Whiston Hospital

Updated 28 January 2025

Date of assessment 27 February to 19 June 2024. We conducted an on-site, focussed assessment visit of urgent and emergency care services on 25 March 2024 in response to concerns around access and flow and care of patients in non-clinical areas. We assessed a small number of quality statements from the safe, effective, caring, responsive and well-led key questions. The scores for these areas have been combined with scores based on the key question ratings from the last inspection. Therefore, our overall rating for urgent and emergency care remains requires improvement and the overall service remains outstanding.

Updated 27 February 2024

Date of assessment 27 February to 19 June 2024. We conducted an on-site, focussed assessment visit on 25 March 2024 in response to concerns around access and flow and care of patients in non-clinical areas. We assessed a small number of quality statements from the safe, effective, caring, responsive and well-led key questions. The scores for these areas have been combined with scores based on the key question ratings from the last inspection. Therefore, our overall rating remains requires improvement for this service. The service mostly provided and maintained safe systems of care, in which safety was managed, monitored, and assured. However, people were not always cared for in the right place with the right level of staffing. We found 5 breaches of the legal regulations in relation to safe care and treatment, staffing and governance.

Updated 19 January 2016

We gave the medical care services at Whiston Hospital an overall rating of good. However, we found further improvements were needed in how the service provided care that was effective to patient needs

Patients received compassionate care and their privacy and dignity were maintained. Patients were involved in their care, and were provided with appropriate emotional support.

Incidents were reported by staff through effective systems and lessons were learnt and improvements made from Investigations where findings were fed back to staff. Staff were aware of how to ensure patients’ were safeguarded from abuse and neglect. The wards were visibly clean and staff followed good hygiene practices.

There were effective systems in place to ensure patient safety was monitored and maintained. Staffing levels were overall sufficient to meet the needs of patients. Care was provided in line with national best practice guidelines and medical services participated in the majority of clinical audits. There was a strong focus on discharge planning from the moment of admission and services to support timely discharge were provided seven days a week.

We found that staffs’ understanding and awareness of assessing people’s capacity to make decisions about their care and treatment were variable.

Services took into account the needs of the local people. There were good ambulatory care services and a specialist unit for the frail and elderly.

The hospital had implemented a number of schemes to help meet people’s individual needs, such as the forget-me-not sticker for people living with dementia or a cognitive impairment and the falling leaf symbol to indicate that a patient was at risk of falls. This helped alert staff to people’s needs.

Medical services captured views of people who used the services with changes made following feedback. A survey showed that people would recommend the hospital to friends or a relative.

Staff told us that they felt valued and supported. There was good staff engagement with staff being involved in making improvements for services. All staff were committed to delivering good, compassionate care and were motivated to work at the hospital.

Updated 19 January 2016

We gave the Services for children and young people at Whiston Hospital an overall rating of Good; however in some areas we saw elements of outstanding practice.

Treatment and care were delivered in accordance with best practice and recognised national guidelines.

Children, young people and their families were respected and valued as individuals. Feedback from those who used the service was positive. Staff were compassionate, caring and provided effective care to children, young people and their families. Transition and acute community nursing support was comprehensive and made a positive impact for young people transitioning into adult services.

Staff were both creative and flexible to ensure care met the needs of individual children and young people. Feedback from children, young people and parents was exceptionally positive.

Staff were passionate about delivering high quality care and went above and beyond the usual duties to ensure children and young people experienced high quality care

The staff worked well with other teams and worked hard to provide a service to meet the needs of the child or young person who presented to the hospital. Processes were in place to provide an initial or long term service to any child or young person brought to Whiston hospital.

Staff were passionate about working with children and young people and felt valued by senior managers.

There was a good track record of lessons learnt and improvements being made when things went wrong. This was supported by staff working in an open and honest culture with a desire to get things right.

Children, young people and their families were not provided with regular opportunities to comment about the services provided. The trust was in the process of sourcing a system to help them gain an understanding of how children and young people felt about the care provided.

Updated 19 January 2016

We gave the critical care services at Whiston Hospital an overall rating of good.

There were sufficient numbers of suitably skilled and experienced nursing and medical staff on duty to care for patients.

Critical care services were being delivered by caring, compassionate and committed staff. We saw patients, their relatives and friends being treated with dignity and respect. The unit provided a critical care outreach service. We found that the critical care service was well led.

Patients and those close to them were positive about their care and treatment.

There were robust systems and processes in place for reporting incidents and there was evidence that learning from incidents was shared.

However, we found that medicines were not always stored securely and regular checking had not picked up on some out of date equipment on the resuscitation and difficult airway management trolleys.

When people required intensive care there were no significant delays in that care being delivered, however, there was often a delay in discharging patients once they had been judged as medically fit for discharge.

The unit continued to collect and submit data for the intensive care national audit and research centre (ICNARC) for validation, so it was able to benchmark its performance against comparable units. This data showed that patient outcomes were within the expected ranges when compared with similar units nationally.

