The Care Quality Commission
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Northumbria Healthcare NHS Foundation Trust

This is an organisation that runs the health and social care services we inspect

Overall: Outstanding read more about inspection ratings
Important: Services have been transferred to this provider from another provider

All Inspections

21st May to 28th June 2019

During a routine inspection

  • We rated effective, caring and responsive as outstanding and safe and well-led were rated as good. Four ratings stayed the same as our previous inspection in 2016.
  • In rating the trust, we took in to account the current ratings of the services that we did not inspect during this inspection but that we had rated in our previous inspection.
  • We rated well led for the trust overall as good. This was not an aggregation of the core service ratings for well led.
  • Our full inspection report summarising what we found and the supporting evidence appendix containing detailed evidence and data about the trust is available on our website.

24-26 April 2017

During an inspection of Community mental health services with learning disabilities or autism

  • There was a proactive approach to anticipating and managing risks to people who use the services. This was embedded and recognised as being the responsibility of all staff. People who use and those close to them were actively involved in managing their own risks.

  • There was a holistic approach to assessing, planning, and delivering care and treatment to people who use services. The use of innovative approaches to care was actively encouraged. New evidence based techniques and technologies were used to support the delivery of the service.

  • There was continued development of staff skills, competence, and knowledge. Staff were proactively supported to acquire new skills and share best practice.

  • The service was committed to working collaboratively and had developed innovative and efficient ways to deliver more joined-up care to people who use the service.

  • There was a holistic approach to planning people’s discharge, transfer, or transition to other services. Arrangements fully reflected patient needs.

  • There was participation in relevant local and national audits, including clinical audits and other monitoring activities such as reviews of services, benchmarking, peer review and service accreditation.

  • There was a strong, visible person-centred culture. Staff were highly motivated and inspired to offer care that is kind and promotes people’s dignity. Relationships between people who use the service, those close to them and staff were strong, caring, and supportive. These relationships were highly valued by staff and promoted by leaders

  • People’s individual needs and preferences were central to the planning and delivery of services. The services were flexible, provided choice, and ensured continuity of care.

  • Leaders had an inspiring shared purpose, and motivated staff to succeed. Comprehensive and successful leadership strategies were in place to ensure delivery and to develop the desired culture.

  • There were high levels of staff satisfaction across the service. Staff were proud of the organisation as a place to work and spoke highly of the management and culture. Staff at all levels were actively encouraged to raise concerns.

22-23 September 2016

During an inspection of Specialist community mental health services for children and young people

We rated specialist community mental health services for children and young people as good because:

  • The service had clear criteria for referrals into the service with timescales for assessment for urgent, priority and routine referrals.

  • Initial assessments were thorough and included a full assessment of risk and staff used a range of assessment and diagnostic tools for specific areas of need.

  • The service delivered a wide range of psychological interventions recommended by National Institute for Health and Care Excellence to meet the needs of children and young people who used the service.

  • Staff delivered care in a thoughtful and sensitive way that was adaptive to the needs of the young person. Interactions were at an appropriate level for young people which focussed on recovery and respected young people’s needs.

  • Feedback from people who use services and their carers was positive about the care they received.

  • Staff were passionate, enthusiastic and dedicated to their work with children and young people.

However:

  • Interview rooms were not fitted with alarms and staff did not have access to personal alarms. At the Albion Road clinic, the door from reception area to staff offices and rooms where staff saw patients was not secure.

  • Although risk was reviewed with young people and within multi-disciplinary teams, it was not easy to access this from the information in the care records.

  • The involvement of young people and parents was not well documented within care records.

  • There was insufficient hand washing and sanitising equipment at Albion Road and Baliol Centre.

9th - 13th November 2015

During a routine inspection

Northumbria Healthcare NHS Foundation Trust provides services for around 500,000 people across Northumberland and North Tyneside with 999 beds. The trust has operated as a foundation trust since 1 August 2006. The trust manages adult social care services on behalf of Northumberland County Council and it also has General Practitioner services.

The trust serves one of the largest geographical areas of any NHS trust in England, from the Scottish border down to North Tyneside and west across to Tynedale.

We inspected Northumbria Healthcare NHS Foundation Trust as part of our comprehensive inspection programme. This did not include the adult social care services managed on behalf of Northumberland County Council or the General Practitioner services. We inspected this trust between 9 and 13 November 2015 and 2 December 2015.

Overall, we rated it as outstanding. We rated it outstanding for being effective, caring, responsive and well-led, and good for safe.

