The York Hospital

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

People and communities have the best possible outcomes because their needs are assessed. Their care, support and treatment reflect these needs and any protected equality characteristics. Services work in harmony, with people at the centre of their care. Leaders instil a culture of improvement, where understanding current outcomes and exploring best practice is part of everyday work.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good.

The service was previously in breach of the legal regulations relating to need for consent. Improvements were found at this assessment and the service was no longer in breach of this regulation.

Patients were involved in assessments of their needs. Staff reviewed assessments taking account of patients’ communication, personal and health needs. Care was based on latest evidence and good practice. Staff worked with all agencies involved in patients’ care for the best outcomes and smooth transitions when moving services. Staff made sure patients understood their care and treatment to enable them to give informed consent.

This service scored 67 (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 planned and delivered patients’ care and treatment with them, including what was important and mattered to them. Staff did this in line with legislation and current evidence-based good practice and standards.

Staff followed up-to-date policies to plan and deliver care according to best practice and national guidance, such as from the National Institute for Health and Care Excellence (NICE) and Royal College of Emergency Medicine (RCEM) clinical guidelines. There was a trust wide issue with some out-of-date policies, but actions had been taken to ensure that current guidelines were followed whilst policies were being ratified. Staff used a range of care pathways which was in line with national guidance for common emergency department presentations.

The service participated in a range of local and national clinical audits. Audit findings were reviewed to monitor compliance against local and national standards and action plans and planned re-audits were in place where further improvement was identified.

Staff protected the rights of patients subject to the Mental Health Act and followed the Code of Practice. Patients presenting in the emergency department with mental health needs could access specialist support.

The service worked well across teams and services to support patients. Staff made sure patients only needed to tell their story once by sharing their assessment of needs when patients moved between different services.

Doctors, nurses, and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care. Staff held regular and effective multidisciplinary meetings to discuss patients and improve their care.

However, there were sometimes lengthy delays between emergency department referrals to specialties and speciality review. Once patients had been seen by the specific speciality, they became the responsibility of that team, with the ongoing support of the emergency department. Teams mainly worked collaboratively within the emergency department by seeing those patients who had stayed for extended periods. Senior clinicians highlighted that this was not consistent among all specialities, particularly the medical team, which led to significant delays. Patients in the department sometimes did not have their daily speciality review though they were cared for by the emergency department staff. Reviews were being monitored, and a plan was in place to ensure patients were seen by the right team whilst in the emergency department.

An in-reach service from the frailty team attended the emergency department daily and assessed patients who would be appropriate to admit to the frailty unit.

The department had a dedicated therapy team which included physiotherapy, occupational therapy and social workers. Patients could be seen promptly when a referral was needed. We observed multidisciplinary working with services, such as occupational therapy, psychiatric liaison, and diagnostics to identify the most appropriate care and treatment for patients.

The service routinely monitored patients’ care and treatment to continuously improve it. Staff ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of patients themselves.

Staff monitored the effectiveness of care and treatment. They used the findings to make improvements and achieved good outcomes for patients. The service participated in relevant national clinical audits. Outcomes for patients were positive, consistent, and met expectations, such as national standards.

The department took part in Royal College of Emergency Medicine (RCEM) audits and benchmarked its performance against best practice and other emergency departments. Managers and staff used the results to improve patients' outcomes. Managers and staff carried out a programme of repeated audits to check improvement over time. Regular support was provided to the department by the clinical educators and the information gathered from audits was shared with staff and used to improve care and treatment.

Leaders monitored the wait times within the department in line with national standards. The trust was performing below the national standards but were collaborating closely with their external partners across the whole health system to reduce waiting times.

The service told patients about their rights around consent and respected these when delivering person-centred care and treatment.

Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent. Consultants described the process of consent according to trust and RCEM guidelines. Consent was asked for before any procedure performed in the department. Staff gained consent from patients for their care and treatment during triage in line with legislation and guidance and this was clearly recorded in the patients’ records. Staff supported children and their families in decision making about their care and treatment. Staff understood the process to assess whether a child had the competence to make their own decisions and give consent to any care or treatment.

The trust provided mental health awareness training. Compliance in Mental Capacity Act Basic Awareness for the department was 90.54% against a target of 87%. Compliance was reviewed monthly and individuals not compliant were reminded and given the time to complete training online. Staff told us that they would like more training on mental health and therapeutic observations.

The service had systems to ensure staff assessed and managed the risks to patients in relation to their mental health. A review of patient records showed a risk assessment of the patient’s mental health needs was completed or an appropriate plan to manage their mental health risks recorded. However, staff felt they needed further training on using the risk screening tool.

Staff supported patients who lacked capacity to make their own decisions or were experiencing mental ill health. Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. When patients could not give consent, staff made decisions in their best interest, considering patients’ wishes, culture and traditions. The service had effective systems to ensure staff assessed the mental capacity of patients and recorded decisions made in patients’ best interest when applying to deprive the patient of their liberty.

Managers monitored the use of Deprivation of Liberty Safeguards and made sure staff knew how to complete them.