Tetbury Hospital

Updated 11 July 2022

Tetbury hospital trust limited is a charitable company formed in 1992 and registered as a charity on 27 February 1992. The charity’s patron is HRH The Prince of Wales. Prior to the formation of the charity the hospital was owned by the NHS and has delivered care to the local community for over 55 years. The hospital provides care to both NHS and privately funded patients.

The Minor Injuries Unit (MIU) is now located in a new area in the hospital. This change was made in 2021 because during the COVID-19 pandemic, limited space prevented patients from following social distancing requirements. The relocation saw the development of a waiting area that was monitored by reception staff at all times, a dedicated MIU reception booking in team, a triage room, a resuscitation area within the unit and a large assessment room.

In April 2022, the MIU became a Minor Injury and Illness unit (MIIU). The MIIU is nurse led with triage nurses and Emergency Nurse Practitioners. Nurses in other areas of the hospital are trained in triage so they could assist the MIIU staff if required. No medical staff were employed within the MIIU. The MIIU had 3 substantive nursing staff. The service was supported by the hospital matron, wider hospital leadership team and a reception team who rotated between the main hospital reception and the MIIU reception.

The MIIU provides urgent and emergency care services for adults and for children and young people.

Updated 11 July 2022

We carried out a comprehensive inspection of Tetbury Hospital Trust Ltd on 3 and 4 May 2022. The service was last inspected in September 2016 when it was rated as requires improvement overall.

Tetbury Hospital provides the following services: surgery, outpatients, diagnostic imaging and urgent and emergency care. The urgent and emergency care service at Tetbury hospital is provided through a Minor Injuries and Illnesses Unit (MIIU). We only inspected the MIIU during this inspection. The MIIU was open 8:30am to 4:30pm Monday to Friday. Patients were unable to access the service out of these times and instead had to access other local MIIU’s who have extended hours, acute trusts, NHS 111 or their GP services.

Before the inspection, we reviewed information we had about the location, including information we received and available intelligence. The inspection was unannounced.

We rated safe, effective, caring, responsive and well Led as Good.

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

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients and acted on them. 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, gave patients enough to eat and drink, and gave them pain relief when they needed it. 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 health 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 them to give feedback. The service had a variety of communication tools to enable staff to support patients with communication difficulties. Patients could access the service when they needed it.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. 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 some community services to plan and manage services and all staff were committed to improving services continually.

However:

• The service did not always manage medicines well.
• Not all policies were updated in line with most current guidance or practice in the department.
• Not all equipment was maintained or checked in line with the trust’s policy.
• Key services were not available seven days a week.

Updated 29 March 2017

We rated outpatients and diagnostic imaging as good overall because:

• People were protected from avoidable harm. The trust had a range of safety measures in place and there were systems to report concerns or incidents and learn from them.

• There were reliable systems, practices and processes to keep people safe and safeguard them from abuse.

• Training was provided for all staff to ensure they were competent and effective in their roles. Sufficient numbers of nursing staff were provided and maintained to ensure that the department operated smoothly and safely.

• The outpatient and diagnostic imaging services incorporated relevant and current evidence-based best practice guidance and standards. Any new procedures or treatments to be delivered had to be agreed by the medical advisory committee.

• People’s consent to care and treatment was sought in line with legislation and guidance. We observed written consent was sought, and records placed in patients’ records.

• We received positive feedback about staff and services from all of the patients we spoke with. Patients were treated with respect and shown kindness by all staff when they visited the outpatient clinics.

• The needs of the local population were considered in the development of services provided by Tetbury Hospital. The hospital worked in collaboration with the commissioning groups and liaised with the NHS trusts that provided services to the local community.

• People had timely access to initial assessment and diagnosis and waiting times for referral to treatment were consistently below the NHS England target of 18 weeks. The hospital was achieving 100% compliance with the government target of 31 days for patients, from having a cancer diagnosis until the start of their treatment.

• Clear information was provided to patients about how to make a complaint or raise a concern. The hospital had received few complaints but had responded to them all within their given timescale.

• There was an effective governance structure in place to support the delivery of good quality care in the outpatients department. Staff were aware of their responsibilities and their roles and who they were accountable to.

• The hospital had reviewed and rewritten all its policies since 2013, with many being reviewed annually since then.

• There were effective arrangements for identifying recording and managing risks. There was a risk register in place for the outpatient department area which was maintained and updated by the manager.

• The hospital actively sought the views of patients and staff about the quality of the service provided. Opportunities were available for patients and staff to comment on all aspects of the care and treatment provided.

Updated 29 March 2017

We rated surgery as good overall because:

• There were no surgical site infections from April 2015 to March 2016. During the same period there were no incidences of methicillin resistant Staphylococcus aureus (MRSA) or clostridium difficile.

• The hospital reported no never events or serious untoward incidents.

• There were low levels of staff sickness and staff turnover.

• The hospital reported no safeguarding concerns.

• The hospital had a low rate of unplanned patient transfers to other hospitals and there were no unplanned patient readmissions.

• Medical staff were checked for their fitness to practise.

• Staff were encouraged and supported to undertake training relevant to their role.

• Staff worked together to assess, plan and deliver care and treatment. They treated patients with kindness, dignity and respect and recognised when patients were anxious and provided them with reassurance.

• Patients with complex needs were assessed and plans were made for them prior to their admission.

• Patient care records were always available.

• Care was responsive and met the needs of the local population. Information about the local population was used to inform how services were planned and delivered.

• Targets for referral to treatment times for NHS patients were always met from April 2015 to March 2016. Staff managed admission times to ensure patient waiting times were kept to a minimum.

• There was a programme of clinical audit and governance.

• Complaints were investigated. Actions were taken and lessons learned as a result of complaints.

• Leaders were approachable and visible.

• The hospital had a clear vision and set of values.

However:

• Cleaning schedules, fridge temperature and daily equipment checks were not always recorded as complete.

• Emergency drugs were not tamper-evident.

• The day surgery unit did not have piped oxygen.

• The hospital did not participate in national audits regarding patient outcomes.

• The hospital had not adapted guidance on quality standards for sepsis screening and management. There was no policy regarding sepsis.

• Patient allergies were not always recorded on prescription charts.

• There was poor compliance with some mandatory training.

• The hospital did not have a supply of blood products for use in an emergency.

• Not all risks were identified on the risk register such as such as the lack of piped oxygen and emergency blood provision.

Updated 11 July 2022

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

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients and acted on them. 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, gave patients enough to eat and drink, and gave them pain relief when they needed it. 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 health 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 them to give feedback. The service had a variety of communication tools to enable staff to support patients with communication difficulties. Patients could access the service when they needed it.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. 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 some community services to plan and manage services and all staff were committed to improving services continually.

However:

• The service did not always manage medicines well.
• Not all policies were updated in line with most current guidance or practice in the department.
• Not all equipment was maintained or checked in line with the trust’s policy.
• Key services were not available seven days a week.

We rated this service as good because it was safe, effective, caring, responsive and well led.