Queen Alexandra Hospital

Updated 9 February 2024

Pages 1 to 3 of this report relate to the hospital and the ratings of that location, from page 4 the ratings and information relate to maternity services based at Queen Alexandra Hospital.

We inspected the maternity service at Queen Alexandra 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.

The Queen Alexandra Hospital provides maternity services to the population of Portsmouth and surrounding areas.

Maternity services include an outpatient department, maternity day assessment unit, maternity triage, antenatal ward, labour ward, midwifery led birthing centre, two maternity theatres, postnatal ward, assessment observation unit, and ultrasound department. Between October 2022 and September 2023 4,874 babies were born at Queen Alexandra Hospital.

We will publish a report of our overall findings when we have completed the national inspection programme.

We carried out a short notice announced focused inspection of the maternity service, looking only at the safe and well-led key questions.

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

• Our rating of Good for maternity services did not change ratings for the hospital overall. We rated safe as Good and well-led as Good.

We also inspected 2 other maternity services run by Portsmouth Hospitals University NHS Trust. Our reports are here:

Gosport War Memorial Hospital – https://www.cqc.org.uk/location/RHU10

St Mary's Hospital - https://www.cqc.org.uk/location/RHU02

How we carried out the inspection

We provided the service with 2 working days’ notice of our inspection.

We visited the maternity day assessment unit, maternity triage, antenatal clinic, labour ward, birth centres, induction bay, maternity theatres, the antenatal and postnatal wards.

We spoke with 47 multidisciplinary staff, 3 women and birthing people and 1 birthing partner. We received 34 responses to our give feedback on care posters which were in place during the inspection.

We reviewed 10 patient care records, 8 observation and escalation charts and 10 medicines records.

Following our onsite inspection, we spoke with senior leaders within the service; we also looked at a wide range of documents including standard operating procedures, guidelines, meeting minutes, risk assessments, recent reported incidents as well as audits and action plans. We then used this information to form our judgements.

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 21 July 2022

Updated 5 October 2018

Our rating of this service stayed the same. We rated it as good because:

• Staff were clear about their safeguarding responsibilities and if there was a concern about a child’s wellbeing staff understood and followed safeguarding procedures. All staff we spoke with had completed the appropriate level of training in safeguarding, apart from the medical and dental staff who had not yet achieved above 85% training in levels two and three.
• There was openness and transparency about safety, and continual learning was encouraged. Staff were supported to report incidents, including near misses. Both units were secured both day and night.
• The service controlled infection control well.
• Staff used a paediatric early warning system for the early detection of any deterioration in a child’s condition, and we observed children and young people’s pain effectively assessed and treated.
• Services were provided seven days a week by medical and nursing staff. There was good multidisciplinary working evident across both units.
• Inpatient services were tailored to meet the needs of individual children and young people. Access and flow through all departments was very good and complaints were dealt with in a timely manner. Staff listened to feedback and complaints and responded to them in a timely manner.
• Staff planned and delivered care in line with evidence-based guidance, standards and best practice and met the individual needs of the child and family through the careful care planning. Staff followed care pathways on electronic, multidisciplinary patient records to support practice.
• Staff received annual appraisals and new staff were supported when completing their competency assessments, helping to maintain and further develop their skills and experience.
• Parents and children gave feedback about the care and kindness received from staff, which was positive. All children and their carers we spoke with were happy with the care and support provided by staff. We observed staff treated children, young people and their families with compassion, kindness, dignity and respect. Staff worked in partnership with children, young people and families in their care.
• Play staff ensured that children and their families were supported during their hospital stay and their interventions during procedures reduced the anxiety and worry for the children for example during blood tests.
• The children’s unit had its own radiology department which provided specific ‘child friendly’ environments for children to wait and undergo investigations and worked closely with the play therapist team to reduce stress and anxiety during those procedures.

However:

• There was not enough nursing staff on the neonatal unit and medical staff on the children’s unit with the right skill mix to provide safe care. The trust had reviewed staffing levels, and identified a shortage of medical and nursing staff. Recruitment to vacant posts was ongoing at the time of inspection. Nursing levels on the neonatal unit did not conform to the British Association of Perinatal Medicine (BAPM) standards and the medical staffing on the children’s unit did not conform to the Royal College of Children’s and Child Health (RCPCH).
• There was a risk children would be distressed in the maxillo facial (Max Fax) outpatient’s clinics as they were treated alongside adult patients Mandatory training rates for both medical and nursing staff were below the trusts target of 85% for nine mandatory training modules.
• The Children and Adolescent mental health service (CAMHS) did not cover weekend and evenings, therefore children requiring a review before discharge would have extended stays in hospital.
• Adult trained nurses who had not completed child specific competencies worked with children and young people in the children’s fracture clinic and ophthalmology clinic.

