The York Hospital

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

At our last assessment we rated this key question as requires improvement. At this assessment the rating has remained requires improvement. The service was in breach of legal regulations in relation to premises and equipment as it was not always suitable for the purpose it was being used.

We looked for evidence that the service met people’s needs. We assessed three quality statements.

There were times when there was still insufficient bed capacity to meet the needs of patients but there were specific clear procedures or policies in place to help manage these patients effectively. However, this resulted in many patients being cared for in non-speciality beds and this meant the trust was not always responsive to the specialised and individual needs of patients whilst receiving care and treatment. In addition, a significant number of patients experienced one or more ward moves during their admission.

The service was putting in place actions to improve discharges from hospital and flow throughout the service. There was mixed feedback from patients about how well informed they were about their care and treatment plans.

The trust was working with other organisations to develop new models of care and improvement plans were in place and being evaluated. The service was providing person centred care and meeting individual needs for patients who had dementia or required palliative care.

This service scored 57 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service and its staff aimed to provide person-centred care.

The service showed commitment to supporting patients with dementia. Specialist Admiral Nurses were recruited to provide support to patients with dementia, their families and carers. They also provided education, leadership, development and support to other colleagues and service providers.

As part of ongoing support for patients living with dementia and their carers, the trust had refreshed its approach to implementing John’s Campaign. The campaign centred on the development and implementation of a standard operating procedure to support staff, the introduction of a care partner card and updated information leaflets for carers. Carers, carrying the visiting card, could also access free car parking to enable them to visit and continue to support their loved one.

The hospital had implemented the ‘forget-me-not’ sticker scheme. This was a discrete flower symbol used as visual reminder to staff that patients were living with dementia or were confused. This was to ensure that patients received appropriate care, reducing the stress for the patient and increasing safety.

Staff also undertook training on learning disability and autism. At the time of the assessment, the compliance rate was 74% for nursing and allied health professional staff and 56% for medical staff.

We observed that patients were regularly reviewed and that the care and treatment was appropriate to their needs. Allied healthcare professionals used the service’s board rounds as an opportunity to review patients’ therapy assessment forms. This helped them to ensure care plans were responsive to patients’ improvement or deterioration and made sure patients did not remain in acute beds when it was no longer appropriate. It also prevented patients being discharged with unnecessary packages of care.

Staff told us the palliative and nursing teams would regularly ensure that the wishes of dying patients were achieved. We were told of a time when the palliative team “pulled out all the stops” for a patient with end stage lung disease who wanted to get married. Further examples were shared of the palliative team supporting patients to get home and be comfortable in the location of their choice at the end of their lives.

The creation of the safeguarding and complex needs team allowed the service to improve its provision for patients with complex needs, such as patients with autism. The team told us they aspired to build care around the patient, rather than around what worked easiest for the provider. Their approach was to consider what they should do to provide the best personcentred care and individual patient journey. At the time of assessment, these aspirations were not fully implemented which meant it was difficult for us to fully assess.

On the acute medical unit we observed that several patients did not have the information boards above their beds completed with their name or additional information. Some of those patients told us they had been on the ward for a few days. The absence of such easily accessible information about patients meant there was a risk that staff interactions with patients were not truly person-centred.

The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs in most cases.

We heard mixed feedback from patients about how well informed they were about their care and treatment plans. Most patients we spoke with told us that they felt well informed and understood their plan of care. They had been frequently updated with results and were aware of their treatment plan.

They also understood their discharge plans, and what was being put in place to move them along their journey and follow up on their care. One patient told us they had arrived on the frailty same day emergency care unit with a letter from their GP, and they already had their discharge letter. They knew where to call if they needed anything after they were discharged.

Other patients told us they had been told multiple conflicting things by different teams or members of staff, which led to confusion over their condition or care plan. One patient and their family member told us they had been on 6 wards since their admission and they found it difficult to get information on their care plan, as ward staff often did not know the answer to their questions. Some of the medical ward staff members told us that a high proportion of complaints on their ward related to delays to, or absence of, communication about discharge plans.

We observed positive examples of how the service provided information to patients, their families and carers. Translation services and interpreters were available to support patients whose first language was not English. Staff confirmed they knew how to access these services. Leaflets were available for patients about services and the care they were receiving.

The Accessible Information Standard (AIS) is a legal requirement introduced in 2016 to ensure that adults and children who have a disability, impairment or sensory loss receive information in a way that they can access and understand, and any communication support that they need is identified, recorded and provided. The trust had in place a policy setting out how services should ensure that patients, their carers and those supporting them can access and understand information. For example, producing accessible content and documents.

The service did not always ensure people could access the care, support and treatment when they needed it and in the most appropriate place. However, the service was taking action to improve and new initiatives were being put in place.

Information provided by the trust showed that there was a shortage of medical beds and a number of patients placed on wards that were not best suited to meet their needs (also known as outliers). Between January 2024 and December 2024 data showed that there had been 2073 medical outliers at the hospital. Patients who were outliers were reviewed daily by a member of the medical team. We were told that the service avoid medical outliers from the admission units and are made to free up capacity for the admission of acute patients.

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Senior leaders in the trust told us that they were aware of the large number of outliers and were beginning to put in place actions to ensure that patients were in the correct speciality for their care needs, for example ensuring surgical patients were correctly categorised as many were being categorised as medical patients which increased the demand on medical care services.

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We observed there were times when patients were transferred between different wards. The policy stated that these should be for clinical need, however due to pressure it may be necessary to transfer patients to a ward within another speciality but should avoid moving after 10 pm.

