Kidderminster Hospital and Treatment Centre

Updated 20 September 2019

Kidderminster Hospital and Treatment Centre provides a minor injuries unit, medical care, surgery, outpatients and diagnostic imaging services.

The minor injuries unit (MIU) at Kidderminster Hospital and Treatment Centre is open 24 hours a day, seven days a week. From May 2018 to April 2019, there were 21,356 attendances at the MIU. 27% of these were children of 17 years and under. The MIU provides care and treatment for patients with minor injuries, such as wounds, sprains, broken bones, minor dislocations and head injuries. It is staffed by emergency nurse practitioners and health care support workers. Emergency nurse practitioners (ENPs) are experienced and specially trained nurses who are qualified to diagnose and treat minor injuries. Patients generally present to the MIU by walking into the reception area and booking in. Some patients (from two to six per week) arrive by ambulance. Patients who attend should expect to be assessed, transferred or discharged within a four-hour period in line with the national target for emergency and urgent care facilities.

Medical care services include endoscopy and renal dialysis. The renal dialysis unit is open from Monday to Saturday between the hours of 06:00am and 19:30pm and provides two sessions per day. It has 20 dialysis stations providing haemodialysis (HD) and haemodialysis filtration (HDF). From 2018 to April 2019 the dialysis unit provided a total of 11,231 dialysis sessions. The renal dialysis sits within the speciality medicine division. Care of the patients is overseen by a renal consultant at another trust. The endoscopy service has two endoscopy theatres. One of which is used for diagnostic gastrointestinal procedures and the other for urology and gynaecological procedures. The unit has a decontamination facility, two admission rooms, two recovery beds, and four chairs. The service is open from 08:00 to 18:00 Monday to Friday, with some additional clinic lists being delivered at weekends. From January to December 2018, 3,393 endoscopic procedures were carried out. The endoscopy service sits within the specialised clinical services division.

Surgery services provided by Worcestershire Acute Hospitals NHS trust are located on four hospital sites. Worcestershire Royal Hospital is the largest site with Alexandra Hospital, Kidderminster Hospital and Treatment Centre and Evesham Community Hospital as additional sites. The trust provides services to a resident population of 550,000 people in Worcestershire. Surgery services provided at Kidderminster Hospital and Treatment Centre are planned (elective) surgery and consists of four theatres and two treatment rooms, a 12-bedded surgical ward and a theatre admissions area. There was a separate theatre admission area and second stage recovery area for day case patients who would not require an overnight stay. We inspected the service on 14 and 15 May 2019 and on 23 May 2019. As part of the inspection, we visited the pre-assessment clinics, the operating theatres, recovery areas and ward one. Surgical services provision at Kidderminster Hospital and Treatment Centre included general surgery, trauma and orthopaedics, urology, ear nose and throat surgery and ophthalmology.

Outpatient clinics are held in the treatment centre, with the majority of outpatient clinics are on the first floor. Oncology outpatient appointments are held in the Millbrook Suite, which is on the first floor in C block. The Millbrook Suite tended to only treat certain site-specific cancers, generally referring any head and neck cancers to other sites. There are consultant and nurse-led outpatient clinics across a range of specialities, which are provided in the outpatients’ department. Outpatient clinics are held Monday to Friday from 8am to 6pm. Some ad-hoc Saturday appointments are provided dependent on specialty. The outpatients’ service is part of the specialised clinical services division. The current structure includes a divisional director of operations, a divisional director of nursing and a divisional medical director. A deputy divisional operational manager, a deputy divisional director of nursing and a deputy divisional medical director, plus a directorate manager and matron, supports the team.

The radiology service forms part of the specialised clinical services division. The current structure includes a divisional operational manager, divisional director of nursing and divisional medical director. This team is supported by speciality leads. Radiological services are led by a clinical director, the chief radiographer and directorate manager. Diagnostic imaging also occurs in the clinical investigations department. These investigations included non-radiological investigations, such as electrocardiograms, heart monitoring, respiratory function testing and echocardiograms. These were performed by specialist technicians within an outpatient’s clinic. Diagnostic investigations, such as echocardiograms, electrocardiograms and respiratory function tests were completed by the clinical investigation team. These investigations took place in the clinical investigations department on level one. The department was managed by a senior physiologist and reported to consultants within the medicine division. The medicine division had the same structure as the specialised clinical services division.

