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St Luke's Hospital Requires improvement

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

Inspection Summary


Overall summary & rating

Requires improvement

Updated 24 June 2016

Bradford Teaching Hospitals NHS Trust is an integrated trust, which provides acute and community health services. The trust serves a population of around 500,000 people in the Bradford and surrounding area. The trust operates acute services in Bradford Royal Infirmary and St Luke’s Hospital. The trust has four community hospitals; Eccleshill, Shipley, Westbourne Green and Westwood Park. Eccleshill Hospital was closed at the time of the inspection.

St Luke’s Hospital provides general medicine for adults as well as rehabilitation and therapy services. The hospital also provides outpatient services for adults and children.

We carried out a follow up inspection of the trust from 11-13 January 2016. This was in response to a previous inspection conducted as part of our comprehensive inspection programme in October 2014. In addition, an unannounced inspection was carried out on 26 January 2016.

Follow up inspections do not always look at every service the trust provides. They focus on the areas identified as requiring improvement in the previous inspection and any areas of concern identified in the time since the last inspection. In addition, not all of the five domains: safe, effective, caring, responsive and well led were reviewed for each of the core services we inspected.

At this inspection of St Luke’s Hospital we re-inspected the safe domain for medicine as we previously rated this service as requires improvement. We did not inspect the other domains for medicine as they were previously rated as good. We also re-inspected the safe, responsive and well-led domains in outpatient services as they were previously rated as inadequate for safety and requires improvement for the responsive and well-led domains.

At this inspection we rated St Luke’s Hospital as requires improvement. This was because outpatients was rated as requires improvement overall. Medicine remained rated as good overall, however safety was still rated as requires improvement.

Our key findings were as follows:

  • In relation to outpatient services, the trust had taken the necessary steps to ensure that the backlog of over 250,000 on non-referral to treatment patient pathways identified in May 2014 and April 2015 had been clinically reviewed and actions taken to reduce risks to patients, including prioritising appointments and the assessment of potential harm.  An improvement plan had been developed and systems and processes had been changed. The trust had revised executive, clinical and managerial leadership arrangements for outpatients and invested in additional administrative staff and a rolling programme of staff training.

  • However, the new systems and processes had not yet been embedded within the outpatient service and further work was required to establish the new centralised patient booking system. Staff did not feel engaged with the changes and expressed frustration at the new systems and processes. There were still a large number of patients waiting for outpatient appointments, which could delay access to treatment.

  • Policies and procedures in outpatients and diagnostics were not always up to date.

  • At the previous inspection in October 2014, concerns were raised about the out of hours medical cover at St Luke’s Hospital and the management of the deteriorating patient. At this inspection we found that all staff had a good understanding of the arrangements for medical cover out of hours. The trust had also commissioned an external review of medical staffing at St Luke’s and had concluded the medical cover was adequate for the service.

  • We had concerns about nurse staffing levels in medicine and found a number of occasions when the number of staff on duty was significantly below the planned level. We saw occasions when there was only one registered nurse and two health care assistants to look after 27 patients.

  • Nursing records were not stored securely on Ward F3. This meant there was a risk of confidential patient information being accessed.

  • In medicine, improvements had been made with safeguarding training and mandatory training rates were now above the trust target of 95%.

  • Ward and outpatient areas were visibly clean and staff generally followed infection prevention and control practices. There had been no cases of MRSA or Clostridium difficile on the medical wards at St Luke’s from January 2015 to the time of our inspection.

We saw several areas of good practice including:

  • Systems were in place to report and learn from incidents, wards monitored safety and harm-free care and safety thermometer information was now visible.

  • We saw evidence of shared learning between Bradford Royal Infirmary and St Luke’s Hospital. Staff at St Luke’s were able to tell us about a recent serious incident that had occurred at Bradford Royal Infirmary.

  • There were robust arrangements in place to ensure that only suitable patients were admitted to St Luke’s Hospital. We observed a nurse on F6 take a handover of a new patient and they challenged the staff member to ensure the patient was medically stable and appropriate for the ward

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

Importantly, the trust must:

  • Ensure that there are in operation effective governance, reporting and assurance mechanisms that provide timely information so that risks can be identified, assessed and managed.

  • Ensure there are improvements in referral to treatment times and action is taken to reduce the number of patients in the referral to treatment waiting list to ensure that patients are protected from the risks of delayed treatment and care.

  • The trust must ensure that robust arrangements are in place to ensure that policies and procedures (including local rules in diagnostics) are reviewed and updated.

  • Ensure patients notes are securely stored to ensure patients’ confidentiality is maintained.

  • The trust must ensure at all times there are sufficient numbers of suitably skilled, qualified and experienced staff in line with best practice and national guidance, taking into account patients’ dependency levels.

In addition the trust should:

  • Consider identifying a nominated individual at the hospital who is responsible for coordinating any concerns out of hours and at the weekend.

  • Review the use of interpreters in outpatients and diagnostics to ensure that patients’ privacy is maintained.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection areas

Safe

Requires improvement

Updated 24 June 2016

Effective

Good

Updated 24 June 2016

Caring

Good

Updated 24 June 2016

Responsive

Requires improvement

Updated 24 June 2016

Well-led

Requires improvement

Updated 24 June 2016

Checks on specific services

Medical care (including older people’s care)

Good

Updated 24 June 2016

Overall, we rated this service as good. However the safe domain remained as requires improvement. We did see some improvements from out last inspection. However, we found problems with medicine fridges and no action had been taken when temperatures were recorded out of range.

Documentation was to a good standard with risk assessments completed, however, patient’s notes were not always stored securely.

The trust had taken action to address concerns about nurse staffing levels by closing beds on ward F3 and moving Eccleshill Community Hospital to ward F5. However, we did not have assurances about staffing levels and found a number of occasions when the number of staff on duty was below the planned level.

However, we found systems were in place to report and learn from incidents, wards monitored safety and harm-free care, and safety thermometer information was now visible.

Improvements had been made with safeguarding training and mandatory training rates were now above the trust target of 95%.

At the previous inspection in October 2014, concerns were raised about the out of hours medical cover, and the management of the deteriorating patient. All staff had a good understanding of the arrangements for medical cover out of hours. The trust had also commissioned an external review of medical staffing at St Luke’s and had concluded the medical cover was adequate for the service.

Outpatients and diagnostic imaging

Requires improvement

Updated 24 June 2016

We inspected the outpatients department at St Luke’s Hospital in October 2014 as part of a comprehensive inspection. We rated the service overall at that inspection as inadequate. We rated safety, being responsive and well led as inadequate. Caring was rated as good. The effectiveness domain was inspected but not rated.

We had serious concerns over the large backlog of patients waiting for a review of their outpatient care pathway. There had been around 205,000 patient pathways to be reviewed. This figure was revised in April 2015 when a further 47,000 non-refer to treatment (RTT) backlog was identified adding to the previous backlog accumulating to around 250,000.

At this inspection, we rated the service overall as requires improvement. We rated safety as good, responsive and well led as requires improvement.

We found that a great deal of work had been undertaken to improve the arrangements for booking appointments, addressing concerns over the identified backlog with outpatient appointments and develop assurance mechanisms. The new systems and processes had not yet been embedded within the outpatient service and further work was required to establish the new centralised patient booking system. Staff did not feel engaged with the changes and expressed frustration at the new systems and processes. A programme of training and development had been introduced as part of the improvement plan to establish the centralised patient booking service. This was work in progress at the time of this inspection.

We found that there were systems and processes in place for incident reporting and learning from incidents.