Chelsea and Westminster Hospital NHS Foundation Trust

Chelsea and Westminster Hospital NHS Foundation Trust Report following a monitoring visit to a ‘requires improvement’ provider

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Name of lead inspector: Joanna Walters, His Majesty’s Inspector

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Inspection dates: 25 and 26 October 2023

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Address:

369 Fulham Road London SW10 9NH Monitoring visit: Chelsea and Westminster Hospital NHS Foundation Trust, 25 and 26 October 2023

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Context and focus of visit

Chelsea and Westminster Hospital NHS Foundation Trust was inspected in December 2022. At that time, inspectors judged the overall effectiveness of the provision to require improvement.

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Context and focus of visit

The focus of this monitoring visit was to evaluate the progress that leaders and managers have made in resolving the main areas for improvement identified at the previous inspection.

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Significant progress

Since the previous inspection, leaders and managers have put in place a rigorous recruitment and induction programme for the level 2 healthcare support worker apprenticeship. Trainers and hospital ward managers are both part of the recruitment process. The new process means that hospital ward managers and apprentices have a good understanding of the demands and expectations of an apprenticeship.

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Significant progress

Leaders and managers have introduced a highly effective induction programme through which apprentices are motivated to remain in training while they settle in. For example, apprentices shadow hospital colleagues and have good support from a buddy on every hospital shift. This helps apprentices to develop resilience and to transition successfully to work in a clinical setting. As a result, a high proportion of apprentices remain in training.

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Significant progress

Trainers and hospital ward managers work collaboratively to identify apprentices at risk of falling behind in their training and those who require additional help and support. This includes extra training time or practical support when apprentices work on the wards. Hospital ward managers speak highly of the clear communication that they receive from the training team. As a result, most apprentices are on track with their training, and more apprentices achieve their planned learning goals. The majority of apprentices who achieve gain high grades.

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Significant progress

Leaders and managers ensure that apprentices with additional learning need receive appropriate support from the start of their course. This includes extra time to complete their work and assessments and an individual support plan. As a result, apprentices who need extra help make good progress towards achieving their apprenticeship within the planned period. Monitoring visit: Chelsea and Westminster Hospital NHS Foundation Trust, 25 and 26 October 2023

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Reasonable progress

Since the previous inspection, leaders and managers have taken suitable actions that have had a positive impact on apprentices’ development of English and mathematical skills. For example, leaders and managers have put in place a suitable assessment at the start of the programme. They share the assessment results with the subcontractor (Runway Training Limited). Apprentices now study an English and mathematics curriculum within one month of the start of their apprenticeship.

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Reasonable progress

Leaders and managers do not ensure that the English and mathematics curriculum is integrated well enough throughout the apprenticeship programme. The model of English and mathematics curriculum teaching relies too heavily on apprentices using self-directed learning through online tutorials and resources. Apprentices do not receive specific tailored feedback following English or mathematics mock examinations. This means that they do not know how to improve their knowledge to ensure that they do not make the same mistakes again.

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Reasonable progress

Hospital ward managers and trainers provide good opportunities for apprentices to develop mathematics and English skills when they work on the wards. For example, apprentices apply mathematical skills well to work out fluid inputs and outputs when caring for patients. As a result, apprentices can make the link between applying mathematical skills and being an effective healthcare assistant. However, the opportunities for apprentices to apply mathematical skills are not directly related to areas they need to improve. This is because the specific areas for development for each apprentice are not shared by the subcontractor with trainers at the hospital.

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Significant progress

Trainers have purposeful and meaningful progress review meetings with apprentices. During reviews, trainers and hospital ward managers give apprentices detailed feedback about their performance at work and with their studies. They set meaningful targets to support apprentices to make progress. For example, they include targets on how apprentices can improve their patient clinical observations. Hospital ward managers give apprentices useful feedback when they are in the workplace to make sure that apprentices use key medical terminology correctly. As a result, apprentices are clear about what they need to do to improve their skills and knowledge to become better healthcare support workers. Monitoring visit: Chelsea and Westminster Hospital NHS Foundation Trust, 25 and 26 October 2023 Leaders and managers have made significant improvements to the way in which trainers give apprentices written feedback on their workbooks. Trainers use a well-

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Significant progress

designed feedback form on which they provide detailed feedback on each section of apprentices’ workbooks. For example, trainers give apprentices feedback on how to improve their clinical knowledge, such as giving the correct calculations for heart resuscitation. They also correct apprentices’ spelling, punctuation, grammar, and sentence structure. This helps apprentices to improve their work and knowledge over time.

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Significant progress

Trainers provide apprentices with highly effective feedback to make sure they are clinically competent. For example, trainers carry out thorough practical assessments to check that apprentices can remember and apply the correct steps before they undertake supervised electrocardiogram tests on patients with help and feedback from a nurse. Hospital ward managers report that apprentices become highly confident and trusted members of the team as a result of the support and feedback they receive.

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Significant progress

Trainers have purposeful review meetings with apprentices and their hospital ward managers, where they discuss and plan the career aspirations of apprentices. For example, they give good information to apprentices about the various pathways they can take to qualify as a nurse. As a result, apprentices have a thorough understanding of the different pathways they can choose to meet their career goals.

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Significant progress

Trainers organise valuable shadowing opportunities so that apprentices gain experience in roles related to their career aspirations. For example, apprentices who would like to become physician associates spend a day shadowing a clinical team to find out about the role. As a result, apprentices are in a strong position to make informed decisions about their next steps.

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Significant progress

Leaders and managers provide a wide range of opportunities for apprentices to receive unbiased careers advice. For example, they arrange careers talks about non- NHS pathways, where apprentices can discover alternative clinical or administrative pathways. As a result, apprentices understand the career pathways available to them so they can make informed choices about their next steps.

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Significant progress

Since the previous inspection, leaders and managers have introduced regular informative ‘careers clinics’ for apprentices. Trainers facilitate these events once a month across both hospital sites. Guest visitors attend to speak to apprentices on roles such as patient liaison services and nurses. This is a valuable opportunity for apprentices to speak with people about their career choices. Monitoring visit: Chelsea and Westminster Hospital NHS Foundation Trust, 25 and 26 October 2023 regulates and inspects to achieve excellence in the care of children and young people, and in education and skills for learners of all ages. It regulates and inspects childcare and children’s social care, and inspects the Children and Family Court Advisory and Support Service (Cafcass), schools, colleges, initial teacher training, further education and skills, adult and community learning, and education and training in prisons and other secure establishments. It assesses council

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Significant progress

children’s services, and inspects services for children looked after, safeguarding and child protection.

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Significant progress

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T: 0300 123 1231 Textphone: 0161 618 8524 E: enquiries@ofsted.gov.uk W: www.gov.uk/ofsted

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