George Eliot NHS Hospital

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

The service had access to risk assessments which were based on nationally recognised, evidence-based assessments. Staff mostly completed and update risk assessments for each patient but the risk assessments lacked key detail. Managers used information from audits to improve care and treatment for patients. Staff followed national guidance to gain patients’ consent.

This service scored 62 (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 felt their needs were being assessed and they understood their care and treatment. Patients felt the staff worked well together and with the wider team to assess their needs. We spoke to 3 patients who were boarding on different wards, and they all told us they were happy with the situation, it had been explained to them why they were there and were being cared for well.

Staff mostly completed and updated risk assessments for each patient and reduced foreseeable risks. Staff used booklets to complete the risks assessments. There was an online system to complete observations and some further assessments. We reviewed 32 records and found them to have up-to-date risk assessments completed for most of the patients. However, we found that whilst the risk assessments were complete, at times, they lacked detail. It was highlighted on the electronic dashboard when tasks were overdue. On Elizabeth ward, they had highlighted this and implemented an admission checklist for the ward to prompt staff to complete certain assessments on admission, this included the MUST scores. The service had patients on the wards who were ‘boarding’. This meant they were there in addition to the bed numbers and a bed space had been created for them. There was a criteria to ensure the patients boarding were suitable as well as a risk assessment. This was monitored monthly by matron during their safe environment audit. Staff considered the patient and their needs as well as the needs of the carers or families. For example, on Felix Holt ward and Bob Jakin ward, the consultants had set slots every week for families to book into to have a discussion or if they needed further support. Patient records were audited monthly but there were no associated action plans. In April 2024 114 records were audited including all aspects of the patient records. We saw that 6 out of 60 patients who required a sepsis screen did not have one and 8 out of 66 patients had not had their ReSPECT form completed appropriately. However, there was no action plan associated with the audit therefore we were not assured that actions were taken to make improvements where needed. Managers communicated the audit results to staff in team meetings and newsletters.

Staff mostly followed up-to-date policies to plan and delivered high quality care according to best practice and national guidance. However, we did find the enhanced care policy was out of date in 2019; we raised this with the managers. At handover meetings, staff routinely referred to the psychological and emotional needs of the patient and their relatives. For example, we listened to a handover on Aubrey Lodge and the staff stated that a patient was lonely in their room, and it was affecting their mental health. They planned to move the patient into a bay to provide some company for them. Staff completed patients’ fluid and nutrition charts where needed but they did not always give patients enough food and drink to meet their needs and improve their health. We observed 3 mealtimes during our assessment. On Felix Hold ward and Melly ward, all patients who were able sat out in a chair for their meal and staff assisted where needed. However, we saw on the Acute Medical Unit staff did not always assist patients with their food or drinks. We saw meals were left untouched and not always put in reach of the patients. We observed a healthcare assistant giving a patient 1 mouthful of mashed potato and gravy and then taking the food away without offering the patient more food or their yoghurt. We were told about “tea trolley learning sessions” where specialist nurses came to the wards, offered the nurses a cup of tea and did a short evidence-based learning session. Staff told us these were really useful.

The service used National Institute for Health and Care Excellence (NICE) guidelines to ensure care was evidence-based. The risk assessments staff used were evidence-based and widely used and recognised across healthcare. Policies, processes and other supporting documentation in relation to risk assessments within patient care was based upon national guidance and policies. NICE guidelines were discussed in monthly governance meetings and allocated to clinicians to ensure relevant information was utilised. There was a deep vein thrombosis pathway which had been implemented to avoid hospital admission. There was a stroke pathway which meant all patients who had an acute stroke were transferred to a neighbouring hospital. Once the patient was fit for rehabilitation, they were transferred back to the Felix Holt ward. There was a frailty service which was led by a physician associate on the acute medical ward. They had their own assessment booklets and patients had rapid assessments from physiotherapists and occupational therapists to try and support prompt discharge.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

Managers and staff carried out a comprehensive programme of repeated audits to check improvement over time. Managers used information from the audits to improve care and treatment. Managers shared and made sure staff understood information from the audits. Improvement was checked and monitored. The endoscopy service had received Joint Advisory Group on GI Endoscopy (JAG) accreditation. The dementia nurses conducted an audit against the compliance with the ‘forget me not’ pathway. Results showed that there had been significant improvement since the first audit in all the standards measured. For example, in the first audit 0% of patients had a ‘This is me’ booklet and this audit showed 90% of patients had this in place and the first audit showed 15% of patients had the appropriate use of Deprivation of Liberty Safeguards (DoLS) and this audit showed this had improved to 90%.

The service participated in relevant national clinical audits. These included the National Audit of Care at End of Life (NACEL), Dementia Care in General Hospital, Sentinel Stroke National Audit Programme (SSNAP), National Audit of Cardiac Rehabilitation Quality and Outcomes Report 2023, National Audit of Inpatient Falls (NAIF) and the Society for Acute Medicine Benchmarking Audit (SAMBA). Outcomes for patients were mostly positive. Where they weren’t, such as the NAIF audit which showed outcomes for patients were mixed, there was a clear and detailed falls safety action plan. This was reviewed monthly at the falls steering group. We looked at the key successes and key concerns for all the audits and there were actions to make improvements where required. For example, the service were below national average in documentation for case notes for the NACEL audit. They implemented a retrospective audit to be completed, they were reviewing the training package and had formed an End of Life Care Improvement Group. The service discussed the SSNAP audit results at monthly meeting. The physiotherapist told us they were creating a plan of how to bring in the SSNAP requirement of 3 hours of therapy per patient with the number of staff they had. The matron completed Care Quality Indicator audits for each ward every 2 months. This consisted of 48 questions including risk assessments, infection prevention and control, environment, incidents and complaints. These were discussed at governance meetings and safety huddles. There was a hospital audit day on 13 May 2024 where doctors were encouraged to present their audit projects and its findings.

Patients told us staff gained consent to provide treatment. They told us doctors explained their condition and plan well. All patients we spoke to knew why they were in hospital and what they were waiting for. We observed a ward round on the acute medical ward and found the doctors to be engaging, informative and made daily plans for the patients care. We observed a physiotherapist approach a patient and ask them for their consent to provide treatment. The patient declined the treatment and the physiotherapist respected this and said they would review them later in the day.

Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent. Staff made sure patients consented to treatment based on all information available. Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. We looked at 32 records and saw that where required, a mental capacity assessment had been completed along with a Deprivation of Liberty Safeguards (DoLS) if required. Staff told us that on Elizabeth Ward they completed MCA on all patients on admission to ensure they had a baseline of their capacity and could reassess if this changed. Staff received and kept up to date with training in the Mental Capacity Act (MCA) and DoLS. Training percentages were 94.5% for DoLs and 95.5% for MCA. Staff could describe and knew how to access the policy and get advice on MCA and DoLS.

There was an up-to-date consent policy which staff followed when gaining consent from patients. Staff clearly recorded consent in the patients’ records. We saw the appropriate use of a consent form for a patient who lacked capacity. Staff knew how to support patients who lacked capacity to make their own decisions. They used measures that limit patients’ liberty appropriately.