Our key findings were as follows:

  • The trust covered a large geographical area that managed four acute hospitals, a large community service and various other smaller community hospital sites. It was a very geographically diverse and complex trust. We rated all four hospitals and community services as outstanding.
  • The trust had undergone a major transformation and change during the previous four months before our inspection with the reconfiguration of the acute care pathways through the Northumbria Specialist Emergency Care Hospital (NSECH).
  • The opening of NSECH in June 2015 had resulted in a new model of care and different patient pathways in emergency, maternity and medical and surgical care at this hospital. This had resulted in different ways of working for some staff.
  • Inspirational leadership and strong clinical engagement had ensured that this change had been managed extremely well and effectively.
  • Staff felt fully informed about all the changes which had taken place and were proud of the trust and the care it provided to the local community and beyond.
  • Strong governance structures were in place across the trust and there was a systematic approach to considering risk and quality management. Senior and site level leadership was visible and accessible to staff. Leadership was encouraged at all levels and staff supported to try new initiatives.
  • Managers at all levels understood the challenges of the new model of care and were actively addressing any issues that this had presented, specifically around nursing and medical staffing and patient acuity.
  • There was total integration of all services between the hospital and community.This was particularly apparent in end of life care services.
  • Staff and patient engagement was seen as a priority with several outstanding and effective systems in place to obtain feedback.
  • When we spoke with managers and staff throughout the trust, the “Northumbria Way”, which incorporates the trust’s values, behaviours and culture was evident.
  • 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.
  • There were excellent processes to ensure patients were cared for in the right place at the right time. Patient flow was a priority, and the trust proactively managed this.
  • For all performance measures relating to the flow of patients the trust was performing the same or better than the England average.
  • The transfer of patients between NSECH and the ‘base’ hospitals was still being configured and embedded at the time of inspection and staff were working flexibly to accommodate patient needs.
  • The trust had infection prevention and control policies in place, which were accessible, understood and used by staff.
  • Patients received care in a clean, hygienic and suitably maintained environment.
  • The trust routinely monitored staff hand hygiene procedures and at the time of inspection, compliance was high.
  • Between June 2014 and June 2015, there were 2 cases of MRSA, one in January 2015 and one in February 2015.

  • There were 30 cases of Clostridium difficile with peaks in June and November 2014 and February and May 2015. This was an average of around 2 each month.

  • Nurse staffing was maintained at safe levels in most areas. The trust had implemented a ‘Safer Nursing Care Tool’ (SNCT) to assess the staffing requirements across wards.
  • The ratio of consultants was better than the England average.
  • The trust utilised advance nurse practitioners to support doctors.
  • Community services staffing levels and caseloads were meeting national recommendations.
  • Mortality and morbidity meetings were held at least monthly and were attended by representatives from teams within the clinical business units.
  • Patients were assessed regarding their nutritional needs using the Malnutrition Universal Screening Tool (MUST).
  • Nutritional assistants were employed to provide patients with eating and drinking assistance if required within the hospital sites.
  • The trust followed the ‘well organised ward’ model to ensure that equipment storage was standardised and consistent across the trust.

We saw several areas of outstanding practice including:

In medical care:

  • The joint working by the falls team, which has raised the profile of falls and engaged staff, patients and their relatives in trying to reduce falls.
  • The role of nutritional assistants and the focus on the nutritional needs of patients which had improved the patient experience.
  • The ‘real time’ data collected on patient experience to assess how each ward is performing.
  • The inclusion of a psychological assessment for patients who require isolation for infection prevention reasons.
  • The development of comfort care packs for relatives.

In surgery services:

  • North Tyneside General Hospital is rated in the top five hospitals in the country for the treatment of emergency hip fractures.
  • North Tyneside General Hospital was recently recognised by the General Medical Council as the best in the country for the quality of training for orthopaedic surgeons of the future.
  • The service had developed a day case mastectomy service. This was proposed to save 201 bed days each year. Average length of stay had also reduced to between 2.7 and 4.2 days (depending on patient risk at the time of surgery). This compared to a national average of around 4.8 days.
  • The development of the ‘block room’ had resulted in a streamlined approach to the recovery of patients following surgery.
  • Guidelines for oncoplastic breast reduction and guidelines for best practice in reducing surgical site infections had been developed.
  • A dedicated team contacted patients by telephone following discharge to gather information about any immediate concerns the patient may have and provide advice and guidance.

In critical care services:

  • Over 300 days without an avoidable pressure ulcer and the overall safety thermometer results.
  • Patient outcomes and the access and flow data were adjusted internally to monitor the standardised mortality ratio following the trust’s change to the model of delivery of care.
  • A member of staff had been nominated for multiple awards for their compassionate care: The NHS FAB stuff awards; patient champion of the year: North East and they came second in trust experience nationally.
  • The pit stop handover for all admissions to the unit had been developed with human factors training using formula one pit-stop models, to facilitate a structured handover and improve patient safety.
  • The culture of everyone was valued and 'had a voice' seemed embedded in the daily multidisciplinary safety huddle.
  • Staff considered patients individual preferences and evidently went out of their way to exceed expectations to meet their wishes particularly in end of life care.
  • Staff had adapted the “This is me” booklet and used it for long term patients where they included information from relatives and visitors about the patients personal preferences.
  • The rehabilitation after critical illness service.
  • Leadership of the service was excellent particularly in relation to the planning, preparation and the move to NSECH. Time was taken to engage staff in cross-site working prior to the move and work undertaken to standardise guidelines, procedures and equipment.

