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  • NHS hospital

St Helens Hospital

Overall: Good read more about inspection ratings

Marshalls Cross Road, St Helens, Merseyside, WA9 3DA (01744) 26633

Provided and run by:
Mersey and West Lancashire Teaching Hospitals NHS Trust

All Inspections

6 October 2022

During a routine inspection

We carried out an announced comprehensive inspection at St Helens Hospital (Marshalls Cross Medical Centre) on 4, 6 and 12 October 2022. Overall, the practice is rated as Good.

Safe - good

Effective - good

Caring - good

Responsive – good

Well-led - good

Following our previous inspection on 18 August 2018 the practice was rated requires improvement overall and for key questions safe, effective and well-led and good for providing caring and responsive services.

Marshalls Cross Medical Centre is run by St Helens and Knowsley Teaching Hosptials NHS Trust and comes under St Helens Hospital location regulated activities. It is not required to register with the Commission as a separate GP practice location.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for St Helen’s Hospital on our website at www.cqc.org.uk

Why we carried out this inspection

We carried out this inspection to follow up breaches of regulation from a previous inspection in line with our inspection priorities.

How we carried out the inspection

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.

This included :

  • Conducting staff interviews using video conferencing.
  • Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
  • Reviewing patient records to identify issues and clarify actions taken by the provider.
  • Requesting evidence from the provider.
  • A short site visit.

Our findings

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected
  • information from our ongoing monitoring of data about services and
  • information from the provider, patients, the public and other organisations.

We found that:

  • The practice had implemented a system for ensuring that patients on long term or high-risk medication were monitored. Uncollected prescriptions were followed up and monitored.
  • Detailed risk assessments for the premises, facilities and to provide services for patients on the specialist allocation scheme had been undertaken and were regularly reviewed.
  • Safeguarding processes had been strengthened.
  • Systems were in place to monitor NICE and other best practice guidance.
  • Staff had completed essential training relevant to their role and responsibility.
  • Effective clinical audits had been undertaken and an annual audit programme was in place.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • Patients could access care and treatment in a timely way.
  • Clinical oversight and governance systems for the practice had been reviewed and integrated into the Trust’s community services directorate.
  • The governance arrangements, strategy and plans for the practice were regularly reviewed and monitored.
  • There were effective systems and processes for identifying, managing and mitigating risk.

Whilst we found no breaches of regulations, the provider should:

  • Continue to improve uptake for cervical screening and childhood immunisations.
  • Continue to monitor patient medication reviews.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services

17 July 2018 - 23 August 2018

During a routine inspection

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

  • Safe, effective and responsive were rated as good.
  • Caring and well led were rated as outstanding however it should be noted that we did not inspect the outpatients service at this inspection and the outstanding ratings were awarded at the previous inspection in August 2015.
  • The surgery services were rated as good in all domains.
  • Marshalls Cross Medical Practice required improvement in safe, effective and well led but were rated good in caring and responsive.

14/8/2018

During a routine inspection

This practice is rated as requires improvement. (This was the first inspection for this practice).

The key questions at this inspection are rated as:

Are services safe? – Requires improvement

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires improvement

We carried out an announced comprehensive inspection at St Helen Hospital, Marshalls Cross Medical Centre 14 August 2018. This inspection was carried out as part of the inspection of the St Helens and Knowsley Teaching Hospital NHS Trust inspection programme completed by the Care Quality Commission (CQC) hospital directorate inspection.

The trust had taken over two practices and was working hard to provide safe, effective, caring, responsive and well-led service. The two patient lists were joined and patients were given an automatic right to remain at the practice if they wished.

The trust had successfully amalgamated two administration teams and provided training and support to ensure they could work together and in keeping with the trusts values. Only one of the original GP’s continued to work at the practice. The practice used locums GP’s and advanced nurse practitioners to ensure patients continued to receive a service at the location. A suit of policies and procedures had been developed for staff to follow.

At this inspection we found:

  • The practice had systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes. These systems, however, needed to be strengthened.
  • Patients were involved in planning the care they received.
  • There was a focus on continuous learning and improvement and elements of this had been embedded into the Marshalls Cross Practice, however, additional steps needed to be taken to ensure all staff completed the training and acquired the expertise necessary to carry out their current or proposed responsibilities.
  • Patients reported they found the appointment system easy to use, could access care when they needed it and appointment availability was flexible.
  • Patient feedback and the management of complaints, we reviewed, indicated that staff treated patients with compassion, kindness, dignity and respect.
  • The practice did not have a comprehensive programme of clinical improvement activity. A program of clinical audits to measure outcomes and drive improvements was not in place.
  • The audits or checks that had been completed were not thorough because they did not include information about the basis for any findings.
  • There was no evidence that the provider had completed performance management for GPs, locum GPs and advanced nurse practitioners on an ongoing basis.
  • Processes for dealing with child protection issues needed to be strengthened.
  • Processes for dealing with uncollected prescriptions were not robust.
  • All relevant risk assessments had not been completed.