Updated 5 October 2018

Our rating of this service stayed the same. We rated it it as outstanding because:

• People were protected from abuse and avoidable harm by a strong comprehensive safety system, with a focus on openness, transparency and learning from when things went wrong.
• People received excellent care, treatment and support which achieved good outcomes when compared with similar services, promoted a good quality of life based on the best evidence-based care and treatment.
• People were treated with compassion, kindness, dignity and respect. They were truly respected and valued as individuals and were empowered as partners in care received, practically and emotionally, by an exceptional and distinctive service.
• Services were tailored to meet the needs of individual people and were delivered in a way to ensure flexibility, choice and continuity of care.
• The leadership, management and governance of the critical care unit assured the delivery of high-quality and person-centred care, supported learning and innovation and promoted an open and transparent culture.
• The critical care unit had been rated as outstanding following our last inspection in 2015. However improvements had been made to the service since our last inspection. This included but not limited to: safety briefings increased to twice daily; a dedicated dietitian; increased physiotherapist staffing levels; new systems for improving patient flow; an improved and extended critical care outreach team that was now 24 hours a day seven days a week; an updated computer information system; introduced a relatives bleep system; and looked at ways to humanise the critical care environment to aid patient treatment and recovery.

Updated 5 October 2018

• Staff had completed training which allowed them to undertake their role effectively. Further training opportunities were provided by the trust to allow staff to expand their skills and professional knowledge.
• Staff took appropriate action to minimise the risk of cross infection between patients.
• Staff followed professional guidance and working practices during investigation to keep patients safe.
• Risk to patient safety due to the type of investigation being undertaken were identified and managed appropriately
• Patients received care from staff who treated them as individuals and ensured their physical and emotional wellbeing needs were met
• Waiting times for investigation were similar or better than the national average identifying patients received the right investigation at the right time.
• Staff felt valued and supported in their role enabling them to provide high quality care. Patient feedback confirmed this was happening.
• Innovative practice was supported and promoted by staff who took responsibility to explore options to increase the quality of patient care

However

• The trust did not consistently meet the national and trust target of 48% of patients entering the emergency department with a suspected stroke receiving a CT scan within an hour of arrival.
• The Queen Alexandra Hospital environment did not fully support patients to move around the hospital independently. Environmental design did not always support those with a sensory loss such as vision impairments to negotiate the hospital whilst transferring between departments.
• Steps taken by staff to ensure a patient’s individual needs could be met appropriately were not always followed consistently. Information about particular additional needs or patient support was not always passed between teams to ensure these needs could be met prior to investigation.
• The investigation of complaints did not take place in a timely way leading to delays in responding to the complainant. The service did not complete investigation of, respond to, and close complaints within agreed timescales

Updated 5 October 2018

• The service provided mandatory training in key skills to all staff and made sure everyone completed it.
• 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.
• 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 service provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.
• 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.
• Managers 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 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.
• The service mostly took account of patients’ individual needs.
• People could access the service when they needed it. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were in line with good practice.
• Managers at all levels in the trust had the right skills and abilities to run a service providing high-quality sustainable care.
• The trust had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected.
• The trust engaged well with patients, staff, the public and local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively.

However,

• Not all staff had received an annual appraisal of their work, although the trust had plans to address this.
• The trust was not able to provide a seven day service. This was due to some long term sickness within the nursing team. Actions had been taken to mitigate the impact of this, freeing up nurses for clinical time on the ward. Cover arrangements had been put in place for out of hours. Patients received consistent end of life care because care was provided on the wards by staff across the trust.

Updated 9 February 2024

Updated 29 January 2020

Our rating of this service stayed the same. We rated it as good because:

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.

• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.

• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.

• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it.

• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services.

  However

• Patients in some departments were waiting for lengthy periods before they were given a follow-up appointment.

