St Helier Hospital and Queen Mary's Hospital for Children

Updated 14 February 2024

Pages 1 and 2 of this report relate to the hospital and the ratings of that location, from page 3 the ratings and information relate to maternity services based at St Helier Hospital and Queen Mary's Hospital for Children.

We inspected the maternity service at St Helier Hospital and Queen Mary's Hospital for Children as part of our national maternity inspection programme. The programme aims to give an up-to-date view of hospital maternity care across the country and help us understand what is working well to support learning and improvement at a local and national level.

St Helier Hospital and Queen Mary’s Hospital for Children provides maternity services to the population of south west London and north east Surrey. St Helier and St Mary’s Hospital for Children is 1 of 2 sites for maternity services for the trust. Maternity services at St Helier Hospital comprise of a consultant led delivery suite, alongside midwifery led unit and a 40-bed maternity ward providing ante and post-natal care and an induction of labour bay. There is a maternity assessment unit and triage space, on the delivery suite, and antenatal clinics. Between April 2022 and March 2023 there were 2,220 deliveries at St Helier Hospital. Maternity services are operated as one service over 2 sites (St Helier Hospital and Queen Mary's Hospital for Children and Epsom General Hospital) with the same leadership team and governance processes.

We will publish a report of our overall findings when we have completed the national inspection programme.

We carried out a short announced focused inspection of the maternity service, looking only at the safe and well-led key questions.

Our rating of this hospital ​stayed the same​, we rated it as Good because:

Our rating of Requires Improvement for maternity services did not change ratings for the overall hospital.

We rated safe as Inadequate and well-led as Requires Improvement in maternity services.

We also inspected other maternity services run by Epsom and St Helier University Hospitals NHS Trust. Our report is here:

Epsom General Hospital - https://www.cqc.org.uk/location/RVR50

How we carried out the inspection

We provided the service with 45.5 working hours notice of our inspection.

We visited maternity assessment unit, triage, delivery suite, maternity theatres and the maternity ward which included post and antenatal inpatient care and induction of labour bay.

During the inspection we spoke with specialist midwives, 16 midwives and support staff, and 3 doctors. We also spoke with spoke with 1 woman or birthing person. We received 66 responses to our give feedback on care posters which were in place during the inspection.

We reviewed 7 patient care records, 7 observation and escalation charts and 7 medicines records.

Following our onsite inspection, we spoke with senior leaders within the service; we also looked at a wide range of documents including standard operating procedures, guidelines, meeting minutes, risk assessments, recent reported incidents as well as audits and action plans. We then used this information to form our judgements.

You can find further information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

Updated 27 May 2016

We rated medicine as good for being effective and well led; but as requiring improvement for being safe, caring and responsive. We foundmandatory training and staff appraisal completion rates were low; not all patient records were accurate; some wards repeatedly fell below the trust's infection control thresholds' and patients were able to access areas of wards that might compromise their safety. We also found staff were not always carrying out daily checks of resuscitation equipment.

The medical directorate’s use of locum staff, both medical and nursing, had consistently been above the trust average. The hospital had recently undergone a recruitment drive which had enabled it to fill some of its nursing and medical vacancies.

There was a lack of clarity amongst staff with regard to how the Deprivation of Liberty safeguards should be used. Staff generally provided care in a compassionate and kind way that preserved patients’ dignity, and said they felt supported by their line managers to provide high quality care. Patients’ feedback was largely positive however relatives’ comments were less so.

In all but neurology and dermatology, the medical directorate achieved the 18 week referral to treatment thresholds. The average length of stay trust wide was similar to the England average, but longer at St Helier for non-elective geriatric medicine.

