Hemel Hempstead General Hospital

Updated 17 June 2020

Hemel Hempstead General Hospital has an urgent care centre (UCC) which is open from 8am to 10pm daily, seven days a week. Other facilities provided by the trust on site includes a medical inpatient ward (Simpson ward), endoscopy unit, diagnostic imaging and outpatient clinics. The inpatient ward was transferred to the trust from another provider in October 2019. 

Updated 17 June 2020

Our rating of services stayed the same. We rated it them as requires improvement because:

• Patients assessments were not always completed in a timely manner, and records were not always kept up to date. There remained some confusion within the inpatient team as to the long term plans for the service.

However

• Urgent and emergency care services improved and were rated good overall. There had been improvements in the governance arrangements of the department and there was clear oversight from clinical leads based at Watford General Hospital. The team were fully engaged and were starting to look at quality and service improvements.
• Medical services improved and were rated as requires improvement. There had been changes to the functionality of the inpatient area and the leadership which had impacted positively.

Updated 17 June 2020

• The service had enough staff to care for patients and keep them safe and most staff had completed relevant training. The service controlled infection risk well. Staff did not always assess risks to patients, act on them or kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.

• Staff provided good care and treatment and gave them pain relief when they needed it. However, documentation did not always demonstrate that a patient’s food and fluid intake had been assessed accurately. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.

• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.

• 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.

• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually. However, not all risks had been identified by leaders.

Updated 1 March 2017

We inspected, but did not rate, elements of the safe key question. We did not inspect the effective, caring, responsive, or well-led key questions on this inspection. Significant improvements had been made since the April 2015 inspection. We found that:

• Staff knew how to report incidents appropriately and incidents were investigated, shared, and lessons learned. Risks in the environment and in the service had been recognised and addressed and the service had a robust risk register in place.
• Standards of cleanliness and hygiene were well maintained. Reliable systems were in place to prevent and protect people from a healthcare associated infection.
• Facilities were in a good state of repair in the mortuary. The air-change system in the mortuary was being monitored to ensure there were no risks to staff.
• Appropriate checking systems were in place to monitor the temperatures of the body fridges. Equipment was generally well maintained and fit for purpose. Chemicals hazardous to health were generally appropriately stored.
• Appropriate systems were in place to respond to major incidents and emergencies.

Updated 10 January 2018

Overall, we rated the outpatients and diagnostic imaging service as good because:

• Since our previous inspection in September 2016, an outpatient quality improvement plan (QIP) had been implemented. Performance data had improved and the service was performing in line with their planned trajectory.
• There was a positive incident reporting culture across the hospital. All staff we spoke with knew how to report an incident and were aware of details of recent incidents and learning.
• Radiation protection in the diagnostic imaging department was robust.
• The main outpatient department had no nursing vacancies at the time of our inspection.
• Since our previous inspection in September 2016, the availability of patient notes had improved.
• Medical records were comprehensive, legible, accurate and up-to-date. They were stored safely in a locked office or in lockable trolleys when being used in clinics.
• Medicines and prescription pads were stored securely in all areas we visited.
• Waiting lists for outpatient appointments were reviewed weekly. Risk assessments and individual treatment plans were completed for patients who waited 30 weeks or more. At the time of our inspection, no clinical harm had occurred to patients because of waiting over 30 weeks.
• Care and treatment was delivered in line with evidence-based guidance, standards and best practice. Pathways were in place for the management and treatment of specific medical conditions that followed national guidance.
• There was a local audit programme in the outpatient department that included monitoring compliance with best practice.
• The diagnostic imaging department was working towards the Imaging Services Accreditation Scheme (ISAS).
• There was a comprehensive clinical audit programme in the radiology department to monitor compliance with trust policy and Ionising Radiation (Medical Exposure) Regulations (IR(ME)R).
• Clinics were run by specialists in their field and staff were supported to develop based on their professional and clinical interests. Multidisciplinary meetings were held to assess, plan and deliver co-ordinated patient care.
• The service communicated regularly with patients’ GPs and worked with the trust’s GP liaison manager to share information.
• Staff understood their responsibilities for obtaining consent and making decisions in line with legislation, including the Mental Capacity Act (MCA) 2005.
• Patients were treated with kindness, dignity, respect and compassion. In addition, staff were considerate of people’s personal, cultural, and religious needs.
• Chaperones were offered and available throughout the outpatient and diagnostic imaging services.
• Staff communicated with people so that they understood their care, treatment and condition. Patients we spoke with felt well-informed about their treatment and could explain what would happen next.
• Staff recognised when people needed additional support to help them understand and took action to meet their needs.
• Patients we spoke with described being offered emotional and social support.
• During our last inspection, we were not assured that patients had timely access to outpatient treatment. The service was found to be in breach of Regulation 12 of the Health and Social Care Act Regulations 2014: Safe care and treatment, due to being worse than national standards for waiting times. During this inspection, we found that most waiting times had improved to meet national standards.
• The trust had improved its performance for cancer waiting times and was meeting the national standard in four out of five measures.
• Patients had timely access to diagnostic imaging services and the percentage of patients waiting more than six weeks was lower than the England average.
• Services were planned and delivered to take into account different people’s needs. This had improved since our previous inspection with the introduction of written information in languages other than English.
• The main outpatient department was working towards gaining a Purple Star accreditation for the care and treatment they provided to patients with a learning disability.
• The phlebotomy service engaged with people in vulnerable circumstances and took actions to overcome barriers when people found it difficult to access services.
• Leaders and staff across outpatient and diagnostic imaging services were continuously striving for improvement. In addition to the QIP, local leaders had further plans to improve services.
• The culture in across outpatient and diagnostic imaging services encouraged openness, candour and honesty. All staff we spoke with felt supported, respected and valued.
• Patients, relatives and visitors were actively engaged and involved when planning services. People were encouraged to provide feedback and we saw their comments used to improve services.
• Leadership of the diagnostic imaging department was focused on driving improvement and delivering high quality care to patients.