Updated 19 January 2016

We gave the end of life care (EOL) services at Whiston Hospital an overall rating of good.

The palliative and end of life patient journey was supported by a strong Nurse led Specialist Palliative Care Team that worked closely with the ward based staff. There had recently been board approval to appoint a specialist consultant with recruitment underway.

We found that staff were committed to providing a good quality service that was delivered with compassion and dignity.

Staff were clear about their commitment to providing care that ensured patients ended their life in a dignified way in their preferred place of care. There were good systems in place for rapid discharge so that patients could return to their preferred place of care at short notice.

Patients were involved in their care, supported to make informed decisions and were provided with appropriate emotional support at a difficult time for patients and those close to them.

The trust had acted on the Department of Health’s National End of Life Strategy recommendations and was introducing the amber care bundle which encouraged talking openly about people's wishes and putting plans in place should the person die.

The service had a work programme in place and wished to develop this into a future strategy for the service. The trust had a board member with a specific lead for EOL care to ensure scrutiny and challenge regarding performance at a senior level.

Staff spoke positively about the support they were given by senior staff and management.

Systems were in place to prevent patients suffering avoidable harm. Incidents were reported by staff appropriately, they were investigated, lessons were learnt and improvements made to the service as a result.

Patients’ medication was well managed with the pharmacy team responding to requests promptly so patients received effective symptom control in a timely way.

Updated 5 April 2024

Updated 19 January 2016

We gave the outpatients & diagnostic imaging services at Whiston Hospital an overall rating of outstanding.

Incidents were being reported and staff were aware of the reporting system and how to use it. There was evidence of learning from incidents and how this learning was shared across the service and trust wide.

Cleanliness and hygiene was of a high standard throughout the hospital outpatient departments and staff followed good practice guidance in relation to the control and prevention of infection.

The service used electronic medical records that were easily accessible when patients visited the service. Information about patient’s treatment and care needs were obtained from relevant sources before clinic appointments to enable the service to meet the patient’s individual needs. The electronic patient record enabled timely access to information and diagnostic test results during consultation which contributed to patients making fully informed decisions about their care and treatment.

Staff were aware of their role in safeguarding, a reporting process was in place, and staff knew how to escalate issues of abuse and neglect.

Patients attending the outpatient and diagnostic imaging departments received care that was evidence based and followed national guidance. Staff worked together in a multidisciplinary environment to meet patients’ needs.

Staff were competent in their roles and supported by management systems to provide a good quality service to patients.

The service had been proactive in working towards providing seven days services within radiology and pathology services.

Patients were treated in a compassionate, respectful and considerate manner. The majority of patients said the staff had a good attitude, this was also reflected in a patient satisfaction survey.

There were good examples of a clear pathway and assessment planning for patients with additional needs this to ensure they received the appropriate support in a timely manner. This included the use of identifying the need for pre appointment visits to relevant departments to be arranged if required.

Leadership within the outpatient and diagnostic imaging service was very positive, visible and proactive. Managers had a strong focus on the needs of patients and the roles staff needed to play in delivering good care.

All the staff we spoke with were aware of the feedback from the NHS friends and family test. The trust was ranked one of the highest in the country for extremely positive feedback received from patients.

The service had a range of forums to seek patients’ feedback such as the “patient power” group.

The trust ranked in the top 100 places to work in the NHS in an external health journal.

Many of the departments we visited had awards on display and staff and patients were proud to show us what they had achieved. There were many examples of national targets being shortened by internal targets to drive improvements throughout the service.

Updated 20 March 2019

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

• The service controlled infection well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection.
• Staff worked together as a team to benefit patients. There were good examples of multidisciplinary working from admission through to discharge and beyond. Different teams worked closely to deliver safe co-ordinated care and treatment.
• Staff cared for patients with compassion and kindness. Staff ensured that patients and those close to them understood the care they would receive, and helped to minimise their distress.
• People could access the service when they needed it. Waiting times from treatment were and arrangements to admit, treat and discharge patients were in line with good practice. The service prioritised the care and treatment of patients with the most need.
• The service cancelled a lower percentage of operations than the England average.
• The service had managers at all levels with the right skills and abilities to lead the service and provide high-quality sustainable care. The trust scored highly in the 2017 national NHS survey for a number of indicator including; reporting good communication between senior management and staff.
• There were established governance systems in place to continually monitor and improve the quality of its services.
• The service engaged well with patients, staff, the public and local & partner organisations to plan and manage services effectively.

However:

• There was not always a full, clear and comprehensive record kept of all patients care and treatment. Care and treatment was not always delivered as per trust policies.
• Resuscitation equipment checks and monitoring were not always completed appropriately.
• During pre-operative assessment patients did not have a pain management plan put in place and the taking of informed consent was inconsistent.
• Services were not always effective when benchmarked against national averages.