Updated 14 May 2018

Our rating of this service improved. We rated it as good because:

• There was a good overall safety performance in the service and a culture of learning to ensure safety improvements. Staff were encouraged to report incidents and received timely feedback. There was evidence of learning from incidents, which was shared in a number of ways.
• There were processes in place to ensure safe staffing levels. The service had 24 hour consultant cover.
• There were effective processes in place to assess and escalate deteriorating patients.
• There was good compliance with infection prevention and control processes. Equipment was checked regularly and medicines were stored appropriately.
• Staff had a good understanding of safeguarding and were aware of their responsibilities in relation to safeguarding children. The service had good multi-agency partnerships to share relevant safeguarding information.
• Patient records were completed to a good standard.
• Staff provided care and treatment in line with national guidance and good practice. The service monitored the effectiveness of care and treatment through continuous local and national audits.
• There were effective processes in place to ensure that patients’ nutritional and pain management needs were met.
• Staff were supported to develop and there was a culture of learning and teaching within the service.
• There was effective multidisciplinary team (MDT) working both internally and externally to support patients’ health and wellbeing.
• There was a range of information and support available for patients and their families and carers. Staff helped patients manage their own health.
• Staff understood their responsibilities as set out in the Mental Capacity Act (MCA).
• Staff in children and young people’s services demonstrated a patient-centred approach which encouraged family members to take an active role in their child’s healthcare.
• All staff interacted with patients and their family members and carers in in a caring, polite and friendly manner.
• The service had a broad programme of emotional support services for children and young people and their families and carers. This included a variety of therapeutic support services.
• There was timely access to a broad range of children and young people services including a number of highly specialist paediatric services. The flow of patients through children and young people services from admission, through theatres, wards and discharge was mostly managed effectively.
• There was provision to meet the individual needs of children and young people using services at the hospital, including vulnerable patients and those with specific needs. There were efforts across the hospital to make the environment more child-friendly and welcoming for young people.
• There was an established and stable leadership team in the CYP service. Staff told us senior leaders of the service were visible, approachable and supportive. There was an inclusive and constructive working culture within the services. We found dedicated staff that were knowledgeable about their work.
• The department used appropriate governance, risk management and quality measures to improve patient care, safety and outcomes. Senior staff understood their local challenges and demonstrated a desire to improve CYP services for the benefit of patients.

However:

• There remained some challenges with staffing vacancies, for example, nurse staffing in the neonatal unit (NNU) and on the children’s ward. Managers were aware of these challenges and there were interim measures in place to ensure safety.
• The hospital had one lift to serve all floors. The lift was taken out of service when routine maintenance was required. However, a business plan was in place to build a new external lift.
• There was no formal clinical supervision for nursing staff.

Updated 27 May 2016

We rated the critical care unit as ‘requires improvement’ overall. Although staff were reporting incidents, there was no system in place to ensure that all staff were learning from incidents. We identified gaps in record keeping and found that intravenous (IV) fluids were not being stored securely. The unit was small and cramped and staff told us this made it difficult to have all the equipment required around the patient bedspace.

There was a lack of agreed guidelines specific to the critical care unit and multidisciplinary working was not well embedded. The unit had a larger number of delayed discharges and out of hours discharges compared to similar units and staff in other parts of the hospital reported delays in accessing critical care.

Patients were not always given the opportunity to be involved in their care. There was a poor response to patient feedback surveys and the unit did not offer a follow up clinic for patients post discharge.

The leadership team had struggled to achieve good team dynamics because of behavioural issues from certain staff members and had not been successful in their attempts to manage this. The service had been unable to agree a strategy and an external advisor had been appointed by the trust to assist the critical care workforce in achieving this. The culture on the unit was very hierarchical and challenges were not always welcome.

The unit had good outcomes for patient when compared to similar units and staffing was in line with national guidelines, although agency nurses were used frequently. Staff, including agency, received a good induction and competency based assessment prior to caring for patients independently. Doctors in training received good teaching and support from consultants and patients we spoke with spoke highly of the staff and the care they received on the unit.

Updated 27 May 2016

The Specialist Palliative Care (SPCT) team provided end of life care and support six days a week, with on call rota covering out-of-hours. There was visible clinical leadership resulting in a well-developed, motivated team.