However:

• During our previous inspection, we found that not all staff working in clinics that saw children had the appropriate level of safeguarding training. This was still the case at the inspection in August 2017.
• We could not be assured that the service was fulfilling its mandatory duty to report cases of female genital mutilation (FGM) as all staff we spoke with were unaware of the trust policy on identifying and assessing the risk of FGM.
• Hand hygiene and environmental infection control audits were not carried out in the phlebotomy department.
• Compliance with fire safety training in the radiology department was worse than the trust target of 90%.
• Staff compliance with Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DOLS) training was below the trust target.
• There were no seven-day outpatient services provided at the time of inspection. Some ad-hoc Saturday clinics had been provided, but this had not taken place since March 2017. There were no plans to introduce evening or weekend clinics.
• Friends and Family Test scores for outpatient services across the trust were worse than the England average from January to June 2017. This had improved in July 2017.
• Five out of 16 specialties were not meeting the England overall performance for patients being seen within 18 weeks of referral.
• During the previous inspection, it was raised that hearing loops were not in use to aid people with hearing impairment. This was still the case at the most recent inspection.
• Staff were not always informed in advance if a new patient had mobility issues, a learning disability or dementia. This meant adjustments could not be made prior to their attendance to facilitate their journey through the department.
• At the time of inspection, there was only one risk on the outpatient department risk register. This was related to clinics being overbooked. However, during our inspection we identified other risks that should have been recognised and mitigated.

Updated 17 June 2020

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

The service maintained safe staffing numbers and ensured that staff received the appropriate training to complete their roles. Patient risks were assessed, and referrals were made to appropriate services or clinicians in a timely manner. There were processes in place to ensure patient safety and follow up any incidents or delays to ensure patients were not harmed. Clinical areas were clean, well maintained and suitable to patient’s needs. Medicines were managed in line with guidance and policy.

Staff used relevant guidance to inform treatment and decision making. Staff worked collaboratively to manage the workload and were supported by managers to ensure competence and development. Patients pain was well managed, and patients could access food and hydration. The service was available seven days a week and staff offered guidance to patients to lead healthier lives.

Patients were treated respectfully and with compassion. Where possible feedback was gathered, and this was largely positive. Patients relatives were supported.

The service was designed to meet the needs of the local population and staff worked flexibly to ensure that patients were treated in line with key performance indicators. Specific needs were largely met. Managers measured treatment times to ensure that performance was in line with national guidance. Complaints were well managed, and any learning shared across the team.

There had been changes across the leadership and governance structure of the service which staff felt were positive. There was a shared governance process across the trust, and a robust process for escalating information to and from the clinical leads and trust board. Audits were used to inform decision making about performance and risks were reviewed regularly. There was a positive culture of support and staff worked collaboratively with partner organisations to maintain an effective service.