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South Tyneside District Hospital Good

This service was previously managed by a different provider - see old profile

Inspection Summary


Overall summary & rating

Good

Updated 10 June 2020

We rated services as good because:

  • We rated safe, effective, caring, responsive and well led as good.
  • We rated six services as good and one service as requires improvement.
  • The service provided mandatory training in key skills, including safeguarding training, to all staff. Staff had training on how to recognise and report abuse. The service controlled infection risk well. Staff completed and updated risk assessments for each patient and took action to remove or minimise risks. The service had enough staff with the right qualifications, skills, training and experience. Staff kept detailed records of patients’ care and treatment. The service managed patient safety incidents well.
  • The service provided care and treatment based on national guidance and best practice. Staff gave patients enough food and drink to meet their needs and improve their health. Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way. Staff monitored the effectiveness of care and treatment. Key services were available seven days a week. Staff supported patients to make informed decisions about their care and treatment.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. Staff provided emotional support to patients, families and carers to minimise their distress. They understood patients personal, cultural and religious needs. Staff supported patients, families and carers to understand their condition and make decisions about their care and treatment.
  • The service planned and provided care in a way that met the needs of local people and the communities served. The service was inclusive and took account of patients’ individual needs and preferences. People could access the service when they needed it and received the right care promptly. It was easy for people to give feedback and raise concerns about care received.
  • Local leaders had the skills and abilities to run the service. They were visible and approachable in the service for patients and staff. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service had an open culture where patients, their families and staff could raise concerns without fear.

However:

  • In a number of services appraisals and mandatory compliance rates fell below the trust target. The facilities in the emergency department for conducting assessments of patients with mental health conditions were not compliant with national guidance. We had staffing concerns on the medical care wards. The critical care service was not fully meeting the GPICS standards for medical and allied health professional staffing. We found medical devices which were out of date for servicing and maintenance.
  • Staff in surgical services had limited understanding of the Mental Capacity Act and Deprivation of Liberty Safeguards. In critical care services we found some printed guidelines which were out of date and there were not enough clinical educators to meet the GPICS standards.
  • Surgical services were not meeting the trust targets for theatre utilisation. In some services identified risks had been on the risk register for a number of years and mitigating actions were not sufficient to reduce their impact and we saw limited examples of cohesive working across the trusts two critical care units. Whilst some services had a vision for what they wanted to achieve, the strategies were not yet developed. Some services needed more work to ensure effective governance processes were in place. We did not see or hear of many examples of innovation, improvements or research.
Inspection areas

Safe

Good

Updated 10 June 2020

Effective

Good

Updated 10 June 2020

Caring

Good

Updated 10 June 2020

Responsive

Good

Updated 10 June 2020

Well-led

Good

Updated 10 June 2020

Checks on specific services

Medical care (including older people’s care)

Good

Updated 10 June 2020

  • The service provided mandatory training in key skills to all staff and had systems in place to monitor compliance.
  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
  • Staff kept detailed records of patient’s care and treatment. Records were clear, up-to-date and easily available to all staff providing care. On the wards we visited we saw all paper records were locked in records cabinets. Electronic records could only be accessed through a password and login system.
  • Staff knew how to support patients who lacked capacity to make their own decisions Mental Capacity Act and Deprivation of Liberty Safeguards training compliance did meet the trust target of 90%. The target was met for the Mental Capacity Act and Deprivation of Liberty Safeguards training module for which medical staff at South Tyneside District Hospital were eligible.
  • The service had suitable premises and equipment and looked after them well. We found the hospital was accessible to wheelchair users, with clear signage.
  • The service managed patient safety incidents well. Staff recognised and reported incidents and near misses. Managers investigated incidents and shared lessons learned with the whole team and the wider service.
  • Staff completed and updated risk assessments for each patient and removed or minimised risks.
  • The service provided care and treatment based on national guidance and evidence-based practice. Managers checked to make sure staff followed guidance. Staff protected the rights of patient’s subject to the Mental Health Act 1983.
  • 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 needs.
  • Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way. They supported those unable to communicate using suitable assessment tools and gave additional pain relief to ease pain.
  • Staff monitored the effectiveness of care and treatment. They used the findings to make improvements and achieved good outcomes for patients. The service had been accredited under relevant clinical accreditation schemes. For example, they had achieved Joint Advisory Group accreditation for their endoscopy services.

