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Care Services

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Alexandra Hospital, Redditch.

Alexandra Hospital in Redditch is a Hospital specialising in the provision of services relating to assessment or medical treatment for persons detained under the 1983 act, caring for adults over 65 yrs, caring for adults under 65 yrs, caring for children (0 - 18yrs), diagnostic and screening procedures, family planning services, management of supply of blood and blood derived products, maternity and midwifery services, surgical procedures and termination of pregnancies. The last inspection date here was 13th February 2020

Alexandra Hospital is managed by Worcestershire Acute Hospitals NHS Trust who are also responsible for 4 other locations

Contact Details:

Ratings:

For a guide to the ratings, click here.

Safe: Inadequate
Effective: Requires Improvement
Caring: Good
Responsive: Inadequate
Well-Led: Inadequate
Overall: Inadequate

Further Details:

Important Dates:

    Last Inspection 2020-02-13
    Last Published 2019-03-01

Local Authority:

    Worcestershire

Link to this page:

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Inspection Reports:

Click the title bar on any of the report introductions below to read the full entry. If there is a PDF icon, click it to download the full report.

14th January 2019 - During an inspection to make sure that the improvements required had been made pdf icon

We carried out an unannounced focused inspection of the emergency department at the Alexandra Hospital on 14 January 2019, in response to concerning information we had received in relation to care of patients in this department. At the time of our inspection the department was under adverse pressure.

We did not inspect any other core service or wards at this hospital. During this inspection we inspected using our focused inspection methodology. We did not cover all key lines of enquiry and we did not rate this service at this inspection. We found that:

  • There were delays in off-loading ambulances and resultant delays in assessment and treatment for some patients due to overcrowding.
  • Whilst the service mostly had suitable premises, there were insufficient cubicles to accommodate all the patients in the department when it was overcrowded. Patients were being cared for in a crowded corridor at the time of the inspection.
  • Triage times were not always in line with guidance. Some patients waited considerable time to be assessed due to overcrowding.
  • Whilst risks to patients were assessed and their safety monitored and managed, not all patients received treatment in a timely manner due to overcrowding. The trust reviewed these patients and reported no harm had been experienced.
  • The emergency decision unit did not have separate male and female areas.
  • Not all emergency equipment was recorded as checked in line with trust policy or best practice.
  • The department did not offer majors’ treatment for sick children, but some parents brought children to this ED. There was only one paediatric trained nurse employed in the department. There were no child specific competency frameworks used to train adult nurses how to look after children. Nursing staff did not have paediatric competencies. There were some shifts without an advanced paediatric life support trained nurse, although there were always medical staff on duty who had advanced paediatric life support training.
  • Whilst there were enough medical staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care at the time of the inspection, consultant cover in the department did not meet recommended guidelines. Some doctors told us they needed more doctors in order to keep the department safe when it was overcrowded.
  • Patient privacy and dignity was not always protected due to overcrowding. Nurse handover was taken in the middle of the ward outside a patient cubicle. Handovers could be heard by other people in the department.
  • Patients could not always access the service when they needed to due to overcrowding. Some patients had long delays in accessing emergency care and treatment.
  • Specialty doctors were unable to respond to all patients in a timely manner.
  • Some staff were frustrated by the recent changes to service delivery. This included the change of post code areas and the frequent ambulance diversions to the Alexandra Hospital from Worcestershire Royal hospital.

However:

  • Staff cared for patients with compassion during the inspection. Staff were friendly, professional and caring at all times even when under extreme pressure due to overcrowding in the department. Staff tried to maintain patient privacy and dignity in times of overcrowding.
  • Feedback from parents and relatives confirmed staff treated them well and with kindness. Staff involved patients and those close to them in decisions about their care and treatment.
  • Patients received a comprehensive assessment in line with clinical pathways and protocols. Risk assessments were completed accurately, and actions taken to address any concerns.
  • There were processes in place to escalate concerns regarding patients’ safety/care or treatment. The trust had policies in place for responding when demand exceeded capacity in the ED. The service had introduced a tool for recognising patients at risk which promoted actions to be taken to prevent deterioration.

