Sir William Gowers Centre

Updated 11 December 2018

The Sir William Gower Centre is a specialised assessment and treatment centre for people with epilepsy and non-epileptic attack disorder. It is part of the University College Hospitals London NHS Foundation Trust (UCLH), but is located outside of London, in Buckinghamshire. The centre is part of The National Hospital for Neurology and Neurosurgery (NHNN) division but is separately registered as a location with CQC.

The centre is run in partnership with a charity. The centre had an inpatient ward with 26 beds and a separate outpatients service.

Our inspection was announced (staff knew we were coming) to ensure that everyone we needed to talk to was available and took place between 24 July and 13 August 2018.

During our inspection, we spoke with 20 members of staff, including nurses, doctors, health care assistants, and administrators. We also spoke with nine patients and/or their carers, and looked at 10 care records.

Updated 11 December 2018

• We rated caring and responsive as outstanding, effective and well led as good and safe as requires improvement.
• We rated medical care as outstanding and outpatient services as good overall.
• Staff cared for patients with compassion. Feedback from patients and their carers confirmed that staff treated them well and with kindness. We were consistently told by patients that staff were very caring and went above and beyond the call of duty.
• All patients, relatives and carers we spoke with described their experiences as positive and said they were always included in care planning. Patients told us that their privacy and dignity was respected, especially during physical or intimate care or when they were most vulnerable when they had a seizure.
• The service provided care and treatment that was tailored to meet people’s individual needs. The preadmission nursing assessment included detailed questions on the patient’s individual communication requirements and behavioural preferences. Staff we spoke with demonstrated a patient-centred approach to making adjustments to support patients’ admission and a good understanding of caring for patients with a learning disability.
• Mandatory training compliance for nursing staff was above the trust target of 90% for all modules.
• Processes for establishing and addressing clinical risk and safeguarding needs were clearly embedded. There were robust processes to assess patient risk. Patients were triaged by a consultant and pre-assessed by nursing staff prior to admission, and then had through nursing and medical assessments upon admission.
• Systems were in place for recording, investigating and learning from incidents that occurred across the trust.
• Staff we spoke with demonstrated a strong understanding of safeguarding procedures and knew how to raise concerns. They said they felt they could contact the trust safeguarding team when they needed to and were well supported by them.
• There was effective multidisciplinary team working. Relevant professionals were involved in the assessment, planning and delivery of patient care.
• Care and treatment were evidence-based and staff represented the specialty and trust on international expert panels and committees. This enabled them to plan care with the latest available understanding of epilepsy and its treatment.
• Staff demonstrated a passion and commitment to the development of the service. There was a strong focus on research activity to help drive improvement in patient outcomes. Staff were involved in the development of innovative practice including research to eliminate epileptic seizures through improved surgical planning and reduce seizures through innovative diet control.
• There was a clear leadership structure and staff told us they felt well supported by their line managers. There was a strong positive culture and good morale amongst staff at the unit. Staff were proud of the care they provided and had a patient-centred approach.

However:

• Infection control and environmental standards in the outpatients department were inconsistent and did not reflect good practice. The environment was not in a good state of repair, clean and free from infection risks. There was a need for improvement in daily monitoring of cleanliness of these areas.
• The service occasionally admitted children aged 16 and 17 but no staff had level three safeguarding training. However, staff demonstrated a good understanding of safeguarding procedures.
• In outpatients, the pharmacy staff told us there was no coherent medicines management system in place and they had limited access to safety and governance processes, which they said reduced safety. On the inpatient unit, there was no temperature monitoring for the storage of non-refrigerated medications. This meant that medication could be exposed to temperatures above the recommended maximum.
• There were some gaps in the systems in place for staff or patients to call for emergency help and non-clinical staff did not have basic first aid or basic life support training. This presented a risk as outpatients may not always have a second clinical member of staff on shift.
• There were inconsistencies in the standards of patient record completion in relation to the legibility of writing and staff signatures.

Updated 11 December 2018

This site has not been inspected under our new methodology so there is no previous rating.

We rated it as outstanding because:

• Mandatory training compliance for nursing staff was above the trust target of 90% for all modules.
• Staff we spoke with demonstrated a strong understanding of safeguarding procedures and knew how to raise concerns. They said they felt they could contact the trust safeguarding team when they needed to and were well supported by them.
• There were robust processes to assess patient risk. Patients were triaged by a consultant and pre-assessed by nursing staff prior to admission, and then had through nursing and medical assessments upon admission. Where patients were at risk of seizure-related injury, necessary precautions were taken such as helmets and padded bed rails.
• There was strong multidisciplinary team (MDT) working. The service held weekly MDT meetings which included the clinical lead, consultants, SHOs, the ward sister, pharmacist, and a ward nurse.
• Medical and nursing staff worked well together. Staff said they interacted regularly as it was a small single site. They met at formal meetings on Tuesdays every week, and on Fridays in ward rounds. The SHOs interacted daily with ward staff, and the ward sister usually had daily contact with the clinical lead.
• The service provided care and treatment that was tailored to people’s individual needs. The preadmission nursing assessment included detailed questions on the patient’s individual requirements and preferences. These included behavioural preferences, communication, mood, mobility, personal care requirements, and seizure-related details.
• There was a clear leadership structure and staff told us they felt well supported by their line managers. There was a strong positive culture and good morale amongst staff at the unit. Staff were proud of the care they provided and had a patient-centred approach.

However:

• The service occasionally admitted children aged 16 and 17 but no staff had level three safeguarding training. However, staff demonstrated a good understanding of safeguarding procedures.

Updated 11 December 2018

This site has not been inspected under our new methodology so there is no previous rating.

We rated it as good because:

• Care and treatment were evidence-based and staff represented the specialty and trust on international expert panels and committees. This enabled them to plan care with the latest available understanding of epilepsy and its treatment.
• Standards of mandatory training and continuing professional development were embedded, met trust standards and reflected a culture of learning amongst all staff.
• There was a demonstrable focus on research activity to improve patient outcomes, which was reflected in the development in specialist treatment and permanent presence of a research team.
• Processes for establishing and addressing clinical risk and safeguarding needs were clearly embedded.
• Systems were in place for recording, investigating and learning from incidents that occurred across the trust.
• Care and treatment was coordinated in a multidisciplinary, multi-organisational environment that demonstrably met individual needs.
• All patients and relatives we spoke with described their experiences as positive and said they were always included in care planning.
• Staff were demonstrably passionate and committed to the development of the service and the trust placed significant focus on the site in the vision and strategy.
• The service provided significant additional capacity to the trust’s larger locations and offered shorter waiting times and a calmer environment for patients.

However:

• Infection control and environmental standards were inconsistent and did not reflect good practice.
• There was a lack of daily senior oversight in some areas that led to substandard infection control and out of date resources such as in relation to health promotion and directional signage.