However:

  • At this inspection we found concerns surrounding safe staffing levels and the governance, oversight and monitoring of staff training for both mandatory training, safeguard training and staff appraisal rates in the medical care service.
  • We were not assured the service always had enough nursing staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed and adjusted staffing levels but staff told us skill mix was not always appropriate and staff were regularly moved to work in other areas.
  • Fill rates for qualified nurses and non-qualified care staff varied in the six months before inspection and did not rise above 86% for qualified staff during the day and 86% at night. These shortfalls in qualified nurse staff had been met by an increase in non-qualified care staff with on average 117% during the day and 103% at night.

Critical care

Good

Updated 10 June 2020

  • We rated safe, effective, caring, responsive and well led as good.
  • The service provided mandatory training in key skills, including safeguarding training, to all staff and made sure most completed it. Staff had training on how to recognise and report abuse and they knew how to apply it. The service controlled infection risk well. On the whole, the design, maintenance and use of facilities, premises and equipment kept people safe. Staff completed and updated risk assessments for each patient and took action to remove or minimise risks. The service had enough medical staff with the right qualifications, skills, training and experience. Staff kept detailed records of patients’ care and treatment. The service managed patient safety incidents well. Staff collected safety information and shared it with staff, patients and visitors.
  • The service provided care and treatment based on national guidance and best practice. Staff gave patients enough food and drink to meet their needs and improve their health. Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way. Staff monitored the effectiveness of care and treatment. The service made sure staff were competent for their roles. Key services were available seven days a week. Staff supported patients to make informed decisions about their care and treatment. They knew how to support patients who lacked capacity or were unable to make their own decisions or were experiencing mental ill health.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. Staff provided emotional support to patients, families and carers to minimise their distress. They understood patients personal, cultural and religious needs. Staff supported patients, families and carers to understand their condition and make decisions about their care and treatment.
  • The service planned and provided care in a way that met the needs of local people and the communities served. The service was inclusive and took account of patients’ individual needs and preferences. People could access the service when they needed it and received the right care promptly. It was easy for people to give feedback and raise concerns about care received.
  • Local leaders had the skills and abilities to run the service. They were visible and approachable in the service for patients and staff. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service had an open culture where patients, their families and staff could raise concerns without fear.

However, we also found:

  • Although the trust had plans to reconfigure, modernise and extend the department, it did not meet the requirements for the relevant health building note at the time of our inspection. The service was not fully meeting the GPICS standards for medical and allied health professional staffing. Some staff were not up to date with their mandatory training. We found medical devices which were out of date for servicing and maintenance. There was some damage to the flooring in the side rooms and we found items on the floor of the store room. This could result in cleaning processes being ineffectual or restricted.
  • We found some printed guidelines which were out of date. The service was not meeting the trust’s appraisal compliance level to support staff development. There was not enough clinical educators to meet the GPICS standards.
  • Whilst the service had a vision for what it wanted to achieve, the strategy to turn it into action was not yet developed. More work was needed to ensure effective governance processes were in place. We did not see or hear of many examples of innovation, improvements or research.

