to ensure the risk of infection was controlled well. The policy laid out for staff the expected standards required and the practices they were expected to complete. To ensure staff adhered to the processes and policies in place, they completed audits to assess the standards. Hand hygiene was an essential measure of infection prevention and control standards, adherence to the 5 moments for hand hygiene is a key measure in the prevention of transmitting infection. Evidence provided after the assessment showed hand hygiene results dropped in March to 93%. Also noted that uniform had also dropped. There was no additional comment on the action that was due to be taken to improve the compliance again. However, it was noted within the audit that this was not specific to the service, with many elements being recorded as not applicable. Monitoring of the cleanliness within the service was also a high priority. Evidence shared by the trust showed OPD C appears to have scored 92% according to the audit report. The audit had RAG rating details to demonstrate compliance levels. The area was required to achieve 94% or above to be compliant with the cleanliness standards. As part of the monitoring processes, the service completed some action plans in response to the audits conducted. They had an IPC assurance action plan was provided after the assessment. This appeared to have an action on this which is not relevant to the area. We were therefore not assured the processes in place for monitoring the IPC standards of the service were always effective and relevant. The policy in place was in date and referenced the appropriate documents and legislation. However, it was noted at the beginning of the policy that the assurance was required for CQC rather than referring to the Health and Social Care Act 2008 Code of Practice on the prevention and control of infections and related guidance.

Staff told us they did not have systems and processes to ensure antibiotics were not over prescribed to patients undergoing minor procedures in OPD. The data being used to monitor the prescribing of antibiotics was not live and relied on the publication of national benchmarking data. This meant, for example, prescribing of antibiotics to patients that did not require them may not be detected until patient has had completed a course of antibiotics. Overprescribing of antibiotics can lead to antibiotic resistance. Staff told us outpatients' pharmacy was outsourced to another local trust; prescribing staff gave patients prescriptions which they would take to the other trust for fulfilment. Staff told us there had been concerns over patient outcomes at times due to stock shortages such as with the antibiotic clarithromycin, which there is a national shortage. This was made even more difficult due to being unable to suggest an alternative antibiotic as there was no AMS consultant within the trust.

We observed the drugs cupboard was locked and was situated in a room which also secured. There were no concerns with how the medicines were been stored. The department did not hold controlled drugs. All medicines had an expiry date, and a list situated in the room which also identified when medicines were to go out of date. We did not find any medicines which were out of date. We reviewed the fridge and room temperatures; these were all completed and recorded appropriately. We observed doctors discussing medicines with patients and recording them, doctors also completed prescriptions on the system ready for patients to collect this from pharmacy.

There were processes in place to ensure staff prescribed, administered, recorded and stored medicines safely. The trust had a medicines policy in place which provided all relevant information which was in line with national best practice, professional standards and legislation. The policy was in date and had evidence of amendments being made when there were relevant updates which impacted the policy. The policy also covered another trust which was under the same executive leadership, but there were clearly identified areas which applied to the separate hospitals. There was a trust wide antimicrobial policy in place and processes to ensure staff were compliant with this. Information showed the trust as a whole were not meeting the target for reducing the number of antimicrobials being prescribed from the watch and reserve list. It was also noted there was no Antimicrobial Surveillance Group meetings being conducted, AMS audits were not being completed and antimicrobial wards rounds were due to recommence which meant there had been a period of no AMS ward rounds. This highlights the processes which the trust had in place was not assured for the stewardship of antimicrobial use, which in turn meant the service would not be engaged in stewardship of antimicrobials. The service provided evidence that a medicine audit was completed for March 2024, all actions completed.