George Eliot NHS Hospital

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We reviewed assessing needs, delivering evidence-based care and treatment, how staff, teams and services work together, supporting people to live healthier lives, monitoring and improving outcomes and consent to care and treatment as part of the effective key question. We were previously unable to rate effective in outpatients, however on this assessment we rated effective as good. 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 good information. Key services were available 7 days a week.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

With permission of 8 patients, we were able to sit in their clinic appointments. Patients were involved in their planned care and treatment, as well as the next steps of their treatment. Staff gave patients time within their appointments to be able to have open discussions, and to be able to ask questions if they did not understand the information that had been given. Staff also took time with patients and family members where they become upset due to receiving bad new, they ensured the patient was ok to leave the clinic and provided support and advice of who they can talk to in relation to their continuous planned care.

We saw staff using following best practice guidance, for example, from the World Health Organization to ensure patient care was safe during minor surgical procedures. Staff told us they reviewed patients' needs and what support they would require when attending their appointment. An example of this was ensuring a translator was present for patients whose first language was not English. Staff told us they had access to an interpretation service for patients and their families. Staff told us they were able to print out information in several different languages to ensure patients gained the information they required. Staff were able to give examples where they had supported patients with any psychological and emotional needs, for example where a patient was raising concerns relating to their home life, and the staff member was able to signpost them to be able to gain additional support. After a clinic had finished, we observed doctors completing and updating care plans, arranging for medication to be given, arrangements for follow up appointments, and letters explaining their appointment and what is next within the patient's treatment.

There were processes in place for staff to follow to assess and meet the needs of patients. The service used clinical tools which were relevant to the patients' needs, for example WHO checklists, mobility and falls assessments to name a few. Within the Clinical Support Service report, there was details of 2 patient falls. Details from any consultations including assessment of needs was utilised to ensure appropriate care was provided going forward. Processes were in place to ensure patients received translation and interpretation services to enable them to be involved in the assessment of their needs and to ensure that care was patient centred. Staff used clinical audits to ensure the care they provided was patient centred and met the needs of the patient. An example of this was the Making Every Contact Count- MSK clinic staff. The outcome was that the new assessment increased confidence in identifying patients who were at risk as inactivity, therefore being able to tailor any advice and recommendations. Outcomes: The service conducted audits called making every contact count. The outcome was that the new assessment increased confidence in identifying patients who were at risk as inactivity, therefore being able to tailor any advice and recommendations.

Staff told us they followed up-to-date policies to plan and deliver high quality care according to best practice and national guidance. Different staff members had specialist knowledge in a range of different subjects including diabetes, falls, tissue viability, sepsis, dementia and learning disabilities. This meant there was someone who could offer additional up to date advice or support to other staff working with a patient with additional or complex needs. Staff told us that if a patient has long wait for the ambulance to collect them, they will ensure food and drinks are offered, staff were able to request snack boxes from the kitchen. Staff told us that if a patient attended by ambulance and required a bed or trolley during their appointment, they ensured they repositioned patients to prevent any pressure damage occurring. Staff told us they regularly discussed pain with their patients. If patients experienced pain whilst attending their appointment, staff enabled them to receive medication if required.

The risk assessments and clinical assessment tools which staff used were evidence-based and widely used and recognised across healthcare. Policies, processes and other supporting documentation in relation to risk assessments and clinical assessment tools were based upon national guidance and polices. Clinical audits were conducted to ensure that staff were providing care which was in line with local policies and processes which were based on national evidence, guidance and legislation. The service were responsible for ensuring 12 processes and policies were updated and remained in line with national recommended best practice. The Clinical Support Service meeting ensured the oversight of these documents was maintained to ensure they remained in line with the most recent guidance. Additional evidence provided by the trust provided details of a process that was in place to ensure that processes/policies/ standard operating procedures were in line with evidence-based national guidance. This process also ensured clinical audits were completed to demonstrate compliance against national guidance.

The service had Professional Nurse Advocates (PNA), who provided Restorative Clinical Supervision (RCS) to nursing staff. In 2023 there had been an increase in PNA’s to 24 staff this was an increase of 18 staff in 12 months. In the same time period, the PNA’s provided 63 RCS sessions with staff. Staff told us they were key individuals who supported them in the roles, and they had the ability to self-refer if they needed a session. Staff told us they regularly received an appraisal on their work. The service provided data in relation to staff appraisals, for nursing staff this was 74.7% completion rate. For administration staff there was 27.27% completion rate. For booking staff there was 0% completion rate. Staff told us that they feel there is a good staff moral within the team and the staff team support each other. Staff told us that they feel supported by their managers and feel they could approach them if they had any concerns. Staff told us that they received induction, when they started in the service, this was monitored by managers and signed when staff had achieved the task.