End of life care

Good

Updated 10 June 2020

  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
  • Staff supported patients, families and carers to understand their condition and make decisions about their care and treatment.
  • The service provided mandatory training in key skills to all staff and made sure everyone completed it.
  • The service used systems and processes to safely prescribe, administer, record and store medicines.
  • Staff used infection control measures when visiting patients on wards and transporting patients after death.
  • Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date and easily available to all staff providing care.
  • The service provided care and treatment based on national guidance and best practice. Managers checked to make sure staff followed guidance.
  • Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way. They supported those unable to communicate using suitable assessment tools and gave pain relief to ease pain.
  • Patients could access the specialist palliative care service when they needed it. Waiting times from referral to achievement of preferred place of care and death were in line with good practice.
  • Leaders had the integrity, skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff. They supported staff to develop their skills.
  • The service had a vision for what it wanted to achieve and a draft strategy to turn it into action, developed with all relevant stakeholders. The vision and draft strategy were focused on sustainability of services and aligned to local plans within the wider health economy.
  • Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service promoted and provided opportunities for career development. The service had an open culture where patients, their families and staff could raise concerns without fear.

However:

  • There was no concealment cover for transporting bariatric patients to the mortuary. Nursing staff and porters told us that bariatric patients were transported with a sheet over them and sometimes a face mask. We did not think this was very dignified way to transport deceased bariatric patients.
  • The end of life strategy was still in draft at the time of inspection and although there was an improvement plan, there were no agreed timescales for implementation.

Maternity

Good

Updated 10 June 2020

  • The service had enough skilled and experienced maternity staff to keep women safe from avoidable harm and to provide the right care and treatment. Staff completed and updated risk assessments for each woman and took action to remove or minimise risks; and kept detailed records of women's care and treatment. They understood how to protect women from abuse and the service worked well with other agencies to do so.
  • Staff identified and quickly acted upon women at risk of deterioration and completed frequent (planned and unplanned) simulations of obstetric emergencies. All emergency equipment we reviewed was secure, appropriately stocked, equipment was in date, and checks had been completed. The service controlled infection risk well.
  • Outcomes for women and babies were good. Staff monitored the effectiveness of care and treatment. Staff supported women to make informed decisions about their care and treatment. They assessed and monitored women regularly to see if they were in pain and gave pain relief in a timely way. The service used systems and processes to safely prescribe, administer, record and store medicines.
  • Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff treated women with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and provided emotional support to women, families and carers. The service had an open culture where patients, their families and staff could raise concerns without fear. It was easy for people to give feedback and raise concerns about care received.
  • Leaders and staff actively and openly engaged with patients, staff, equality groups, the public and local organisations to plan and manage services. People could access the service when they needed it and women received the right care promptly. Services had been designed so that women could continue to access the majority of antenatal and postnatal care locally, despite the reorganisation of services.

However:

  • Compliance targets for mandatory training and appraisal were not always met for midwifery staff for the period April 2019 to January 2020.
  • The (trust-wide) audit schedule for the service was not comprehensive. There was no evidence of key audits being carried out from April to December 2019, including record keeping, medicines management and infection prevention and control audits. We were mindful that service reconfiguration had only taken place in August 2019.
  • At trust level, there was not sufficient oversight of benchmarking outcomes with other regional services, and this had been an ongoing concern. We also saw some risks on the maternity risk register had been ongoing for a considerable amount of time. We saw that there were no specific risks entered on the risk register pertaining to the South Tyneside site. However, services at the location were substantially reconfigured in August 2019, and the risk register we reviewed was dated to September 2019. Following our inspection, we received an updated copy of the risk register which included review dates, stating that some risks had been reviewed in February 2020, however, there remained no risks pertaining to the South Tyneside site.

