Hexham General Hospital

Updated 6 September 2023

Pages 1 and 2 of this report relate to the hospital and the ratings of that location, from page 3 the ratings and information relate to maternity services based at Hexham General Hospital as part of Northumbria Healthcare NHS Foundation Trust.

We inspected the maternity service, of which the midwifery led unit is a part, at Hexham 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.

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

Our rating of this hospital stayed the same. We rated it as outstanding because:

• Our ratings of the Maternity service did not change the ratings for the hospital overall. We rated safe and well-led as good and the hospital as outstanding.

Hexham General Hospital provides a midwife led maternity unit (MLU) and general maternity service in the hospital and community to women and birthing people in West Northumbria and surrounding areas. We only looked at the MLU as part of this inspection. Staff in the MLU delivered 33 babies in 2022.

We also inspected one other maternity service run by Northumbria Healthcare NHS Foundation Trust. Our reports are here:

Northumbria Emergency Specialist Care Hospital - Search Results - Care Quality Commission (cqc.org.uk)

How we carried out the inspection

We carried out a short notice announced focused inspection of the maternity service, looking only at the safe and well-led key questions. 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 5 May 2016

We rated medical care services as outstanding because:

An experienced and cohesive team who demonstrated a clear understanding of the challenges of providing high quality, safe care, managed medical services. They had identified and implemented actions and strategies to manage this and this had been done with the involvement of frontline staff. This meant staff we spoke with felt valued and were engaged with the process. The directorate had a clear vision and business strategy. Staff felt valued and were encouraged to contribute to service development. Staff and patient engagement was seen as a priority with several systems in place to obtain feedback. Governance processes were embedded which allowed clear identification and monitoring of risk and we saw evidence of related progress and action plans. Diabetes research, in particular the long term self-management of diabetes, was at the forefront of medical research within the medical directorate. The service had a significant national profile and influence as a result, including research papers on person centred care in long term conditions.

Staff delivered compassionate care, which was polite and respectful and went out of their way to overcome obstacles to ensure this. All patient feedback was extremely positive.

Staff were encouraged to report incidents of harm or risk of harm and learning from incidents was demonstrated. The wards were visibly clean and organised. There were some nurse staffing vacancies but the trust was recruiting to fill posts. On most wards, adequate cover was in place and actual staffing numbers reflected the planned figures. Staff worked additional hours and could be brought across from other wards or the trust if needed. The level of staff completing mandatory training was good. Medicines management was appropriate. Clinical records were well organised and fully completed.

The service participated in national audits and had a robust system of local clinical audits. Information about people's care and treatment and their outcomes were routinely collected and monitored. Outcomes were positive and met expectations.

There were processes to ensure patients were cared for in the right place at the right time. Patient flow was a priority, and the bed management team proactively managed this. The movement of patients during admission was monitored effectively.

Updated 6 September 2023

Updated 5 May 2016

Overall, we rated Hexham General Hospital outpatients and diagnostic imaging services as outstanding because:

Staff and managers had a clear vision for the future of the service. They knew the risks and challenges the service faced. Staff we spoke with at all levels felt supported by their line managers, who encouraged them to develop and improve their practice. Staff embraced change and there was a real focus on patient experience and leaders and managers drove this. There were well embedded systems and processes for gathering and responding to patient experiences and the results were well publicised throughout the departments. There were effective and comprehensive governance processes to identify, understand, monitor, and address current and future risks. These were proactively reviewed. There was an open, honest and supportive culture where staff discussed incidents and complaints, lessons were learned and practice changed. All staff were encouraged to raise concerns. The departments supported staff who wanted to work more efficiently, be innovative, and try new services and treatments and ways of engaging with the public.

Waiting times for all types of appointments consistently met national targets. Some specialties had experienced capacity and performance difficulties but these had been well managed and resolved. All appointments were booked within acceptable timescales. Outpatient clinics and related services were organised so patients only had to make one visit for investigations and consultation or, if possible, did not have to return to hospital for unnecessary appointments. The department teams recorded concerns and complaints and used patient feedback proactively to prevent recurrence that might affect others. They reviewed and acted on problems quickly and demonstrated an open and transparent outlook with the aim to learn from them and improve patient experience.

Staff respected patients’ privacy, dignity, and confidentiality at all times. Patients told us, and we saw without exception, that staff treated them kindly, and in a consistently caring and compassionate way. Staff spent time with patients and those close to them to give explanations about their care and encouraged them to ask questions. Staff, from volunteers to senior managers regularly went out of their way to provide help and assist patients in all aspects of care. There were a range of services and opportunities to provide emotional support for patients and their families.

The hospital had good systems and processes in place to protect patients and maintain their safety. The departments were clean and hygiene standards were good. Medical records were stored and transported securely.

Updated 5 May 2016

We rated surgery as outstanding because:

There was a clear vision for the service and the new model of care being delivered, with a clear focus on improving the quality of care and people’s experiences. The change to the provision of emergency and high risk surgical services centred at NSECH ensured patients received the right care and treatment, support services, nursing and clinical staff at the appropriate time and location. The strategy clearly identified the new model of emergency and high-risk surgery provided at NSECH and the relationship between NSECH and the base hospitals. The new model was under constant review to determine the most effective site to undertake different procedures depending upon risk and safety. Local communities had been engaged in the consultation and development of the strategy for the new model of care. This had a positive effect upon the feedback received from patients and relatives received during the inspection at NSECH and also at the base hospitals.

