Stoke Mandeville Hospital

Updated 25 October 2023

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 Stoke Mandeville Hospital.

We inspected the maternity service at Stoke Mandeville Hospital 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.

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

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

We previously inspected maternity jointly with the gynaecology service, so we cannot compare our new ratings directly with previous ratings from the last inspection in 2014. As such the historical Maternity and Gynaecology rating is not comparable to the current maternity inspection and is therefore retired. This means that the resulting rating for Safe and Well-led from this inspection will be the first rating of maternity services for the location. We rated safe as requires improvement and well-led as good; this is a rating of requires improvement and the hospital remains as good. This does not affect the overall Trust level rating

How we carried out the inspection

We provided the service with 2 working days’ notice of our inspection. During our inspection of maternity services at Stoke Mandeville Hospital we spoke with staff including leaders, obstetricians, anaesthetists, midwives, theatre staff, maternity support workers, the Maternity Voice Partnership team, and women and birthing people.

We visited all areas of the unit including maternity triage, the birth centre, labour ward, day assessment and mixed (antenatal and postnatal) ward. We reviewed the environment, maternity policies, 5 maternity records and 6 prescription charts. 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. Following the inspection, we reviewed data we requested from the service to inform our judgements.

The trust provided maternity services at hospital and local community services and 4577 babies were born at the trust between April 2021 to March 2022.

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

Updated 4 July 2022

Updated 6 October 2014

Services for children and young people were good throughout. Most parents told us the staff were caring, and we saw that children and their parents and carers were treated with dignity, respect and compassion. Ward areas and equipment were clean. There were enough trained staff on duty to ensure that safe care could be delivered. There were thorough nursing and medical handovers that took place between shifts to ensure continuity of care and knowledge of patient needs.

The services were responsive to the needs of children and young people and their families and carers. The ward sisters communicated well with staff, and staff were positive about the service and quality. Children’s experiences were seen as the main priority. Staff felt supported by their managers and were encouraged to be involved in discussing their ideas for improvements.

Updated 6 October 2014

Patients we spoke with gave us examples of the outstanding care they had received in the unit. Staff built up trusting relationships with patients and their relatives by working in an open, honest and supportive way. There was strong local leadership of the units. Openness and honesty was encouraged at all levels.

The unit had an annual clinical audit programme to monitor how guidance was adhered to. All staff, including student nurses, were involved in quality improvement projects and audit. There was good multidisciplinary team working. Patients underwent an assessment of their rehabilitation needs within 24 hours of admission to the unit, and the subsequent plan for their rehabilitation needs was clearly documented in the notes.

Updated 18 June 2019

We previously inspected the Florence Nightingale Hospice within the acute End of Life Care core service, so we cannot compare our new ratings directly with previous ratings.

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 kept themselves, equipment and the premises clean.
• Staff completed and updated risk assessments for each patient. They kept clear records and asked for support when necessary.
• 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 had enough medical 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.
• 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. When things went wrong, staff apologised and gave patients honest information and suitable support.
• The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.
• Staff gave patients enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary. The service made adjustments for patients’ religious, cultural and other preferences.
• Staff assessed and monitored patients regularly to see if they were in pain. They supported those unable to communicate using suitable assessment tools and gave additional pain relief to ease pain.
• Staff of different kinds worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.
• The service made sure staff were competent for their roles. Managers appraised staff’s work performance and clinical supervision meetings were available to staff to provide support and monitor the effectiveness of the service.
• Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. They followed the trust policy and procedures when a patient could not give consent.
• Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness. All the patients and relatives we spoke with told us they were very happy with their treatment all saying the doctors and nurses all contribute to their care and wellbeing in an outstanding way.
• Staff provided emotional support to patients to minimise their distress. Patient’s individual concerns were identified and responded to in a positive and reassuring way. A patient and their relative described the hospice as an “Oasis of calm”.
• Staff involved patients and those close to them in decisions about their care and treatment. It was clear from observing that interactions between patients and relatives they trusted the medical and nursing staff. Patients told us they were treated as individuals and that they felt listen too.
• The trust planned and provided services in a way that met the needs of local people.
• The service took account of patients’ individual needs. Patients who were receiving EoLC where identified by a ‘Purple Rose.
• 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.
• The service used a systematic approach to continually improve 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.
• Managers across the service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.

However

• The service had suitable premises and equipment and looked after them well. However, the hospice did not record temperatures of the chilled room, which meant the service could not be assured the deceased appearance, condition and dignity was preserve or what actions they would need to take if the chilled room temperature became out of range.
• Managers monitored the effectiveness of care and treatment, through national audits, and used the findings to improve them. However, they were not undertaking local audits which meant they could not compare local results to learn from them.
• The service could not be assured people could access the service when they needed it as the service did not record when they were not able to admit a patient when there were no beds available.