Patients told us the ward based staff and the palliative care clinical nurse specialists were caring and compassionate and we saw the service was responsive to patients’ needs. The SPCT responded promptly to referrals. There was fast track discharge for patients at the end of life wishing to be at home or their preferred place of death.

Staff throughout the hospital knew how to make referrals to the SPCT and referred people appropriately. The team assessed patients promptly, to meet patient needs. The chaplaincy and bereavement service supported patients’ and families’ emotional and spiritual needs when people were at the end of life.

Most hospital staff were complimentary about the support they received from the SPCT. Junior doctors particularly appreciated their support and advice, and said they could access the SPCT at any time during the day. They recognised that the SPCT worked hard to ensure that end of life care was well embedded in the trust.

The director of nursing had taken the executive lead role for end of life care, along with a non-executive director (NED), to ensure issues and concerns were raised and highlighted at board level. The trust's board received EOLC reports, outlining progress against key priorities within the EOLC strategy, including audit findings, themes from complaints and incidents, evidence of learning and compliance with end of life training requirements.

The SPCT provided a rapid response to referrals, assessed most patients within one working day. Their services included symptom control and support for patients and families, advise on spiritual and religious needs and fast-track discharge for patients wanting to die at home.

The National Care of the Dying Audit 2013/2014 (NCDAH) demonstrated that the trust had not achieved three out of seven organisational key performance indicators. At the time of the inspection, the trust had not fully rolled out the replacement of the LCP, and this delay meant that staff were not fully supported to deliver best practice care to patients who were dying. The leadership failed to apply enough urgency to have an individual plan of care in place.

Updated 14 February 2024

Updated 27 May 2016

Overall, we found that outpatients and diagnostic imaging were good. The service was rated as good for safety, caring, responsive and well-led. The effective domain was inspected but not rated. Some aspects of the delivery of safe patient care in relation to radiation safety were excellent.

Patients, visitors and staff were kept safe as systems were in place to monitor risk. Staff were encouraged to report incidents and we saw evidence of learning being shared with the staff to improve services. There was a robust process in place to report ionising radiation medical exposure (IR(ME)R) incidents and the correct procedures were followed. The pathology department had a comprehensive quality management system in place with compliance targets set at higher than the national average to improve safety and quality. There was evidence of excellent practice for the monitoring and administering of patient radiation doses to be as low as possible.

The environments we inspected were visibly clean and staff followed infection control procedures. Records were almost always available for clinics and if not, a temporary file was made using available electronic records of the patient. Staff were aware of their responsibilities within adult and children safeguarding practices and good support was available within the hospital.

Nurse staffing levels were appropriate and there were few vacancies. The diagnostic imaging vacancies were higher, particularly ultra sonographers. There was an ongoing recruitment and retention plan in place.

There was evidence of service planning to meet patient need such as the emergency eye service offered Monday to Friday 8.30am to 4.30pm for patients with sight threatening eye conditions, requiring urgent specialist ophthalmic treatment. National waiting times were met for outpatient appointments and access to diagnostic imaging. A higher percentage of patients were seen within two weeks for all cancers than the national average, but the cancer waiting times for people waiting less than 31 days from diagnosis to first definitive treatment and the proportion of people waiting less than 62 days from urgent GP referral to first definitive treatment were both below the national average.

Staff had good access to evidence based protocols and pathways. There was limited audit of patient waiting times for clinics, but patients received good communication and support during their time in the outpatients and diagnostics departments. Staff followed consent procedures and had a good understanding of the Mental Capacity Act 2005.

We observed and were told that the staff were caring and involved patients, their carers and family members in decisions about their care. There was good support for patients with a learning disability or living with dementia.

Staff were aware of the complaints policy and told us how most complaints and concerns were resolved locally.

The outpatients and diagnostic imaging departments had a local strategy plan in place to improve services and the estates facilities. From December 2015, the current outpatient services that are in Clinical Services Directorate will move to a new Outpatients and Medical Records Division. Staff expressed some concern over these changes.

