You are here

Inspection Summary


Overall summary & rating

Good

Updated 24 March 2020

Our rating of services stayed the same. We rated it them as good because:

  • Patients were protected from abuse and avoidable harm. Most infection prevention and control practices were carried out effectively. There were good staffing levels and most patient records well managed with medicines looked after safely. There was a strong culture around reporting incidents. Most risks to patients were assessed well and acted upon.
  • Care was effective and patients had good outcomes. Staff promoted a good quality of life with patients. There was a strong culture of multidisciplinary input into care and treatment. Care was delivered in line with evidence-based practice and legal frameworks. Pain relief, nutrition and hydration were managed well.
  • Patients and those who cared for them spoke highly of the care and treatment given to them. They were treated with compassion and kindness and as individuals. People were able to make their own decisions and supported to do so. The right people were involved when patients were not able to decide for themselves.
  • Services were designed to meet the needs of local people. Patients were treated as individuals and adjustments were made to give everyone the best outcome. Care was mostly available to people when it was needed. There was learning from complaints and concerns raised by patients and those who spoke for them.
  • The staff leadership teams had the skills, knowledge, and experience to manage services. High-quality and patient-centred care was promoted. There was a vision for the future of services, and a clear set of values for staff based on the experience for the patient. Staff were well supported and there was good morale and a strong culture. Staff were willing to challenge poor practice and support each other. There was a strong culture around innovation, research, development and improvement. There were mostly good governance systems to give assurance of good, safe and quality services.

However:

  • We had concerns about the safety of the anaesthetic cover out of hours, particularly in maternity and critical care services. We had this concern on our previous inspection in 2017, and although this had progressed, it was not fully resolved. Staff were not compliant with the target for updating some mandatory training modules. As with our previous report in 2017, not all emergency equipment was being checked as it should be, although this had improved. There were security problems in critical care (although the unit was locked to open access shortly after our inspection). There were insufficient numbers of allied health professional staff in critical care.
  • Clinical deterioration of patients was not always well documented once the patient was highlighted to the medical staff for review.
  • Most patient records were held securely, although as with our previous inspection, there were some lapses in this area at times. The care for children admitted with underlying mental health illnesses had sometimes impacted on others on the ward.
  • Not all mental capacity assessments were documented consistently. Less than the recommended number of nursing staff in critical care had post-registration training. Not all staff were receiving annual performance reviews.
  • The trust had not met the NHS constitutional standards for treating patients on time for a number of years, and this was not improving.
  • Governance meetings did not always include key elements and not all were well recorded.
Inspection areas

Safe

Requires improvement

Updated 24 March 2020

Effective

Good

Updated 24 March 2020

Caring

Outstanding

Updated 24 March 2020

Responsive

Good

Updated 24 March 2020

Well-led

Good

Updated 24 March 2020

Checks on specific services

Urgent care centre

Updated 21 November 2013

The A&E department provided effective care and staff were caring and responsive. Most patients were seen and treated within the national waiting time limit of four hours and plans were put in place for discharge or transfers for further care and treatment. However, there were not always enough senior doctors present at night and weekends. Children were seen by appropriate child care specialists but there were concerns that not enough staff in the A&E department had up-to-date qualifications in emergency child care.

Medical care (including older people’s care)

Good

Updated 24 March 2020

Our rating of this service stayed the same. We rated it as good because:

  • 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 mostly managed safety well. The service controlled infection risk well. Staff assessed risks to patients most, acted on them and kept good care records most of the time. They managed medicines well. The service managed safety incidents well and learned lessons from them. 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 consistently 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. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However:

  • Nurse staffing levels in the four-bed high dependency respiratory area did not always meet the trust policy, specifically at night, although a business case had been submitted to address this.
  • Although this had improved since our last inspection, when this was an area of concern, some emergency equipment was still not consistently checked on a daily basis in all areas.
  • Staff were not compliant with the target for updating some mandatory training modules.
  • The service was not meeting the NHS constitutional standards for treating patients on time in a number of specialties and over a number of years. This was not improving.

Services for children & young people

Good

Updated 24 March 2020

  • The service had enough staff to care for children and young people and keep them safe. Staff had training in key skills, understood how to protect children and young people from abuse, and managed safety well. Staff assessed risks to children and young people, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
  • Staff provided care and treatment, gave children and young people 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 children and young people, advised them and their families 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 consistently treated children and young people 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 children and young people, families and carers.
  • The service planned care to meet the needs of local people, took account of children and young people’s 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 children and young people receiving care. Staff were clear about their roles and accountabilities. The service engaged well with children, young people and the community to plan and manage services and all staff were committed to improving services continually.

However:

  • The children’s unit and the neonatal unit were situated within ageing buildings and the management and maintenance of the environments were complex and challenging.
  • Although the units and most clinical areas were seen to be visibly clean, well-organised and tidy some areas were showing signs of age, wear and tear, making them harder to keep clean.
  • Not all records were stored securely. Although locks were on order, some records were held in unlocked ward cupboards.
  • The provision of care and treatment to children and young people with mental health illnesses had at times impacted upon others on the ward.

Critical care

Good

Updated 24 March 2020

  • The service had enough staff to care for patients and keep them safe. Staff mostly had training in key skills, understood how to protect patients from abuse, and managed safety well. The service mostly controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. 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 consistently 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. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However:

  • There were concerns surrounding the environment and equipment. The critical care unit was situated within ageing buildings so the environment was complex to manage. There was unrestricted access to the unit (although this was resolved shortly after our inspection). There was unrestricted access to some equipment cupboards where locks had been damaged.

End of life care

Good

Updated 5 December 2017

A summary of this service appears in the Overall summary.

Outpatients and diagnostic imaging

Good

Updated 5 December 2017

A summary of this service appears in the Overall summary.

Surgery

Good

Updated 5 December 2017

Maternity

Good

Updated 24 March 2020

We previously inspected maternity jointly with gynaecology so we cannot compare our new ratings directly with previous ratings.

We rated this service as good because:

  • We rated effective, caring, responsive and well led as good and safe as requires improvement.
  • Staff provided effective maternity care. The service provided care and treatment based on national guidance and evidence-based practice. The effectiveness of care and treatment was monitored, and findings used to make improvements. Staff were competent for their roles. Staff supported women to make informed decisions about their care and treatment and provide consent. Women were supported to feed their babies well and the service had achieved ‘gold’ in the UNICEF baby friendly accreditation.
  • People were supported, treated with dignity and respect, and were involved as partners in their care. Support for women who experienced pregnancy loss was especially caring and sensitive to the needs of women and their families.
  • The service was planned and delivered to meet the needs of the local population and was responsive to people’s individual needs.
  • The service was well led, and the leadership team understood and managed the priorities of the service, and there was a vision and strategy aligned to local and national priorities.

However:

  • Systems and processes were not always reliable or appropriate to keep people safe. Checks to specialist equipment and medicines management processes were not always effective. The service did not meet national guidelines for 24 hours a day, seven days a week anaesthetic cover for obstetric theatres.

Urgent and emergency services

Good

Updated 5 December 2017