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Provider: The Dudley Group NHS Foundation Trust Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 18 April 2018

  • We rated safe, effective, responsive and well led as requires improvement and caring as good. We rated two of the trusts core services as good, two as requires improvement and one as inadequate. We rated community services including sexual health as good.
  • In rating the trust, we took into account the current ratings of the four core services and community end of life services that were not inspected this time.
  • Our decisions on overall ratings take into account, for example, the relative size of services and we use our professional judgement to reach a fair and balanced rating.
  • We rated well-led at the trust level as requires improvement.

Inspection areas

Safe

Requires improvement

Updated 18 April 2018

  • The executive team recognised that there was still work to do to ensure a robust safety culture across the whole organisation.
  • Staff did not always understand how to protect patients from abuse. Not all staff had received the right level of training and were not always recognising’s and reporting abuse.
  • We rated safety in urgent care services as inadequate. We found significant failings in the identification and management of deteriorating patients. Triage processes were inconsistent and not exercised in line with the trusts local policy and national guidelines. We saw examples where patients had been exposed to and potentially suffered avoidable harm as a result of these failings.
  • Some of the core services did not have enough 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.
  • There were not always suitable premises and equipment in place. There was limited storage in medical and high dependency units and there were not enough sinks for the number of cots in the special care baby unit, however staff we spoke with on the ward were aware of this concern and described how they worked to mitigate this risk such as maintaining high standards of handwashing techniques.

However;

  • The service provided mandatory training in key skills to all staff and compliance was generally good.
  • Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service.
  • The service controlled infection risk well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection.
  • Staff kept appropriate records of patients’ care and treatment. Records were clear, up-to-date and available to all staff providing care.

Effective

Requires improvement

Updated 18 April 2018

  • Care and treatment was not always based on national guidance and managers were not checking to ensure staff followed guidance. Some core services did not always monitor the effectiveness of care and treatment and then use the findings to improve.

However;

  • Staff gave patients enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary. The service made adjustments for patients’ religious, cultural and other preferences.
  • Managers appraised staff’s work performance and held supervision meetings with them to provide support and monitor the effectiveness of the service.
  • Staff of different kinds 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. They knew how to support patients experiencing mental ill health and those who lacked the capacity to make decisions about their care.

Caring

Good

Updated 18 April 2018

  • Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.
  • Staff involved patients and those close to them in decisions about their care and treatment. Staff provided emotional support to patients to minimise their distress.

However;

  • In urgent and emergency services patient’s privacy and dignity was not always respected. The Friend and Family Test results were worse than the England average and patients did not always have their call bells within reach.

Responsive

Requires improvement

Updated 18 April 2018

  • The service took longer than expected to respond to complaints.
  • People could not always access the service when they needed it. In some areas such as the urgent and emergency care department, the children and young peoples department and maternity some waiting times and arrangements to admit, treat and discharge patients were not always in line with good practice.
  • Bed occupancy rates were higher than recommended limits in some areas. This impacted on the provision of a suitable environment to receive care. There were some mixed sex breaches.

However;

  • The service took account of patients’ individual needs although children between the ages of 16 to 18 did not necessarily gain access to the children’s ward or paediatric facilities.
  • The trust planned and provided services in a way that met the needs of local people.

Well-led

Requires improvement

Updated 18 April 2018

  • Our rating of well-led went down. We rated it as requires improvement overall with one area, the urgent and emergency care department being inadequate because: The trust did not have effective systems for identifying risks, robust plans to eliminate or reduce them, and coping with both the expected and unexpected. In urgent and emergency care services we found that systematic failings and lack of oversight in the service at all levels had led to patients being exposed to the risk of avoidable harm.
  • The arrangements for governance and performance management were not always operated effectively.

However;

  • The trust had a vision for what it wanted to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community.
  • Managers across the trust promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
  • The trust engaged well with patients, staff, the public and local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively.
Checks on specific services

Community health services for adults

Good

Updated 18 April 2018

We rated it as good because:

  • The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.
  • The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.
  • We saw excellent innovative multidisciplinary team working. Staff of different disciplines 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 planned and provided services in a way that met the needs of local people.
  • Managers across the trust promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
  • The trust was committed to improving services by learning from when things go well and when they go wrong, promoting training, research and innovation.

However

  • Community staff were not fully compliant with mandatory training or appraisal rates.
  • Whilst we were confident patients were receiving person centred care, we found patient care plans were generic and not person centred.
  • People could not always access services when they needed it. Waiting times for treatment were not always in line with good practice.