Wexham Park Hospital is situated in Slough and has been part of Frimley Health NHS Foundation Trust since October 2014. The hospital provides surgical services such as emergency, orthopaedic, trauma, plastic and reconstructive surgery to a population of more than 450,000.

We completed a focussed inspection of the surgery service at Wexham Park Hospital on 3 July 2018. This inspection was in response to information of concern about the safety of the surgical services. The focus of this inspection was to review how the hospital responded to risks, shared learning from incidents and how the service leaders ensured changes were implemented and adhered to. During our inspection we came across a number of concerns relating to the environment, cleanliness and medicines that we followed up on at the time of the inspection.

Our key findings were as follows:

• Substances subject to Control of Substances Hazardous to Health (COSHH) legislation were not always stored securely. We found cleaning tablets stored in an unlocked utility room.

• Access to medicines was not appropriately restricted on the surgical unit. We found prescription only medicines left unattended in an unlocked pharmacy room.
• Accesses to various areas within the service were not appropriately restricted. Doors were left open and unlocked and there was no way of tracking the entering and exiting of visitors into the department.
• Staff were knowledgeable about incident reporting and their responsibilities.

• Lessons learned were communicated widely to support improvement within the service.
• Governance arrangements were clear and structured ensuring leaders and staff received  information to enable them to challenge and improve performance.

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

Importantly, the trust must:

• The service must ensure there are appropriate systems of medicine management and that staff are of their responsibilities in relation to this.
• The service must ensure safe and secure storage of substances subject to Control of Substances Hazardous to Health (COSHH) legislation.
• The service must ensure the access to surgical areas is restricted to authorised persons.
• The service must ensure the temperature of the blood fridge is checked and recorded regularly in line with national requirements.
• The service must ensure all sections of the WHO surgical safety checklists are performed for every procedure undertaken.

In addition the trust should:

• The service should ensure equipment including sterile supplies are stored safely and securely.
• The service should ensure all policies are up to date.
• The service should display stop before you block information in the anaesthetic room as a visual reminder for staff involved in anaesthetic procedures.
• The service should ensure the environment is free from clutter.

Professor Edward Baker

Chief Inspector of Hospitals

Our rating of services stayed the same. We rated them as good because:

• We rated the hospital as good overall. We rated well led as outstanding, and safe, effective, caring and responsive as good. In aggregating ratings, we took account of the ratings from 2014 for the six services we did not inspect at this time.
• On this occasion we rated both surgery and maternity as good in effective, caring, responsive and well led. For safe we rated surgery as good and maternity as requires improvement.

• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

• The hospital controlled infection risk well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection. The hospitalhad suitable premises and equipment and looked after them well.

• The hospital followed best practice when prescribing, giving, recording and storing medicines. Patients received the right medication at the right dose at the right time.

• Generally the hospital had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.

• The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support in line with the duty of candour.

• The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance and monitored the effectiveness of care and treatment and used the findings to improve them.

• Staff gave patients enough food and drink to meet their needs and improve their health. The hospital made adjustments for patients’ religious, cultural and other preferences.

• Staff assessed and monitored patients regularly to see if they were in pain. They supported those unable to communicate using suitable assessment tools and gave additional pain relief to ease pain.

• Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.

• The trust planned and provided services in a way that met the needs of local people and took account of patients’ individual needs. The trust was a leader in the Frimley Integrated Care System and collaborated well with partners.

• The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with all staff. However, the trust did not always meet its own standard in response timeliness.

• Managers at all levels in the hospital had the right skills and abilities to run a service providing high-quality sustainable care.

• The trust had a vision for what it wanted to achieve and workable plans to turn it into action. This was underpinned by a set of values that staff at the hospital understood.

However:

• Although the trust provided mandatory training in key skills to all staff the trust was not achieving its completion target of 85% in all topics.

• Although there were systems for managers to appraise staff’s work performance not all staff had received an up to date appraisal.

• Midwifery staffing did not always meet national guidance. Women did not always receive one to one during labour.