‘Patients speak highly of the care received’ during unannounced inspection at Western Isles Hospital

Areas of good practice as well as a number of areas for improvement were identified by Healthcare Improvement Scotland (HIS) during a recent unannounced inspection, focusing on the safe delivery of care, of Western Isles Hospital in Stornoway.

NHS Western Isles welcomes all inspections as opportunities to both identify and action improvements, as well as to acknowledge areas of good practice. Following this inspection, on September 3 and 4, 2024, NHS Western Isles has developed a full and comprehensive action plan and work on addressing improvements is underway.

During the inspection of Western Isles Hospital, HIS:

• inspected the ward and hospital environment
• observed staff practice and interactions with patients, such as during patient mealtimes
• spoke with patients, visitors and ward staff, and
• accessed patients’ health records, monitoring reports, policies and procedures.

Inspectors identified eight areas of good practice and twenty-two requirements.

Positively, inspectors observed staff working hard to provide compassionate and responsive care with all patients being complimentary about the care provided. Patients described to Inspectors receiving good communication from both nursing and medical staff. Patients advised that although staff were visibly busy there were no delays to responding to call bells, gaining assistance or administration of medications.

The report also highlights: “Patients we spoke with advised they would be happy if a loved one had to access care at Western Isles Hospital.”

Inspectors found the hospital environment to be clean and well maintained; whilst they described mealtimes as ‘calm and well led’ with ‘patients receiving assistance with hand hygiene prior to meals and with eating and drinking where required’. All observed interactions were found to be ‘professional, friendly and respectful’. And despite being busy, Inspectors described that ‘staff were working hard to deliver care’.

Inspectors observed good team working and support provided by clinical support nurses (CSNs), and ‘good leadership’ in the majority of areas inspected. Staff also described to inspectors that they feel ‘supported to escalate issues and concerns to ward managers’. Also highlighted as an area of good practice was the ‘variety of development opportunities for senior charge nurses’.

The HIS report acknowledges that, at the time of the inspection NHS Western Isles, like much of NHS Scotland, was experiencing ongoing pressures including increased hospital capacity, reduced staff availability and increased patient acuity. During the onsite inspection inspectors observed that the hospital was operating between 115% and 119% capacity for acute beds. Of the 52 acute beds, there were 14 delayed discharges within the hospital due to delays with patient care packages and awaiting placement within care homes.

Inspectors commented: “During the onsite inspection, despite wards being busy with high acuity and additional patients, staff were observed working together to deliver care.”

In terms of the Emergency Department, Inspectors highlighted that 98.1 per cent of patients were seen within the four-hour target in the emergency department at Western Isles Hospital, compared to the Scottish average at the time of 66.5 per cent. They also observed on the first day of the onsite inspection that the longest time to first assessment by a clinician was under 30 minutes, and observed that there were no delays in patient triage during the inspection period. Inspectors described the department as an ‘effective emergency department working to ensure patients receive the right care in the right place’.

One of the main issues identified by Inspectors was the number of nursing staff with up to date paediatric immediate and advanced life support training. Training is delivered annually by external trainers and whilst staff are trained in this subject, unacceptably low numbers have completed the most recent round of training to ensure valid certificates are held. This is being addressed in the Board’s action plan with staff in the appropriate areas being prioritised to attend the next round of training offered early next year.

Staff training rates in child support and protection and adult support and protection training were also found to be low and NHS Western Isles has undertaken to addressing compliance rates within acute services by the end of March 2025.

Inspectors also highlighted a lack of availability of registered children’s nurses. NHS Western Isles consistently has been challenged in trying to recruit  registered children’s nurses, however was able to positively report to Inspectors that the total compliment of four in the hospital recently increased to five, with the successful recruitment of a band 6 paediatric nurse. A clinical support nurse is always on duty to support staff, along with 24 hour availability of a Consultant Paediatrician and Consultant Anaesthetist.

Fire safety was highlighted as a concern by Inspectors – in particular the outcomes of the fire safety risk assessment such as the servicing of firefighting equipment and a low compliance rate of staff training. NHS Western Isles provided assurance to Inspectors that fire extinguisher servicing would be complete by 21 October 2024, and this has been carried out. A range of improvement actions are now also underway to address service improvement in this area.

Inspectors reported that some staff reported challenges in receiving scheduled breaks on time, or in some cases are ‘not able to take any break throughout their shift’. They also reported that ‘staff were often late leaving shift due to the acuity within the ward and shortages with staffing’. NHS Western Isles will investigate this further, as these issues had not been previously escalated, and there are processes in place to ensure staff are able to get appropriate breaks during shifts, regardless of how busy the hospital or ward is at the time. These matters are extremely important as they impact on staff wellbeing and morale, and so further investigation into this will be carried out internally to ensure that the appropriate support and measures are in place and clear.

NHS Western Isles Chief Executive Gordon Jamieson said: “We welcome all inspections and opportunities to address areas and issues to be improved so that we can provide the best care to patients that we possibly can, and to ensure that are staff are well supported.

“There are a number of points in the report that demonstrate the excellent care provided by our staff to the local population and it is testament to the staff delivering care that all patients spoke highly of the care received and wouldbe happy if a loved one had to access care at Western Isles Hospital.

“As well as the positive findings, it is the purpose of an inspection to identify areas where improvements could be made. There were a number of areas identified for improvement and it is a priority for us to address these as quickly and comprehensively as possible. Since the inspection, we have developed a detailed Improvement Action Plan to address the areas that Inspectors have identified. Ensuring all relevant staff are up to date with their annual paediatric immediate and advanced life support training is a priority for us, and ensuring that staff continue to be supported in terms of their wellbeing is key, in particular during these challenging times when hospital occupancy is so high and as recruitment remains one of the Board’s main challenges.”

ENDS

Further information/background:

In November 2021 the Cabinet Secretary for Health and Social Care approved Healthcare Improvement Scotland inspections of acute hospitals across NHS Scotland to focus on the safe delivery of care. HIS carried out an unannounced inspection to Western Isles Hospital, NHS Western Isles from Tuesday 3 to Wednesday 4 September 2024 using our safe delivery of care inspection methodology. We inspected the following areas:

• acute assessment unit

• ambulatory care unit

• day surgery unit

• emergency department

• Erisort ward

• medical ward 1

• medical ward 2, and

• surgical ward

The full report and improvement action plan is available at Western Isles Hospital – safe delivery of care inspection: December 2024 – Healthcare Improvement Scotland