Crawley Hospital

Updated 31 March 2016

After a comprehensive inspection in May 2014, the CQC rated the hospital’s outpatient department as requiring improvement as it was not fully compliant with Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 210, then in force. Consequently we issued a requirement notice, a form of enforcement action which demands providers make necessary improvements to meet the required standards.

The purpose of this inspection was to check improvements had been made and the hospital no longer breached regulation in relation to its outpatient services. Therefore the focus of our visit was to ensure that the terms of the requirement notice had been met and we did not rate this service. We found the trust has met the required standards.

Updated 31 March 2016

Surrey and Sussex Healthcare NHS Trust provide outpatient and day surgery services at Crawley Hospital. This hospital is owned and managed by NHS Property Services. The trust provides day case surgery and outpatient services at this location, which are two of the eight core services that are always inspected by the Care Quality Commission( CQC) as part of its new approach to hospital inspection.

We carried out this comprehensive inspection to Surrey and Sussex Healthcare NHS Trust as an example of a low-risk trust as determined by CQC’s intelligent monitoring system. The inspection took place between 20 and 22 May 2014 and an unannounced inspection visit took place between 6pm and 10.30pm on 6 June 2014.

Overall, this hospital is good but the outpatient service required improvement.

Our key findings were as follows:

• Staff were caring and compassionate and treated patients with dignity and respect.
• The hospital was clean and well maintained. The trust’s infection rates for Clostridium difficile and MRSA were within an acceptable range, taking account of the size of the trust and the national level of infections.
• Patients whose condition might deteriorate were identified and escalated appropriately and the mortality rates for the hospital were within the expected range.
• The vast majority of patients reported a positive experience to us during our visits. The NHS Friends and Family Test showed the trust performed above the England average between November to February 2014.
• Outpatient services required improvement. Patients were treated with compassion, but many appointments were cancelled at short notice; and because clinics were so busy, patients often had to wait a long time to be seen. Medical records were often incomplete because notes could not be obtained in time for clinic appointments.
• Mortality rates were within expected ranges and there were no indicators flagged as being a risk or an elevated risk.
• Medical records, medical secretaries and ward clerks felt they had not been listened to as much as they could have been and expressed concern about some of the changes that were taking place.
• Without exception, clinical staff were proud to work for the trust and spoke very positively about the effective leadership within the trust. Staff recognised the significant progress the trust had made, particularly in the past two years. The commitment to the trust was exceptionally good.
• The work the trust had done on major incident preparedness was good.
• The trust was focusing on the performance of complaint handling and extra resources had been put into place within some of the divisions. We saw performance was improving and both clinical staff and the executive team were committed to this.

We saw several areas of outstanding practice including:

• There was very poor mobile signal at the Crawley Hospital site. Relatives were given a bleep that meant they could be contacted if they left the clinical areas. This meant that people were not restricted to stay in one place for long periods and could be effectively contacted by staff.
• The pre-assessment clinic at Crawley Hospital had been extended into the evening in a response to feedback and local demand.
• We saw staff wearing “ask me anything” badges. These badges encouraged patients and their loved ones to engage with staff to improve communication.

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

Importantly, the trust must:

• Carry out a review of the outpatient service to ensure there is adequate capacity to meet the demands of the service.
• Implement a system to monitor and improve the quality of the outpatient service that includes the number of cancelled appointments, waiting times for appointments and the number of patients that do not have their medical records available for their appointment.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Updated 31 March 2016

Since our last inspection there had been a significant change in the outpatient management structure to provide more robust governance. An outpatient board had been established and reported to the executive committee. This board was supported by an outpatient delivery group.

Nursing leadership had been strengthened in the department since our last visit with a new structure and an emphasis on stronger leadership with the introduction of more senior roles and a matron.

The trust had made significant changes and improvements to the management of medical records. We saw improvements in the level of reporting incidents and there were mechanisms in place to provide feedback following an incident. However, some staff were still unsure how to report incidents and had not accessed the training in the electronic system.

Although there was increased attendance in training in the Mental Capacity Act, some staff were unable to tell us how they would effectively apply the act in practice to situations that may arise in the department.

Updated 8 June 2014

Patients who used the service experienced safe, effective and appropriate care and treatment and support that met their individual needs and protected their rights. The care delivered was planned and delivered in a way that promoted safety and ensured that people’s individual care needs were met. We saw patients had their individual risks identified, monitored and managed and that the quality of service provided was regularly monitored. We found the clinical environments we visited and other communal areas in the hospital meticulously cleaned. Hospital-acquired infections were monitored and rates of infection were of a statistically acceptable range for the size of the trust.

Outcomes for patients were good and the department followed national guidelines. Complaints were investigated and handled in line with standard policy. We saw the trust use patient’s complaints and comments used as a service improvement tool and the trust actively encourage feedback from its patients and their relatives or loved ones.