• Hospital
  • NHS hospital

Archived: Wexham Park Hospital

Overall: Inadequate read more about inspection ratings

Wexham Street, Wexham, Slough, Berkshire, SL2 4HL (01753) 63000

Provided and run by:
Heatherwood and Wexham Park Hospitals NHS Foundation Trust

Important: This service is now managed by a different provider - see new profile
Important:

We have recommended Heatherwood and Wexham Park Hospitals NHS Foundation Trust should be placed into special measures. Find out more.

All Inspections

11-13, 15 and 19-20 Feb 2014

During a routine inspection

Wexham Park Hospital is the main site of Heatherwood and Wexham Park Hospitals NHS Foundation Trust and provides services to a large and diverse population of more than 465,000. The area it covers includes Ascot, Bracknell, Maidenhead, Slough, South Buckinghamshire and Windsor. The trust has approximately 3,200 staff and a total of 650 beds, with 588 on the Wexham Park Hospital site. The trust has recently increased the bed capacity to meet increased demand following an increase in its catchment area in accident and emergency (A&E), paediatrics and wards and had plans to open more capacity later in 2014.

The trust’s catchment area population includes a significant proportion ethnic minority groups and 30 languages are spoken in the area covered by the trust. The most common (excluding English) include Hindi, Polish, Urdu, Somali, Romanian and Punjabi.

The trust became a foundation trust in 2007. At the time of the inspection, the executive team (based at Wexham Park Hospital) comprised members who were either interim appointments or relatively new in post, with only one member of the executive team in post for over three years. The chief executive had been in post for two years and four months (but had formally resigned, with a leaving date in March 2014).

At the time of the inspection, Wexham Park Hospital was in breach of a number of regulations and, in many instances, it has been providing care below the essential standards, as found during two previous CQC inspections in May and October 2013. In May 2013, there were particular concerns about the care provided to patients in (A&E and the impact this had on the ability of inpatient wards to provide the essential standards of care. At the inspection in October 2013, improvements in A&E were noted to have been made. However, we found that Wexham park Hospital was in breach of eight regulations. We served compliance actions for breaches of two regulations (15 and 16). We also served warning notices for breaches of six of the regulations (9, 10, 12, 17, 20 and 22).

We gained views from partner organisations who expressed their concerns about the care provided at Wexham Park Hospital and the future sustainability of the trust.

Wexham Park Hospital provides the following regulated activities, which formed part of our inspection: diagnostic and screening procedures, management of supply of blood and blood derived products, maternity and midwifery services, surgical procedures, termination of pregnancies and treatment of disease, disorder or injury.

We carried out an announced inspection visit on 12 and 13 February. We held focus groups and drop-in sessions. We talked with patients and staff from many areas of the hospital. We observed how people were being cared for, talked with carers and/or family members, and reviewed patients’ records of personal care and treatment. We held two listening events when patients and members of the public shared their views and experiences of Heatherwood and Wexham Park Hospitals NHS Foundation Trust. Patients who were unable to attend the listening events shared their experiences via email or telephone. We carried out three unannounced visits, when we looked at how the hospital ran at night, the levels and type of staff available, how they cared for patients, and patient flow through the hospital.

The trust had a long history of turbulence, which was felt by our inspection team at Wexham Park. Financial shortfall and high turnover of senior leadership had resulted in poor outcomes in recent CQC inspections and expressions of increasing concern from multiple stakeholders. We found the trust had significant legacy from a history of financial challenges and the hospital had a culture that was not open with learning at its heart. Although the financial challenges had been addressed and improvements trust-wide were beginning to be made with external support from agencies, the trust remained very challenged. The future sustainability of the trust and its hospitals remained a concern. Although efforts had recently been made in response to concerns raised by CQC about Wexham park Hospital, they were still very much in their infancy.

The culture was one of learned helplessness and accusations of bullying and harassment were seen throughout. Although the chief executive was reported to have high visibility and communicated regularly with the frontline, she had recently resigned and was due to leave in March 2014.

The lack of bed capacity in the hospital meant that many patients were moved from ward to ward during their stay, which impacted on their continuity of care and consultants being unaware of where their patients were in the hospital.

