Surrey hospital let 63 people stay for up to a month despite not needing care
St Peter’s Hospital discharged some vulnerable patients without support and scores of people were still in the hospital for up to a month despite no longer needing medical care, a watchdog has said after a surprise inspection.
The Care Quality Commission (CQC) received several notifications from community teams about missed opportunities at St Peter’s for safeguarding referrals, and the watchdog told the Chertsey hospital in a report that it needs to continue developing a safer discharge process.
Though most patients’ discharges were carefully planned, there were gaps reported for those with complex mental health and social care needs.
And a lack of beds in social care for people with complex mental health needs meant that scores of medically fit people were stuck on medical wards waiting for discharge.
Amanda Williams, CQC’s head of hospital inspection, said in the report: “During the inspection, there were 63 patients who were still on the ward when they should have been discharged, and some of them had been there for 30 days.
“This was affecting the trust’s ability to manage patient flow, and it also meant these patients were not in the best place to meet their needs.”
She added that the trust was working to address the issue and had recently opened a 19-bed ward for medically fit patients to move to while they are waiting for community placements.
St Peter’s’ safety rating in medical care improved to good and leadership retained its good grade, following the focused inspection visit in November, its first since 2018.
Inspectors observed staff taking the time to care, brushing patients’ hair, taking them to the toilet and sitting and speaking with them.
They said patients were treated with compassion and kindness and had their individual needs considered.
A space had also been created in the hospital for patients to find peace and reflect away from the busy wards.
For surgery, on the other hand, St Peter’s’ CQC rating fell to requires improvement in both safety and leadership.
The theatre had damage to the walls, floors and fittings, which was an infection control risk.
Several items of medical equipment were out of date for servicing, meaning staff could not be sure they were safe to use.
David Fluck, interim chief executive at Ashford and St Peter’s NHS Foundation Trust, told their board meeting yesterday (February 3): “It’s quite easy to get sometimes a little bit complacent about things that you tolerate it. That’s what we learned from the pandemic.
“Pre-pandemic, healthcare systems generally were complacent about infection control to a certain extent, and what we’ve realised is how important it is.
“The things that we’ve put in place that have actually solved those other infection control problems.”
He added: “There are a few things where we need to improve. Things like some of the infrastructure in theatres was not as good as it should be and that does carry an infection control risk.”
It was concerns raised by staff whistleblowers that triggered the unannounced inspection of both St Peter’s and Ashford hospitals, mainly to check how safe and well-led their surgical services are.
As a result St Peter’s’ overall CQC rating has fallen and now both hospitals are graded ‘Requires improvement’ overall.
A “significant number” of staff in the theatre and recovery areas at St Peter’s Hospital told the CQC they felt they had “not been consulted on changes to the way in which the service ran, or ways of working in a way that was meaningful to them”.
Staff at St Peter’s said that divisional leaders were visible, but members of the trust executive team were not.
Mr Fluck said at the board meeting they will reflect on whether they could have better managed discussion with staff in surgery, who had been redeployed from their theatres to intensive care and had their work shifted over to another hospital.
He said: “Particularly at Ashford they found the team really proud of what they’d developed. They didn’t detect a huge amount of unhappiness in that environment.
“They did however detect more on the St Peter’s side, and fed back that some of the senior clinicians didn’t feel that we’d listened to them as much as we should. I think we need to reflect on that.
“This has been an absolutely dramatic time of change for the clinical teams and looking back and seeing what’s happened over the last two years, with the radical change in the delivery model, with us moving outpatients out of the hospital, elective care all over to Ashford, that has great impact on the staff.”
The trust has brought in an external company to help address issues, and is implementing an action plan focused on supporting theatre teams to manage change, as well as team-building and leadership development.
At Ashford Hospital, most staff said that morale was good, and they felt happy and supported, both by managers and their colleagues.
It kept its good rating in leadership and was upgraded to good in safety.
Inspectors said the service controlled infection risk well. Ward areas were visibly clean, staff cleaned equipment after patient contact, and there was good compliance with using personal protective equipment (PPE) correctly.
However a minority of staff were not bare below the elbows, which is not in line with national guidelines.
It was also noted that only 61 per cent of medical staff were up-to-date with mandatory training, most of which was paused during Covid surges.
Chief nurse Andrea Lewis said: “In light of the pandemic to go up from requires improvement to good, both in medicine at St Peter’s and surgery in Ashford is commendable.
“With all the challenges that staff have had, to actually improve on safety at this time is exceptional, I’m really proud.”
They were not full inspections and only focused on surgery in both hospitals plus medical care at St Peter’s.