Ropewalk House

Updated 8 March 2016

Nottingham University Hospitals NHS Trust is the fourth largest acute trust in England and provides services to more than 2.5 million residents of Nottingham and its surrounding communities. It provides specialist services to between three and four million people from neighbouring counties. The trust is based in the heart of Nottingham on three separate sites around the city: Queen’s Medical Centre, Nottingham City Hospital and Ropewalk House. Queen’s Medical Centre is the emergency care site, where the emergency department, major trauma centre and the Nottingham Children’s Hospital are located.

The trust provides specialist services to between three and four million people from neighbouring counties. Twenty eight per cent of the population are aged 18 to 29 and full-time university students comprise about one in eight of the population. Also 35% of the population are from ethnic minority groups.

Nottingham is ranked 20th most deprived district out of 326 in England in the 2010 Indices of Multiple Deprivation. The health of people in Nottingham is generally worse than the England average. Deprivation is higher than average and about 33.7% (18,600) of children live in poverty, and 21.7% of adults are classified as obese. Life expectancy for both men and women is lower than the England average (approx. 8 years). The rate of alcohol related harm hospital stays, rate of self-harm hospital stays, the rate of smoking related deaths, estimated levels of adult smoking and rates of sexually transmitted infections and TB are all worse than average.

Nottingham University Hospitals were inspected as one of 18 CQC new wave pilot inspections in November 2013, the trust was not rated at this inspection. The purpose of this comprehensive inspection was to award a rating to the trust for the services it provides. We carried out an announced inspection of ropewalk House on 15 September 2015.

Updated 8 March 2016

Ropewalk House is part of Nottingham University Hospitals NHS Trust. Ropewalk House provides outpatient services; diabetic eye screening, audiology, and breast screening services. Diabetic eye screening and audiology were provided to both adults and children.

We inspected Ropewalk House on 15 September 2015 as part of the comprehensive inspection programme.

Overall, this trust was rated as Good. We made a judgements about the outpatient service as well as judgements about the five key questions that we ask. We rated the key questions “are services safe, effective, caring and well led as “Good.”

Our key findings were as follows:

Cleanliness and infection control

• We found the hospital appeared clean. Staff cleaned their hands between patients and adhered to infection prevention and control policies and procedures.

• Equipment was cleaned between use and waste was disposed of appropriately.

Staffing levels

• Outpatient clinics were staffed with appropriate numbers of staff, this was determined on how many consultants and patients were attending clinics.The skill mix of staff was considered.

• Data from the trust showed staff turnover for medical and nursing staff at Ropewalk House was low. Bank and agency usage was also low. Patients were able to build relationships with staff and receive continuity of care.

• There were enough medical staff employed to run clinics at Ropewalk House. There were no medical staffing vacancies.

Safety

• Staff knew how to report incidents and these were investigated with actions and learning identified where necessary.

• There was a strong open culture and staff were encouraged and supported to report incidents.

• Learning from incidents was shared through team meetings. We saw examples of changes being made following the learning from incidents.

• Incidents relating to ophthalmology (eyes) were reported to the national eye screening incident board so incidents and performance safety could be monitored nationally.

• Trusts are required to report any unnecessary exposure of radiation to patients. The breast screening service met both Ionising radiation regulations 1999 (IRR99) and Ionising radiation (medical exposure) regulations 2000 (IR(ME)R). Procedures were in place to report incidents to the correct organisation ensuring a review of practices when incidents occurred.

• All staff knew the whereabouts of all relevant procedural documentation including local rules, IR(ME)R procedures and trust policies

Compassionate Care

• Staff were caring and we observed positive interactions between staff and patients. Patients were positive about the staff, and we observed patients who had mobility difficulties being supported in and out of clinics. Patient privacy and dignity was respected, and patient confidentiality was maintained by staff.

• Patients were involved in their care and we saw examples of staff explaining the next steps and when results would be available.

Service planning

• The environment, despite being old, was adapted to suit the needs of services and patients. There were clear pathways for patients, and patients were able to be referred to services in multiple ways. There were clear processes for patients who did not attend clinics; however, these were not followed with some adult patients. Cancellation rates for the trust were low, and follow up to new ratios were better than the England average.

• Services were responsive to patient needs with specific initiatives designed to improve the experience of young people, and patients living with dementia. Translators and interpreters were available along with limited written materials in other languages.

• There was a clear complaints process and staff were aware of what to do if patients made a complaint. There was information available to patients about the complaints process and patients were encouraged to give feedback about their experience.

Leadership

• Services at Ropewalk House were well-led, staff felt supported and there was a positive working environment.

We saw several areas of outstanding practice including:

• Ropewalk House had a 3D printer which printed individual hearing aid earmoulds for patients. Patients were able to receive a fast individualised service that was more financially sustainable for the service.

• The blue box initiative for elderly patients and patients living with dementia. It enabled patients to store hearing aids and alerted staff that a hearing aid needed to be removed overnight. It also alerted staff the patient has hearing problems.

However, there were also areas of practice where the trust should make improvements.

The trust should:

• Consider following up DNA attendances for adult patients in audiology as per the patient management access policy. This includes ensuring sending letters to GP’s and ensuring they are aware of patient outcomes.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Updated 8 March 2016

There was an incident reporting culture which focussed on improving and learning from incidents. Equipment was clean, had been checked, and medicines were stored appropriately. The breast screening service met standards and safety requirements as set by Ionising radiation (medical exposure) regulations 2000 (IR(ME)R).

Staff were up to date with mandatory training (including safeguarding) meeting the trust target. There were examples of evidenced based care and treatment and patient outcomes were recorded. We saw examples of multidisciplinary working including work with GP and health professionals to identify and screen patients with diabetes. Staff were up to date with appraisals and complimentary about development opportunities within the trust.

Staff were caring and we observed positive interactions between staff and patients. Patients were involved in their care and treatment. Services were responsive with positive actions to reduce ‘did not attend’ rates for patients. Translators and interpreters were available for patients and there were examples of meeting the needs of young people, patients with learning disabilities, and people living with dementia. Services could be accessed in a number of ways including self-referral. Locally services were well led with leaders and staff aware of the issues affecting services at Ropewalk House. Senior managers felt supported and part of the trust, however, there were examples of where some staff did not feel part of the trust. We saw examples of staff and public engagement, as well as a number of improvement and innovative initiatives.