  • All patient assessments we looked at included an accurate NEWS score, which had been recorded on admission and regularly thereafter.
  • There were enough nursing staff with the right qualifications, skills, training and experience to keep adult patients safe from avoidable harm and to provide the right care.
  • The service had sufficient quantities of suitable equipment which was easy to access and ready for use.
  • The service had managers at all levels with the right skills and abilities to run a service providing high-quality sustainable care. Clinical leaders were visible in the department.
  • The service had a documented vision for what it wanted to achieve. Plans were being implemented to ease overcrowding in the department were in development with involvement from staff, patients, and key groups representing the local community.
  • Staff and managers across the service promoted a positive culture that supported and valued one and other. Staff were respectful of each other and demonstrated an understanding of the pressures and a common goal.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

  • Reduce the number of ambulance handover delays.
  • Ensure all patients receive timely initial clinical assessments.
  • Ensure all patients are seen by emergency department doctors and speciality doctors when needed.
  • Reduce the number of patients cared for in corridor areas.
  • Consultant cover in the department must meet national guidelines.

In addition, the trust should:

  • Fully implement the trust wide actions to reduce overcrowding in the department.
  • Emergency equipment must be recorded as checked in line with trust policy.
  • Consider joint nursing and medical handovers.
  • Review that nursing handovers occur in an appropriate environment which allows privacy for patients and patient details.
  • Monitor that there are nursing staff with children’s nursing competencies on duty at all times.
  • Review mixed sex breaches in the emergency decision unit to ensure separate areas are available to respect dignity and privacy.
  • Monitor that medicines are provided from pharmacy and administered by staff in a timely manner.

Following this inspection, we considered enforcement action, however, we were not assured that conditions applied would benefit or improve the situation or manage the risks. The trust was therefore issued with a requirement notice.

Professor Edward Baker

Chief Inspector of Hospitals

24th March 2015 - During an inspection to make sure that the improvements required had been made pdf icon

We inspected Worcestershire Acute Hospitals NHS Trust on the evening of the 24th March 2015 as a part of a responsive inspection. The purpose of the unannounced inspection was to look at the emergency departments (ED) at Worcestershire Royal Hospital and Alexandra Hospital. The services were selected as examples of a high risk services according to our intelligent monitoring model. This looks at a wide range of data, including patient and staff surveys, hospital performance information and the views of the public and local partner organisations.

We did not inspect any other services provided at the trust.

The inspection focused on the safety of patients. We found that improvements were needed to ensure that the EDs were safe.

We also looked to ensure each ED was effective, caring, responsive and well led. However, we did not have sufficient evidence to rate domains.

Our key findings were as follows:

Incidents

  • Systems were in place for reporting incidents. However, incidents were not always reported. This meant that data provided in relation to incidents may not provide a reliable oversight of incidents occurring in these services.

Safeguarding

  • Children were not routinely screened for safeguarding concerns. At Alexandra Hospital we found one child who had received an injury, did not have a safeguarding assessment completed.
  • We found paediatric patients were at risk because there were inadequate measures in place in relation to their security.

Medicines management

  • The medicines in the resuscitation room were stored in a lockable cupboard, which was in constant use during our visit.
  • The register for the controlled medications were completed and tallied with the actual medications in the controlled drug cupboard.

Staffing

  • There was a shortfall in nursing staff numbers. There was no evidence shifts were being planned to reflect the patients’ acuity and therefore the planned staffing did not always meet the needs of the patients in the department.
  • Senior staff told us they had escalated concerns about staffing and capacity in the department to senior managers as they considered the department was “not safe” at times due to the high volume of patients.
  • We saw evidence of the department being “Overwhelmed”. However the escalation process could not always been carried out because there were no more staff available. This meant that the department was not able to manage the situation safely.

