St Peter's Hospital

Updated 29 March 2023

Pages 1 and 2 of this report relate to the overall hospital ratings of this location, from page 3 the ratings and information relate to maternity services based at St Peters Hospital.

We inspected the maternity service at St Peters 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 unannounced focused inspection of the maternity service, looking only at the safe and well-led key questions.

St Peters Hospital is in Chertsey Surrey and part of the Ashford and St Peters NHS Foundation Trust. The trust serves a population of 410,000 people. Maternity forms part of the Women Health and Paediatric division with an annual birth rate of 3,280 births with 6% of women choosing to give birth in the co-located Abbey Birth Centre or at home.

Maternity services offered low and acute care during the antenatal, intrapartum, postnatal and community care. Services included antenatal clinics, antenatal education programme a maternity day assessment unit, maternity triage, an obstetric led labour ward, and antenatal and postnatal wards. Women and pregnant people could access their personal care records digitally.

Our rating of this hospital stayed the same. We rated it as requires improvement because:

• Our ratings of the Maternity service went down but the ratings for the hospital remained the same. We rated safe as inadequate and well-led as requires improvement and the hospital as requires improvement.

How we carried out the inspection

This maternity thematic review was a focused inspection; we inspected the domains of safe and well-led using the CQC’s specific key lines of enquiry designed to support the National Maternity Services Inspection Programme.

Inspectors visited maternity services on 4 January 2023. We spoke with 20 staff and reviewed 6 sets of patient care records. We looked at a wide range of documents including audits, standard operating procedures, meeting minutes, risk assessments and recently reported incidents.

After the inspection we requested further documentary evidence to support our judgements including training records, staffing roster, reports, and quality improvement initiatives.

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

Updated 27 January 2022

Updated 4 October 2018

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

• Staff fully understood how to protect patients from abuse and the service worked well with other agencies to do so. The safeguarding team were visible on the children’s wards both days of our inspection and staff told us they came to the wards every morning to assist with any safeguarding issues.
• Risks to people who used the services were assessed, monitored and managed on a day-to- day basis. We saw comprehensive risk assessments carried out on admission. This included background information on the child’s previous admissions and if they were known to social services or under any protection plan.
• Although medical staffing was on the risk register, the division were maintaining safe staffing levels. Nurse staffing levels were often achieved by using bank and agency nurses. However, the department had a robust induction and competencies check and tried where ever possible to use regular agency to mitigate the risk.
• The service used safety monitoring results well. Staff collected safety information and shared it with staff, patients and visitors. The service used information to improve the service. The department also had a separate children and young people specific safety thermometer.
• Pain assessments on children and young people had greatly improved, with pain assessment forming part of the paediatric early warning systems (PEWS) chart.
• The service monitored the effectiveness of care and treatment and used the findings to improve them. They compared local results with those of other services to learn from them.
• Staff involved patients and those close to them in decisions about their care and treatment.
• The play therapy team were available seven days a week. They came to the wards to work with patients around anxiety and distress, and helped to prepare them for procedures.
• Patients’ needs were considered at all stages of paediatric care. There had been a marked improvement to the care of children or adolescents suffering with mental ill health since our last inspection.
• People could access the service when they needed it. There were good links with local GPs who could call the paediatric registrar (who held a bleep) for telephone advice, or could directly contact the consultant in charge. The service has helped to reduce referral to hospital and improved patient experience.
• Staff universally felt supported by their managers and each other. We saw a collaborative team who worked together to ensure they were delivering the best care to their patients.
• The senior staff we spoke to understood the challenges and could identify what changes were needed to address them. An example of this is the planned paediatric assessment unit to help with the flow and staffing of the department.

However:

• We found chipped skirting boards and peeling paint in bathrooms, this could be an infection control risk as these areas could not be cleaned effectively. We also found some light dust in high areas, such as above beds, and on television brackets, suggesting these areas may need to be cleaned more often.
• We found an un-locked sluice which contained cleaning products and waste in the incorrect bin. This could mean patients could access the harmful cleaning products.
• The department did not have a dedicated pharmacist. The ward was visited each day by a pharmacist or pharmacy technician. However, we found for one ward had not been visited by a pharmacist for over two days to clinically check the medicine charts or carry out medicines reconciliation.
• Some leaflets needed to be reviewed to ensure they contained up-to-date information.

There was no formal care passport for patients with complex needs. This was not in line with recently recommended National Confidential Enquiry into Patient Outcomes.

Updated 4 October 2018

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

• Following our inspection in 2014, there had been improvements to the critical care unit. These improvements contributed to the safety of patients.
• There were effective systems in place to protect patients from harm and a good incident reporting culture.
• The critical care outreach team provided effective support to the general wards with the management of deteriorating patients and preventing admissions to ICU.
• Patients received effective, evidence-based care and patient outcomes were within the expected range. There was an extensive audit and research programme and an investment in finding new ways to improve patient outcomes.
• Appropriately qualified staff cared for patients. There were effective training programmes for both nursing and medical staff. The percentage of nursing staff with post registration qualification in critical care met the recommended guidelines.
• There was a strong culture of multidisciplinary working on the unit.
• There was an embedded culture of supporting patients and their families during and after admission to critical care. The service was committed to engaging with patients and their relatives and tailored care to suit individual needs.