Updated 20 September 2019

Our rating of services improved. We rated them as good because:

• Improvements had been made in all core services inspected to address most concerns from the last inspection.
• Medical care, surgery, outpatients and diagnostic imaging services were rated as good overall.
• The minor injuries unit was rated as requires improvement overall.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
• Feedback from parents and relatives confirmed staff treated them well and with kindness.
• Managers monitored the effectiveness of care and treatment and used the findings to improve them. They made sure staff were competent for their roles by appraising work performance and holding supervision meetings with them to provide support.
• People could access the service when they needed it.
• Managers at all levels had most of the right skills and abilities to run a service providing high-quality sustainable care.
• The services had a systematic approach to continually monitor the quality of its services. The service monitored activity and performance and used data to identify areas for improvement.
• The services had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected.
• Staff felt respected, supported and valued. They were focused on the needs of patients receiving care.
• Staff and managers across the service promoted a positive culture that supported and valued one and other.

However,

• In the minor injuries’ unit, the trust must take actions to improve. These are:
  • To ensure all patients receive a timely initial clinical assessment to identify patients arriving with serious injuries and illnesses.
  • To ensure an evidenced-based review of the nursing establishment (including skill-mix) is carried out to ensure there are sufficient staff with the right skills and experience to meet the needs of patients who attend the minor injuries unit.
  • To ensure governance processes include reviews of clinical guidelines to ensure that they follow current best practice.

Updated 20 September 2019

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

• The service provided mandatory training including safeguarding to all staff and made sure everyone completed it. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
• The service generally had suitable premises and equipment and looked after them well. The service controlled infection risk well. Staff kept themselves, equipment and the premises clean.
• The service followed best practice when prescribing, giving, recording and storing medicines.
• Staff assessed and responded to patient risk appropriately. Records were clear, up-to-date and easily available to all staff providing care. The service managed patient safety incidents well.
• The service had enough nursing staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.
• The service generally provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance. Most managers monitored the effectiveness of care and treatment and used the findings to improve them.
• Staff gave patients enough food and drink to meet their needs and improve their health. Staff assessed and monitored patients regularly to see if they were in pain.
• Evidence provided, and observations made showed that staff were competent for their roles, which was an improvement since our last inspection. Staff worked together as a team to benefit patients.
• Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. Consent was consistently undertaken in line with the trust consent procedure.
• Staff cared for patients with compassion at all times during the inspection. Staff were friendly, professional and caring, even when under pressure during busy periods. Feedback from parents and relatives confirmed staff treated them well and with kindness.
• The service planned and provided services in a way that met the needs of local people. The service took account of patients’ individual needs. The service had a person-centred care approach to meeting the needs of people with complex or additional needs.
• Most patients could access the service when they needed to.
• The service treated concerns and complaints seriously, investigated and responded to them in a timely manner, learned lessons from the results, and shared these with all staff at meetings and safety huddles.
• Managers at all levels had the right skills and abilities to run a service providing high-quality sustainable care. Clinical leaders were visible in the department.
• There was a documented vision and strategy for what staff working within services wanted to achieve, in line with trust’s quality improvement strategy.
• The service had a systematic approach to continually monitor the quality of its services. The service monitored activity and performance and used data to identify areas for improvement. The service had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected.
• Staff and managers across the service promoted a positive culture that supported and valued one and other. Staff felt respected and valued which was an improvement since our last inspection.

However,

• The changing room facilities in endoscopy were not appropriate as they contained the only staff toilet in the department.
• The service was working towards achieving Joint Advisory Group (JAG) accreditation.
• Staff knowledge of audit and performance related to audit within endoscopy was variable.
• Some patients had delays in accessing some endoscopy services.

