Hospital of St John & St Elizabeth

Updated 28 March 2024

The Hospital of St John and St Elizabeth is one of the UK's largest independent charitable hospitals, with any profits used to fund the on-site hospice. The hospital was founded in 1856 with Roman Catholic affiliation and is a registered charity. Facilities at the hospital include: a pre-assessment unit, six theatres (four theatres on the 1st floor and two theatres on the second floor each with their own dedicated recovery unit), a 19 bedded dedicated day surgery unit, four, critical care unit with level 2 care beds, a day surgery unit, endoscopy unit, a 23 bedded dedicated surgical ward, diagnostic imaging, outpatient department, and a walk-in urgent care centre. The hospice has 17 beds and is located within the main hospital.

The service provides surgery, medical care, end of life care, urgent care, outpatient and diagnostic services. The hospital is registered to provide the following regulated activities:

• Diagnostic and screening procedures
• Management of supply of blood and blood derived products
• Maternity and midwifery services
• Personal Care
• Surgical procedures
• Transport Services
• Treatment of disease, disorder or injury

This was a comprehensive inspection of the critical care core service and safe and well-led domains of surgery core service.

The hospital provides day case surgery and inpatient care for private patients. The service offered a range of different surgical specialities, including orthopaedics, ophthalmology, gynaecology, cosmetic, gastro-intestinal and more. A resident medical officer (RMO) and a critical care fellow are on site 24 hours a day, seven days a week.

Updated 28 March 2024

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risks well. Staff assessed risks to patients, acted on them and kept good care records. The service managed safety incidents well and learned lessons from them.
• Staff provided good care and treatment and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients supported them to make decisions about their care and had access to good information. Key services were available seven days a week.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.
• The service had a vision for what it wanted to achieve and a strategy to turn it into action. The vision and strategy had supporting plans and objectives which were innovative and achievable. Staff felt respected and valued and were focused on providing patient centred care. The service had an open culture where patients, their families and staff could raise concerns without fear. Leaders operated effective governance processes, and a demonstrated commitment to best practice, performance and risk management systems and processes. They identified and escalated relevant risks and issues and identified actions to reduce their impact effectively and in a timely manner. Leaders and staff actively and openly engaged with patients and staff. All staff were committed to continually learning and improving services.

Updated 7 June 2017

We rated this service as good because it was safe, effective, caring, responsive and well-led.

Staffing was managed jointly with surgery.

Updated 28 March 2024

This was the first time we rated critical care. We rated it as good because:

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risks well. Staff assessed risks to patients, acted on them and kept good care records. The service managed safety incidents well and learned lessons from them.
• Staff provided good care and treatment and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients supported them to make decisions about their care and had access to good information. Key services were available seven days a week.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However:

• We found some out-of-date saline fluids in stock. Staff were made aware and immediately rectified this.
• The critical care facility was not always compliant with recent guidance. However, controls were in place to manage patients safely.

Where arrangements were the same as the surgery core service, we have reported findings in that section.

Updated 15 November 2021

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

• Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients and acted on them. They managed medicines well. The service managed safety incidents well. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers made sure staff were competent. Staff worked well together for the benefit of patients and supported them to make decisions about their care. Key services were available seven days a week.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged with patients to plan and manage services and all staff were committed to improving services continually.

However:

• Porters within the hospital were given some end of life care (EOLC) training at their induction but only 64% had completed this. Following our first site inspection, the hospital began to deliver further EOLC tailored training to the porters, which 81% of these staff had completed by the time of the second site visit. The remaining staff were booked to complete this training.
• In the day centre and basement areas, there were some environmental issues such as lack of air conditioning and poor wheelchair access. However, the hospital was aware of these issues and were in the process of redesigning the areas with staff input, with plans and concept designs being drawn up.
• Life support training compliance was 100% for inpatient unit staff, but only 76% for community staff at the time of our inspection. The provider explained this was due to lack of face-to-face training sessions during the COVID-19 pandemic and training was booked for these staff.
• There had been a 43% increase in patient contacts to the social work team in the last year due to pressures from the pandemic, leaving the team feeling stretched. There was a feeling amongst staff we spoke with that whilst the team offered excellent support, they perhaps they did not have the capacity to support everyone. Senior staff told us that they were aware of the workload challenges of the team and another post focusing specifically on welfare benefits had been agreed.
• There were medical vacancies within the service. This reflected a national shortage of palliative care consultants, and the service had been trying to recruit into these vacancies for some time. The provider had identified insufficient consultant cover as a risk and was working with a local NHS trust to develop a joint consultant post to attract a greater number of applicants.
• Although staff were aware of incidents that had occurred, we were not always assured that planned actions or recommendations from incident investigations were taken forward. Action plans as a result of incidents were not always clear and responsible people were not always assigned to ensure that learning was fully implemented across the service.
• The community and inpatient unit teams used different patient record systems, and IT systems and records across the hospital were not integrated. This led to some duplication, frustration and delays. The hospital was aware of these issues and were working to integrate systems and ultimately the creation of a hospital-wide patient record system.
• Staff monitored the effectiveness of some care and treatment, but not all audits were consistent. They used the findings to make some improvements but action plans were not always clear.
• There was no separate multifaith room, although the service informed us that alternative quiet rooms were available on request. There were also no prayer mats available for patients.

Updated 7 June 2017

We rated this service as requires improvement for well-led. For safe, caring, and responsive we found this service was good. We did not rate the effectiveness of the service.

Updated 28 March 2024

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

• The service had enough staff to care for patients and keep them safe. They had training in key skills, understood how to protect patients from abuse, and managed safety well. The service managed infection risks well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them.
• The service had a vision for what it wanted to achieve and a strategy to turn it into action. The vision and strategy had supporting plans and objectives which were innovative and achievable. Staff felt respected and valued and were focused on providing patient centred care. The service had an open culture where patients, their families and staff could raise concerns without fear. Leaders operated effective governance processes, and a demonstrated commitment to best practice, performance and risk management systems and processes. They identified and escalated relevant risks and issues and identified actions to reduce their impact effectively and in a timely manner. Leaders and staff actively and openly engaged with patients and staff. All staff were committed to continually learning and improving services.

Updated 15 November 2021

This is the first time we rated this service. We rated it as good because:

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, supported them to make decisions about their care, and had access to good information.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs and helped them understand their conditions. They provided emotional support to patients.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients to plan and manage services and all staff were committed to improving services continually.

However:

• There was no handwashing poster displayed by the handwashing sink in the treatment room.
• Staff told us that the box and toys in the treatment room for children were cleaned daily and after every use, but no record of cleaning of this was kept. We also found a picture book and a squeezable ball within the toy box, which would be difficult to disinfect. Staff were working to rectify this following this inspection and introduced a cleaning checklist.
• The hospital policy for reception staff dress code within the urgent care centre was not in line with the best infection prevention control practice, as staff were not required to be ‘bare below the elbow’ (BBE).
• There was no safeguarding flagging system in the electronic health records to identify adult patients who may be vulnerable. Senior leaders told us that they were working with the IT software team to incorporate this.
• We found some emergency medicines in the resuscitation trolleys were stored incorrectly and did not match the daily stock list. However, the service rectified this immediately on the day of inspection.
• Electronic patient records were not integrated with the hospital wide health record system.