Governance processes were embedded across outpatients and diagnostics. The directorate was commended on its risk register in a recent review of risk registers in the trust. Senior managers told us the newly appointed quality manager had made significant improvements in making sure priorities, challenges and risks were well understood. Good progress was evident for improving services for patients.

We found good evidence of strong, local leadership and a positive culture of support, teamwork and innovation.

Updated 27 May 2016

Overall, we found renal services were good. Reviews of care through incident investigation and morbidity and mortality were completed throughout the service and opportunities for learning were shared with staff. Infection control practices were robust in all areas. Staffing levels and skill mix were appropriate in all areas across the service with low agency staff usage.

Patient outcomes were in line or exceeded with national standards and effectiveness was regularly assessed and benchmarked. There was effective multidisciplinary working, with specialist nurses and allied health professionals and joint clinics were held with relevant specialties including diabetes. However we noted that standards for vascular access for haemodialysis were not met.

Most patients’ spoke positively of the care they received within the hospital, and individual patient needs were met. Delays in transport were noted as a particular concern by patients’ and their carers.

The environments in the dialysis units were cramped and in some areas, including at St Helier, facilities for patients were limited.

The service was well led with a clear vision and strategy and effective governance and risk management processes. Managers in the service were aware of shortfalls and took steps to address them. Staff spoke positively of the leaders and culture within the service . 

Updated 19 September 2019

• Following our inspection in 2018, there had been improvements to the surgical service. The trust had strengthened the leadership of the service with the recruitment of senior nursing staff. In addition, the trust appointed two joint directors of planned care to oversee surgical services. There were clear lines of responsibility and accountability on the units and staff understood how to escalate problems.
• There were effective systems in place to protect patients from harm and a good incident reporting culture.
• Patients received effective, evidence-based care from staff who were appropriately qualified to care for them. The service monitored the effectiveness of care and treatment and achieved good outcomes for patients.
• Feedback for the services inspected were mostly positive. Staff respected confidentiality, dignity and privacy of patients.
• Services were developed to meet the needs of patients. The service had recently opened a new Surgical Ambulatory Care Unit (SACU) for rapid assessment and treatment of patients. There were dedicated surgical wards for different specialities and good patient flow across surgical services.
• Most staff were positive about the local leadership across surgical services. In contrast to findings during our last inspection, staff felt the senior leadership were visible and approachable. Nursing staff felt senior staff listened when they raised concerns about staffing and they were willing to improve the service.

However:

• Staff on Mary Moore ward and the SACU said they were caring for too many patients and did not always have enough time to provide the appropriate level of care.
• Medicines management was not always in line with best practice. Allergy statuses were not recorded for nine out of 10 patient prescription sheets reviewed on the SACU. The fridge temperature on B3 Ward was not checked regularly and the room temperature was not checked. Staff did not update the controlled drugs register to reflect when patients were discharged with “to take out” (TTO) medication.

Updated 19 September 2019

Our rating of this service stayed the same. We rated it as requires improvement because:

• Staff we spoke with were not always able to demonstrate they understood how to protect patients from avoidable harm or abuse.
• The service did not always monitor the effectiveness of care and had limited scope to improving the service as a result.
• The paediatric ED did not have a suitable room for assessing children and young people presenting with mental ill health.
• The service did not adequately safeguard children and young people who had left the department without being assessed by a member of the nursing or medical team.
• The service was not achieving national key performance indicators in line with the Royal College of Emergency Medicine (RCEM).
• Appraisal rates for staff in urgent care and emergency services across staff grades had not attained the trust’s target of 85%. Yearly appraisals were not completed in line with the trust’s target for any of the staffing groups working in the emergency department.
• Governance and risk management processes were not as strong or effective as would be expected. There service did not have effective systems for identifying risks, planning to eliminate or reduce them.

However:

• There was good multidisciplinary team working both within the department and with teams outside the department, including external partners.
• Staff were using latest guidelines to provide effective treatment, these were up-to-date with national guidance, regularly reviewed and audited.
• Staff delivered care and treatment with kindness and compassion.