Kettering General Hospital

Updated 7 March 2024

Pages 1 to 3 of this report relate to the hospital and the ratings of that location, from page 4 the ratings and information relate to maternity services based at Kettering General Hospital.

We inspected the maternity service at Kettering General Hospital as part of our national maternity inspection programme. The programme aims to give an up-to-date view of hospital maternity care across the country and help us understand what is working well to support learning and improvement at a local and national level.

The Kettering General Hospital provides maternity services to the population of Kettering and the surrounding areas.

Maternity services include an early pregnancy unit, outpatient department, maternity assessment unit known as the Fetal Health Unit, antenatal and postnatal ward (Rowan), Delivery Suite incorporating an assessment bay, triage bay and an enhanced care area, 2 maternity theatres, and an ultrasound department. The service had previously had a midwifery led birthing centre, although this was closed at the time of our inspection and had been for some time. Between April 2021 to March 2022 there were 3,275 deliveries at Kettering General Hospital.

We will publish a report of our overall findings when we have completed the national inspection programme.

We carried out a short notice announced focused inspection of the maternity service, looking only at the safe and well-led key questions.

We last inspected the maternity service in February 2019 and rated it as good. At this inspection we rated safe and well led only. We rated both safe and well-led as Requires Improvement.

Our rating of this hospital is Requires Improvement because our rating of Requires Improvement for maternity services did not change the ratings for the hospital overall.

How we carried out the inspection

We provided the service with 2 working days’ notice of our inspection.

We visited maternity assessment (Fetal Health) Unit, delivery suite including triage, and the maternity theatres, and the antenatal and postnatal wards. The midwifery led birthing centre rooms were closed during the inspection.

We spoke with 18 midwives, 4 support workers, 9 women and birthing people and 3 birthing partners and or relatives. We received 6 responses to our give feedback on care posters which were in place during the inspection.

We reviewed 9 patient care records, 5 observation and escalation charts and 7 medicines records.

Following our onsite inspection, we spoke with senior leaders within the service; we also looked at a wide range of documents including standard operating procedures, guidelines, meeting minutes, risk assessments, recent reported incidents as well as audits and action plans. We then used this information to form our judgements.

You can find further information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

Updated 6 May 2022

Updated 20 April 2023

Updated 12 April 2017

Overall, we rated the critical care service as good because:

• There were systems in place to protect patients from harm and a good incident reporting culture.
• The department complied with the Department of Health’s Health Building note HBN 04-02, which sets standards for critical care units.
• Effective infection control practices were in place throughout the unit and visitors were encouraged to take part in the prevention of infection.
• Safe numbers of staff cared for patients using evidence-based interventions.
• Staff at all levels had a good understanding of the need for consent and systems were in place to ensure compliance with the Deprivation of Liberty Safeguards.
• Patient’s pain, nutrition and hydration was appropriately managed.
• Intensive Care National Audit and Research Centre data showed the intensive care unit to be in line with the England average for all areas except delayed discharges.
• Staff were compassionate and put patients at the centre of the work. They obtained consent prior to procedures and maintained patient privacy and dignity.
• Complaints were dealt with in a constructive and timely way, ensuring that patients or relatives were kept up to date with any actions resulting from their complaint.
• Staff had access to communication aids and translators when needed, giving patient the opportunity to make decisions about their care, and day to day tasks. There were very few complaints about the services and staff dealt with complaints appropriately.
• Dementia training and staff guidance was suitable and staff showed a good understanding of how to provide quality care for those living with dementia.
• There was good local leadership on the unit and staff reflected this in their conversation with us.

However, we also found that:

• There was a lack of sufficient pharmacy support within the department, leading to potentially avoidable medicine incidents.
• The critical care outreach team was not fully established to provide the necessary support and education to the rest of the hospital.
• There was no delirium screening process in place.