Updated 5 June 2018

• The trust provided mandatory training in key skills to all staff but data provided showed they did not ensure staff completed it. The trust identified issues with data quality which may have resulted in under reporting of the actual position.
• Staff understood the need to protect patients from abuse, but had not always completed training at the appropriate level to ensure they had the appropriate level of knowledge to do so.
• Although the environment was generally well maintained, equipment in the outpatient areas did not have up to date electrical safety checks.
• Staff had access to policies and procedures based on national guidance and the service had an annual audit plan. However, there were few audits which considered the effectiveness of children’s outpatient services.
• The facilities and premises were not always suitable for the service being delivered. More than two thirds of children were seen in adult outpatient areas. Play specialists were not available to support children in outpatient clinics.
• Staff assessed children’s and young people’s pain in the day surgery unit and provided pain relief. However, we could not find evidence they monitored its effectiveness and in the fracture clinic where children and young people were seen, children’s pain was not assessed.
• The service had systems to monitor the effectiveness of care and treatment for inpatients and used the findings to improve, but there was little monitoring of outcomes of outpatient care.
• Waiting times targets from referral to treatment were not met in specialties where children were seen in adult services. Waiting times within the clinics were not monitored.
• The service had a vision how children’s services would be configured in the future and what it wanted to achieve, but did not have a documented strategy or action plan to enable the vision to be realised.
• Governance processes were becoming more established and had improved since the inspection in November 2016. However, there was little engagement and involvement of nursing staff at clinic level in governance processes and no flow of information between directorates.
• The service did not have effective systems for identifying risks, and coping with the unexpected. They measured key performance indicators on a monthly basis but there was little evidence of improvement in some indicators over the period of a year.

However:

• Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.
• Staff provided emotional support to patients to minimise their distress.
• The service took account of patient’s individual care and support needs.
• The service had measures to control infection risk. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection.
• The trust had suitable arrangements in place for the ordering, dispensing, prescribing, recording and handling of medicines.
• Staff recognised incidents and reported them appropriately. Managers investigated incidents and provided feedback to staff. When things went wrong, staff apologised and gave patients honest information and suitable support.
• Children and young people were supported to make decisions. Consent to care and treatment was provided in line with legislation and guidance. Staff were aware of their roles and responsibilities under the Mental Capacity Act 2005 (MCA). However, staff completion of training in the MCA was low and no audits of consent were completed
• The service engaged with children and young people using the service effectively. Staff showed an enthusiasm for their roles and a commitment to improving services for the benefit of patients.

Updated 20 September 2019

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

• The service provided mandatory training in key skills to all staff and made sure everyone completed it. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
• The service controlled infection risk well.
• The service had suitable premises and equipment and looked after them well. All diagnostic and imaging equipment was tested and serviced regularly to ensure that it was safe to use.
• Staff completed and updated risk assessments for each patient. They kept clear records and asked for support when necessary. Risk assessments were completed for all patients using the service, and there were processes in place to escalate any concerns.
• The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment. The service made sure staff were competent for their roles.
• The service followed best practice when prescribing, giving, recording and storing medicines. Staff ensured that radiation doses were in line with national guidance.
• The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately.
• The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.
• Managers monitored the effectiveness of care and treatment and used the findings to improve them. Discrepancy meetings were held and that there was a process for discrepancy feedback outsourced work.
• Staff understood how and when to assess whether a patient had the capacity to make decisions about their care.
• Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness. Staff respected patient’s privacy and dignity. The service took account of patients’ individual needs.
• Patients could access the service when they needed it. Waiting times to treat patients were generally in line with good practice. Most patients received diagnostic imaging within the six week target. The backlog of unreported images and delays in reporting had significantly improved.
• The service had managers at all levels with the right skills and abilities to run a service providing high-quality sustainable care. Clinical leaders were visible in the department. The team appeared focused and driven. Most staff reported leadership within the diagnostic and imaging departments was strong, with visible, supportive, and approachable managers and superintendents.

Updated 20 June 2017

We rated maternity and gynaecology as requiring improvement because:

• Environmental checks were inconsistent. Systems for monitoring equipment safety were not robust.
• Limited use of local audit meant that some outcomes with regards to patient safety, care and effectiveness were not fully understood. This was especially noticeable with regards to documentation and assessment.
• Compliance with mandatory training modules remained below the trusts target of 90%.
• Multiple sets of patient notes led to gaps in information in some records that we saw.
• Senior leaders were not always visible and some had limited capacity due to multiple roles.
• New pathways were not dated or referenced with up to date evidence.
• Staff had a poor understanding of female genital mutilation, child sexual exploitation, the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Leaders had told us that all staff had been trained in these areas.
• Medical staff vacancy rates in obstetrics and gynaecology were above the national average, leading to cancellation of clinics.
• There was no awareness, amongst staff, of major incident plans or roles that individuals would take should there be a major incident.
• Midwives were not rotated to different areas, potentially resulting in loss of some skills.

