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Updated 1 May 2014
Heatherwood Hospital provides services to people living in the Ascot area as well as some trust-wide services, including: minor injuries unit, medical and stroke rehabilitation, elective orthopaedic surgery and a range of outpatient departments.
Heatherwood Hospital was inspected in May 2013. Non-compliance was found in the following areas: care and welfare and records.
Updated 1 May 2014
Heatherwood Hospital is an acute location run by Heatherwood and Wexham Park Hospitals NHS Foundation Trust. The hospital provides the following services: medical rehabilitation, orthopaedic elective surgery, short stay surgery, minor injuries unit, theatres and outpatients departments. There is no Accident and Emergency at this site.
We inspected the following regulated activities for which the hospital is registered: treatment of disease, disorder or injury, diagnostics and screening, and surgical procedures.
Patient needs were assessed and care was planned and delivered to meet those needs. Patients were communicated with and felt involved in their care and in decision making. All feedback received from patients was positive; this applied across the multidisciplinary team. Patients were provided with appropriate information at all stages of their care and treatment.
Although patients received safe care and were protected from risks, incidents were not always reported appropriately and there was some evidence that the learning from incidents needed to improve (for example in relation to falls). In addition, the trusts own audits found that the World Health Organisation checklist was not being completed robustly at this site. Hospital areas visited were clean, and staffing levels were maintained for the majority of shifts.
Patient care and treatment were planned and delivered in line with legislation and best practice. Patient records were kept up to date and were updated in a timely manner. Audits were undertaken to monitor care and outcomes, and, where required, action plans were implemented to improve care. Appropriate equipment was not always available to reduce the risk of harm (for example to prevent falls). This is a breach of Regulation 10 regarding the safety and suitability of premises. There were systems in place to ensure that staff had undertaken mandatory training, but not all staff had received an annual appraisal.
All wards and departments at Heatherwood Hospital were managed as part of the three divisional structures based at Wexham Park Hospital. Governance arrangements and support from senior staff were communicated via the lead nurses for the relevant division, who ensured that reporting and feedback for Heatherwood Hospital wards and departments were fed into the relevant committees.
During our inspection, it was confirmed that the minor injuries unit and ward 8 were due to close in the near future. The plan was for the services provided by the unit and ward 8 to continue but to be provided by other providers and within the community. This situation had an impact on staff working in the affected areas, although they all continued to be committed to the delivery of high standards of care in the interim.
During our inspection, we spoke with patients and their relatives and to members of the public who shared their experience with us at a listening event the week prior to the inspection. We spoke with 10 patients and 15 members of staff.
Some wards and departments we visited had staff vacancies. These were covered by either bank or agency staff to ensure patient safety and that the needs of patients were met. There were some occasions when the required number of staff was not available for a shift; this could have an impact on patient safety. Wards and departments at Heatherwood Hospital were supported by on-site medical staff and a range of allied health professionals. These staff members were based on the wards and worked as a cohesive team with the nursing staff. All staff we spoke with felt that joint working with the multidisciplinary team ensured positive outcomes for patients.
All the areas of the hospital that we visited were clean and free from clutter. Alcohol hand disinfectant was available on entry to wards and departments, at the patients’ bedsides and in other key points, enabling good access for staff and visitors. However, this was not the case in the outpatient departments. We noted that audits of staff compliance with hand hygiene were between 89% and 100% in surgical areas. The areas we visited displayed the results of cleaning audits, which were above 90%.
Updated 1 May 2014
Patient’s needs were cared for by a multidisciplinary team of healthcare professionals who ensured joint working and communication throughout the patient journey. Systems for identifying risk and reporting incidents did not always lead to actions being taken to protect patients from harm (for example from falls). A lack of access to a range of appropriate equipment prevented staff from being able to ensure that patients were safe.
Updated 1 May 2014
We found that some improvements were required to keep the outpatient service safe and effective for people at Heatherwood Hospital. These included better infection control and systems to ensure that people received treatment in a timely way, as well as better performance in arranging outpatients’ appointments in line with the trust’s own policies.
We found that the hospital was good at caring for people on a one-to-one basis. Most front-line staff were respectful and considerate. Insufficient work had been done to improve the booking and appointments systems, waiting times and the cancellation of clinics. Improvements were required to ensure that the service was well led. There was good leadership at a local level, but it needed to be improved at senior manager level.
Updated 1 May 2014
Patients received safe and effective care. Staff were aware of how and when to report incidents, and they confirmed that they had feedback on these after local investigation and learnt lessons to improve patient care. Care was delivered in line with national standards and evidence-based practice. Staff were trained appropriately to deliver care to meet patient needs. Multidisciplinary staff working was effective in achieving patient outcomes and planning discharge from hospital. Patients were positive about all aspects of the surgical pathway and about all groups of staff involved in their care and treatment. Monitoring was undertaken and action plans were in place to address areas of non-compliance.
Updated 1 May 2014
The minor injuries unit provided safe and effective care for patients. There were sufficient numbers of staff, with appropriate qualifications, skills and experience to ensure that patient needs were met. The majority of patients were seen within four hours. The patients and their families with whom we spoke were very positive about the care and treatment they received in the department.