Care Quality Commission trial ratings

As a result of the Mid Staffs debacle the Care Quality Commission revamped its inspections making them longer, more detailed and with more clinical inspectors. They tested out the new regime in a number of hospitals including the Royal Surrey: see my blog of 18 December. The resulting report was generally good with some areas needing attention.

The CQC intends to publish ratings for all hospitals over the next year or so. So, from those 18 who were subject to the test inspections, the CQC sought volunteers to be trial rated. Royal Surrey agreed and the trial ratings have just been published. They are below.

   

	Royal Surrey County Hospital NHS Foundation Trust
		Safe	Effective	Caring	Responsive	Well Led	Overall
	Accident & Emergency	G	UA	G	G	G	G
	Medicine	RI	G	G	G	G	G
	Surgery	G	G	G	G	G	G
	Critical Care	G	G	G	G	G	G
	Maternity & Family Planning	G	G	O	G	O	G
	Paediatrics	G	G	G	O	G	G
	End of Life	G	G	G	G	G	G
	Outpatients	G	UA	G	RI	RI	RI
	Overall	G	G	G	G	G	G

 

The ratings are Outstanding (O), Good (G), Requires improvement (RI), Inadequate and Unassessed (UA).

The Royal surrey was thus overall rated Good for all aspects of care.

Outpatients was the main area requiring improvement with the Eye Clinic being particularly criticised (see some of my earlier blogs. A Business Case to rebuild the Eye Clinic is due to be presented to the Board at its next meeting and hopefully, at last, work will start to create a clinic for which the hospital can be proud.

Checks on cleanliness and maintenance

 I coordinate a team of Governors who undertake checks on cleanliness, maintenance, hygiene etc. (see earlier blog). In the last 5 months we have checked

·         Out Patients 1, 2, 5, 6, 7, 8, 9 and 10

·         Patients Lounge, front entrance and main corridor including WCs

·         Radiology including X-ray, ultrasound, CT, Interventional Suite

·         EAU (Emergency Assessment Unit)

·         Short Stay Surgery and Elective Surgery

·         Physiotherapy

·         Phototherapy

·         Rehabilitation and Occupational Therapy

·         HASTE and MRI

·         Day Surgery

·         Nuclear Medicine

 

Whereas we have found some areas where cleaning needs to be improved, where maintenance attention is required and where clutter was unacceptable, overall the checks have shown all features to be pretty good and some departments to be excellent and believe me we look for dust and dirt in every corner! Our reports are sent to senior staff responsible for all these aspects and are taken very seriously with follow up action which we intend to check. The hospital has made clear that it appreciates what we are doing and that is good.

 

 

Care Quality Commission Report on hospital inspection published

 The CQC Report on their inspection of the RSCH was published today. It was very good. Staff can be proud to have been found caring, inclusive, open and skilled in what they do. The CQC were in receipt of some adverse comments of course but overwhelmingly patients and the public were complimentary. Maternity and Children’s services were found to be particularly good.

On the down side there was criticism of staffing levels on some wards and some OP services were deemed in need of improvement. The Eye Clinic was the focus of particular criticism and in terms of patient experience (not clinical outcomes) was seen as not fit for purpose. This was no surprise – see my earlier blogs. The hospital does have in hand draft plans to rebuild the Clinic and has been working hard to improve matters but the CQC felt that the pace needed to be accelerated.

Overall a good and reassuring result from the CQC’s new and very intense inspection regime.

 

 

Outsourcing

As reported in the Surrey Advertiser the RSCH has decided to out source a number of functions including housekeeping (cleaners). When the vogue for out sourcing was at its peak some years ago the RSCH, wisely to my mind, decided to keep cleaning in -house and expressed itself proud to have done so. They wished to keep a firm and direct hold of cleanliness.

The hospital has clearly changed its mind and to many it appears to have happened very quickly not least because there was no public, competitive tendering (Governors were not consulted or pre-warned). Hospital staff transferred will have their conditions safeguarded through TUPE but understandably are not happy.We must hope that cleanliness standards are upheld as of course they can be. The checks which governors have just agreed to undertake (see earlier blog) will help to ensure that.

Cleanliness, hygiene and maintenance checks

Cleanliness, hygiene and maintenance are extremely important aspects of any hospital. I used to be a member of the Surrey LINk RSCH Group and over a period of about 6 years I organised checks of these features throughout the hospital . When LINk folded to be replaced by Surrey Healthwatch (yet to get in to its stride) such checks lapsed. However I am pleased to say that the Council of Governors has recently agreed to a proposal from me that these checks should be undertaken by a volunteer group of 8 governors working in pairs.

We intend to cover all parts of the hospital other than the wards (wards are encompassed in a different manner and will also involve governors). Our first check visit (to Nuclear medicine and day Surgery) has taken place and we expect to cover all the ground over a 10 month period. Reports will be sent for action to the hospital's  Patient Quality and Safety Committee and to the appropriate head of department.

Mortality up-date

In my blog of 28 February I reported on mortality statistics (please see for background). At that time RSCH’s performance according to the national index ‘SHMI’ was good (and still is but according to statistics published by Dr Foster performance was poor. The reason suspected was the way the hospital was coding palliative care. This plus events in Mid-Staffordshire caused the hospital to mount a substantial review by examining the notes of all deaths in 2012, recoding where appropriate and resubmitting the data to Dr Foster for reprocessing. The work was checked by a group of GPs to ensure there was no bias.

 The hospital does not use Dr Foster’s services but uses another company CHKS. Recoded data was also sent to them for reprocessing.

 The results confirmed that the main reason for the poor results from Dr Foster was substantial undercoding of palliative care ( the criteria and guidance for palliative coding is open to interpretation and this is widely recognised). The position of RSCH compared with other hospitals changed from being near the bottom to approaching the average. Also the results from CHKS changed from around average to very good. The national index SHMI is unaffected by palliative coding and remains good (5 to 10 percent less deaths than expected).

This review has been followed not only by a focus on better coding but also has led to more formalised monthly reviews of statistics and deaths in all specialties and the formation of a top level Mortality Review Committee. This is all good news and will be reassuring to patients, I continue to keep an eye on mortality data and will be interested to see what the next Dr Foster publication has to say – it is due soon.

Dementia Quality Mark

I am a member of the Trust’s Dementia Steering Group. The hospital is making good progress in meeting the needs of patients with dementia and related conditions. More and more staff at all levels are being trained, patient information leaflets are now available around the hospital as is information on notice boards.  

Wisley and Ewhurst wards have just achieved the stage 1 ‘Quality Mark for care of elderly people’. This is a mark awarded by the College of Psychiatry and involves questionnaire surveys of dementia patients and their families/carers and staff questionnaires. These wards will be seeking the stage 2 mark next year based on even more rigorous criteria. Eashing ward is planning to seek Stage 1 soon.  This is good progress and greatly welcome. I am anxious to see this excellent work extended across all relevant wards.