Updated 10 March 2015

The specialist palliative care team were accessible, visible and supportive of all areas in the trust. Team working with all wards and departments was evident to promote safe and effective end of life care. Staff throughout the trust valued the skills and support of the specialist palliative care team. The review of patients took place within multidisciplinary meetings to promote coordinated, safe and effective care. Care records demonstrated that potential problems for patients were identified and planned for in advance. The team were piloting and reviewing a person-centred care plan to be used to improve the safe and effective delivery of care in line with current best practice.

Staff throughout the trust were caring and treated end of life patients and their relatives with dignity and respect. Staff made every possible effort to ensure that patients and relatives had everything they needed to be comfortable and accommodated. The close working relationship between the nursing and medical staff, chaplaincy, bereavement, mortuary services and porter services was evident to support patients and relatives.

Updated 29 March 2023

Updated 10 March 2015

We found that a safe environment for patients was maintained and that the required safety checks were being completed and recorded. The outpatient waiting areas and clinic rooms were clean and hygienic.

Patients attending the outpatient clinics were positive about their treatments and consultations and the professionalism of the staff.

Clinical staff were caring and compassionate in their approach to patients. Staff were treated with respect.

The trust was taking action and implementing changes to respond to an increased demand in some clinic services. Some additional clinics were being run and action was being taken to improve the patient experience with regards to appointment booking.

There were consistent processes to monitor the performance of the different clinic services and identify risks and ongoing concerns. There was an ongoing transformation plan for the outpatient service that was being implemented with the engagement of staff.

Updated 27 January 2022

Updated 4 October 2018

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

• The service did not always control infection risks well as there were ineffective systems in place to protect patients from cross infection. Staff did not clean their hands at the right time, did not wear personal protective equipment, such as gloves and aprons, correctly, or manage linen in line with policy. There was a lack of adequate isolation facilities within the emergency department. Waste was not segregated in line with guidance. We found inappropriate items in all of the different waste containers
• The service had suitable premises and equipment but did not a look after them well. Equipment used in the event of an emergency was not checked consistently to ensure it was present, and in working order. Fire exits were blocked; fire doors were not fit for purpose, and would be ineffective at protecting patients and staff from fire and smoke.
• Staff did not always keep appropriate records of patients’ care and treatment. Casualty care records we looked at varied in quality and completeness. We found two set of notes where we could not read the writing.
• The service provided mandatory training in key skills but not everyone completed it. Mandatory training was below the trust target of 90%, for all staff groups.
• The service monitored the effectiveness of care and treatment and used the findings to improve them. The department took part in both national and local auditing. However local audits did not reflect, or limited improvements were seen despite non-compliances being identified.
• Patient indefinable information was not kept secure. Patients’ information including full name, date of birth and other information was on display to other patients and visitors to the department.
• Staff did not always give patients food and drink to meet their needs and improve their health. Patients were not routinely offered a choice of food to meet both dietary and cultural requirements. This meant, that patients with dietary requirements or choices, such as lactose intolerance or being a vegetarian were not offered a choice of food.
• Pain was manged well, but the assessment and recording of patient’s level of pain on arrival at the emergency department was variable. Waiting times from treatment and arrangements to admit, treat and discharge patients were not in line with good practice. The service did not meet the Department of Health’s standard for emergency departments, which is that 95% of patients should be admitted, transferred, or discharged within four hours of arrival in the emergency department The service did not meet the Royal College of Emergency Medicine recommends that the time patients should wait from time of arrival in the department to receiving treatment should be no more than one hour.

However:

• Equipment was visibly clean and had been checked for electrical safety. There was a programme of planned preventative maintenance
• The service managed patient safety incidents well. Risk was managed and incidents were reported and acted upon with feedback and learning provided to staff. There were effective systems in place to report incidents. Incidents were monitored and reviewed and staff gave examples of learning from incidents. Staff understood the principles of Duty of Candour regulations and were confident in applying the practical elements of the legislation
• The service provided care and treatment based on national guidance and evidence of its effectiveness Staff had access to up to date evidenced based guidance from organisations such as the National Institute for Health and Care Excellence and the Royal College of Emergency Medicine. There was effective multidisciplinary team working within the service and with other agencies. The service also participated in national audits.
• Staff knew the trust’s vision and strategy, and told us how they made sure they put these into their practice.
• Patients were treated with dignity and respect. Staff introduced themselves to patients and asked what they would like to be called.
• Staff involved patients and those close to them in decisions about their care and treatment. Patients confirmed that they felt involved in decision-making and medical and nursing staff shared enough information to support their decision-making; we observed that staff asked if what they said had been understood by the patient and if there were further questions the patients, relatives or carers had.