Borders General Sep 17

“Our inspection for the nutritional care of people at Borders General Hospital followed on from the findings of a joint inspection of adult health and social care services by Healthcare Improvement Scotland and the Care Inspectorate. Although we found a flexible approach taken by kitchen staff in trying to meet patient needs and requests, we found that a lack of governance and leadership for nutritional care meant that national standards for safe and effective patient care are not being met. We also found that there was a lack of training to provide the knowledge and skills required to meet patients’ food, fluid and nutritional care needs. We expect NHS Borders to address all the areas for improvement.”

Ian Smith, Senior Inspector for Healthcare Improvement Scotland

Borders General Hospital

Nutritional care in acute hospitals unannounced inspection

In December 2015, the Ombudsman published a report into an investigation of a complaint about the care of older people in Borders General Hospital. The complaint related to the care of a patient admitted to Borders General Hospital twice in 2014 and the handling of the complaint by NHS Borders. The Ombudsman report highlighted similarities between the care described in the complaint and findings of a Healthcare Improvement Scotland care of older people inspection carried out in July 2012.

In April 2016, Healthcare Improvement Scotland carried out a review into the care of older people in Borders General Hospital and the complaints handling process. This review report published in August 2016 contained 12 areas for improvement.

Our unannounced inspection to Borders General Hospital in June 2017 follows an inspection carried out by the joint inspection of adult health and social care services team. The joint inspection team includes staff from the Care Inspectorate and Healthcare Improvement Scotland. Several issues were identified relating to nutritional care which led to our unannounced inspection.

Summary of inspection

During this unannounced inspection to Borders General Hospital, which took place from Monday 12 to Wednesday 14 June 2017, we inspected the following areas:

  • ward 4 (general medicine)
  • ward 5 (general medicine)
  • ward 6 (medical assessment unit)
  • ward 7 (urology, ophthalmology and general surgery)
  • ward 9 (orthopaedics)
  • wards 10 (medicine for the elderly)
  • ward 12 (medicine for the elderly), and
  • Borders Stroke Unit (stroke care)


Before the inspection, we reviewed NHS Borders’s self-evaluation and gathered information about Borders General Hospital from other sources. This included Scotland’s Patient Experience Programme and other data that relates to the nutritional care of patients. We also reviewed information gained from a planned NHS board visit to NHS Borders on 7 May 2015. Based on our review of this information, we focused the inspection on the following outcomes:

  • treating people with compassion, dignity and respect
  • screening and initial assessment (relating to nutritional care)
  • person-centred care planning (for nutritional care)
  • decision making, consent and capacity (where this related to nutritional care)
  • food, fluid and nutrition
  • skills and accountability
  • leadership and management, and
  • communication.

During the inspection, we:

  • spoke with staff and used additional tools to gather more information. In all wards, we used a formal observation tool and a mealtime observation tool, where appropriate. We carried out eight periods of observation and, in each instance, members of our team observed interactions between patients and staff in a set area of the ward for 20 minutes.
  • carried out patient interviews and used patient and carer questionnaires. A key part of the public partner role is to talk with patients about their experience of staying in hospital and listen to what was important to them. We spoke with 23 patients during this inspection. We received completed questionnaires from 24 patients and 12 family members, carers or friends.
  • reviewed 39 patient health records to check the care we observed was as described in the care plans. We reviewed all 39 patient health records for food, fluid and nutrition and relevant recorded cognitive impairment issues.

Areas of good practice

  • positive patient feedback relating to food quality and choices
  • flexible approach taken by kitchen staff in trying to meet patient needs/requests.

Areas for improvement

  • a lack of governance and leadership for nutritional care meant that national standards for safe and effective patient care are not being met, and
  • a lack of training to provide the knowledge and skills required to meet patients’ food, fluid and nutritional care needs.

This inspection resulted in four areas of good practice and 10 areas for improvement. A full list of the areas of good practice and areas for improvement can be found in Appendices 1 and 2, respectively on pages 22 and 23.

We expect NHS Borders to address all the areas for improvement. The NHS board must prioritise those areas where improvement is required to meet a national standard.

Published Date: 27 September 2017

Scrutiny

Borders General Hospital overview

Find out more about this hospital, including the latest inspection report, on the Borders General Hospital overview page.