In acute children and young people's services:

  • Planning for the new model of care and facilities in the hospital was excellent. Managers had fully engaged staff in planning which resulted in a smooth transition into the new build and services being quickly up and running. Following a training needs analysis, staff had received additional training to ensure they had the correct skills to deliver the new model of care. There was ongoing work to further support staff in adjusting to the new services especially in the Children’s Unit.
  • The volume of information collected from service users was outstanding. The trust had innovative ways of engaging with patients and used a number of different methods for collecting information. This was shared with managers and clinical staff in order to improve services for children and young people.
  • A mother told us that while she was in recovery following the birth of her baby, a member of staff from the special care baby unit brought her a picture of her baby. She was extremely happy with this, as she was upset that she had to be separated from her new born baby. We thought this was extremely caring and responsive to her needs.
  • A parent passport was in place in the special care baby unit. This was held and completed by parents to increase their involvement in caring for their baby. The passport summarised the parents confidence and competence in carrying out this care. Following discharge, it provided a record for other healthcare professionals to understand the continuing needs of the parents in caring for their baby.
  • The trust was supporting a Consultant Clinical Psychologist in a longitudinal study to address the question of how health services could contribute most effectively to facilitating successful transition of young people with complex health needs from childhood to adulthood. The study involved young people from the conception of the research idea and throughout the course of the programme. Information from the study was fed into the National Institute for Care Excellence (NICE) as part of a consultation on draft guidelines on transition. The trust had a robust trust policy, which included transition and transfer of young people with long-term conditions and disabilities, which was being rolled out across business units. We thought the work on transition was outstanding.

In end of life care:

  • The model of end of life care services working alongside acute services at NSECH and out into the community was an innovative and pioneering approach to care.
  • Specialist palliative care was aligned with emergency care to ensure patients received specialist palliative care at the earliest opportunity.
  • The trust had responded to a higher than anticipated number of referrals to the specialist palliative care team by increasing the specialist palliative care resource within the hospital.
  • The trust had adopted an innovative approach to providing an integrated person-centred pathway of care in partnership to provide services that were flexible, focused on individual patient choice and ensured continuity of care.
  • The trust had taken positive action to increase the number of patients who were dying in their usual place of residence.
  • The leadership, governance and culture were used to drive and improve the delivery of high quality person-centred care through collaboration and partnership working. The trust had clear leadership for end of life care services that was supported at the top of the organisation.
  • Investment in end of life and palliative care services was apparent and staff we spoke with consistently told us they felt that end of life care was a priority for the trust.
  • Innovations were seen in relation to a focus on spiritual support and an assessment model that aimed to increase staff understanding of spirituality and confidence around assessment.
  • Partnership working with Marie Curie and joint management and nursing posts enabled the trust to provide prompt support and continuity of care for patients being discharged to their preferred place of care in the community.
  • The development of a tool for the assessment of patients spiritual needs that focused on providing staff with prompts that would make it easier for them to have this discussion with patients. The tool also helped staff to engage in a clearer way to ensure patients understood.

In outpatient and diagnostic imaging services:

  • NSECH provided a seven day a week consultant led outpatient trauma service for people from across Northumberland and North Tyneside to access, as well as a teleconference clinic for patients who lived in Berwick, almost 60 miles away.

In Community health services for adults:

  • The immediate response team (IRT) provided urgent support for people in a time of crisis. The IRT team joint worked across adult social care between Northumbria Healthcare NHS Foundation Trust and the local authority. The partnership working had developed a range of integrated services to support care closer to home for patients and avoid unnecessary hospital admissions. The fully integrated team of community health and social care staff aim to make contact with the person in need within two hours of the first call for assistance, and could provide equipment to help people move around their house, arrange emergency short term care support to enable them to remain at home, and help people to regain their confidence and independence.
  • Community Adult Services ran a free of charge ‘Inspired Carer Masterclass’ for staff from local residential care and nursing homes to improve care for patients receiving care in care homes. This was a one day course for care home managers and staff. The training covered dementia care, falls prevention, infection prevention and control, swallowing assessment, depression, skin integrity, and supporting families. The training was delivered by a variety of CAS staff including community matrons, SALT, and physiotherapists.
  • Community Adult Services had specialist community research nurses that were funded by the trust’s research and development team. For example, the Tissue Viability Service (TVS) research nurse was involved in a clinical trials study with a university into pressure ulcer mattresses. The TVS service had also conducted research for a large corporate company who specialised in providing products for advanced wound management.
  • The TVS had introduced a SSKIN bundle and ‘reminder note’ for pressure ulcer care. This had resulted in the trust moving from being a national outlier in pressure ulcer care, to performing better than the national average.

