The Royal Wolverhampton NHS Trust (RWT) is a large tertiary, acute, community and primary care provider, with 808 beds available across its three sites.

The trust three main hospital sites are New Cross Hospital, Cannock Chase Hospital and West Park Hospital.

The trust provides urgent care, medical care, surgery, children and young people services, maternity services, outpatients, diagnostic services, end of life and critical care services. The trust serves a population of over 450,000 across Wolverhampton and surroundings areas.

In addition, the trust manages nine GP practices in and around the Wolverhampton area.

The RWT provides medical care across two sites:

• Cannock Chase Hospital

• New Cross Hospital.

At New Cross Hospital there are 432 medical beds across 20 wards and other reporting units: This includes Cardiology, Elderly care, Renal, Diabetes, Stroke, Cancer, Neurology, Respiratory and Gastroenterology.

At Cannock Chase Hospital there are 27 beds located on Fairoak ward, a care of the elderly and rehabilitation ward.

The trust (New Cross Hospital and Cannock Hospital) had 59,533 medical admissions from April 2017 to March 2018. Emergency admissions accounted for 18,253, 907 were elective, and the remaining 40,363 were day case.

Admissions for the top three medical specialties were:

• General medicine: 28,754

• Clinical haematology: 8,297

• Clinical oncology (previously radiotherapy): 8,254

Inspection of the medical services at New Cross Hospital, took place in February 2018.

The trust consists of three hospital sites and includes several GP practices.

New Cross Hospital provides a range of services including Emergency care, Medical Care, surgery, outpatients and diagnostics services , maternity, and critical care services. Other services including specialist care are also provided at the hospital. There are specialist facilities for cardiac and stroke patients provided by the regional heart and lung centre.

Cannock Chase Hospital provides medical care, surgical services and a range of outpatient services and diagnostic services.

Rehabilitation and community inpatient services are provided at West Park Hospital.

This inspection was focussed on the care of the elderly ward at Cannock Chase Hospital.This was due to be inspected as part of the Royal Wolverhampton NHS Trust inspection that took place in February 2018, however was excluded due to an infection prevention and control concern causing the ward to be closed to visitors. A report for the February 2018inspection can be found on the CQC website.The medical ward at Cannock Chase Hospital is known as Fairoak Ward, it has 27 beds split between both male and female patients. The beds are in bays containing four beds and allocated as single sex areas, there are three single occupancy rooms.

The ward accommodates elderly care patients and those in need of rehabilitation. Referrals are generally made from within the trusts two other locations, New Cross Hospital and West Park Hospital.

We visited the Fairoak Ward at Cannock Chase Hospital, unannounced, on 24 July 2018.

We spoke with 13 members of the medical team including a consultant and junior doctors, a matron, nurses, health care assistants, physiotherapists and members of the domestic staff team.

We spoke with 11 patients and 4 visitors.

We looked at the records for 11 patients in total.

Our key findings were as follows:

• We saw improvements in processes to protect patients from harm compared with the previous inspection.

• Staff understood the procedure to raise concerns, reports incidents and near misses and told us they were supported to do so.

• Areas were clean and regular audits were carried out. Action plans were put in place to make improvements where required.

• Patient notes were multi-disciplinary and had name and date stamps throughout all entries, indicating which member of staff had seen the patient.

• The trust had been working to improve the implementation of the sepsis pathway since the last inspection. On this inspection we found that management of sepsis had improved.

• The ward carried out various local audits, including auditing their own documentation to check that care plans were being completed correctly.

• Senior service leaders regularly reviewed the effectiveness of care and treatment through local and national audit.

• Staff were supported to undertake professional development training to enhance their knowledge and skills and were well supported with their training and development.

• Patient information huddles were held each day on each ward so that information could be shared with all relevant staff involved in the care and treatment of the patient.

• Nursing and medical staff ensured that patients received timely pain relief.

• Patients’ nutritional needs were assessed and care plans developed.

• Staff understood their roles and responsibilities under the Mental Capacity Act 2005.

• We observed both nursing and medical staff interacting with patients with dignity and respect.

• Patients told us they felt involved in their care and they were given enough information.

• Staff supported patients’ emotional needs and responded to their care and treatment in different ways and according to their social, religious and spiritual needs.

• Families were encouraged to be part of the rehabilitation process and could support patients whilst on the ward.

• There was a robust discharge procedure which used a checklist to aid staff in monitoring discharges.

• Relatives of patients were included in the planning of care and the consultant or a senior member of staff would try to see relatives or loved ones, within 48 hours of an admission to the ward.

• Patients told us the therapy was “brilliant” and that there was a range of activities to suit individual needs.

• Staff told us complaints management had improved and they received feedback from complaints across the trust and discussed these at team meetings.

• Training and development for staff was a priority for the trust and we saw examples where staff had been involved in developing training.

• There was a local vision and strategy for medicine which was linked to the trust’s overall vision.

• Nursing forums had been introduced throughout the trust to allow staff to discuss issues openly and offer views on potential solutions.

• Shared governance meetings were held monthly where staff sent a representative from the ward to attend.

• The Fairoak Ward team were shortlisted for the “enhancing patient dignity” category at the 2018 nursing times awards.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

• review security arrangements around the access to the ward.

In addition the trust should:

• ensure it continues to work to reduce the number of patients sustaining falls.

• review training schedules and prioritise basic life support and tissue viability and pressure injury management training.

Professor Edward Baker

Chief Inspector of Hospitals

Our rating of this hospital stayed the same. We took into account the current ratings of services not inspected at this time.

We rated the hospital as requires improvement because:

• We found that some infection prevention and control processes were not robust. One theatre was closed due to its unsatisfactory condition. There were loose tiles in the theatre and an unsatisfactory seal on the doors, which compromised the air pressure control.
• We also saw theatre staff wearing gowns and hats that had been used in theatre. This contradicted policy for standards of dress at work.
• There were inconsistencies around the world health organisation checklists, with some staff not completing some stages. We found that staff were not always following the correct protocol for taking time out of the theatre environment.

However:

• Staff told us that they were fully supported by their managers and were proud to work at the trust. They subscribed to the trusts visions and values and demonstrated good care and support to the patients.
• Staff knew how to access relevant information to perform their duties. There were regular meetings where learning from incidents would be discussed and staff were confident and competent in reporting incidents.