Queen Mary's Hospital

⚠ Governance arrangements were not in place in relation to Mental Health Act 2015 administration and compliance. The trust did not have a mental health act strategy and a paper had not been presented to board.

⚠ In urgent and emergency care we found insufficient safeguarding processes which did not protect vulnerable adults or children from the risk of abuse.

⚠ Systems and processes regarding the oversight of temporary workers required development required further development to ensure compliance with the Health and Social Care Act 2008 regulations.

⚠ Records were not always stored securely or kept confidential. Medical records were not stored securely.

⚠ The chair patients on Cypress ward shared mix sex accommodation. At busy times, this area lacked space which meant patients dignity and confidentiality was not maintained.

⚠ The standard of record keeping lacked consistency and varied greatly across the trust. The standard of records lack consistency and varied greatly across the department.

⚠ Emergency equipment was not consistently checked in line with trust policy.

⚠ Patients were not protected from the risk of healthcare acquired infections because national and trust guidance was not being consistently adhered to. Poor infection control standards went unaddressed.

⚠ We still saw ‘escalation’ beds in use on Chestnut ward, Linden ward and AMU. The beds on Chestnut ward in particular are not fit for purpose and have no lighting, piped oxygen and are using doorbells to attract the nurse’s attention if needed.

⚠ During our previous inspection in 2013 we found that there were mixed gender bays in use. We found that during our recent inspection there were still mixed gender breaches and bays in use.

⚠ Although there were effective structures, processes and systems of accountability to support the delivery of good quality and sustainable services, these were not effectively reviewed to ensure safe practice, for example cleaning audits were not consistent with what we saw on inspection.

⚠ Mandatory training figures were not in-line with trust targets. Staff did not have the required level of safeguarding training, particularly children’s safeguarding.

⚠ Patient confidentiality was not always maintained as we witnessed patient identifiable information on unattended computer screens. We also saw discussions about patients’ treatment held in open areas where members of the public and hospital staff could overhear.

⚠ During our previous inspection in 2013 we found that there were mixed gender bays in use. We found that during our recent inspection there were still mixed gender breaches and bays in use.

⚠ Patient confidentiality was not always maintained as we witnessed patient identifiable information on unattended computer screens. We also saw discussions about patients’ treatment held in open areas where members of the public and hospital staff could overhear. During our recent inspection we saw several breaches of patient confidentiality. Staff did …

⚠ Patients dignity, respect and confidentiality was not maintained in theatres, whilst waiting for their operations.

⚠ Infection control practices were not effective and hand hygiene practices in the recovery unit placed an unacceptable risk to patient safety. Audit results were not consistent with what we observed during our inspection.

⚠ Patient records were incomplete, poorly managed and not stored securely on ward areas. This meant patient confidentiality was not maintained and in an emergency it may be difficult to obtain essential information about the patient.

⚠ Staff did not assess, monitor or manage risks to patients who use their services. Records showed that patient associated risks were not consistently assessed.

⚠ There were not systems in place to ensure the availability and safety of equipment in theatres. The checking of equipment was not in-line with trust policy or national guidance.

⚠ Patient records were incomplete, poorly managed and not stored securely.

⚠ There was a lack of obstetric theatre nurses 24 hours a day seven days a week.

⚠ The midwife to birth ratio was 1:36, (this means there was 36 births to one midwife), this was identified on the trust’s risk register. The risk register acknowledged the midwife to patient ratio was not at the agreed level according to BirthratePlus.

⚠ Consultant presence on the delivery suite was identified on the maternity risk register. Consultant resident hours on the delivery suite were not defined for evening and weekends. Staff told us consultants were not always visible on the labour ward.

⚠ Patients’ confidentiality, dignity and respect was not maintained within the theatre holding bay.

⚠ There was not a process which ensured ad-hoc agency theatre staff had the skills knowledge and qualifications to perform their role.

⚠ We saw poor compliance with infection control policies and maintenance of equipment. At Elm Court there was no cleaning strategy or operational plan. Both these documents are a requirement of the National Specifications for Cleanliness in the National Health Service.