In Community Services for Children, Young People and Families:

  • Patient outcomes were consistently high and better than the England average. For example, the immunisation rate for measles, mumps and rubella (MMR) vaccine in children aged two was 96% in Northumberland and 96% in North Tyneside, both better than the national average of 93%. The health visiting service ensured all new mothers received a Maternal Mood review and the family nurse partnership exceeded their fidelity stretch goals.
  • There were excellent arrangements to support young people with complex needs and learning disabilities transitioning to adult services. Specialist school nurses supported the transition process for 17 to 19 year olds and the trust had recently appointed a dedicated specialist nurse to review current practice and identify any gaps in the service.
  • Staff from all community services for children and young people went beyond the call of duty to provide compassionate care and emotional support. Parents were unanimously positive about the care they and their children received. We heard and observed examples of outstanding practice that demonstrated staff were caring, compassionate, understanding and supportive.
  • Community services for children and young people had proactively participated in the 'You’re Welcome' toolkit, which was a quality criteria highlighted in the National Service Framework for Children. The toolkit sets out a number of principles to ensure young people aged 11 to 19 (including vulnerable groups) were able to access services better suited to their needs. The toolkit covered 10 key areas assessed, including accessibility, publicity, confidentiality/consent, the environment, staff training, skills, attitudes and values.
  • Services contributed to addressing the public health needs of children and young people. For example, the family nurse partnership had identified an increase in the number of teenage mothers who had returned to smoking once they had given birth. The team sought support from the trust’s Stop Smoking Team who, in turn, trained the nurses to identify triggers and deliver appropriate intermediate care and treatment. This included the use of smoking monoxide monitors and prescribing patches to help sustain the level of reduction.
  • The trust involved and engaged with local communities in planning services for children and young people. Community services in Northumberland had developed a participation strategy and were actively training young people as part of the reaccreditation programme for the You’re Welcome initiative. There were also two participation groups: the Northumbria Healthcare Young Apprentices gathered feedback about services for children and young people provided by the trust; while the Northumberland College Partnership Health Reference Group offered consultation on literature, materials and resources to ensure they were age appropriate, and met the needs of children and young people.
  • Young people were an integrated part of the sexual health service. The service had a very proactive health promotion team who involved young people to promote the delivery of sexual health messages. For example, young people from the YMCA Young Health Champions and the Young People’s Health and Wellbeing Group worked with the health promotion specialist to develop a ‘One2One DVD’. The aim of the DVD was to inform and encourage young people to access appropriate services when they needed to.

In community dental services:

  • The service had developed an orthodontic service to meet the needs of vulnerable children who would not normally be able to access general dental practice due to their physical, sensory, intellectual, mental, medical, emotional or social impairments or disabilities.
  • The service had also co-developed with colleagues in the North East Oral Health Promotion Group, a comprehensive resource pack to support oral health maintenance in elderly care home residents of care homes across Northumbria. The resource folder contained information that oral health promotion teams, commissioners of services, care home managers and their staff could use to deliver key oral health messages. For example, the information for care home staff included learning outcomes, a training session, and quiz and power point presentation detailing key oral health messages. The service has successfully implemented the award scheme in care homes across Northumberland, assuring improved health in their setting.
  • The service oversaw the dental care of all looked after children in the North Tyneside area. This work began several years ago and involved a consultation process with children, young people carers and professionals. They developed a multidisciplinary approach and created a defined dental care pathway for looked after children within North Tyneside. Northumbria Dental Services received an award by the Patient Experience Network National Award for this pioneering work.
  • The oral health promotion team was instrumental in developing innovative resources for patients with learning disabilities. One resource was a patient information booklet that shows a typical journey through the service for patients with learning disabilities. Patients collaborated on the project and took and modelled in the booklet’s photographs. Another dental resource was developed by the oral health promotion team as part of the ‘Jack and Josephine’ initiative. Jack and Josephine are life size cloth models that act as learning aids for men and women’s groups in Northumberland. As part of this project the oral health promotion team developed a leaflet resource about a dental visit using Jack and Josephine to support care provision to patients with learning disabilities.
  • The oral health promotion team was developing a dental component for the Trust’s young peoples ‘You’re Welcome’ project which supports and encourages younger people to access health services in a timely manner.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

  • Complete a comprehensive gap analysis against the recommendation made for the University Hospitals of Morecambe Bay NHS Foundation Trust in relation to maternity services.
  • Ensure that the maternity and gynaecology dashboard is fit for purpose, robust and open to scrutiny.
  • Ensure that the entry and exit to ward 16 in Maternity services at Northumbria Specialist Emergency Care Hospital are as safe as possible to reduce the risk of infant abduction.
  • Ensure that the storage of emergency drugs, within maternity services at Northumbria Specialist Emergency Care Hospital, are stored safely in line with the trust’s pharmacy risk assessment.
  • Ensure risk assessments in relation to falls, pressure ulcers, VTE and nutrition are consistently completed for all patients within medical care services at NSECH.