The areas where the provider must make improvements are:

Ensure care and treatment is provided in a safe way to patients.

Ensure patients are protected from abuse and improper treatment.

Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

  • provide daily cleaning plans and checklists to the practice for cleaning staff to follow so they can be assured that all areas are cleaned as required.
  • keep health and safety risk assessments and corresponding action plans under frequent review to ensure remedial action is timely.
  • revise the induction program for temporary clinicians to ensure the information is tailored to their roles.
  • develop a risk assessment and mitigation plan in relation the medicines omitted from the emergency medicines kit.
  • act to monitor staff compliance with the consent protocol.
  • review staff meeting notes in line with the confidentiality protocol.
  • ensure staff are suitable prepared to take on specialist roles.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

19, 20 & 21 August

During a routine inspection

St Helens Hospital is part of St Helens and Knowsley Teaching Hospital NHS Trust and provides a range of hospital services, including general and specialist medicine, general and specialist surgery outpatients and diagnostics.

St Helens Hospital is situated in St Helens Merseyside and serves a population of approximately 350,000 people residing in the surrounding area of Knowsley, Halton, St Helens and the area of South Liverpool.

We carried out this inspection as part of our scheduled program of announced inspections.

We visited the hospital on 19, 20 and 21 August 2015. During this inspection, the team inspected the following core services:

  • Medical care services (including older people’s care)
  • Surgery
  • Outpatients and Diagnostic Services

Our key findings were as follows:

Leadership and Management.

The hospital was well led and well managed. The Executive Team and senior managers were frequent visitors to the site and were well known by staff. Staff felt managers were visible accessible and supportive.

The trust’s vision regarding 5 star patient care was well understood and embedded. Staff were clear about their roles and responsibilities and all disciplines worked well together for the benefit of patients.

There was a positive culture throughout the hospital and staff felt valued and included. They were proud of the hospital and the care and treatment they provided to patients.

Staff and patients were well engaged in service design and development. Staff were supported and encouraged to be innovative to secure improvement and enhance patient experience. In addition there were good opportunities for staff development and a range of staff awards available for both services and individuals that performed well.

Successes were celebrated and shared at a range of staff events including an annual awards celebration that was highly valued by staff.

Access and Flow

  • For the period April 2013 to February 2015 the hospital met the 18 week standards for referral to treatment times in all specialties provided at the hospital.
  • NHS England data showed the number of elective operations cancelled was better than the England average from July 2014 to September 2014. Trust data between April 2014 and July 2015 showed a low number of operations (87) were cancelled at St Helens Hospital. Reasons for cancellations included the theatre lists overrunning and patients not attending appointments.
  • When an operation was cancelled, staff arranged a new date with the patient on the day of the cancellation. NHS England data showed all patients that had their operations cancelled were treated within 28 days since April 2011 which was better than the England average.
  • Meetings on bed availability were held four times a day to determine priorities, capacity and demand for all specialities. These were attended by both senior management staff and senior clinical staff.
  • Very occasionally there were surgical outliers admitted to Duffy Suite (medical unit). There were recently two patients from Sanderson Suite who had had an operation that day but they only stayed overnight and came with an appropriately trained nurse to look after them.
  • As part of managing the admission and discharge processes there was a ‘patient status at a glance’ whiteboard and we observed the daily board round on Duffy Suite. This was a summary discussion of each patient and the status of their admission and any discharge planning and was attended by the multidisciplinary team.
  • Patient records showed discharge planning took place at an early stage with multidisciplinary input.
  • A policy outlined the selection criteria for inpatient admissions into the Sanderson Suite and a flow diagram procedure was in place for unplanned admissions and for transferring patients to Whiston Hospital if the patient’s condition had deteriorated.

Cleanliness and Infection control

  • Patient-led assessments of the care environment (PLACE) showed that the trust has achieved the best PLACE audits nationally for two consecutive years 2014 and 2015.
  • The areas we inspected were visibly clean. Cleaning schedules were in place with clearly defined roles and responsibilities for cleaning the environment and decontaminating equipment. Staff were aware of current infection prevention and control guidelines, including the use of ‘I am clean’ stickers to inform colleagues at a glance that equipment or furniture had been cleaned and was ready for use.
  • Staff followed correct hand hygiene and 'bare below the elbow' guidance with appropriate protective personal equipment, such as gloves and aprons, whilst delivering care as per National Institute for Health and Care Excellence (NICE) guidance on infection control
  • Patients identified with an infection could be isolated in side rooms, if required, with appropriate signage to protect staff and visitors.
  • The trust had employed a number of infection control link nurses and a surgical site infection specialist nurse working across both sites. Their role was to provide training and to liaise with staff so patients that acquired infections following surgery could be identified and treated promptly.
  • The numbers of MRSA and MSSA infections were below the England average between April 2013 and March 2015. C.diff infections relating to surgery were within expected limits at the hospital between April 2014 and December 2014.
  • Infection control training had been completed by 95% of staff, which was above the trust’s target.

