The Care Quality Commission
  • Hospital
  • NHS hospital

Guy's Hospital

Overall: Good read more about inspection ratings

Great Maze Pond, London, SE1 9RT (020) 7188 7188

Provided and run by:
Guy's and St Thomas' NHS Foundation Trust

All Inspections

02 April to 02 May 2019

During a routine inspection

In rating the location, we took into account the previous ratings of services which were not inspected on this occasion.

Our rating of services stayed the same. We rated it them as good because:

  • The hospital always had enough staff with the right qualifications, skills, experience and training to keep patients safe from avoidable harm and abuse, and to provide them with the care and treatment they needed. Staffing levels were matched to patient need and clinic activities. All staff understood their responsibilities to safeguard patients from abuse and neglect and had appropriate training and support.
  • There was a well-embedded incident process and learning from the investigative process was valued by staff.
  • Departmental leaders had the knowledge and experience to lead and support staff. They promoted a positive culture, which valued and respected staff. There was a commitment to the improvement of waiting times, patient access and the whole patient experience.
  • Staff engaged well with patients, staff, the public and local organisations to plan and manage appropriate services and collaborate with partner organisations effectively. Feedback from patients was used to develop services.

However:

  • Some of the expected service delivery targets were not being met. This included the referral to treatment (RTT) targets for all the specialities and in cancer services patients receiving their first treatment within 62 days of an urgent GP referral.
  • A significant number of patients had overdue follow up appointments, which posed a risk to some. Patients had long waits in some clinics and were not always offered a choice of appointments times.
  • Medicine administration was not always in line with trust policy.
  • Mandatory training in key skills was available to all staff but expected completion rates for this was not being met.
  • The premises were not always suitable for the intended use and patients’ privacy and dignity could not always be maintained. Equipment was not always safely managed.
  • Staff did not always complete patient records to professional standards.

Announced: 8 and 10 September 2015. Unannounced: 21 and 23 September 2015.

During an inspection looking at part of the service

Guy’s Hospital is part of Guy's and St Thomas' NHS Foundation Trust. The trust provides local acute and community services for people living in the London Boroughs of Lambeth, Southwark and Lewisham; and specialist services for patients from further afield. Guy’s Hospital provides acute hospital services to an inner city population of around 975,885.

Guy's and St Thomas' NHS Foundation Trust employs around 12,586 whole time equivalent (WTE) members of staff with approximately 3,637 staff working at Guy’s Hospital.

We carried out an announced inspection of Guy’s Hospital between 7 and 10 September 2015. We also undertook unannounced visits to the hospital on 21 and 23 September 2015.

Overall, this hospital is rated as good. We found urgent and emergency care, medical care, surgery, critical care, outpatients and diagnostic services and end of life care care were good.

Our key findings were as follows:

Safe

  • There was a positive culture of incident reporting. Incidents related to safeguarding were appropriately recorded and actions were taken to address them.
  • Measures for the prevention and control of infection met national guidance and standards of hand washing and cleanliness were consistently high and regularly audited.
  • In most areas, staff were aware of their role in relation to safeguarding children and adults living in vulnerable circumstances and knew how to access the safeguarding team for advice and guidance when required.
  • There were sufficient doctors and registered nurses on duty and good retention of nursing staff.
  • In most cases, patient records, including prescription charts were fully completed and medicines were stored and administered appropriately, including controlled drugs.

Effective

  • Policies, procedures and protocols reflected best practice and guidelines from statutory and professional bodies.
  • Multidisciplinary working functioned effectively.
  • Staff were well supported with access to training, clinical supervision and development.
  • Patients were offered sufficient qualities of fluids with a variety of hot and cold drinks available and drinks were left within easy reach.
  • Most staff understood the basic principles of the Mental Capacity Act, 2005 and could explain how the principles worked in practice. However, in some areas, there was inconsistency in how staff recorded capacity assessments and there was no evidence to support that staff had received training in the Mental Capacity Act 2005 or DoLS.
  • In critical care, fewer than the recommended 50% of staff had completed a post registration critical care nursing award.
  • Understanding of Deprivation of Liberty Safeguards was variable between staff and practice was not embedded in this area.

