Archived: Corby Community Hospital

Updated 27 March 2014

The services on the inpatient ward at Corby Community Hospital were provided by Northampton General Hospital NHS Trust (NGH). The inpatient ward was a 22-bedded ward and provided a programme of rehabilitation from a specialist therapy team for people with clinical needs requiring 24-hour nursing and medical care. In addition, the ward provided nursing care for patients with subacute medical conditions.

The ward provided continuing support and care closer to home, offering help with rehabilitation and recovery from stroke. The aim was to provide care closer to home for patients fit for discharge from the acute hospital, with a clinical need for medical rehabilitation, offering a ‘step-down’ facility or had subacute medical needs. The ward also offered care to patients referred directly from the community with the aim of providing care and treatment in order to prevent the need for their admission to the acute hospital. This was known as a ‘step-up’ facility.

The ward was supported by a multidisciplinary team including nursing, medical and therapy staff.

Updated 27 March 2014

Corby Community Hospital was one of three community hospital sites where Northampton General Hospital NHS Trust provided services on an inpatient ward. Corby Community Hospital Inpatient Ward was a 22-bedded ward providing rehabilitation following discharge from the acute hospital, Northampton General Hospital. The hospital also provided a service for patients with subacute medical conditions who required an enhanced level of care that could not be provided at home.

Northampton General Hospital NHS Trust was an acute trust with 800 consultant-led beds, and provided general acute services for a population of 380,000. It also provided hyper acute stroke, vascular and renal services to people living throughout the whole of Northamptonshire, which had a population of 691,952. The trust was an accredited cancer centre and provided cancer services to a wider population of 880,000 who lived in Northamptonshire and parts of Buckinghamshire.

Northampton General Hospital NHS Trust also provided services at Isebrook Hospital and Danetre Hospital.

We found the medical service on the inpatient ward at Corby Community Hospital to be generally safe because there were assessment and reporting systems in place to identify risk, take action and learn lessons from incidents and complaints. Staff felt informed about incidents and able to report concerns. They followed national and best practice guidelines. There was good multidisciplinary team working throughout the ward and with trust specialist teams across the trust. Outcomes for patients were good.

Nurse staffing and patient dependency levels were assessed using a recognised tool. There were vacancies, which were covered either by staff on the ward doing additional hours or by bank and agency staff nurses. The trust was in the process of recruiting more staff. A consultant specialist in the care of the older person  visited the ward twice weekly for a ward round and multidisciplinary team meeting. In addition, a full-time staff grade doctor worked Monday to Friday 9am to 5pm. In addition to this, the urgent care centre, based on the Corby site, provides doctor cover from 5.30pm to 8pm Monday to Friday and then on Saturday and Sunday also from 8am to 8pm. Outside these hours and at weekends, the countywide ‘out of hours’ service was called to support the medical needs on the ward.

There were arrangements in place for the safe administration and handling, storage and recording of medication. However, there had not been an allocated pharmacist on the ward to oversee and review medicine and prescribing arrangements. This meant that patients were at risk of not receiving appropriate treatment, possible medication errors occurring and necessary reviews of medication not taking place. The trust had employed a locum pharmacist who was due to start by the end of January 2014.

Analysis of infection rates in the trust showed them to be within expected limits. The ward was clean and there were arrangements in place for ward cleaning and decontamination of equipment. We found gels, aprons and gloves were in good supply and waste appropriately dealt with. There were assurance mechanisms in place to identify when standards for cleanliness and infection prevention needed improving.

We sought the views of the public at a listening event before the inspection and also checked on a range of patient feedback and survey information. We spoke with patients and a relative during the inspection who reported they were happy with care and treatment. The relative praised the staff highly and, despite living some considerable distance from the hospital, had been kept fully informed and involved.

There were clear clinical, organisational, governance and risk management structures in operation. Staff had confidence in the ward managers and felt well supported. However, not all staff had completed their mandatory training or been given an appraisal. This meant that the trust could not be assured that staff were up to date with their skills and knowledge to appropriately meet patients’ needs. Issues over the lack of a pharmacist for the ward and non-completion of training and appraisals had been known to the trust for a significant time, with insufficient action taken to address the issues.

We found that the trust had breached Regulation 13 (medication) and Regulation 23 (staff support and training) for the regulated activity ‘Treatment of Disease, Disorder and Injury’.

Updated 27 March 2014

We found the medical service was safe because there were systems in place to identify risk, take appropriate action and learn lessons from any incidents or areas of poor performance. Staff were confident about how to report incidents and felt well informed. However, we found the medication arrangements had not been reviewed by a pharmacist since May 2012. This was because there had been no pharmacist allocated to the ward during this time. A locum pharmacist was expected to start by the end of January 2014.

Staffing levels were calculated using a nationally recognised dependency tool (the Hurst Nursing Workforce Planning Tool). It had been noted that not all shifts achieved the recommended skill mix and recruitment was taking place to address this. Shortages of staff on shifts were covered by bank and agency staff. A consultant visited the ward twice a week for ward rounds and multidisciplinary team meetings. A full-time staff grade doctor worked Monday to Friday. In addition to this, the urgent care centre, based on Corby site, provides doctor cover 5.30pm to 8pm Monday to Friday and then on Saturday and Sunday also from 8am to 8pm. For the remainder of the time (evenings, nights and weekends) staff called the ‘out of hours’ service for medical support.

Services were effective, and designed to meet the needs of patients on the ward. Staff followed national and best practice guidelines. There was good multidisciplinary team working throughout the ward and with trust specialist teams. Outcomes for patients were good. Staff continually sought ways to improve patient experience.

Patients were positive about their experience and found staff kind and caring. We saw several examples of compassionate care. Patients reported they liked the food and we saw positive interactions between patients and staff. The local ward results from the Friends and Family Test were consistently good, but staff were not complacent and continued to seek ways to improve patient experience.

The services on the ward responded to the needs of the local population by providing a ‘step-up’ facility with enhanced care to patients from the community, in order to reduce the need for admission to the acute hospital, Northampton General Hospital. Similarly, a ‘step-down’ facility provided rehabilitation services for patients needing nursing and medical support after discharge from Northampton or Kettering General Hospitals. In addition, the ward provided medical and nursing care for patients with subacute medical conditions. We found that there were no formal arrangements in place for spiritual or multifaith provision. Local ministers supported the ward but their support was not always appropriate and staff had to ask individual patients and their families where to obtain the help needed for their particular faith.

There were clear clinical, organisational, governance and risk management structures in operation. There was an open culture of reporting incidents and learning from incident investigations and complaints. Staff had confidence in the ward managers and felt well supported. However, staff were having difficulty with some of the care documents including observation charts recently introduced by the trust, and felt scores on ward performance audits did not always reflect practice. The lack of dedicated pharmacy support, poor levels of attendance at mandatory training and a failure to complete appraisals had been known to the trust for a significant time but insufficient action had been taken to address these issues.