We observed staff of all levels working well together, good teamwork and a positive moral within the team. staff were communicating effectively to meet the needs of the patients who were attending the service. We observed staff seeking support from local managers and managers giving support and advice to staff.

There were processes in place to ensure member of the multidisciplinary team (MDT) worked together to ensure the needs of the patients were met. Key governance meetings were attended by members of the MDT which demonstrated an effective and cohesive service. Minutes from various governance and quality meetings were attended by members of the MDT. There was also evidence which demonstrated external staff and teams worked well with the staff from the service, for example Midlands Outpatient Network.

We saw posters encouraging people who required surgery to self-refer to a service that provided support to lose weight, stop smoking, and/or reduce alcohol consumption. We also saw posters relating to a care app, bereavement care, sepsis, and questions relating to cancer, and diabetes information.

Staff told us that they have discussions with patients in relation to health promotion, including healthy eating, and to stop smoking. Staff told us they communicate with outside agencies to help support patients, this includes safeguarding team, and GP’s.

There were processes in place to provide patients with relevant information to support a healthy lifestyle. There were also programmes in place which along with supporting patient's wo live healthier lives, it also bridged the gap when moving between hospital-based care and community care. This programme also looked to address health inequalities within the surround area that the service (and trust as a whole) served.

Staff told us they reviewed patients on the waiting list who had been waiting a long time to access treatment to assess if they had come to harm while waiting to be seen. Staff had introduced several initiatives to try and reduce the length of time patients waited for their first appointments and review appointments. This included ensuring all clinic space was fully utilised, contacting patients to see if they needed to cancel or rearrange their appointment to reduce the number of appointment slots that were not filled, and offering patients follow up appointments based on their requirements rather than at a predetermined rate. Staff told us the service completed audits these included: ward assurance, health and safety, IPC, hand hygiene, environmental, medicines, LocSSIPs and National Safety Systems for Invasive Procedures (NatSSIPS), temperature checks, resuscitation trolleys and cleaning rota. These would be completed either daily, weekly, monthly, or twice yearly. regularly reviewed audit information and patient outcomes as part of their department meetings. Post assessment the service provided data for the months of January, February, and March 2024; these were monthly compliance audits of Local Safety Standards for Invasive Procedures (LocSSIPS), which were all compliant. Staff regularly reviewed the outcomes of audits as part of their department meetings and ensure any actions required were implemented. The service ensured that staff were trained and completed competencies to evidence that staff knew the training and understood this and ensuring that they could complete the training in practice.

There were processes in place within the service to monitor and improve outcomes for patients who used the service. There was evidence of regular audits being conducted which included patient reported outcomes. In addition to this, the service participated in 2 national audits to ensure the quality of the service being provided met the needs of patients. The trust provided evidence in relation to CQUIN 03: prompt switching of IV to oral 2023/24. This had been identified as being relevant to the service, however they had decided not to complete this due to this being labour intensive. In addition to this, additional audits of compliance in relation to the NHS Standard Contract 2023/24 in relation to broad spectrum antibiotics prescribing identified the trust were not meeting the standard. Information within the report identified there were no Antimicrobial Stewardship Group meetings taking place due to a gap in staffing. Although this was trust wide, this impacted the service assessed. The service had previously undergone PLACE audits of their environment to ensure this met the needs of patients, however information shared by the trust identified this had not been completed since they were suspended during COVID-19. The service was expecting a PLACE audit at some point during this year. There was evidence shared which demonstrated there was a process in place to share relevant outcomes with staff.

During our onsite visit 4 minor operations procedures were observed. Consent had been gained and documented before the procedure took place. Patients told us they gave consent to care and treatment, and they understood why they were consenting to treatment. We observed staff providing patients with post operative instructions. Patients told us they were given a copy of their consent form they had completed before the procedure as well as details instructions about how to help their own recovery.

Staff told us they used a separate consent form for patients who did not have capacity to make their own decisions about their care and treatment. In these cases, decisions were made by 2 consultants and a relative with power of attorney to ensure best interest decisions were made. Consultants told us they were always informed if a patient required additional support before the appointment takes place. Staff told us patients consented on the day of their minor procedures, with a full explanation of the procedure provided, and patients were given the opportunity to ask questions before they signed the consent form. We observed this being completed with no concerns. The service provided Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) training for all staff; we saw data that showed all staff were up to date with this training.

There were processes in place to ensure staff supported patients to make informed decisions about their care and treatment. There were policies and processes which staff were aware of and followed to gain patient consent. Where patients lacked the capacity to make decisions about their care and treatment themselves, there were processes which were in line with national guidance and legislation to ensure consent was gained lawfully. Information in relation to the consent process was observed by staff whilst on site completing the assessment.