At our last inspection in April 2014 we found concerns with the arrangements for the management of medicines. The provider wrote to us and told us that they had taken action to address the concerns. At this visit we saw that this plan was being acted upon and medicine management had improved.

Prior to our inspection we had received information which raised concerns about the management of medicines in the service. This information raised concerns that private prescription records were incomplete.We checked the private prescription record book and found that for private prescriptions dispensed for people who attended a separate clinic, a record of people’s addresses was not made in the prescription book.

We visited the short-stay and long-stay wards, critical care and theatres in the hospital. There were 17 people admitted to the hospital on the day of the inspection.

We looked at satisfaction survey results for the period of October – December 2013 to which 325 people responded. Overall the respondents expressed high levels of satisfaction about the care they had received.

Care and treatment was planned and delivered in a way that was intended to ensure potential risks to people's health were considered and people's needs were assessed. We observed that care records for people using the service were securely stored across the hospital and could be located promptly.

There were systems in place to reduce the risk and spread of infection. Overall the ward and theatre areas we visited in the service appeared clean and well maintained on the day of the inspection.

Medical equipment committee meetings were held quarterly. Issues with equipment were identified within this forum along with actions to follow up on.

The provider had effective recruitment and selection processes in place. We saw vacancies were currently being advertised on the website.

People we spoke with on the day of the inspection reported being satisfied with the quality of the care they had received.

Over 96% of people who responded in the hospital’s recent survey rated their overall care as ``excellent’’ or ``very good’’.

There was a consent policy and procedure in place and the hospital were found to be following their own guidance in obtaining consent from people. People we spoke with confirmed they were asked for their permission before care and treatment was carried out.

Staffing levels were planned and adjusted to accommodate the specific needs of people using the hospital.

Staff we spoke with knew what procedures to follow if they suspected abuse and people we spoke with told us they felt safe at the hospital. The hospital only treated adults.

It was evident that people knew how to make a complaint. People we spoke with knew how to raise complaints.

As part of our inspection we talked with a number of patients. They spoke positively about the staff and care provided and told us that staff treated them with dignity and respect. Everyone we spoke with felt they were involved in their care and in making decisions about their care and treatment.

Patients described staff as treating them as individuals, with personalised care. We were told by the patients that information about their treatment and care was regularly supplied to them by staff and that they were kept informed regarding their progress and changes in their treatment plans.

Patients told us that staff responded quickly to their call bells and that the hospital environment was comfortable and clean.

King Edward VII’s Hospital is operated by King Edward VII’s Hospital Sister Agnes. The hospital has 50 beds. Facilities include three operating theatres, a four-bed level three critical care unit, and X-ray, outpatient and diagnostic facilities.

The hospital provides surgery, medical care, critical care, outpatient services and diagnostic imaging. We inspected all core services.

We inspected this service using our comprehensive inspection methodology. We carried out the unannounced part of the inspection between 11 and 13 December 2018.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

The main service provided by this hospital was Surgery. Where our findings on surgery – for example, management arrangements – also apply to other services, we do not repeat the information but cross-refer to the surgery service level report.

Services we rate

Our rating of this hospital improved. We rated it as Good overall.

We found mainly good practice in all the key questions for all the five services we inspected.

The hospital had made significant improvements in the services of surgery and outpatients; both of these services had previously been rated as requires improvement.

We found the following areas of good practice across all services:

• The service had improved the systems in place for reporting, investigating and learning from incidents.
• The service had improved the systems of outpatient record keeping.
• The service provided mandatory training in key skills to all staff and made sure everyone completed it.
• The hospital used current evidence-based guidance and quality standards to plan the delivery of care and treatment to patients. There were effective processes and systems in place to ensure guidelines and policies were updated and reflected national guidance and improvement in practice.
• We observed staff treated patients and their families with compassion and care to meet their holistic needs.
• The hospital planned, developed and provided services in a way that met and supported the needs of the population that accessed the service, including those with complex or additional needs.
• The service treated concerns and complaints seriously, investigated them and learned lessons from the results, which were shared with all staff.
• Managers had implemented systems to strengthen governance, performance and risk management arrangements across the hospital since the last inspection.
• Managers across the services promoted a positive culture that supported and valued staff. The majority of staff told us they felt listened to and well supported by managers and colleagues and were confident to raise any concerns they had.
• The hospital engaged well with patients, staff, the public and local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively.
• We found the following areas of outstanding practice:
• The Veteran’s Centre provided a tailored pain management programme for veterans. A multidisciplinary team of consultants in pain medicine and clinical psychology, clinical nurse specialists and physiotherapists, worked together to treat patients suffering from chronic pain (often in association with post-traumatic stress disorder). Objectives of the programme were to help veterans to improve their mood, to develop a better understanding of their pain and to increase levels of meaningful activity, self-management skills and general quality of life.
• The breast unit was designed and organised around patients’ individual needs, taking emotional effects into consideration and valuing patients’ time. It was well managed and staff were enthusiastic and compassionate.

However, we also found the following issues that the service provider needs to improve in surgery, critical care, outpatients and diagnostic imaging:

• In surgical services, the hospital did not have an emergency anaesthetic consultant rota.
• Managers did not always monitor the effectiveness of care and treatment in all areas.
• Staff and patient survey results showed response rates below expectations.
• In the diagnostic imaging department, not all staff complied with infection control procedures. Staff did not consistently clean ultrasound probes according to hospital procedures and national guidance, sharps bins were not always stored safely, all staff were not bare below the elbows and equipment cleaning checks were not consistently completed.
• The safety barrier to prevent unauthorised access to the MRI room was not always pulled across when it should have been. The waiting area did not promote privacy and dignity.
• Staff did not always log out of computers to ensure security of patient data.
• There was a lack of health promotion material available across the diagnostic department.
• There was not full dietetic support over the weekend for patients requiring specialist input or those with total parenteral nutrition (TPN) prescriptions.
• Patient records were not always complete. We found some issues with completion of the WHO checklist, patient observation charts and tissue viability assessments.
• Not all medicines stored on the critical care unit were clearly labelled with expiry dates.
• There were high levels of bank staff in the outpatient department.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements. We also issued the provider with a requirement notice. Details are at the end of the report.

Dr Nigel Acheson

Deputy Chief Inspector of Hospitals