Caring

  • Patients received compassionate care and were treated with dignity, respect and privacy and involved in their care.
  • Patients receiving end of life care received good care.
  • Patients were happy with the standard of care they had received and they felt staff had a genuine interest in helping them.
  • Patients and their relatives were positive about their experience of care and the kindness afforded them.
  • Emotional support was provided by staff in their interactions with patients.

Responsive

  • Complaints were taken seriously were investigated using a process that was evidence-based to ensure that learning took place.
  • Discharge plans were commenced on admission and most patients had estimated dates of discharge documented in their records.
  • In surgery, there were some challenges with referral to treatment waiting times due to demand outstripping capacity, but this was being addressed appropriately.
  • Information leaflets were available in waiting areas and were provided to patients by staff.
  • Outpatient and diagnostic imaging services were not always responsive as the trust was persistently failing to meet the national waiting time targets related to cancer treatment.

Well-led

  • Most staff were aware of the trust vision and incorporated this as part of their daily work.
  • Staff showed a positive attitude to their work and spoke well of the trust and their colleagues.
  • Senior managers were supportive to their staff and were visible on the wards.
  • Patients were engaged in service development.
  • The surgery service was innovating in a number of areas to improve patient outcomes and build capacity within the service, including highly effective multi-disciplinary outreach services.
  • There were effect governance processes in place and staff were able to provided examples of feedback and learning points.
  • Most staff felt empowered to drive forward initiatives and improvements.

We saw several areas of outstanding practice including:

  • The SPCT was effective and provided face to face support seven days per week with visits up till 9pm and calls till 11pm and a consultant providing out of hours cover
  • The Amber care bundle and a range of training courses for staff in end of life care such as the Sage and Thyme training model, Simulation days and Schwartz rounds.
  • The Guy’s Orthopaedic Outreach Team (GOOT): a fast track discharge and multi-disciplinary support service which improved patient outcomes and reduced length of stay. 
  • Proactive Care of Older People Service (POPS): an award-winning service and the first of its kind in the UK. The POPS service looks after patients aged 65 years and above to improve their medical health before and after surgery by assessing them before surgery, following their care while in hospital and supporting consultants and ward staff.
  • The use of 'Barbara's story' to engage with staff and enhance a compassionate approach to patient care.
  • ​Supportive practice of the mortuary and bereavement team.
  • Staff in the bereavement office had sourced funding to provide family members with sympathetically designed cloth bags so they had a more discreet way of taking home personal belongings of a deceased patient, rather than use a plastic hospital property bag.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

  • Improve governance links between directorates with surgical activity to ensure learning and concerns are shared across these directorates in a timely way.

In addition, the trust should:

  • Take steps to increase the number of day surgery cases to reduce bed demand and reduce length of stay. The trust should consider introducing a named day surgery clinical lead to improve coordination of day surgery and provide a single contact for surgical directorates.
  • Take steps to improve the working culture within theatres to ensure that all theatre staff have fair access to learning and development opportunities.
  • Continue embedding and monitoring use of the ‘five steps to safer surgery’ WHO surgical safety checklist, with a particular focus on pre-briefing and de-briefing.
  • Ensure consent for surgery is clearly documented in patient records and patients are given adequate time and documentation to make decisions about their care in advance of their planned procedure date.
  • Improve engagement with lifestyles teams in tertiary, secondary and primary care to help surgery patients with smoking cessation, weight loss or exercise programmes to improve local health outcomes.
  • Review the process for completing DNACPR forms and determine a specific location where they are kept for end of life care patients .
  • Improve the consistency of mental capacity assessments and the recording of them for patients receiving end of life care.
  • Review the escalation process when delays occur with the completion of death certificates.
  • Reduce delays in 31/62 days cancer waits (diagnosis and treatment) in Outpatients.
  • In the outpatients department, ensure all staff are aware of protocols related to obtaining patients’ consent; including protocols for those who might lack capacity to make a decision”. 
  • Ensure all incidents in the outpatients department are investigated promptly and outcomes of the investigations recorded and shared with team to prevent recurrence. 
  • In the outpatients department, ensure all staff receive mandatory training and are appraised regularly as prescribed by trust’s policies related to staff training and development.
  • On Samaritan Ward, review the provision of toilet facilities for patients.
  • Improve mandatory training completion by staff on the medical wards/departments.
  • Improve performance on the number of patients starting treatment within 62 days for upper and lower gastro-intestinal illnesses.
  • Ensure all staff, including staff working in outpatients departments, are provided with basic life support training.