Staff stated they did not always report incidents or concerns because when they had done so previously, there had not always been any feedback and nothing had changed as a consequence. There was a consistent theme that learning was not implemented to improve patient care.

Cleanliness and infection control

Infection rates were in line with the national average. There were still concerns regarding infection control in some areas of the hospital but improvement been made since CQC raised concerns CQC during the inspection in October 2013. The trust had carried out a full deep clean of the whole hospital recently to good effect.

Staffing

There was high use of agency and locum staff, both in nursing and medical staffing. The trust recognised it had a high turnover of nursing staff and was considering approaches to retain and recruit nurses at the time of our inspection. During the inspection we noted agency staff were not consistently being appropriately checked or given an induction on arrival to the ward.

Staffing in radiology was a particular concern. There were 11.7 vacancies for radiographers, although the trust was in the process of recruiting. The radiology department consistently operated with agency radiographers every weekend and there were no plans in place to change this approach.

There were low levels of staff satisfaction and many reported concerns about a ‘bullying and harassment’ culture from senior managers and above. There was a significant level of conflict within the organisation among medical staff, which was impacting upon effective multidisciplinary working. Clinical engagement through the hospital was relatively low, with evident conflict and lack of belief in managers from many clinicians. The trust was aware of this and had gained external support to take steps to improve this.

16, 17, 19, 21 October 2013

During an inspection looking at part of the service

At our previous inspection of Wexham Park Hospital in May 2013, we found the hospital was in breach of a number of regulations and, in many instances, delivered care that was below essential standards. There were particular concerns about the care provided to patients in the accident and emergency department (A&E) and the impact this had on the ability of in-patient wards to provide essential standards of care required by the regulations. Following that inspection we issued a warning notice to the trust against regulation 10: assessing and monitoring the quality of service provision.

Our inspection in October 2013, to which this report relates, was a follow up inspection to determine whether the trust had addressed the concerns we raised during our previous inspection. We inspected the hospital's accident and emergency department (A&E), emergency department decision unit (EDDU), acute medical unit (AMU), medical intervention day unit (MIDU), and wards 1, 3, 4, 5, 7, 9, 17, and 18. We also inspected in-patient paediatrics, the neonatal unit, diagnostic imaging, and rehabilitation. We also inspected the hospital's maternity service in response to concerns which were raised with us. This included triage and assessment, labour ward, post natal ward, and birthing centre. We tracked care pathways for 12 patients, looked at 24 sets of patient records and 45 drug charts, interviewed 137 members of staff and 3 paramedics, and spoke with 56 patients and/or their relatives.

We found the trust had made significant improvements in some areas, particularly in managing capacity issues in A&E and ensuring the movement of patients from A&E and onto in-patient wards. At the time of our inspection, the A&E department was undergoing an expansion and refurbishment programme. Dedicated facilities for assessing and treating patients were newly in place. There were improved systems for assessment and triage, reduced waiting times, and improved arrangements for protecting patients' privacy and dignity. Standards of care and clinical assessment in the EDDU were improved. Two new wards had been developed to provide additional hospital beds and reduce the hospital's need to use escalation areas. New systems were in place for setting up and opening areas which were not normally used to accommodate in-patients, called escalation areas. We found the storage of medicines was better managed.

A number of wards we inspected were well led and well managed. These included wards 1, 3, and 5 as well as MIDU and the neonatal unit. Patients on these wards were pleased with the care they received and spoke highly of the staff. We observed staff worked well together as a team; patient records were up to date; the wards were clean; and patient care was of a high standard.

We re-visited the medical wards we had previously inspected and found marked improvement in the standard of care provided on some but not all of them. We had particular concerns about the leadership and management of AMU / ward 7 and ward 4. On these wards, we observed many instances of poor practice where the quality of care fell significantly below essential standards. Patients' privacy and dignity was not always respected; medical and nursing notes were not complete or up to date; there were poor arrangements for ensuring the confidentiality of patient records; and standards of hygiene and cleanliness were not maintained. These wards were also found to be consistently short staffed. The care some patients received was below essential standards and put them at risk of harm. We raised our concerns with trust managers during our inspection so that safety issues could be addressed immediately.

