Paediatric acute and emergency services were provided at St Peter’s Hospital. The paediatric outpatient service provided at Ashford Hospital is part of the trust’s Women’s and Children’s clinical division.

We spoke with staff at all levels of the trust as well as members of the Council of Governors to gain their views about the delivery and safety of the services we reviewed. We looked at systems, and reviewed documentation. We spoke with two senior nursing staff on site but as there were no clinics we were unable to speak with patients or parents at the time of our visit. As part of the overall inspection we spoke with the Clinical Lead for Women’s and Children’s service as well as the leads for safeguarding children and the Chief Nurse. The paediatric outpatient staff worked to the trust wide and clinical division protocols and guidance.

From the feedback we received and records viewed we were satisfied that the trust was providing a safe, effective, responsive, caring and well led paediatric outpatient service.

During our inspection we visited the operating theatre, three wards and spoke to seventeen patients in detail. We looked at seventeen individual care plans for patients, talked to staff and met some relatives.

People that we spoke with told us they were happy with the care they received and that generally staff had time to spend with them and the atmosphere was relaxed. We were told “the nurses are very kind” and another person told us “they do a good job here, the wards are light and airy with plenty of space.”

Two people on one of the wards made us aware of concerns they had and when we discussed these with the management, they acted swiftly to address the issues raised.

The staff that we spoke with were knowledgeable about the patients needs and with the procedures on the wards and in theatre to ensure people were cared for safely.

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.

Our rating of services went down. We rated them as requires improvement because:

The service had suitable premises and equipment but did not always look after them well. Emergency equipment in general outpatients and the ophthalmology clinic was not always checked in line with trust policy. Some items of clinical equipment in the ophthalmology clinic were seen to be overdue for maintenance. Overall, facilities and premises were appropriate for the services delivered. There were facilities for patients in wheelchairs in the outpatient department including disabled toilets.

Medicines and medicines-related stationary were not always managed in a way that kept people safe in relation to the storage temperatures of medicines and the tracking of prescription forms.

The service controlled infection risk well. Staff kept themselves, equipment and the premises clean. Standards of cleanliness and hygiene were generally maintained but cleaning schedules were not in use in all clinic areas such as the ophthalmology clinic.

People could access the service when they needed it. However, services did not always run on time, although patients were informed of delays. There was some overbooking in clinics which had caused delays.

Governance structures were not consistently in place to support the delivery and development of outpatient services. Arrangements for identifying, recording and managing risks, issues and mitigating actions were not consistent or comprehensive.

The trust had managers at all levels with the right skills and abilities to run a service but senior trust and divisional leaders were not perceived as visible within the outpatient department. Staff felt uncertain about the future of Ashford Hospital and did not feel engaged with the wider organisation.

However:

The trust had a vision for what it wanted to achieve and workable plans to turn it into action but there was no outpatient strategy recorded that showed how the service would develop to contribute to those strategic objectives. There was a clear set of values with quality of care and meeting patients’ needs as the top priority.

The service managed patient safety incidents well. Lessons were learned and improvements made when things went wrong. Staff recognised incidents and reported them appropriately but not all staff had received feedback on incidents reported and outpatient team meetings did not include safety incidents as a standing agenda item.

Staff kept appropriate records of patients’ care and treatment. People’s individual care records, including clinical data was written and managed in a way that kept people safe.

The service took account of patients’ individual needs. Patient’s physical, mental health and social needs were holistically assessed and staff delivered patient care in line with evidence based and best practice guidelines. There was evidence of multidisciplinary working with all necessary staff, including those in different teams, services and organisations, involved in assessing, planning and delivering care and treatment.

The trust collected, analysed, managed and used information well to support all its activities. Information about patient outcomes were recorded after each clinic appointment and there were processes to audit these to promote quality improvements. The trust closely monitored cancellations in fewer than six weeks’ notice and referral to treatment times.

People were treated with compassion, kindness, dignity and respect when receiving care.

There were processes to manage current and future performance which were regularly reviewed and improved. There were clear and robust service performance measures, which were reported and monitored.

We did not inspect all core services. The previous rating for those services we did not inspect were taken into account when working out the overall trust ratings for this inspection.