Nurse staffing

  • Nurse staffing levels were determined using an evidenced based acuity tool.
  • Staffing levels were planned to provide an appropriate skill mix to provide care and treatment for patients.
  • The expected and actual staffing levels were displayed on a notice board on each unit/ward and these were updated on a daily basis.
  • Staffing levels were reviewed every six months using the ‘safer nursing care tool’ (Shelford group, 2013) endorsed by NICE.
  • Seniors managers were proactive in managing staff shortages through both escalation and recruitment processes.

Medical staffing

  • The wards and theatres had sufficient numbers of medical staff with an appropriate skills mix to ensure that patients received the right level of care.
  • There was sufficient on-call consultant cover over a 24 hour period with appropriate medical cover outside of normal working hours and at weekends. The on-call consultants were free from other clinical duties to ensure they were available if needed.
  • The hospital employed a resident medical officer (RMO) who was based at the hospital 24 hours per day covering a weekly or fortnightly rota. The RMO was resident on site and available on call outside of normal working hours.
  • Existing vacancies and shortfalls were covered by locum, bank or agency staff when required. All agency and locum staff were provided with a local induction to ensure they understood the hospital’s policies and procedures.
  • Daily medical handovers took place during shift changes which included discussions about specific patient needs.

Mortality rates

  • Mortality and morbidity reviews were held in accordance with trust policy and procedures. and were underpinned by policies and procedures.
  • Deaths were reviewed thoroughly and opportunities for learning were shared and disseminated amongst staff teams.

Nutrition and hydration

  • There was a wide range of meals available including options for a healthier choice, higher energy, softer (easier to chew), vegetarian, vegan and gluten free. There was a separate menu for modified texture foods which included thick puree, pre-mashed or fork-mash able options for patients with swallowing difficulties.
  • There was a patient list with dietary requirements identified, for example identifying if patients were diabetic, dysphasic, on a low residue diet. For patients requiring assistance at meal times a red tray system was in operation so that they could be easily identified. There were also red jugs available, and this system was consistent with the Whiston site so that when patients were transferred the same processes around meal times were in place.

We saw several areas of outstanding practice including:

  • The clinical staff in the breast unit had published extensively in their field and had developed innovative approaches to localisation of breast cancer surgery.
  • The additional needs pathway and coordinated approach to a patient with additional needs to reduce the need for repeat procedures was seen as outstanding in terms of enhancing the patient’s experience.
  • In order to improve the response time and access to timely treatment for a patient, if a critical or abnormal finding on an X-ray was seen designated radiology staff could book another follow up appointment with the appropriate specialist.

However, there were also areas where the trust could make improvements.

Importantly, the trust should

  • Consider the review of training of the medicines policy in relation to the administration of regular medication via oral or intravenous routes.
  • Consider the review of training around incidents and risks, to include the use of SMART principles when developing and documenting action plans.
  • Consider the use of Measles charts or similar tools for mapping the geographical location of falls.
  • Ensure all prosthetists receive an appraisal in a timely manner.
  • The provider should continue monitoring the ophthalmology services ability to manage the clinic and reduce the waiting time in clinic to improve the patients’ experience.

Professor Sir Mike Richards

Chief Inspector of Hospitals

27 February 2014

During a routine inspection

Patients across the areas we visited told us they were treated with dignity and respect. Within ophthalmology we saw excellent joint working with patient groups to improve the delivery of care. Patients told us they were provided with the information they needed to understand the care and treatment options available to them.

Patients experienced effective, safe and appropriate care and treatment. Care was tailored around patient's individual needs and arrangements were in place for managing foreseeable emergencies. However, patients felt that waiting times within the ophthalmology clinics were problematic.

We found suitable arrangements were in place to pass patient information between the hospital and other providers of care. In addition, information was being transferred internally between outpatients and day surgery effectively. Target timescales for both referral to treatment for ophthalmology and waiting times for day surgery were being adhered to. Discharge from day surgery was taking place effectively and follow up information passed to patient's GPs and also the district nursing team if required.

Staff received appropriate support, supervision and training to ensure they could provide effective care, treatment and support to patients within their departments. Staff were encouraged to develop their skills further and access additional training and development opportunities. Clinical audits were being undertaken to evaluate and improve the quality of care being provided.

Patients were protected against the risks of unsafe or inappropriate care and treatment because accurate records were maintained. Trust audits within ophthalmology had identified further improvements in record keeping could be achieved. Patient and staff records were held securely and patient confidentiality was maintained.