We found many areas of the hospital were in need of refurbishment and redecoration. Signage was poor and many people told us they found it difficult to find the area of the hospital which they needed. There were inadequate arrangements for ensuring hospital facilities and equipment were appropriately maintained. With limited exception, we found patient areas across the trust to be dirty and dusty. In some instances, the poor condition of the premises prevented the proper cleaning and disinfection. Equipment was not always cleaned or replaced when needed.

There were systems in place to identify risks to patient safety and maintain the quality of services. As we found in our previous inspection, however, these were often ineffective. There were examples of breaches in care that were not picked up through the trust's quality monitoring arrangements. We found staff did not always comply with trust policies and procedures. Specific examples of this which we found were not identified by the trust. Staff did not always report incidents of harm to patients. There were systems in place for implementing National Institute for Health and Clinical Excellence (NICE) guidelines but the use of the guidelines was not robustly audited. Where audits raised concerns, the concerns were not always addressed. The use of national guidelines other than those published by NICE were not systematically implemented, monitored or audited.

While lessons from incidents and complaints were identified by managers and clinical leads at governance meetings, they did not always translate into changes on wards or in clinical practice. Lessons learned were not always communicated to staff on ward level. On the labour ward, midwives and doctors told us lessons learned from a series of serious patient safety incidents were not communicated to them. They felt this contributed to tensions between labour ward staff and to the development of a culture of blame and suspicion.

There was a lack of engagement between trust managers and ward level staff. Staff did not feel they were encouraged or empowered to raise concerns and make suggestions for improvement. A number of staff across the hospital expressed concerns about bullying and harassment from managers. In some instances staff raised concerns with us but told us they were reluctant to speak with us for fear of reprisal from their managers and asked not to be named.

7, 8, 13, 22 May 2013

During an inspection in response to concerns

Reflecting national trends, the hospital's accident and emergency department experienced unexpectedly high demand for its services over the winter period and has continued to do so. This has had an adverse impact on the hospital's ability to meet its targets in relation to the four hour A&E waiting time, ambulance handover, and elective procedures. This inspection visit was prompted by these concerns and by the results of the adult in-patient survey, published in April 2013.

We visited the hospital's Accident and Emergency Department (A&E), Emergency Department Decision Unit (EDDU), acute medical unit (AMU), medical interventions day unit (MIDU), acute stroke unit as well as wards 4, 6, 7, 9, and 18. We also visited the paediatrics unit and a number of the hospital's escalation areas. We tracked care pathways for 12 patients, interviewed 56 members of staff and four paramedics, and spoke with 42 patients and relatives.

We found that the A&E department was overwhelmed by a combination of high A&E attendances and a shortage of in-patient beds in the rest of the hospital. The department was very crowded and busy. Our observations showed staff struggling to cope with high numbers of A&E attendances and patients waiting up to eleven hours to be admitted onto a ward. There was a clear focus on managing the demand for in-patient beds, sometimes at the expense of providing basic care.

Across the hospital, we saw many instances where the care given to patients was good; however, we also saw a number of instances where the quality of care given to patients was below essential standards. The majority of patients we spoke with were satisfied with the quality of care provided. However, we received a number of complaints from patients about the quality of nursing care and poor communication.

We observed a number of instances where peoples' privacy and dignity were not respected. This was particularly the case in A&E and EDDU. We found poor standards of cleanliness and inadequate infection control arrangements in some areas of the hospital. Storage of medicines on wards was poor, with patients and visitors on some wards easily able to access drugs which should have been kept in a locked area. We identified a number of concerns around staffing including high vacancy rates in some areas and an over reliance on bank and agency staff. In all of the patient records we checked, we found evidence of poor record keeping, poor communication, and an absence of care plans.

There were systems in place for identifying risks to patient safety and maintaining the quality of services. However, in many instances, these were ineffective. Where concerns were identified, they were not always addressed and reviewed to ensure standards were maintained. There was a clear emphasis on responding to national and local clinical targets but little emphasis on ensuring that overall patient experiences were positive.