Medical staffing

  • Forty percent of the senior staff were locum.
  • There was one consultant on site after 5pm covering both the Worcestershire Royal Hospital and the Alexandra Hospital site, including trauma calls. This was raised as a concern during a peer review from NHS England. If two trauma patients were admitted at the same time on each site, the protocol was that one of the trauma calls would be led by the orthopaedic doctor.

Environment and equipment

  • All of the cubicles had nurse call bells available.

Ambulance Handovers

  • There were delays in handover time from ambulance crew to the emergency department team. This meant that patients, including clinical unstable patients, remained under the care of the ambulance crew longer than expected which delayed initiation of treatment.
  • In the past 12 months the trust had not consistently met its 15 minute triage target or its target for patient handovers being carried out within 30 minutes of arrival by ambulance.

There were areas of poor practice where the trust needs to make improvements.

We found breaches with the following regulations:

  • Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 [now Regulation 15 (1) and (2) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014].

Importantly, the trust must:

  • The trust must ensure that service users are protected against the risks associated with unsafe or unsuitable premises, by means of appropriate measures in relation to the security of the EDs.

Professor Sir Mike Richards

Chief Inspector of Hospitals

6th March 2014 - During a routine inspection pdf icon

This inspection looked at how the provider dealt with and responded to hospital acquired infections. In particular we looked closely at how outbreaks of Norovirus were managed. Norovirus causes sickness and diarrhoea and can cause complications for people that are vulnerable due to illness. This infection has been known to be a recurrent problem for hospitals throughout the winter months.

We were unable to carry out any observations in ward areas. However, we met with the registered manager, the chief executive and with a range of staff which included doctors, nurses, housekeepers and care assistants. We held a special forum with staff to enable them to discuss with us their feelings on how infection prevention and control was managed. We also looked at the policies, procedures and risk assessments for infection control.

During our inspection we found that the provider had systems in place to prevent, detect and control the spread of infection. For example, we read the policies and procedures around the management of Norovirus. We found that these policies provided robust guidelines for the monitoring, reporting and management of this infection.

We saw that the provider had risk assessments and action plans for how to manage the risk if infections were present in the hospital. These included guidance for staff on isolating patients if they had any infection that could be contracted by other patients, this included Norovirus. The policy stated that this prevented the further spread of infection and also protected patients that were at increased risk of acquiring an infection from other patients. Staff we spoke with confirmed that wards were closed and staff movements to other wards restricted when Norovirus was present. This meant that the provider had appropriate measures in place to reduce the risk of the spread of infection.

7th March 2013 - During a routine inspection pdf icon

We carried out observations on wards 9, 10, 12, and 16. We also spent time in the Accident and Emergency department and the Discharge Lounge and spoke with some of the staff who worked in the areas we visited. We also took the opportunity to formally meet with groups of staff who worked in other areas such as physiotherapy, occupational therapy, pharmacy and portering services.

We observed how care was delivered and spoke to 26 patients about the care they had received. Most people told us they were happy with the care provided and the level of information they had been given about their care and treatment.

One person told us: “The staff here are brilliant, whichever part of the hospital I’ve been on. Despite staff always being busy, you never see them stood”. Another person said: “They always ask if I need anything and explain before they start and say what they are doing it for”.

Overall we found that there were arrangements in place to ensure that people’s needs would be met when they were discharged or were transferred to other care providers .

There were appropriate arrangements for staff training and staff told us they received training which was appropriate to their roles and responsibilities.

There were arrangements for monitoring the quality of care delivered at ward and departmental level and for reporting the information to the trust board. Information from audits or checks completed was used to improve practice where necessary.

15th June 2011 - During an inspection to make sure that the improvements required had been made pdf icon

We spoke to a total of nine patients, one relative and two visitors at the Alexandra Hospital and three patients at the Worcestershire Royal Hospital.

