Essex County Hospital

⚠ The consultant managing the orthodontic clinic expressed concern over the adequacy of decontamination procedures in the clinic. He informed us that these were non-compliant with national standards.

⚠ We witnessed that the ‘five steps to safer surgery’ was not undertaken consistently and that not all patients were seen daily by a consultant at weekends. Use of the ‘five steps to safer surgery’ checklist was not fully embedded in surgical practice. We did not observe compliance with all procedures …

⚠ We were unable to locate centrally held medical and nursing staff appraisal records. Some nursing and support staff told us they had not received an appraisal within the last 12 months and none were planned. One-to-one meetings and appraisals were irregular.

⚠ There was an overall lack of continual professional development reported among the qualified staff. Nursing staff reported that the practice development team focused on training for inpatient staff and that outpatient development was limited. They commented that outpatient nursing staff had little study leave as it was, “difficult to release …

⚠ Incident reports used to be completed for clinics that were delayed, overbooked or cancelled at the last minute. However, due to the high number of incidents, the staff no longer completed reports. Staff did not get feedback from incident reports and were not encouraged to complete these reports. Staff were …

⚠ On entering the main outpatient foyer, we found rubbish in black bags and broken-down cardboard that had been left on the floor. We saw a variety of different coloured bins. It was not clear what they were used for as they were not labelled. This meant that there was a …

⚠ We found cleaning products not stored securely. We observed that one storeroom for cleaning equipment, which contained cleaning products, was left open and accessible to patients.

⚠ We found equipment, including needles, surgical packs and swabs, had expired and two pieces of endoscopic apparatus expired in September 2011. This meant that patients were at risk of being treated with out-of-date equipment and that equipment was not stored safely and securely to prevent theft, damage or misuse.

⚠ Staff were busy. Patients commented, “They need more staff” and “They need more funding as staff are very busy.” A nurse concerned about staffing told us that “a skill mix [assessment] has taken place and now I’m the only qualified nurse in the area”.

⚠ We were concerned about the number of outpatient appointments cancelled by the hospital. Data showed that the overall trust rates were 14.17%, 14.66% and 15.29% for February, March and April 2014 respectively. A total of 77,670 appointments were cancelled between April 2013 and March 2014. Patients reported previous appointments being …

⚠ Patients in various waiting areas reported their appointments were delayed and that this was normal. Patients commented, “Clinics are always late” and “They need more staff or to book in less patients”. Five patients in the oncology clinic had not been told how long the waiting time was. One patient …

⚠ There had been a recent complaint regarding access for patients on stretchers in ophthalmology. We saw that the doors were narrow and that it would be difficult to navigate a patient on a stretcher into a clinic room.

⚠ During our inspection we saw no evidence or literature on display about the complaints procedure or the Patient Advice and Liaison Service. A receptionist gave us copies of leaflets that were stored beneath the reception desk; both had expired their review dates. None of the nine patients we asked had …

⚠ None of the staff we spoke with acknowledged the trust’s vision or objectives. Nursing staff commented about trust executives, saying that, “We don’t see them, don’t even know what they look like.”

⚠ Nursing staff had concerns about moving the service to Colchester General Hospital; one nurse commented, “We are anxious about the move, we’re not told much about it”; and another said, “We found out about Essex County closure on the news. Management had not told us”.