21, 22 June 2012

During an inspection in response to concerns

During this two day inspection visit we spoke with five relatives and 33 patients. The majority of people who spoke with us about the services of the hospital provided favourable comments. People felt that they or their relatives were treated as individuals, with respect and dignity and that their personal needs were generally met.

Information was said to be given in a way that was understood and people felt that they were involved in making decisions about their treatment and care. People felt able to ask for help and that they could inform a member of staff if they were not happy about anything.

Whilst there were some negative comments about food choices and communication between some staff, overall people felt satisfied with the services provided to them. One person told us that the discharge arrangements had improved since their previous experience.

23 March 2012

During a themed inspection looking at Termination of Pregnancy Services

We did not speak to people who used this service as part of this review. We looked at a random sample of medical records. This was to check that current practice ensured that no treatment for the termination of pregnancy was commenced unless two certificated opinions from doctors had been obtained.

18, 19 April 2012

During an inspection in response to concerns

We spoke with 11 people who were using the services of the hospital in either the speciality of gynaecology or obstetrics (maternity), all of whom made positive comments about the level of care or support provided. People said that procedures were explained to them in full and that they were involved in decisions about their care and treatment. Staff were said to be respectful and treated them with dignity.

There were some negative comments made to us about communications and continuity of care. For example, requests for pain relief not being addressed as quickly as would have been expected on the post natal ward, and frequent changes in doctors on the gynaecology ward. This led to the patient having to repeatedly explain things to different doctors at different times.

Ten out of the 11 of the people who spoke with us said that their wishes had been followed in relation to their care or delivery plans. One person told us that they did not have their birthing plan followed in full or in accordance with her wishes, despite alerting staff at the time.

26 October 2011

During an inspection looking at part of the service

People who spoke with us provided positive feedback about the care and treatment they had received. Comments made to us suggested that staff were very good, that staff involved people in discussions about their personal care needs, gave information that was understood and provided updates regarding progress.

People felt safe and supported. They felt able to discuss their needs or concerns.

29 June 2011

During an inspection in response to concerns

People who had used the services at Wexham Park Hospital as part of their care pathway spoke to us, in addition to those receiving care at the time of our visit. We received some complementary comments regarding staff and the level of kindness and caring nature, other comments were less positive. Negative comments related to the attitude of some staff toward patients and appearing as lacking enthusiasm for the work to be done.

Some patients indicated that they were not kept informed sufficiently about the changes in treatment and what would be happening next. In addition to this, patients receiving care at the time of visit had not been made aware of their personalised plan of care.

17, 23 March 2011

During a themed inspection looking at Dignity and Nutrition

During our visit to Wexham Park Hospital, we spoke to a number of patients on the acute stroke ward and on ward 6, elderly care. Patients we spoke with were generally very happy with the way staff cared for them. Staff were described as being 'Very good,' 'Very kind' and 'Excellent.' Patients said that staff spent sufficient time giving care, and that this care was delivered in the correct manner, with dignity and respect.

Patients said that they had been involved in discussions about their care and that the staff listened to their opinions and preferences. They also commented that they had been given sufficient information to assist them in making choices about their treatment options. Staff were said to explain what they were going to do prior to carrying out the care or treatment, though one respondent said that she had been frustrated about the manner in which one member of staff talked and treated her.

Most of the patients were positive about the response of staff to requests for assistance, with call bells provided to the majority of patients. However, one patient was not aware of the provision of a call bell and indicated that he often had to call for help, as drinks had not been placed within reach.

We asked the patients if the staff had talked to them about what they like to eat and if they required help with their diet. One patient indicated that she had been asked what she liked to eat from the menu provided. The remaining respondents made a range of comments, such as being on a restricted menu and that this was not of their choice. In particular, patients who were restricted to pureed diets had negative comments about the food and in some cases the feeling of hunger all the time.

Generally, patients said that they received assistance at meal times as required. Three patients said that they were not given the opportunity to wash their hands prior to eating. The relative of a patient said, that items that are required by the patient are on the bedside locker. This was 'often behind the patient and out of reach'.