Professor Sir Mike Richards

Chief Inspector of Hospitals

9 - 13 November

During an inspection of Community dental services

Overall rating for this core service Outstanding 

We rated the dental services at this trust as outstanding because:

Services were effective, evidence based and focused on patients’ needs. We saw examples of excellent collaborative team working. We also saw examples of innovative working including an orthodontic service that catered primarily for the needs of vulnerable children such as those with disabilities and complex medical conditions. The service had also co-developed with colleagues in the North East Oral Health Promotion Group, a comprehensive resource pack to support the maintenance of oral health of elderly residents in care homes. The service had implemented an award scheme in care homes across Northumberland with the aim of assuring improved oral health in a care home setting. The continuing development of staff was seen as integral to providing high quality care and all staff received professional development appropriate to their role and learning needs. Staff, registered with the General Dental Council had frequent continuing professional development and met their professional registration requirements.

The service was extremely responsive to patients’ needs; people could access services in a timely way that suited them. Service waiting times for each clinic and the waiting times for general anaesthesia at each hospital showed that waiting times for the first available appointment were within one to three weeks dependant on the clinic. The waiting times for special needs adults under general anaesthesia were 6 weeks or less. However, patients requiring urgent care could be seen earlier. Effective multidisciplinary team working and links between clinics ensured patients received appropriate care at the right times and without avoidable delays. Patients from all communities could access treatment if they met the service’s criteria. The dental service had been recognised for pioneering work involving looked after children across North Tyneside and had received a national award by the Patient Experience Network for this work. The service had a proactive approach to understanding the needs of different groups of people. We found that the oral health promotion team had developed a patient information booklet explaining the patient journey for dentistry through the eyes of a patient with learning disabilities. Learning disability patients had taken a joint lead role in developing the booklet

The service was very well-led with organisational, governance and risk management structures in place.

These governance arrangements were proactively reviewed and reflected best practice. There was strong leadership of the service, with an emphasis on driving continuous improvement. The local management team were visible and the culture was seen as open and transparent. There was strong collaboration and support across all of the service with a strong emphasis on improving the quality of care.

Staff were aware of the way forward and vision for the organisation and said that they felt well supported and could raise any concerns with their line manager. Staff at all levels were actively encouraged to raise concerns. There were high levels of staff satisfaction across all staff groups. Team meetings and staff surveys demonstrated that the service engaged all staff.

Staff protected patients from abuse and avoidable harm. Systems for identifying, investigating and learning from patient safety incidents were in place. Infection control procedures were in place. The environment and equipment were clean and well maintained.

Patients, relatives and carers said they had positive experiences of care within the service. We saw good examples of staff providing compassionate and effective care. We also saw effective interactions taking place between individual staff members. We found staff to be hard working, caring and committed to the care and treatment they provided. Staff spoke with passion about their work and conveyed their dedication to what they did.

9-13 November 2015

During an inspection of Community health services for children, young people and families

Overall, we rated community health services for children, young people and families as outstanding because:

Managers and staff created a strong, visible, person-centred culture and were highly motivated and inspired to offer the best possible care to children and young people, including meeting their emotional needs. Staff were very passionate about their role and, in some cases, went beyond the call of duty to provide care and support to families. There was respect for the different personal, cultural, social and religious needs of the children and young people they cared for, and care and treatment was focussed on the individual person rather than the condition or service.

Families were very positive about the service they received. They described staff as being very caring, compassionate, understanding and supportive. Children and young people were able to see a healthcare professional when they needed to and received the right care at the right time. Services were flexible, provided choice and ensured continuity of care. The care and treatment of children and young people achieved good outcomes and promoted a good quality of life. Staff proactively collected and monitored this data and used the information to improve the care they delivered.

The culture was open and transparent with a clear focus on putting children and young people at the centre of their care. Services had good strategies and plans, each with service-specific objectives and goals to meet the needs of children and young people and deliver a high quality service. These plans directly linked with the overarching trust vision and goals.

Staff protected children and young people from avoidable harm and abuse. Managers and staff discussed incidents regularly at monthly meetings and took appropriate action to prevent them from happening again. Staff regularly received safeguarding supervision from managers and the trust safeguarding children team, who also kept services updated on outcomes and learning from serious case reviews. The clinics, health centres, children’s centres and school premises we visited were clean and staff followed national guidance in relation to hand hygiene and infection prevention and control. Staff managed medicines safely and the quality of healthcare records was good. Clinical leads and service managers audited records annually and outcomes shared with individuals and the wider team.

Managers and staff managed caseloads well, and there were effective handovers between health visitors and school nurses to keep children safe at all times. On a day-to-day basis, staff assessed, monitored and managed risks to children and young people and this included risks to children who were subject to a child protection plan or who had complex health needs.