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Information provided by the trust showed during the period January 2024 to December 2024 there were a significant number of patients experienced one or more ward moves during their admission. Approximately half of moves were from assessment units during the day and over 60% of the moves after 10 pm were from assessment units. However, this indicated there were moves from other medical wards during the day and after 10 pm. These results show that several patients admitted to medical services at the trust were not treated in the correct speciality ward for the entirety of their stay. The trust did monitor the number of bed moves via a dashboard.

Staff told us that capacity challenges across the service had increased significantly, which affected the use of rooms. For example, the non-invasive ventilation assessment room which had been used to assess patients more quickly was now used by patients as a side room on the ward. Staff reported this had a negative effect on the assessment of patients requiring the administration of non-invasive ventilation support for acute respiratory conditions, in a timely way. They felt this not only had a negative impact on patient flow across the service but also affected staff's ability to consistently provide patients with appropriate care in line with the non-invasive ventilation guidance of 60 minutes.

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Staff told us that they were concerned the overcrowding of wards at times of high demand had a disproportionately negative effect on frail, older patients. They said that the lack of space made it difficult to mobilise patients or get appropriate equipment to them. As a result, their risk of falls increased. For this reason, we were told patients were not encouraged out of bed which caused their mobility to deteriorate, and their hospital stay to increase. We saw that most patients were in bed.

We were told that there could be significant delays when a patient required admission from the same day emergency care unit. Staff told us about an elderly patient who was cared for in a chair for 3 days whilst waiting for a bed, which was due to the combined wait they experienced in the emergency department and the same day emergency care unit.

We also saw several additional bed spaces being used during the assessment due to increased pressure in the emergency department and the demand on beds on the wards. These areas had been identified as part of the continuous flow programme. On ward 32 there were no areas identified as chair spaces apart from one space 8B which would need a chair as a bed would not fit in this area. This was not to be used overnight. We observed a bed was being used in this area which was not in line with policy. Also on Ward 32 we observed a patient being cared for in a corridor when the policy did not outline this as an area for planned or unplanned space.

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Staff told us there was significantly reduced multi-disciplinary presence or support at the weekends, which meant there was a risk that this could affect a patient's ability to start some of their treatment in a timely manner.

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There were systems, processes and policies to support staff to deliver care to patients especially in times of high demand when medical wards reached full capacity. Capacity shortfalls can adversely affect patients. The policies set out some key principles, for example no patient should be placed in mixed sex accommodation unless this was overridden by clinical need, and every person on every inpatient ward should be reviewed on a twice daily ward round as well as all patients must have an agreed expected date of discharge within 12 hours of admission.

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There was in place a continuous flow model of care with processes to provide all staff with guidance on the flow of patients through urgent and emergency care pathways during business as usual and during times of operational pressure. This guidance was also to support the safe management of patients care in unplanned locations within inpatient wards.

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The continuous flow model had been in place since October 2024 and was now running on all wards except for the dementia ward. This had shown some improvements in the patient journey, for example, The number of discharges before 10am had improved since its rollout to 20% in December 2024. There had also been an increase in the number of patients discharged before noon to 27.8% compared to the previous year.

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The hospital held bed management meetings regularly throughout the day during the week to review and plan bed capacity and respond to acute bed availability pressures.

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The patient's consultant took the overall decision that a patient was medically fit for discharge meaning they no longer meet the criteria to reside. All patients who met these criteria were managed within the discharge command centre. Patients whose discharge was for the following day had arrangements put in place, for example take home medication and transport. This was so they could be discharged in the morning or transferred early to the discharge lounge by 08:00 am.

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The number of bed days lost to patients who stayed past their discharge date (known as `no criteria to reside') was on a downward trend with a slight increase in the last month, meaning beds were more quickly available for other patients.

Over the last 18 months there had been a reduction in the number of patients who had no criteria to reside. This had reduced from 30% to 15% with the aim to reduce this further to 10%. There were regular meetings with local system partners including the integrated care board to discuss capacity and individual patients' needs.

We saw that due to increased bed pressures, additional capacity was required and an escalation ward, ward 12, had been opened. Environmental risk assessments had been completed.

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The service's frailty hub had an advice and guidance line. The number of contacts to the advice and guidance line was 418 in October 2024. As a result, 208 emergency department attendances were avoided, which was an increase in performance over the previous year.

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There was a daily rhythm document in place to help support the discharge lounge team be proactive in moving patients from the ward to the discharge lounge to release bed capacity for patients who needed a ward bed. This allowed for changes and flexibility based on need whilst still providing a general pattern to the day. The service acknowledged that the number of patients using the discharge lounge needed further improvement, especially in the mornings to help with flow through the hospital.

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There were ward round champions for the acute medical unit and short stay ward to help with flow of patients through these areas. Following the assessment, the trust informed us that they recognised the need to ensure there was capacity in the acute medical unit through ensuring earlier discharges where safe to do so, and this work was being led through the trust's discharge improvement programme.

The trust had key performance indicators and targets to help with flow through the medial wards at the hospital which included improving the number of patients discharged by 12 pm and by 5 pm. To help with this there were board round structures and daily ward processes on the acute medical unit and short stay ward which was happening twice a day Monday to Friday.

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The service had a standard operating procedure which outlined that patients with specific individual needs such as delirium, cognitive impairment or learning disability would only be moved between wards if it supported their own clinical care and physical health care needs. If they were moved outside these criteria, then staff were encouraged to report this as an incident to inform any learning or potential adverse outcome.