- NHS hospital
The York Hospital
Report from 1 July 2024 assessment
Contents
Ratings - Medical care (Including older people's care)
Our view of the service
During the assessment, we visited several wards and assessment units. We reviewed the environment and staffing levels and looked at care records and prescription records. We spoke with patients and family members, staff of different grades, including nurses, doctors, ward managers, therapists, a domestic assistant, and the senior managers who were responsible for medical services. We reviewed performance information about the trust. We observed how care and treatment was provided.
Whilst the service had improved in a number of places since the last assessment at this assessment we still found breaches of legal regulations. At the last assessment the service was in breach of the legal regulations relating to person centred care and safeguarding. There had been improvements and the service was no longer in breach of these regulations. The service was in breach of regulations relating to safe care and treatment, premises and equipment and good governance as well as staffing. The service remained in breach of these regulations at this assessment.
Staff did not consistently assess the risk to the health and safety of patients receiving the care or treatment and maintain good infection, prevention and control standards. The service did not always ensure that persons providing care or treatment to patients had the qualifications, competence, skills and experience to do so safely. The service did not consistently maintain the environment and ensure it was suitable for the purpose for which it was being used. Staff did not maintain secure and accurate, complete and contemporaneous records in respect of each patient, including a record of the care and treatment provided to the patient and decisions taken in relation to the care and treatment provided. Senior leaders did not always ensure that systems to monitor and improve were effective and there were areas that were still not meeting the fundamental standards of care.
However, care was provided in line with national best practice guidelines and medical services participated in most clinical audits where they were eligible to take part. Staff teams worked well together when assessing people’s needs and shared information. Patients told us that staff were caring, kind and respected their wishes. The service was providing person centred care and meeting individual needs for patients who had dementia or required palliative care. There was a clear governance and risk management strategy in place and leaders and staff strived for continuous learning. Services were working with other organisations and system partners to develop new models of care and improvement plans were in place and being evaluated.
We have asked the provider for an action plan in response to the concerns found during this assessment.
People's experience of this service
Most patients and their families were positive about staff who were treating them with warmth, kindness and respect. During our assessment we observed most staff were kind and compassionate, responding to patients’ needs in a timely way, though there were isolated incidents where this did not happen. We also saw incidents where patients’ dignity was not always maintained.
Patients told us and we observed that they were offered food and drink and there was a choice of food and in most cases a choice of hot food.
Some patients and families reported there had been a lack of communication about their care and treatment and clarity about the discharge process. However, we did observe positive examples of how the service provided information to patients.
Some patients had also had long waits for a bed and then experienced multiple ward moves or found themselves on a ward that was not for their speciality. A patient and their family member told us they had been on 6 wards since their admission and found it difficult to get information on their care plan and staff did not know the answers to their questions. Many patients we spoke with had been moved multiple times and had found this disorientating.
Records showed whilst patients were seen by the required specialist, there were gaps and omissions in record keeping to demonstrate patients had received the care, treatment and support they needed to keep them safe and well.
Staff showed kindness and understanding when supporting families whose relatives were at the end of life. Patients and relatives knew how to raise concerns and complaints and were able to share their experience for the service to support learning.
We tracked the experiences of six patients on medical wards from admission, the findings of which have been consolidated within the main body of the report.