Staff were very positive about working for the trust and leadership was excellent across all services. There was a clear management structure and managers were visible and involved in the day-to-day running of services. Staff could contact them whenever they needed to and received regular supervision from line managers and clinical leads. The trust provided opportunities for training and development and staff were well trained and highly motivated to offer the best possible care to children and young people.

9-13 November 2015

During an inspection of Community health services for adults

Overall rating for this core service Outstanding

We rated community adult services as outstanding because:

National guidance, the National Institute of Health and Care Excellence (NICE) and professional bodies were complied with and that staff showed awareness of relevant guidance in their work. Staff were actively engaged in activities to monitor and improve quality and outcomes. For example, the tissue viability service (TVS) used the SSKIN bundle, this was a five step model to reduce incidents of pressure ulcers and endorsed by NHS England. The service had gone further in pioneering their own pressure ulcer and skin integrity ‘aide memoire’ for staff to assist in identifying patients at risk of developing pressure ulcers. This had resulted in the trust moving from being a national outlier for pressure ulcer care to consistently performing better than the national average. Quality of care was monitored through audits, which informed the development of local guidance and practice. We found that patients could access all professionals relevant to their care through a system of truly integrated multi-disciplinary teams; and that patients’ care was co-ordinated and managed. There were systems to gain people’s consent prior to care and treatment. Where patients lacked the capacity to give consent, there were arrangements to ensure that staff acted in accordance with their legal obligations. There were robust systems to ensure professional staff remained registered with the relevant professional body.

Patients and carers we spoke with were overwhelmingly positive about their experience of care and treatment, and feedback gathered by the organisation showed high levels of satisfaction. Words and phrases such as “tremendous,” “cheerful and considerate,” “extremely happy with the care,” were used extensively in their feedback. We viewed the Community Services Business Unit (CSBU) Friends and Family Test (FFT) results November 2015; 99% of patients said they were treated with dignity and respect. We reviewed results from the FFT for the period July – September 2015 for 24 Community Adult Services Teams. The average score for people who responded that they would be likely to recommend community services was 99%. We observed all staff responding to people with kindness and compassion. Patients told us they were treated with dignity and respect, and that they were involved in the planning and delivery of their care to the extent they wished to be. Staff were prepared to and did go the ‘extra mile’ for patients.

The involvement of other organisations and the local community was integral to how services were planned and ensured that services meet people’s needs. We found that community adult services had a model of integrated community teams across health and social care to ensure people received truly joined up working that was responsive to patients’ individual needs. There was a focus of providing services close to where people lived and at times that were convenient to them. There was provision to ensure that essential services were available out-of-hours, and there were no major issues with waiting lists.

There was a clear vision and values that were shared by staff and demonstrated in their work. There was a clear articulation of the strategic direction for the service and staff felt engaged with the strategy. Consideration was given to ensure that developments were sustainable. We found evidence of innovative practice and research including partnership working with industry. The leadership drove continuous improvement and staff were accountable for delivering change. There was a clear proactive approach to seeking out and embedding new and more sustainable models of care. There were systems to ensure good governance and monitoring of standards and performance. There was an effective escalation and cascading of information from the board to front-line workers, and vice-versa. We found that there was a positive culture, with staff and managers feeling proud of their work and achievements and speaking well of their colleagues and the organisation.

We found that community adult services (CAS) achieved a good standard of safety. This was because there were robust methods of reporting, investigating and learning from incidents and near misses that were well understood by staff and embedded in their daily work. There were plans to deal with major incident or events that would disrupt the delivery of care. We saw evidence that CAS staff were making appropriate adult safeguarding referrals. There were processes and systems that protected patients from the risk of infection, and the risks associated with equipment used in their care and treatment. There were safe systems of medicines management. Records were accurate, comprehensive and current, and supported the delivery of safe care. We saw that between 85% and 100% of mandatory training had been completed across CAS against a trust target of 85%. Staffing numbers were reviewed, an active recruitment programme was in progress and arrangements to ensure any staffing shortfalls were managed on an on-going basis to minimise the impact on patients.

9 – 13 November 2015

During an inspection of esb.services_rated.urgent care services

We rated urgent care as good because:

The service prioritised patient protection from avoidable harm and abuse. There was a genuinely open culture for both staff and patients to raise concerns and receive appropriate response, feedback and learning. We found ongoing progression towards safety goals including high standards of training, skill and experience. Medicine management and the recording of medical information was of a high standard and well maintained. Training and appraisal rates exceeded trust targets as a whole and we saw the staff were highly competent. Staff were openly encouraged to progress their training both internal and externally. We saw examples of staff being encouraged to undertake university degree courses and progress to Emergency Nurse Practitioner levels.

All staff were aware of their personal accountability in managing risk and took responsibility as a team to ensure that risk management plans were followed, maintained and changes discussed with senior staff. Specific areas of training identified by anticipating risk had been undertaken. We found that all staff were actively engaged in activities to monitor and improve quality outcomes. The trusts contribution to local and national audit was in line with the national average, and evidence of changes made by specialities in response to their outcomes was available and had been actioned.