Outpatients

Good

Updated 10 June 2020

  • The service provided mandatory training in key skills to all staff and made sure everyone completed it. Staff understood how to protect patients from abuse. Staff had training on how to recognise and report abuse and they knew how to apply it.
  • The service controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection.
  • The design, maintenance and use of facilities, premises and equipment kept people safe. Staff were trained to use them. Staff managed clinical waste well.
  • The service had enough nursing and support staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed and adjusted staffing levels and skill mix, and gave bank and agency staff a full induction.
  • Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date, stored securely and easily available to all staff providing care.
  • The service used systems and processes to safely prescribe, administer, record and store medicines.
  • The service managed patient safety incidents well. Staff recognised and reported incidents and near misses. Managers investigated incidents and shared lessons learned with the team.
  • Doctors, nurses and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care.
  • Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. Staff provided emotional support to patients, families and carers to minimise their distress. Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.
  • The service planned and provided care in a way that met the needs of local people and the communities served. People could access the service when they needed it and received the right care promptly. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were in line with national standards.
  • It was easy for people to give feedback and raise concerns about care received.
  • Leaders understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff. They supported staff to develop their skills and take on more senior roles. The service had a vision for what it wanted to achieve and a strategy to turn it into action.
  • Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service promoted and provided opportunities for career development.
  • Leaders operated governance processes, throughout the service and with partner organisations. Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service. Leaders and teams used systems to manage performance effectively. They identified and escalated relevant risks and issues and identified actions to reduce their impact.
  • The service collected data and analysed it. Staff could find the data they needed, in easily accessible formats, to understand performance, make decisions and improvements. The information systems were integrated and secure.
  • Leaders and staff actively and openly engaged with patients and staff to plan and manage services. All staff were committed to continually learning and improving services. They had a good understanding of quality improvement methods and the skills to use them.

However:

  • Although leaders could describe the governance arrangements across all outpatient services, these new governance systems required embedding further. No formal outpatient service clinical governance meetings had taken place since the trust merger. We were made aware that speciality governance meetings took place. Leaders acknowledged the need to embed the governance systems further across outpatients and were working to do this starting with the planned governance meetings.
  • There was a list of patients overdue a review appointment extending to 14,844 patients across all specialties and sites within the trust. Clinicians and senior managers had strong oversight of all patients waiting for appointments and outpatient leaders worked with directorates regarding capacity and demand.
  • Appraisal compliance rates did not consistently meet the trust compliance target, although there were plans to complete the appraisals by the end of January 2020.
  • During the inspection, there was an unlocked storage room in the outpatient department. We raised this with managers during the inspection.

Surgery

Good

Updated 10 June 2020

  • We rated safe, effective, caring, responsive and well-led as good.
  • The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines and safety incidents well. Staff collected safety information and used it to improve the service.
  • Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
  • The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities were committed to improving services.

Urgent and emergency services

Requires improvement

Updated 10 June 2020

  • We rated safe, responsive and well led as requires improvement. We rated effective and caring as good.
  • Some mandatory compliance rates fell beneath the trust target of 90%. We were particularly concerned about resuscitation training for medical staff which was 48% and with compliance with infection prevention and control which was 44%.
  • There was not enough nursing staff, however staffing gaps were filled by bank and agency staff.
  • We did not consider the facilities for conducting assessments of adults and children with mental health conditions to be safe for staff or patients. The room allocated to assess patients with mental health presentations was not appropriate for this use. We acknowledged that work had been undertaken to comply with the quality standards of the Psychiatric Liaison Accreditation Network (PLAN), however we found ligature risks within the room and we were not assured that the emergency alarm system was functioning appropriately.
  • We observed poor compliance with the trust infection prevention and control policy.
  • The department failed to meet the national standards for time to initial assessment, unplanned re-attendance rate within seven days, median time from arrival to treatment (all patients), percentage of patients admitted, transferred or discharged within four hours.
  • There was a steady decline in performance from April 2019 with no actions plans in place to address the issues and improve.
  • Staff felt that they weren’t involved in service planning or strategy development as the perceived focus was on the department at Sunderland Royal Hospital which led to issues within the team.
  • Integration of the two departments within the trust had commenced but this was not fully embedded which left staff at South Tyneside with a sense of disconnect from the wider directorate.

However, we also found:

  • Staff understood how to protect patients from abuse, and managed safety well. They managed medicines well. The service managed safety incidents well and learned lessons from them.
  • Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
  • The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.