Chapel Allerton Hospital is one of seven hospitals that form part of Leeds Teaching Hospitals NHS Trust. The trust is one of the largest in the United Kingdom and includes one of the largest teaching hospitals in Europe. The trust serves a population of 751, 485 in Leeds and surrounding areas. In total, the trust employs around 15,000 staff. Chapel Allerton Hospital was built in the early 1990s. The hospital is home to the Chapel Allerton Orthopaedic Centre, a dedicated centre for the diagnosis, management and treatment of adult patients with upper and lower limb complaints. The hospital provides rheumatology and orthopaedic surgical services. Dermatology services have recently commenced at the hospital. The hospital has 82 beds.

Inpatient services are provided for neuro-rehabilitation, rheumatology, dermatology and orthopaedic surgery. Outpatient services are also provided in the hospital. Staff on site are managed via several trust wide clinical service units, but one management team is based entirely on site and is taking a co-ordinating role in terms of site responsibility.

There were systems to identify risk and report incidents. Lessons were learnt from the investigations of incidents from across the trust and staff felt well informed. There were effective systems in place to prevent patients suffering pressure ulcers, falls and blood clots.

Care was provided in line with national best practice guidelines. Access to services was good and patients reported that the hospital was well thought of locally due to the good outcomes experienced by patients. However, the World Health Organisation safety check list was not fully embedded into operating theatre practice.

Patients were treated with dignity and respect and felt informed about their treatment and care. Patients were positive about their experiences at the hospital.

Staff reported that there had been a positive change in the leadership at trust level and that the executive team were more visible, especially the Chief Executive. Staff reported that they felt supported locally and encouraged to participate in improvement initiatives.

Staffing

The wards and departments were adequately staffed and staff had access to training and development opportunities to improve their knowledge and skills and develop professionally. However, not all staff had completed mandatory training.

Staff were committed and enthusiastic about their work and worked hard to ensure that patients were given the best care and treatment possible.

Cleanliness and infection control

There were arrangements in place to manage and monitor the prevention and control of infection. We found ward and theatre areas were generally clean and there were no reported healthcare acquired infections at the hospital within the last year. However, we identified some issues with storage and cleanliness in parts of the operating theatres (non-patient care area).

We visited an orthopaedic ward and the rheumatology day unit.

People said they were fully involved in decisions about their treatments and the staff were very good at explaining the treatment they received. People told us that the treatment options were explained and the risks and benefits of their treatment were made clear. They said they felt safe. All seven people we spoke with told us they were happy with the care they received and they were well looked after.

Comments included:

“I agreed to the treatment and I have signed something in the past.”

“I made the decisions myself.”

“Care is very good. Staff have been attentive and efficient.”

“I can’t fault anything.”

“It has been a positive experience.”

“I am perfectly satisfied, as satisfied as I could be.”

“I had an exceptionally good discussion with the pharmacist about my medical history and suitable medication for me.”

“As hospitals go this is as good as it gets.”

“Care is better than in a private hospital.”

“They treat you like a person.”

“Care has been excellent. They are so caring.”

The people we spoke with told us there were enough staff on the ward and they were seen to promptly.

Comments included:

“Someone comes if I need help.”

“Even though staff are busy they do not rush with me.”

“Staff are prompt and they double check everything.”

The patients we spoke with were mostly positive about their experiences of care and treatment on the wards visited. They told us that they were kept informed and were involved in making decisions about treatment options. They also commented that they were given enough information to help with this process. Most of the patients interviewed told us they had their care needs met and had been treated with respect. One patient told us how they had been upset by the comments from staff.

Examples of the positive comments included;

“I am happy with the care provided”.

“The staff are very good”; “they try to be fair sharing their time with everyone”.

“Staff call me by the name I asked them to call me by”

“I am listened to about my personal wishes”.

“I am able to choose whether I want a shower or a bath, I am very happy with the support that the staff give to me”.

“Staff explain what they are going to do”.

The negative comment was;

“The staff nurse in charge yesterday made me very uncomfortable and annoyed. She was angry and upset me because I smoke, but she is a good nurse the medical care given is great. It is their attitude because we smoke; it is like a grudge against you”.

Patients and relatives were complimentary about the process of mealtimes. They commented that the staff made an effort to make it a pleasant experience. Patients also commented that they were well supported to eat and drink.

Positive comments about the food included;

“Meal times are quiet; the other patients are nice so mealtimes are pleasant”.

“Food for a hospital is not too bad for a hospital”

“I don’t have specific needs; the staff will help with anything that I find difficult to open”.

“There is enough food to pick from; I stick to what I know I’ll eat”.

Other comments made about the food and meal times included;

“It could be more varied, particularly for patients who are in for a long period”.

“The food is not always served by staff wearing aprons and hair is not always tied back”.

“There is hand washing available but staff have to be asked to wash their hands”

“Hot food could do with being served a bit warmer”

Our rating of services stayed the same. We rated it as good because:

• There were robust systems in place to ensure nursing staff completed their mandatory and safeguarding training, nursing staff training compliance exceeded the trust’s target of 80%.
• Nurse staffing was managed using recognised tools and professional judgement.
• Medical records and medicines including intravenous fluids were accessible to staff and stored securely. Patients food, hydration and pain management needs were met and there were effective processes in place to ensure that guidance used by staff was in line with national guidance such as those issued by the National Institute for Health and Care Excellence (NICE).
• The ward environment was visibly clean, with good infection control and in the period August 2017 to August 2018 there had been no cases of methicillin resistant staphylococcus aureus (MRSA), clostridium difficile (C.Diff) or methicillin susceptible staphylococcus (MSSA). The environment was free from clutter with disabled access and enough equipment for staff to perform their role. The service also used audits to improve patient outcomes and staff were supported by practice educators. Staff in the service demonstrated effective multi-disciplinary team working and a good understanding of consent and mental capacity. Staff we spoke to were able to confidently describe how to report incidents.
• Staff were caring; there were stronger than England average response rates in the Friends and Family test. 90% of those who responded said that they would recommend the service to family and friends. Staff provided support for the emotional needs of the patients and involved patients and carers in decision making where it was safe to do so.
• Senior leadership within the service were visible, approachable and responsive and worked as a cohesive team to promote a positive culture. There were clear governance processes in place to advance patient safety which were implemented and monitored at CSU level. The service engaged with staff and the public through meetings and surveys. All specialities we visited at Chapel Allerton Hospital had examples of innovation, learning and continuous improvement.
• Staff told us that they felt supported by their managers and colleagues at ward level and enjoyed working for the trust.

However

• Medical staff training compliance was not as strong as nursing, with medical staff meeting the trust target of 80% in only one of 16 modules in the medical care service and two in the surgical service.
• Trust performance in some of the national audits, for example those around falls were below the national aspirational targets however action plans were in place to improve performance.