Good Hope Hospital

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We reviewed assessing needs, how staff, teams and services work together, monitoring and improving outcomes and consent to care and treatment for the effective key question. We found effective had stayed the same and was rated as good.

We found patients had their needs assessed accurately and there were processes to monitor outcomes and support multidisciplinary team working. However, we found aspects of care which were not monitored and therefore the service did not always have the assurance required in relation to performance.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Nursing staff we spoke with were generally able to explain the various risk assessment tools and how they used them on the prescribing information and communications system (the system used for patient records – PICS). However, we reviewed 2 electronic fluid balance charts with staff and found it difficult to make sense of these, and could not be assured that fluid balance, and therefore fluid therapy, was correct. Staff were not able to explain how to interpret the information on the chart either. We saw a third fluid balance chart showing nothing documented from 8.30pm to 3am for a patient returning to the ward from theatre at around 8.30pm. We heard fluid balance required improvement, and reports from some staff that risk assessments such as MUST were not being done, and diet and fluid intake not being recorded.

Staff told us recording a NEWS of 5 or more on PICS would create a sepsis alert, and a NEWS of 7 would alert the critical care outreach nurse, who would then assess the patient urgently. They told us the threshold for this nationally was a NEWS of 5 or more but they felt limiting alerts to NEWS 7 or more worked. We heard information suggesting the NEWS2 system and process did not always work, and the importance of using clinical judgement, not just NEWS2.

There was a daily ward ‘red to green’ process to try to correct delays in care and address patient concerns.

There were processes to ensure staff holistically assessed patient needs. This included but was not limited to nutrition, hydration and skin integrity. However, during our onsite assessment we observed staff did not always follow processes ensuring patient needs were always met in relation to their hydration needs.

Due to the number of medical patients who were often admitted to surgical wards as outliers, the trust had provided specific instruction of which patients can be outlied and who cannot (inclusion and exclusion). This enabled the trust to ensure those patients who were assessed as requiring specific medical treatment had their needs met. As part of this process, staff were required to complete an assessment of the patients clinical condition and needs to ensure they would not be disadvantaged by being outlied on to a surgical ward.

The service monitored outcomes in relation to assessing patients’ needs through the clinical dashboard. Results of the dashboard were then regularly discussed at the governance meetings (Clinical Dashboard Review Group). Where performance was continuously challenged, action plans were completed to drive improvement. Information shared by Ward 16 showed where improvements were made in relation to meeting patient needs, this was shared with staff.

In relation to medical outliers, specific follow up for the outliers within gynaecology (Ward 2) was completed and compliance monitored through the incident reporting system. Outcomes of this were discussed during speciality governance meetings.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

Staff told us a number of services were arranged across different sites within the trust. Vascular, urology, trauma and complicated surgical cases required transfer to Heartlands. The laparoscopic cholecystectomy pathway, and robotic surgery, were based at Heartlands and Solihull. As the gynaecology assessment unit (GAU) and inpatient ward was based at GHH, gynaecology patients may require transfer from Heartlands to GHH on the cross-site emergency pathway. There was an online referral system for patients who required services at the main hospital site. We saw examples in incidents where there had been delays in transferring patients to the required site within the trust when the specialty they needed was not available at this location.

Staff told us with parts of the pre-operative service occurring off site, this meant it was difficult at times for staff to work together cohesively and had led to some areas of concern being identified when patients were admitted to the service for their operation. An example highlighted by staff included a patient almost undergoing a procedure they were not consented for.

Staff told us there was 24-hour cover, 7 days a week for critical care outreach on the wards to support staff when patients were identified to be deteriorating. Feedback from staff was they were approachable and very responsive to their needs.

Staff told us there was access to radiography staff overnight. Radiography staff told us they worked well with staff within surgical areas and doctors also confirmed this was the case with them adding they never had any challenges in ensuring their patients had the tests they required.

There were processes to ensure members of the multidisciplinary team (MDT) worked together to ensure the needs of the patients were met. Key governance meetings were attended by members of the MDT which demonstrated an effective and cohesive service.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

There were processes within the service to monitor and improve outcomes for patients who used the service. There was an audit policy which informed staff of the expectations in relation to audits which were conducted within the service. There was evidence of regular audits being conducted which included patient reported outcomes. However, we found there were areas of patient care which were not routinely audited, and the outcomes were therefore not monitored.

Outcomes were discussed at the governance meetings and where action was required, this was identified and plans made to improve outcomes. Governance meetings regularly reviewed the clinical dashboard data which each ward collated and discussed areas which were non-compliant and how improvements would be made.

Information provided showed theatres at Good Hope Hospital achieved 97% compliance for quarter 1 2024/25. This was an improvement from 92% in the previous audit.

There were processes to ensure staff supported patients to make informed decisions about their care and treatment. There were policies and processes which staff were aware of and followed to gain patient consent. Where patients lacked the capacity to make decisions about their care and treatment themselves, the policy provided clear information for staff to follow which was in line with national guidance and legislation to ensure consent was gained lawfully.

However, there were no audits completed by the service in relation to the consent process to ensure staff adhered to the processes. We therefore were not assured the service had oversight of how staff adhered to consent procedures. The information provided following the onsite assessment escalated this to the chief medical officer who had instructed staff to implement an audit programme for consent within the next 3 months.