Updated 18 June 2019

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

• The service protected patients with a strong comprehensive safety system with a focus on openness, transparency and learning when things went wrong.

• Patients could transition seamlessly between services because there was good advance care planning and information sharing between teams.
• There was a genuine open culture in which all safety concerns raised by staff and patients were highly valued as being integral to learning and improvement.
• The continuing development of the staff’s skills and knowledge was recognised as being integral to ensuring high quality care. Staff were proactively supported and encouraged to acquire new skills, use their transferable skills and share best practice. Chaplaincy volunteers were proactively recruited and supported in their role.
• There was a strong, visible person-centred culture. Staff were highly motivated and inspired to offer care that was kind and promoted peoples’ dignity. Relationships between people in the service, those close to them and staff were strong, caring respectful and supportive. These relationships were highly valued by staff and promoted by leaders.
• There was a proactive approach to understanding the needs and preferences of different groups of people and to delivering care in a way that met these needs, which was accessible and promoted equality. This included people with protected characteristics under the equality act, people who are approaching end of life and people in vulnerable circumstances who had complex needs.
• There was compassionate inclusive and effective leadership at all levels. Leaders at all levels demonstrated high levels of experience, capacity and capability needed to deliver excellent and sustainable care. There was a deeply embedded system of leadership development and succession planning, which aimed to ensure that the leadership represented the diversity of the workforce.

Updated 25 October 2023

Updated 18 June 2019

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

• People were protected from avoidable harm and abuse. The department was sufficiently staffed and most of the team had received up-to-date mandatory training, including safeguarding. Premises were visibly clean and tidy. Staff were pro-active in managing risk, and patient records were completed appropriately. Incidents were reported and investigated.
• Patients received effective care and treatment that met their needs. The trust had participated in a national benchmarking programme and was using the findings to make improvements to the service. Staff development was encouraged, and appraisals were up to date.
• People were supported, treated with dignity and respect, and were involved as partners in their care. Patient survey results were good, and patients we spoke with were happy with their care. Staff were compassionate and helpful in their interactions with patients.
• People’s needs were met through the way services were organised and delivered. The trust recognised where the service needed improving and was taking action to do so. People with particular needs were prioritised for appointment times and patients were told when appointment delays were longer than expected.
• The leadership, governance and culture promote the delivery of high-quality person-centred care. The team felt supported by managers and were supportive of each other. Systems were in place with appropriate escalation processes for governance, quality and performance. There was a focus on continuous learning and improvement throughout the service.

However:

• Confidential patient records were not always locked away or kept secure.

Updated 20 June 2014

The NSIC is a national centre for spinal injuries and develops guidelines for other units in the UK to follow. It has been internationally accredited. Staff built up trusting relationships with patients and their relatives through their interactions. Patients and relatives told us that they received considerable support. There was a sense of belonging for them. Care plans for patients with spinal injury identified goals set by the patients and these were monitored by them in partnership with the staff. There was support for current patients from former patients of the unit.

Staff within the Centre spoke positively about the service they provided for patients. There was enthusiasm and energy for providing a high quality of care for patients with spinal injury. The drive to recruit more nurses and healthcare assistants was seen as an example of positively and making a difference to the culture within the service.

Updated 4 July 2022

Updated 18 June 2019

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

• The service effectively controlled all infection risks.
• The service had a good approach to anticipating and managing risks to people who used the service, and they managed patient related safety incidents well.
• There were enough staff with the right qualifications and skills. The training they received helped them to protect patients form avoidable harm and to keep people safe.
• The service provided care and treatment based on national guidance and could evidence its effectiveness.
• There was a multidisciplinaryapproach to working in the service. Staff of different roles worked together as a team to benefit patients and supported each other to provide good care.
• Staff cared for patients with compassion. Feedback from patients, and those close to them, was positive and confirmed that staff treated them with kindness.
• The services provided reflected the needs of the local population and considered patients’ individual preferences and choices.
• Most patients were able to access the service in a timely way.
• The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with staff.
• There was strong leadership in the emergency department with leaders having an inspiring shared purpose and strove to deliver and motivate staff to succeed.
• The governance processes enabled the service to monitor its standards and performance.
• The department was forward looking, promoting training and research and encouraging innovations to ensure improvement and sustainability of the service.

However,

• The service did not provide consultant presence 16 hours a day in line with the Royal College of Emergency Medicine’s recommendations.
• There was lack of a dedicated safe space for assessing patients with mental health needs.
• Patient’s records were not always completed fully or stored securely.