People we spoke to were positive about the care provided and made a number of very positive comments ‘Yes, very happy, the staff are lovely’, ‘Brilliant can’t fault it’, ‘The staff are really nice and provide good care’.

People told us they were kept informed about their care and treatment and that staff explained things to them. Patient information was not widely available at the Alexandra Hospital but we were told that this was being addressed.

All of the people we spoke to felt that staff responded to their needs promptly although not everyone we saw at the Alexandra Hospital had call bells accessible to them.

People we spoke to were very complimentary about the meals served to them and we saw that food was made available to people who may have missed food while investigations were being carried out.

The environment was quiet and conducive to eating, people appeared relaxed and reported they enjoyed their meal. Three of the nine people we spoke with were not aware that snacks outside mealtimes were available if they wished.

22nd March 2011 - During a themed inspection looking at Dignity and Nutrition pdf icon

During our observations on both wards we spoke with a total of five patients and one visitor. People we spoke to were generally complimentary of the care they had received from staff in the hospital. However, some people told us that that they were not given any information on their arrival to hospital and that they were not always kept informed of what was happening to them. When we spoke to people about how staff respond to their individual needs some people told us that they often experienced delays in getting help from staff when they pressed their call bell for help.

People we spoke to were very complimentary of the meals provided to them and most people were able to choose what they wanted to eat from a menu. However, none of the people we spoke to said that snacks were available to them between meals.

1st January 1970 - During a routine inspection pdf icon

Our rating of services stayed the same. We rated it them as inadequate.

  • Patients could not access services when they needed them. Waiting times for treatment were not in line with good practice. The number of cancelled operations for non-clinical reasons was worse than the England average.
  • Not all systems in place were effective in recognising and responding to deteriorating patients’ needs. This included harm reviews of patients waiting for a procedure.
  • The trust was performing worse than the England average for patients waiting over 60 minutes before being handed over to emergency department staff. Not all patients were recorded as being seen by a specialist doctor despite being referred.
  • The trust did not ensure everyone completed mandatory training.
  • While staff understood the need to protect patients from abuse, not all staff had completed training at the required level to ensure they had the appropriate level of knowledge to do so.

  • There were inconsistencies in staff being able to recognise and report incidents.
  • Not all staff had received an appraisal.
  • The hospital had medical staff with the right qualifications, skills and experience to keep people safe from avoidable harm and abuse and to provide the right care and treatment. However, there was insufficient medical cover to provide consultant presence in the department for 16 hours a day, as recommended by Royal College of Emergency Medicine.
  • The trust planned but did not provide services in a way that met the needs of local people.
  • Services did not always have a documented vision or strategy.
  • Information was not always collected, analysed, managed and used well to support activity.
  • Continuous improvement, and learning from when things go wrong was not evident across all areas.
  • There were inconsistencies with infection control and prevention techniques, particularly hand hygiene.

However:

  • Managers investigated reported incidents and shared lessons learned with the whole team. When things went wrong, staff apologised and gave patients honest information and suitable support.
  • Most areas had enough nursing staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and abuse and to provide the right care and treatment.
  • The hospital had suitable premises in most areas and systems were in place to ensure most equipment was well looked after.
  • The hospital prescribed, gave, and recorded medicines well. Patients generally received the right medication of the right dose at the right time.
  • Generally, staff ensured that patients’ individual care records were well managed and stored appropriately.
  • Services took account of patients’ individual needs.
  • The hospital provided care and treatment based on national guidance and evidence of its effectiveness.
  • The hospital managed most patients’ pain effectively and provided or offered pain relief regularly. However, children’s and young peoples’ pain was not always managed effectively.
  • Staff generally gave patients enough food and drink to meet their needs and improve their health.
  • Multidisciplinary staff worked together as a team to benefit patients.
  • Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.
  • Staff provided emotional support to patients to minimise their distress.
  • Most managers across the hospital promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.

 

 

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