Hertford County Hospital

Updated 5 April 2016

East and North Hertfordshire NHS Trust provides secondary care services for a population of around 600,000 in East and North Hertfordshire as well as parts of South Bedfordshire and tertiary cancer services for a population of approximately 2,000,000 people in Hertfordshire, Bedfordshire, north-west London and parts of the Thames Valley. There are approximately 620 beds at the Lister Hospital site and 45 beds at the Mount Vernon Cancer Centre. The trust has a turnover of approximately £375m and 5,290 staff are employed by the trust, representing around 4,540 whole time equivalent posts.

The area served by the trust for acute hospital care covers a population of around 600,000 people and includes south, east and north Hertfordshire, as well as parts of Bedfordshire.

The trust’s main catchment is a mixture of urban and rural areas in close proximity to London. The

population is generally healthy and affluent compared to England averages, although there are some pockets of deprivation most notably in Stevenage, Hatfield, Welwyn Garden City and Cheshunt. Over the past ten years, rates of death from all causes, early deaths from cancer and early deaths from heart disease and stroke have all improved and are generally similar to, or better than, the England average.

The trust concluded its “Our Changing Hospital” programme in October 2014, having invested £150m to enable the consolidation of inpatient and complex services on the Lister Hospital site, delivering a reduction from two to one District General Hospitals. Additional £30m investment enabled the development of the New QEII, to provide outpatient, diagnostic and antenatal services and a 24/7 urgent care centre; which opened in June 2015.

Hertford County Hospital provides outpatient and diagnostic services. The Mount Vernon Cancer Centre provides tertiary radiotherapy and local chemotherapy services. The trust owns the freehold for each of the Lister, QEII and Hertford County. The cancer centre operates out of facilities leased from Hillingdon Hospitals NHS Foundation Trust. The trust is also a sub-regional service in renal medicine and urology and a provider of children’s community services.

The trust is not a foundation trust.

The trust has five clinical divisions: Medical, Surgical, Cancer, Women’s and Children’s and Clinical Support Services, each led by Divisional Director and Divisional Chair. These are supported by a corporate infrastructure.

Therapy Services, Outpatient Pharmacy Services and Pathology Services are provided by different organisations.

From information provided for the year 2013 to 2014, the total number of beds across all trust sites was 724 with:

• 639 General and acute beds

• 66 Maternity beds

• 19 Critical care beds

The trust employees 5,340 staff with:

• 760 Medical staff

• 1806 Nursing staff

• 2,779 Other staff.

The trust’s revenue was £376 million with a deficit of £ 3 million.

Updated 5 April 2016

Hertford County Hospital is part of East and North Hertfordshire NHS Trust and provides a wide range of outpatients, ante/post-natal, diagnostic and therapeutic services to the people of south-east Hertfordshire. It is open Monday to Friday, except on bank holidays, between 8am and 6pm.

During January to December 2014, the hospital facilitated 63,213 outpatient appointments, of which 24% were new appointments and 42% were follow up appointments (7% appointments were not attended by patients).

We carried out an unannounced inspection on 6 November 2015 and inspected a number of the outpatient clinics and diagnostic services at Hertford County Hospital. We spoke with 12 patients and 10 staff including nursing, medical, allied health professionals and support staff. We also reviewed the trust’s performance data and looked at five individual care records.

We inspected one core service, outpatients, and rated it as good.

Overall, we rated Hertford County Hospital as good for four of the five key questions which we always rate. We do not currently rate effectiveness.

Our key findings were as follows:

• Staff reported incidents appropriately, incidents were investigated, shared, and lessons learned.

• Medicines were stored and handled safely.

• Infection control processes had been followed.

• Nurse staffing levels were appropriate with minimal vacancies.

• Patients’ needs were assessed and their care and treatment was delivered following local and national guidance for best practice.

• Staff were suitably qualified and skilled to carry out their roles effectively and in line with best practice.

• Staff working in the outpatient and diagnostic imaging departments were kind, caring and compassionate.

• We found that outpatient and diagnostic services were generally responsive to the needs of patients who used the services.

• Waiting times were within acceptable timescales. Clinic cancellations were around 2%.

• There was a strong culture of team working across the areas we visited.

However, there was an area of poor practice where the trust needs to make improvements.

The trust should:

• Ensure patients’ records are available for clinic appointments in all cases.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Updated 5 April 2016

Overall, we rated the service as good, with a rating of good for safety, caring, responsiveness and for being well led. We inspect but do not rate the effectiveness of outpatient services currently.

Staff reported incidents appropriately, incidents were investigated, shared, and lessons learned.

Infection control processes had been followed. The environment was visibly clean and well maintained. Hand-washing facilities and hand gels for patients and staff were available in all clinical areas. Medicines were stored and handled safely. Diagnostic imaging equipment and staff working practices were safe and well managed.

Medical records were stored centrally off-site and were generally available for outpatient clinics. For those cases when notes were not available, staff prepared a temporary file for the patient that included correspondence and diagnostic test results so that their appointment could go ahead.

Nurse staffing levels were appropriate with minimal vacancies.

Patients’ needs were assessed and their care and treatment was delivered following local and national guidance for best practice. Staff generally had the complete information they needed before providing care and treatment but in a minority of cases, records were not always available in time for clinics.

Staff were suitably qualified and skilled to carry out their roles effectively and in line with best practice. Staff felt supported to deliver care and treatment to an appropriate standard, including having relevant training and appraisal. Consent was obtained before care and treatment was given.

During the inspection, we saw and were told by patients, that the staff working in the outpatient and diagnostic imaging departments were kind, caring and compassionate at every stage of their treatment. Patients we spoke with during our inspection were positive about the way they were treated.

We found that outpatient and diagnostic services were generally responsive to the needs of patients who used the services. Waiting times were within acceptable timescales. Clinic cancellations were around 2%. Patients were able to be seen quickly for urgent appointments if required. New appointments were rarely cancelled but review appointments were often changed.

Staff were familiar with the trust wide vision and values and felt part of the trust as a whole. Outpatient staff told us that they felt supported by their immediate line managers and that the senior management team were visible within the department.

There were effective systems for identifying and managing the risks associated with outpatient appointments at team, directorate or organisation levels. Regular governance meetings were held and staff felt updated and involved in the outcomes of these meetings. There was a strong culture of team working across the areas we visited.