Updated 29 January 2020

Following improvements since the last inspection in record keeping, risk assessment, infection prevention and control, medicines management, theatre safety culture, leadership, Mental Capacity Act (2005) and Deprivation of Liberty Safeguards, our rating of this service improved. We rated it as good because:

• The service managed patient safety incidents well. Staff recognised incidents and near misses 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.
• The service provided mandatory training in key skills to all staff. Nursing staff received and kept up-to-date with their mandatory training.
• 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 service controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean.
• The design, maintenance and use of facilities, premises and equipment kept people safe. Staff were trained to use equipment and carried out daily safety checks of specialist equipment.
• Staff completed and updated risk assessments for each patient and removed or minimised risks. Staff identified and quickly acted upon patients at risk of deterioration.
• The service had enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed and adjusted staffing levels and skill mix, and gave bank and agency staff a full induction.
• Staff kept records of patients’ care and treatment. Records were clear, up-to-date, and available to all staff providing care.
• The service used systems and processes to safely prescribe, administer, record and store medicines. Staff stored and managed medicines and prescribing documents in line with the provider’s policy.
• The service used monitoring results well to improve safety. Staff collected safety information and shared it with staff, patients and visitors.
• The service provided care and treatment based on national guidance and best practice. Managers checked to make sure staff followed guidance. Staff protected the rights of patients subject to the Mental Health Act 1983.
• Staff gave patients practical support and advice to lead healthier lives. The service had relevant information promoting healthy lifestyles and support on the wards. Staff assessed each patient’s health when admitted and provided support for any individual needs to live a healthier lifestyle.
• Staff gave patients enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary.
• Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way. Staff assessed patients’ pain using a recognised tool and gave pain relief in line with individual needs and best practice. Patients received pain relief soon after requesting it.
• Staff monitored the effectiveness of care and treatment. They used the findings to make improvements and achieved good outcomes for patients.
• The service made sure staff were competent for their roles. Managers appraised staff work performance and held supervision meetings with them to provide support and development.
• Doctors, nurses and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care.
• Key services were available seven days a week to support timely patient care. Staff could call for support from doctors and other disciplines, including mental health services and diagnostic tests, 24 hours a day, seven days a week.
• Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent. They knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. Patients said staff treated them well and with kindness.
• Staff provided emotional support to patients, families and carers to minimise their distress. Staff gave patients and those close to them help, emotional support and advice when they needed it. They supported patients who became distressed.
• Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment. The service actively involved patients’ relatives as partners in their care.
• The service was inclusive and took account of patients’ individual needs and preferences. Staff made reasonable adjustments to help patients access services. They coordinated care with other services and providers.
• The service planned and provided care in a way that met the needs of local people and the communities served. It also worked with others in the wider system and local organisations to plan care.
• People could access the service when they needed it. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were generally in line with national averages. Managers and staff worked to make sure that they started discharge planning as early as possible.
• It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with staff.
• Leaders had the integrity, skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff.
• Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service promoted equality and diversity in daily work and provided opportunities for career development.
• Leaders operated effective governance processes. Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service.
• The service had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected. It used a systematic approach to continually improve the quality of the service. Managers we spoke with at all levels understood the risks to the service and could describe action to reduce risks.
• The service collected reliable data and analysed it to understand performance, make decisions and improvements.
• Leaders and staff actively and openly engaged with patients, staff, equality groups, the public and local organisations to plan and manage services. They collaborated with partner organisations to help improve services for patients.
• Staff were committed to continually learning and improving services. Leaders encouraged innovation and participation in research.

However:

• Medical staff received, but did not always keep up-to-date, with their mandatory training. Medical staff met the trust target of 85% for five out of 14 mandatory training modules.
• Although policies included version control information, some forms used by staff did not include version numbers or review dates. This meant staff might not know whether they were using the most up-to-date version of the document.
• Staff did not always fully complete fluid balance charts. This meant it was difficult for colleagues reviewing the chart to see a patient’s fluid balance at a glance.
• Staff appraisal rates for the reporting period June 2018 to May 2019 were 81%, which did not meet the trust target of 85%.
• The service did not meet the trust’s 30-day target for responding to complaints. In the reporting period June 2018 to May 2019, the service took an average of 45.5 days to respond and close complaints. This was not in line with the trust’s complaints policy. Complaints responses we reviewed sometimes included clinical language without explanations in plain English, which might have been difficult for some complainants to understand.
• There were no side rooms for isolation of infectious patients on the Surgical High Care Unit.

Updated 21 July 2022