Updated 22 May 2019

Our rating of this service improved. We rated it as good because:

• Significant improvements had been achieved within the service since our last inspection. The reporting backlog had almost cleared and reporting turnaround times dramatically reduced. This had been achieved as a result of increasing the reporting capacity through use of locum consultants and increased outsourcing to teleradiology providers. The service had an operational plan to create a sustainable and cost-effective reporting team and to move away from reliance on third party support.
• New key performance indicators (KPI’s) and reporting processes were introduced to measure improvements, and to facilitate the ongoing management of the reporting workload. The service was now working to, or very close to, its agreed KPIs for most modalities. The leadership team understood the challenges to service provision and actions needed to address them.
• Patients could access the service when they needed it. Waiting times to treat patients were generally in line with good practice. Most patients received diagnostic imaging within the six-week target.
• Staff were committed to providing the best possible care for patients. Staff felt ownership for the service and were proud to be part of the diagnostic and imaging service.
• There was a strong, visible patient centred culture. Staff were highly motivated and inspired to provide care and treatment that was kind, compassionate and promoted patients’ dignity, and respected people’s needs. Staff of all disciplines worked together as a team to benefit patients.
• Staff understood their responsibilities to raise concerns and report patient safety incidents. There was an effective governance and risk management framework in place to ensure incidents were investigated and reviewed in a timely way. Learning from incidents was shared with staff and changes were made to delivery of care because of lessons learned.
• The service made sure staff were competent for their roles. Mandatory training in key skills was provided to all staff and the service made sure most staff completed it. Staff were encouraged to develop their knowledge, skills and practice.
• The service had enough medical staff with the right qualifications, skills, training, and experience to keep people safe from avoidable harm and abuse and to provide the right care and treatment. The service outsourced activity to ensure timely treatment was provided. Recruitment into the radiologist workforce remained an ongoing challenge, however, locum doctors were used as an interim measure to keep people safe from harm.
• The service had suitable premises and equipment and looked after them well. Although the cardiac investigation unit remained cramped since the last inspection, plans were in place to expand and improve the environment.

However:

• Not all the environment was maintained in accordance with Department of Health guidance. Flooring in the x-ray rooms within the breast unit did not comply with relevant Health Building Note (HBN) requirements.
• Complaints were not responded to in a timely manner.
• A clinical director/lead was not in place to provide additional support and oversight of the service.

Updated 12 April 2017

We rated the service as good for the safe, caring, responsive and the well-led key questions and requires improvement for effective. We found that:

• There were systems in place to protect patients from harm and a good incident reporting culture.
• Medicines were provided in line with national guidance. We saw good practice in prescribing anticipatory medicines for patients who were at the end of life.
• The hospital had a replacement for the Liverpool Care Pathway (LCP) called the ‘Guidance to implement care for the dying patient, and their family and friends’. The document was embedded in practice on the wards we visited.
• Do not attempt cardio-pulmonary resuscitation (DNACPR) records we reviewed were signed and dated by appropriate senior medical staff. There were clear documented reasons for the decisions recorded.
• Patients were happy with the care they received and felt involved in their care planning at the end of their life. Nurses, doctors and the specialist palliative care team (SPC) demonstrated compassionate patient centred care throughout the inspection.
• Relatives rated end of life care provided by nurses and doctors to their relative at the end of life, as ‘excellent to good’.
• Sixty volunteers supported the chaplaincy service through a hospital wide patient-visiting programme, which included support to patients at the end of life.
• Care and treatment was coordinated with other services and other providers. The specialist palliative care team (SPCT) had good working relationships with discharge services and their community colleagues. This ensured that when patients were discharged their care was coordinated.
• All adult wards had end of life care champions who were trained in specialist end of life care and were a direct link to the SPCT.
• The SPCT saw 100% of patients within 24 hours of referral.
• The hospital had an executive and a non-executive director on the hospital board with a responsibility for end of life care.
• There was a clear vision and strategy for end of life care supported by an outcome based work plan, led by the transformational lead nurse and medical lead for end of life care.
• Risks regarding the management of bariatric patients in the mortuary were identified on the support services risk register.
• Risks associated with end of life care were recorded within individual clinical business units (CBU) and recorded on the corporate hospital risk register. Staff had taken action to mitigate against risks.

However, we also found that:

• The hospital performed worse than the England average for the five clinical outcomes in the End of Life Care Audit: Dying in Hospital (NCDAH) 2014/15, published 2016.
• The hospital had scored particularly poorly for the multidisciplinary recognition of patients dying, communication regarding plans of care, and meeting the spirituality and religious needs of patients.
• The hospital was not collecting information on the percentage of patients discharged to their preferred place of death within 24 hours.
• The service did not provide face-to-face access to specialist palliative care for at least 9am Monday to 5pm to Sunday. This did not meet the recommendations from the National Institute for Health and Care Excellence (NICE) guidelines for end of life care for adults.
• There was no practice educator post in the SPCT in line with national guidance.