There was a holistic approach to assessing, planning and delivering care and treatment. The telemedicine service, introduced by the trust in May 2013, used the latest digital technology to help treat fractures in Berwick and Alnwick. Specifically trained staff at each infirmary conducted a live video conferencing linkup to specialist doctors in Wansbeck General Hospital. This saved patients from travelling long distances for appointments and meant the rural population could receive treatment locally. This benefitted patients of all ages and increased multidisciplinary joined-up working with other hospital locations. We observed the telemedicine service provide real-time information across teams and services resulting in quicker treatment times and outcomes.

We found staff to be hard working, caring and committed to delivering a good quality service. They spoke with passion about their work and were proud of what they did. Staff clearly recognised the versatility of people’s needs and were skilled in dealing with vulnerable individuals with complex physical and mental health needs. There was a high emphasis on staff and public engagement. The trust encouraged members of the public to leave feedback, either formally or through social media. The patients we spoke to said they felt very confident about raising concerns or making suggestions.

There was a clear vision and strategy for the service, which was well developed and well understood throughout the department. The behaviours and actions of staff working in the service mirrored the trust values of ‘patients first’, safe high quality care, responsibility and accountability. We saw multiple examples of this during the inspection. There was clear ownership of services and patient-centred care was a priority.

9 – 13 November 2015

During an inspection of Community end of life care

Overall, we rated community end of life care as outstanding because:

The feedback from people who used the service and those who were close to them was extremely positive about the care received by patients nearing the end of life. We saw that staff were motivated to go the extra mile to meet patient’s needs and the care patients received exceeded their expectations. Results from the 2014 cancer patient experience survey showed Northumbria Healthcare NHS Foundation Trust was in the top ten best performance trusts. Families were very positive about staff and the service they received. The service demonstrated a high level of compassionate care to patients and their families. We saw that staff were motivated to go ‘the extra mile’ to meet patients’ needs. We observed a commitment to providing care that was of a consistently high standard and focused on meeting the emotional, spiritual and psychological needs of patients as well as their physical needs.

There was a clear vision and strategy that focused on the early identification of patients at the end of life, patients being cared for in their preferred place of care and the use of partnership working to develop services. The strategy clearly communicated the vision of integrated services across the community and acute sectors to support patients being cared for in their preferred place of care. There was end of life care representation/leadership at trust board level and we saw evidence of active engagement in end of life care at board level. There were innovative approaches being implemented to achieve the joined up service within acute and community end of life teams. There was comprehensive leadership within the palliative care service with clearly defined leadership roles. They were passionate about the service and encouraged staff to deliver high quality care. Local managers were proactive and came from a clinical background. They demonstrated an understanding of the current issues facing the service. There was a clear sense of pride and belonging amongst staff at all levels within the end of life care teams. Each person’s role was seen as being equally as important as the next. Staff appeared to have a genuine respect for each other within the team. Staff we spoke with demonstrated a commitment to the delivery of good quality end of life care. There was evidence that staff felt proud of the care they were able to give and there was positive feedback from nursing and care staff as to the level of support they received from the specialist palliative care team.

The trust was in the top ten and came 6th out of all trusts in England for the quality of care reported by the Cancer Patient Experience Survey 2014.

Staff understood their responsibilities to raise concerns and to record safety incidents. There was an open culture in reporting incidents and there were systems in place to learn from incidents and reduce the chances of them happening again. There was good identification of patients at risk of deterioration and we saw evidence of the use of emergency health care plans in ensuring that all patients had a plan in place should their condition deteriorate. There was appropriate equipment available in patients’ homes and use of anticipatory prescribing of medicines at the end of life. Mandatory training levels were good, with all community palliative care staff up to date across all localities.

The trust provided effective end of life care to patients. Patients in need of end of life care were identified at an early stage in their care, and staff were alerted to patients who were known to the community team or on a palliative care register. The trust had implemented the Care of the Dying Patient document which was being used as a guide to delivering high quality end of life care.

Policies and guidelines were all evidence based and we saw excellent examples of multi-disciplinary and multi-agency working and collaboration.

The partnership with Marie Curie provided additional flexibility to enable specialist palliative care staff to provide support to patients at the end of life. This was irrespective of the complexities of their condition. Also there were strong links between the hospital liaison service, Marie Curie and the specialist palliative care staff. There were integrated person-centred pathways that involved these different service providers. Services were flexible, provided choice and ensured continuity of care.