Innovation was welcomed by senior leaders and there was a culture of innovation embraced and promoted amongst staff. There were high levels of staff satisfaction and staff spoke strongly about the supportive and open culture at the trust. Staff were proud to work for the service. Strong and robust governance structures were in place across the directorate and there was a systematic approach to considering risk and quality management. Senior and site level leadership was visible and accessible to staff. Staff spoke very positively about their immediate line managers and senior leaders and a positive culture was evident during the inspection, supported by initiatives such as the ‘shared purpose’ wards and value based recruitment.

Surgery services at this hospital were planned and delivered to meet the needs of local people in a timely way. The service was part of the wider hospital network and incorporated the NSECH emergency care model. This allowed patients access to elective care and emergency support across hospital sites when needed. The service reported waiting times better than NHS averages and had been responsive in analysing, assessing and considering patient risk when identifying where best to care for high risk patients.

There was a strong patient centered culture that patients reflected on when making decisions on choosing to attend Hexham General Hospital for their surgery. All staff we spoke with were highly motivated and offered care that promoted people’s dignity without exception. The service had consistently high patient feedback scores in the national NHS friends and family test and in the local surveys. Patients explained that all staff ‘went the extra mile’ to help them and all patients reported to us that their care was excellent or very good. Patients we spoke with had chosen to travel significant distance to access this service.

Staff made use of evidence based guidance to inform their practice and were encouraged to seek out new evidence-based techniques and technologies to support the delivery of high quality care. This helped Hexham to achieve patient outcomes and audit results that were better than Trust and national averages. This included readmission rates for elective surgery, mobilisation rates following joint replacement, revision rates for hip replacement procedures, and audits of surgical consent.

Hexham General Hospital had a good track record in regard to patient safety. The surgical service had reported no serious incidents or never events and very low incidences of patient harm were recorded at the hospital. Incidents were discussed in staff meetings and staff felt confident to report incidents, and reported that lessons were shared and senior staff were supportive.

Staffing levels were appropriate for the service being delivered and processes were in place to ensure safe staffing levels. Mandatory training compliance targets had not been achieved in all areas at the time of inspection and it was planned that targets would be met. Staff had access to safeguarding, consent and mental capacity training and had good understanding. Handovers were well planned, attended by the multidisciplinary team and managed to ensure that patient information was accurately passed on. A handover process for patient transfers was also in place. There was a comprehensive understanding of patient risk and this was monitored, recorded and assessed appropriately by staff. There was good understanding of the recognition of the deteriorating patient and staff understood the policy for escalation and transfer of patients to the emergency site when required.

Updated 5 May 2016

Overall we rated the emergency care centre as this hospital as good, with caring as outstanding, because:

The care given to patients by the department was outstanding. Privacy and dignity were maintained and people were dealt with in a kind and compassionate way. Patients were treated as individuals and care was tailored to their specific physical and mental health needs. All staff went the extra mile to ensure that patients received the care and support they needed. Patients were the focus of staff. Patients and families were seen as partners in decisions about their care and emotional support was given during difficult situations. Results from national and local surveys and questionnaires were consistently excellent.

Staff were engaged in the future development of the department. Managers had robust plans in place to ensure the sustainability of the department for the future, including contingency planning and plans to develop the skills and knowledge of staff. The trust has consulted and engaged comprehensively with staff about the recent development of the department and their roles. There were governance, risk management and quality measurement processes in place to enhance patient outcomes. ‘Patient voice’ was seen as important and there were a number of initiatives within the trust designed to ensure that the opinions of patients influenced the delivery of services.

Staff felt that there was good leadership not only in the department but also within the trust. There was an inclusive, learning and supportive culture in the department and staff felt valued and appreciated. The culture in the department supported staff to deliver outstanding patient focussed care.

We had no concerns about safety in the department. We observed that policies and procedures were followed. Safeguarding processes to protect vulnerable adults and children were in place and referrals were made in a timely manner when necessary. There were sufficient medical and nursing staff employed by the department and staffing levels were acceptable. There were some areas where the department was not meeting the trust expected compliance rate for mandatory training. Staff were up to date with annual appraisals.

There were evidence based policies and procedures in place which were easily accessible to staff. These were audited to ensure staff were following relevant clinical pathways. Information about patients such as test results were readily accessible. There was evidence of multi-disciplinary working throughout the department and the department offered a seven-day service. Staff understood their responsibilities in relation to taking consent from patients and the principles of the Mental Capacity Act 2005.

Patients who visited the department had their individual needs met. Interpreters were available and there were facilities available to assist patients with disabilities or specific needs. Pain relief and nutrition and hydration needs of patients were met. The department was meeting the four-hour target and were discharging most patients within three hours of admission. The service was performing better than the England average for a number of other performance measures relating to the flow of patients. Patient complaints were managed in line with the trust’s policy and feedback was given to staff. Lessons were learned and where applicable, practice was changed to minimise the likelihood of recurrence.