Professor Sir Mike Richards

Chief Inspector of Hospitals

20, 21 August 2013

During a routine inspection

The focus of the inspection was on patients who were being admitted for, or had undergone surgery. We visited four surgery wards, the operating theatre unit, the surgery admissions lounge and the day surgery unit. We spoke with patients, their relatives and staff in all areas we visited. We met with senior managers responsible for staff recruitment, quality assurance and records management.

The majority of patients we spoke with had had a positive experience of care, treatment and support at the hospital. We received similar feedback from eight patients and one relative who completed comment cards we made available during the inspection. They were complimentary about the attitudes and competence of staff and felt staff responded quickly to their needs, worries or concerns.

Care and treatment was planned and delivered in a way that ensured patients' safety and welfare. Care plans and risk assessments were completed for all patients as part of their admission procedures and were reviewed and updated to reflect changing needs. Patients told us they were provided with clear information about their treatment and were able to make informed decisions about the surgical procedures they were undergoing.

Patients had access to food and drink both during and outside of main mealtimes. The choice of food provided met patients' individual needs and special dietary requirements, including religious and cultural preferences. They told us they were given clear advice about eating and drinking before and after their operation.

There were effective recruitment and selection processes to ensure that patients were cared for, or supported by, suitably qualified, skilled and experienced staff. Appropriate pre-employment checks were made when employing staff and there were policies and procedures for staff thought to be no longer fit to work at the hospital.

There was an effective system for monitoring the quality of service provision. This included systems for investigating incidents and complaints and communicating lessons learned. There were regular audits to look at service performance and appropriate action plans were put in place to address any areas for improvement.

Medical records were accurate and fit for purpose, were managed securely and were accessible when needed.

Overall our inspection found the surgery areas and associated wards we visited to be well led, effective, and responsive to patients' needs, with a clear commitment to the care, welfare and safety of people using the service.

14 February 2013

During a routine inspection

During the inspection we visited six surgery wards and an outpatient clinic in the older person's assessment unit. We paid particular attention to the treatment and care of older people in these areas.

The majority of people we spoke with told us that they were happy with their care, treatment and communication during their stay at the hospital. They felt that staff took time to discuss and explain their diagnosis and treatment, involved them in decisions and offered them choices about their care. One person said, 'Every member of staff involved in my care from the senior doctor to the person cleaning the ward are committed and friendly.' Another said, 'I've been to a lot of hospitals and this is the best ward I've been on.'

We found that there were effective systems in place for the prevention and control of infection and wards were clean and tidy. One person told us, 'The ward is kept clean and staff always wash their hands before seeing me.'

Most people felt that there were enough staff to meet their care and treatment needs. One person said, 'The nurses are brilliant and they see to me quickly when I needed anything.' However, on one ward people and staff were concerned about staffing levels. We raised this with trust management who took action to resolve these concerns immediately following the inspection.

17, 20 October 2011

During a routine inspection

Most people we spoke to said the staff gave them good, clear information about their treatment and care and their individual needs were taken into account. They were able to contribute fully to discussions about their choices and rights and felt that staff listened to their views and were respectful of their decisions. They were asked for their opinions and feedback about the quality of the service they received.

The majority of people felt the staff were competent and confident and cared for them appropriately. They told us that most of the time there were enough staff available when they needed them. They felt safe at the hospital and believed that staff promoted their health and welfare.