9 - 13 November 2015

During an inspection of Community health inpatient services

We rated community inpatient services as good because:

The service prioritised patient protection from avoidable harm and abuse. There were clearly defined and embedded systems, processes and standard operating procedures to keep people safe and safeguarded from abuse. We saw evidence of an open and transparent culture in relation to incident reporting. Opportunities were available to learn from investigations and the service was aware of areas in which it needed to improve, such as falls. The department was clean and there was an active infection control and prevention audits, which showed high scoring outcomes. Risks to people who used services were assessed, monitored and managed on a day-to-day basis. Escalation and deterioration plans were in place for patients when staff had concerns regarding a patients condition and wellbeing. All wards had good staffing levels and frontline staff told us their managers supported them if they needed to increase their staffing numbers when patient dependency increased.

The trust’s contribution to local and national audit was in line with the national average, and evidence of changes made by specialities in response to their outcomes was available and had been actioned. Accurate and up-to-date information was shared with staff and used to improve care and treatment and people’s outcomes. People’s care and treatment was planned and delivered in line with current evidence-based guidance, standards, best practice and legislation. People had good assessments of their needs, which included consideration of clinical needs, mental health, physical health and wellbeing, and nutrition and hydration needs. Staff were qualified and had the skills they needed to carry out their roles effectively and in line with best practice. Staff were supported to maintain and further develop their professional skills and experience. We saw strong and respectful multidisciplinary team working during our inspection and feedback from all disciplines emphasised this. They worked closely with the local authority when planning discharge of complex patients and when raising safeguarding alerts.

We observed the treatment of patients to be compassionate, dignified, and respectful throughout our inspection. Feedback from numerous patients across all five of the community locations was exceptional. We heard that staff went the extra mile to be supportiv e, to assist patients over and above routine tasks and ensure that patients were fully included in all decision making regarding their health and wellbeing. Relatives said they felt involved in their care and had the opportunity to speak with the doctor looking after their family member. Staff spoke with passion about their work and were proud of what they did. Complaints and concerns were taken seriously and responded to in a timely way. Improvements were made to the quality of care as a result of complaints and concerns.

There was a clear vision and strategy for the service, which was well developed and well understood throughout the department. The behaviours and actions of staff working in the division mirrored the trust values of ‘patient’s first, safe and high quality care, and responsibility and accountability’ of which we saw multiple examples of during our inspection. There was evidence of ownership of services and patient centred care was clearly a priority. Risks and potential risks discussions were ongoing and there was a governance structure for formal escalation where appropriate. Many of the wards were piloting a scheme called ‘Board to Ward’, which encouraged staff to develop safety and quality priorities specific to them and lead on improvements. It provided an opportunity to focus on the issues that matter at ward level, with staff having ownership in deciding what priorities should be, and how to meet these goals.

10-13 November 2015

During an inspection of Wards for older people with mental health problems

We rated wards for older people with mental health problems as good because:

  • assessments were comprehensive, carried out in a timely manner and regularly reviewed.
  • care and treatment was delivered in line with current evidence based guidance. A system of audit was in place to monitor compliance.
  • staff displayed a good understanding of their roles and responsibilities in relation to safeguarding. Safeguarding processes were robust.
  • ward shift establishment were developed using a staffing analysis tool. Actual staffing levels matched the identified need.
  • there were systems in place to ensure adherence with the Mental Health Act and Mental Capacity Act.
  • care plans were up to date and personalised.
  • patients and carers were involved in decisions about care and treatment.
  • feedback from patients, family members and carers was positive.
  • staff felt supported in their roles and worked effectively as a multidisciplinary team.
  • there was a good governance structure in place and an open and transparent culture evident on the wards.

However:

  • the two mixed sex wards were not compliant with same sex accommodation guidelines. However, the trust were aware of this issue and were due to move into new accommodation by March 2016. The new premises are compliant with same sex accommodation guidelines.
  • all staff received line management and caseload supervision.

Use of resources

These reports look at how NHS hospital trusts use resources, and give recommendations for improvement where needed. They are based on assessments carried out by NHS Improvement, alongside scheduled inspections led by CQC. We’re currently piloting how we work together to confirm the findings of these assessments and present the reports and ratings alongside our other inspection information. The Use of Resources reports include a ‘shadow’ (indicative) rating for the trust’s use of resources.

Intelligent Monitoring

We use our system of intelligent monitoring of indicators to direct our resources to where they are most needed. Our analysts have developed this monitoring to give our inspectors a clear picture of the areas of care that need to be followed up. Together with local information from partners and the public, this monitoring helps us to decide when, where and what to inspect.

Mental Health Act Commissioner reports

Each year, we visit all NHS trusts and independent providers who care for people whose rights are restricted under the Mental Health Act to monitor the care they provide and check that patients' rights are met. Immediate concerns raised by patients on those visits are discussed, if appropriate, with hospital staff.

Our Mental Health Act Commissioners may carry out a number of visits to each provider over a 12-month period, during which they talk to detained patients, staff and managers about how services are provided. In the past, we summarised themes from the visits and published an annual statement followed by the provider's response where applicable. We are looking at different ways to indicate the outcomes of our monitoring in the future.