However:

• All staff considered patients’ needs, were respectful and caring in their interactions.
• Staff were valued and respected. There was open and honest communication between staff and managers. Local leaders were visible and approachable.
• Divisional leaders had a clear vision and strategy for maternity services.
• Incident, comments and complaints processes were thorough; lessons were learned and disseminated well. However, the target to complete these was often missed.
• Nursing and midwifery leaders were always available on the telephone or email.

Updated 20 September 2019

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

• The service provided mandatory training in key skills to all staff and made sure everyone completed it.
• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse, and they knew how to apply it.
• The service controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean.
• The service provided care and treatment based on national guidance and evidence-based practice.
• The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and development.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
• The service was inclusive and took account of patients’ individual needs and preferences. Staff made reasonable adjustments to help patients access services. They coordinated care with other services and providers.
• The service had managers with the right skills and abilities to run a service providing high-quality sustainable care. Clinical leaders were visible in the department, but the trust board were not always known to staff.
• Staff and managers across the service promoted a positive culture that supported and valued one and other.

However:

• People could not always access the service when they needed it and did not always receive the right care promptly. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were not in line with national standards.
• The service had systems for identifying risks, planning to eliminate or reduce them. As these were often trust wide, it was hard to pinpoint risks to individual sites.

Updated 20 September 2019

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

• The service provided mandatory training in key skills to all staff and made sure most people had completed it.
• The service controlled infection risk well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection.
• The service generally had suitable premises and equipment and looked after them well.
• The service had enough medical and nursing staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.
• Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date and easily available to all staff providing care.
• The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service.
• The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance. Managers monitored the effectiveness of care and treatment and used the findings to improve them.
• Staff gave patients enough food and drink to meet their needs and improve their health. Staff assessed and monitored patients regularly to see if they were in pain.
• The service generally made sure staff were competent for their roles. Staff worked together as a team to benefit patients.
• Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness. Staff involved patients and those close to them in decisions about their care and treatment.
• The service planned and provided services in a way that met the needs of local people
• The service took account of patients’ individual needs. The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with all staff.
• Managers at all levels in the service had the right skills and abilities to run a service providing high-quality sustainable care. The service had a vision for what it wanted to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community.
• Managers across the service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
• The service used a systematic approach to continually improve and monitor the quality of its services. The service had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected.

However:

• Systems were mostly in place and effective in recognising and responding to deteriorating patients’ needs. Staff completed and updated risk assessments for each patient. They kept clear records and asked for support when necessary. However, staff did not always complete the brief and debrief within the five steps to surgery. We were therefore not assured that all staff were briefed prior to surgery and had the opportunity to debrief afterwards.
• The service followed best practice when prescribing, giving, recording and storing medicines. Patients generally received the right medication at the right dose at the right time. However, we found that four out of seven medication charts we looked at had missed doses. Therefore, we were not fully assured that all patients were given medicines when required.
• Not all staff had received training in the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff generally understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
• People could not always access the service when they needed it. Waiting times from referral to treatment and arrangements to admit treat and discharge patients were not in line with good practice.

Updated 20 September 2019

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

• Staff did not complete risk assessments for all patients when they first arrived. Patients with potentially serious injuries sometimes had to wait for two hours before they received a clinical assessment.
• The service did not always provide care and treatment based on national guidance and evidence of its effectiveness. Much of the guidance provided for staff was out-of-date.
• Although managers at all levels had the right skills and abilities to run a service providing high-quality care, a cohesive, sustainable management strategy had not yet been achieved. This was, in part, due to the fragmented nature of the management structure and conflicting demands on the time of senior leaders.
• The MIU did not always have enough nursing staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.
• Although the MIU had systems for identifying risks and plans to eliminate or reduce them, we could not be certain there was a process for bringing them to the attention of senior leaders within the trust.

However,

• Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
• Managers monitored the effectiveness of care and treatment and used the findings to improve them. They made sure staff were competent for their roles by appraising work performance and holding supervision meetings with them to provide support.
• People could access the service when they needed it.
• Staff felt respected, supported and valued. They were focused on the needs of patients receiving care.
• The service had begun to use a systematic approach to continually improve the quality of its services and safeguarding high standards of care. There had been increased commitment to improving services by learning from when things went well and when they went wrong, as well as promoting training and practice improvement