Updated 7 March 2024

Updated 22 May 2019

Our rating of this service stayed the same. We rated it as good because:

• Mandatory training in key skills were provided to all staff.
• Staff understood how to protect patients from abuse and were aware of the requirement to work well with other agencies to do so.
• Infection risk was controlled well in most areas. The environment was clean and organised.
• Systems and procedures were in place to assess, monitor and manage risks to patients.
• There was enough nursing and medical staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and abuse, and to provide the right care and treatment.
• Staff kept appropriate records of patients’ care and treatment.
• Medicines were prescribed, dispensed, administered, recorded and mostly stored in accordance with best practice.
• Staff recognised incidents and most staff reported them appropriately.
• Policies were aligned and referenced to national guidance, such as National Institute for Health and Care Excellence (NICE) guidelines.
• Some outpatient areas monitored the effectiveness of care and treatment and used the findings to improve them. They compared local results with those of other services to learn from them.
• Staff were competent for their roles. Supervision meetings were held across most specialities to provide support and monitor the effectiveness of the service. Appraisal rates had increased since our last inspection.
• Staff from all disciplines worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.
• Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
• Patients were treated with compassion, kindness, dignity and respect, when receiving care. Staff provided emotional support to patients to minimise their distress. Staff involved patients and those close to them in decisions about their care and treatment.
• The outpatient’s department generally planned and provided services in a way that met the needs of local people.
• Some improvements had been made to the amount of time patients waited from referral to treatment (RTT).
• The service treated concerns and complaints seriously, investigated them and learned lessons from the results, which were shared with staff.
• The service had managers at all levels with the right skills and abilities to run a service working to provide high-quality sustainable care. Managers across the service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
• The vision for the outpatients’ department continued to be one that focused on the delivery of safe and high-quality patient care.
• The outpatients’ department had effective systems for identifying risks and timely plans to eliminate or reduce risks.
• The service collected, analysed, managed and used information to support all its activities, using secure electronic systems and security safeguards.
• The service engaged well with staff and collaborated with partner organisations effectively.
• There was an improvement plan which detailed aims and objectives. We found some service improvements had been made since our previous inspection in 2017.

However:

• Medical staff compliance with mandatory training was low for some training modules.
• Premises or facilities were not always suitable for their intended use. Some areas were overcrowded.
• Lessons learned from incidents were not always shared with the wider service and other specialities.
• Not all patients could access the service when they needed it.
• Complaints were not always responded to in a timely manner.
• There was further work required to ensure all levels of the governance structure functioned effectively to ensure joint working and shared learning across specialties.

Updated 27 February 2018

Our rating of this service stayed the same. We rated it as requires improvement because:

• The service provided mandatory training in key skills but did not ensure all medical staff completed it. Basic life support training compliance was poor for medical and nursing staff. There was an action plan in place to address this.
• The service did not control infection risk well in all areas or always have suitable premises in all areas. Systems to ensure equipment was well looked after required improvements.
• Managers investigated incidents and however there was a lack of formal systems to share lessons learned with the whole team and the wider service.
• The service monitored the effectiveness of care and treatment but inconsistently used the findings to improve them.
• Patients could not always access the service when they needed it but performance was improving. Waiting times from referral to treatment and arrangements to admit, treat, and discharge patients were improving.
• Lessons learned from complaints were not always shared with all staff members effectively.
• The service did not always have effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected.
• The interventional radiology (IR) service was not continuously available. There was no rota or fixed cover out of hours and therefore no IR service out of hours.

However:

• The service had enough staff with the right qualifications, skills, training, and experience to keep patients safe from avoidable harm and abuse and to provide the right care and treatment.
• Staff generally kept appropriate records of patients’ care and treatment. The service prescribed, gave, and recorded medicines well.
• The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.
• Staff worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.
• Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.
• The trust generally planned and provided services in a way that met the needs of local people.
• The service had managers at most levels with the right skills and abilities to run a service providing high-quality sustainable care.

Updated 20 April 2023