Background to this inspection
Updated
4 October 2018
Ashford and St Peter's NHS Foundation Trust was formed from the merger of two hospital sites in 1998 and achieved foundation trust status in 2010. Services are provided on two hospital sites, St Peter’s Hospital (Chertsey) and Ashford Hospital (Ashford, Surrey).
The trust has 575 beds, of which 501 are general and acute beds. The trust provides a full range of general hospital services including A&E, maternity, paediatric and critical care services. It also provides some specialist services such as neonatal intensive care and limb reconstruction surgery.
The trust serves a population of 410,000 people in the boroughs of Runnymede, Spelthorne, Woking and parts of Elmbridge, Hounslow and Surrey Heath. The main commissioners of services from the trust are North West Surrey and Hounslow clinical commissioning groups.
We carried out a comprehensive inspection of the trust in December 2014 and published the report in March 2015. At that time we rated the trust as good overall, though they were rated as requires improvement for the key question of “Is this service safe?” We told the trust it needed to take action to manage four breaches of the regulations we identified at that inspection.
A follow up inspection was undertaken in March 2017 to ensure the trust had rectified regulatory breaches. We found the trust had taken action to comply with regulations for all four breaches. Ratings published in 2015 were not changed.
We carried out unannounced, focussed inspection in September 2017 as a result of information of concern about the care on the medical wards at St Peter’s hospital. We published the report in January 2018. We found there was a breach of regulations in regard to fire safety, proper and safe management of medicines and safety checks on emergency equipment and told the trust it must take action to remedy these, Ratings from 2015 were not changed following this inspection.
Updated
4 October 2018
Our rating of the trust stayed the same. We rated it as good because:
We rated effective, caring responsive and well-led as good. We rated safe as requires improvement overall.
In outpatients at Ashford Hospital we rated safe and well-led as requires improvement and caring and responsive as good. We did not rate effective. We rated the service as requires improvement overall
In urgent and emergency care we rated safe, responsive and well-led as requires improvement and caring and effective as good. We rated the service as requires improvement overall.
In critical care we rated safety, responsive, effective as good and caring and well-led as outstanding. We rated the service as outstanding overall.
In medicine at St Peters we rated safe as requires improvement and effective, caring, responsive and well-led as good. We rated the service as good overall.
In children and young people’s services we rated safe, effective, caring, responsive and well-led as good, and the service as good overall.
We did not inspect all core services. The previous ratings for those services we did not inspect were taken into account when working out the overall trust ratings for this inspection.
We rated well-led for the trust overall as good.
The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately and could discuss the processes involved.
The service used safety monitoring results well and participated in the national safety thermometer scheme. Staff collected safety information and shared it with staff, patients and visitors. The trust used information to improve the service.
The service controlled infection risk well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection. Standards of hygiene and infection rates were monitored to identify any risks and infection rates were low.
Staff kept appropriate records of patients’ care and treatment. Multi-disciplinary, electronic records were clear, up-to-date and available to all staff providing care.
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. Specialist teams support ward staff and patients in vulnerable circumstances.
The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and abuse and to provide the right care and treatment. Recruitment, especially of nursing staff was a major challenge to the trust. However, there were systems, including the use of a flexible workforce that ensured there was a match between staff on duty and patients’ needs.
The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance through programmes of audit.
The trust made sure staff were competent for their roles. There was a programme of mandatory training and staff had opportunities to develop their skills and gain experience and qualifications to help them do their jobs effectively.
Staff always had access to up-to-date, accurate and comprehensive information on patients’ care and treatment. Electronic records were used effectively and there were electronic systems to ensure patients’ conditions were monitored