We undertook this inspection of St Helier Hospital on 6 March 2014 because we received information of concern about the services management of medicines arrangements. As part of our review we visited five wards that specialised in acute or short-stay medical care, care of the elderly, and patient discharge.

During our inspection we spoke with the head of nursing, two pharmacists which included the chief pharmacist for the hospital, eight registered nurses which included three ward sisters, and four healthcare assistants’. We also talked to ten patients and a visiting relative. Patients we met told us they were given their medicines when they needed them, and in a safe way by the nursing staff. One patient told us “I would give the nurses that work here ten out of ten for the way they manage my medicines”. Another patient said “the nurses are pretty good at explaining what medication they’re giving you does”. As part of this inspection we also observed nurses administer medication on two of the wards we visited.

Overall, we found patients were protected against the risks associated with the unsafe use and management of medicines because the Trust had appropriate arrangements in place to ensure the safe obtaining, recording, handling, using, storing, dispensing, administration and disposal of medicines within the hospital.

People told us what it was like to be a patient in St Helier Hospital. They described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people in hospitals were treated with dignity and respect and whether their nutritional needs were met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by a practicing professional and an Expert by Experience, who has personal experience of using or caring for someone who uses this type of service.

We used the Short Observational Framework for Inspection (SOFI), which is a specific way of observing care to help us understand the experience of patients who could not talk with us. We also looked at a sample of patient’s personal records, the hospital menus and complaints procedures.

Most of the feedback we received from patients and their visiting relatives was positive about the standard of the care and treatment they had been provided during their time at St Helier Hospital. Patients we met consistently told us they were “very happy” with the quality of the service they had received at the hospital.

Most patients and their relatives said ward staff always respected their privacy and dignity, and consulted them about their care and treatment. We saw staff treated patients with privacy and dignity, patients described staff as kind and approachable. Patients and their relatives also consistently told us staff ensured curtains were kept closed when personal care was being given, and always discussed care discreetly. Typical feedback we received about staff, included: “All the staff are very approachable and friendly here” and “staff always explain what’s going on and you can ask them questions.”

Most patients also told us the quality and choice of the meals they were offered was good and several people felt it had improved in recent years. Typical comments received from patients included “the food is lovely. No complaints”, “There’s plenty to choose from on the menu“, and “the food has definitely improved since the last time I was here”.

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.

Since our last review of compliance we have visited the hospital on three occasions. On the 22nd December 2011 we had hoped to check on the progress they had made in addressing the issues we had previously raised at our review in May 2011. Unfortunately we were not able to continue our visit as ward areas had been closed due to the winter vomiting bug, Norovirus.

On the 28th December 2011 we visited following some concerns that had been raised. We also asked about how the hospital had managed increased demands over the Christmas Period.

On 24th January 2012 we again visited to look at the progress made following our review of May 2011. During this time we were able to talk with some of the staff and patients even though, once again, some areas were closed because of a further outbreak of Norovirus.

At this visit we received several positive comments from patients regarding the care and support they had received.

They told us “we’re being very well looked after,” and “it’s fine here, very good”.

They also told us “staff are very kind” “they explain what’s going on” and one said “they’re really good here, “really professional”.

Generally the people that we spoke with, when we visited St Helier Hospital and Queen Mary’s hospital for Children, were very happy with the care that they were receiving.

They considered that they were able to take an active role in their treatment and able to be involved in decisions about their care. They told us that they were kept fully informed about what was happening, they were able to talk to doctors who were managing their treatment and they were given information both prior to any planned investigation and about any after care that they might need.

One person told us “we have been impressed by the professionalism of the staff” and others told us that staff “were very kind”, “seem to know what they are doing” and “they work as a team”. Most people we spoke with told us that they were happy with the food and there were choices available. One patient described it as being “much better now, compared with previous stays”.

We received some adverse comments regarding staff attitude towards older people, with one person telling us “staff think that just because you’re old, you won’t understand”. Our observations throughout the visit also suggested that some outcomes for older people, especially those with dementia could be improved.

We spoke to people who use the services and found that in general they were happy with the care provided by the hospital. However, a number of people we spoke with told us that they were not happy with the meals they had been served. Some said that although they had been offered a choice when meal time came it was not always available and others that the standard of the food had been poor.

Other people told us that there had been a lack of communication from the staff. Some had moved wards several times during their stay and they did not know why, one patient had been worried because her relative had not been informed when she went to another ward. This had resulted in the relative being faced with an empty bed and becoming anxious about what had happened.

Some patients were being cared for on what had previously been the day surgery ward. Increased winter pressures had meant that it was being used for inpatients from various specialities. They raised concerns about an apparent lack of equipment and supplies on the ward, telling us that they had been told that basic supplies such as bandages were not available.

This is a report on a focused inspection we undertook at St Helier Hospital on 29 and 30 October 2018. The purpose of this inspection was to follow up on concerns raised by HM Coroner, in relation to patients being treated for hyponatraemia (low sodium blood levels), and the internal communication of abnormal pathology results. We also received concerns about the safety of mental health patients in the emergency department, nurse staffing levels in medical care wards, and the safeguarding of patients being discharged from hospital, in particular from ward A6. The concerns raised related to both Epsom General Hospital and St Helier Hospital.

Our key findings were as follows:

• The service provided care and treatment based on national guidance and evidence of its effectiveness. We saw recently adapted guidance on quality standards for the treatment of patients with hyponatraemia and these were embedded in practice.

• Medical staff across the emergency department (ED), acute medical unit (AMU) and the medical wards, received training in the management of patients with hyponatraemia.

• There was a trust wide standardised approach to the detection of deteriorating patients using the National Early Warning Score (NEWS) system and staff knew what action to take when the score was above 4.

• Pathology results needed to deliver safe care and treatment were available to staff in a timely and accessible way. There was a trust wide standard operating procedure for communicating abnormal blood results to appropriate staff.

• Staff received effective training in safety systems, processes and practices. The trust trained staff in the Mental Health Act (MHA) and Safeguarding Adults.

• The design, maintenance and use of facilities and premises was satisfactory. There was a designated room for interviewing patients with mental health needs in the ED at St Helier Hospital.

• ED staff identified adults at risk of causing harm to themselves. Patients assessed as being at risk of suicide or self-harm, received early referrals to the mental health liaison team. Policies and procedures were in place for extra observation or supervision of patients with acute mental health needs.

However:

• Some wards did not use a checklist when discharging patients and this could result in parts of the process being missed.

Professor Ted Baker

Chief Inspector of Hospitals