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Scarborough Hospital Requires improvement

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

Inspection Summary


Overall summary & rating

Requires improvement

Updated 16 October 2019

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

  • We inspected Urgent and Emergency Care and rated the service as requires improvement which was the same rating as previous. The ratings for safe went down to inadequate. The ratings for effective and responsive stayed the same as requires improvement. The ratings for Well led went down to requires improvement.
  • We inspected Medical Care and rated the service as requires improvement which was the same rating as previous. The ratings for safe went down to inadequate. The rating for effective, responsive and well led stayed the same as requires improvement.
  • We inspected Surgical services and rated the service as requires improvement which was the same as the previous rating. The ratings for safe improved to good. The ratings for effective and caring stayed the same as good. The ratings for responsive and well led stayed the same as requires improvement.
  • We inspected Maternity services and rated the service as good which was an improvement. The ratings for safe and effective improved to good. The ratings for caring, responsive and well led stayed the same as good.
  • We inspected Outpatient services and rated the service as requires improvement. We previously inspected outpatients jointly with diagnostic imaging so we cannot compare our new ratings directly with previous ratings. The ratings for safe, responsive and well led was requires improvement. The ratings for caring was good. The effective domain is not rated.

Checks on specific services

Reference: safe not found

Requires improvement

Updated 16 October 2019

We previously inspected outpatients jointly with diagnostic imaging so we cannot compare our new ratings directly with previous ratings.

We rated it as requires improvement because:

  • The service was not consistently assessing the clinical risk inherent in its waiting lists where patients were waiting beyond their expected appointment date for new and follow up appointments.

  • Although ophthalmology could describe the type of clinical validation (Clinical Prioritisation) for patients waiting for appointments, this was inconsistent across the trust and some specialities had not clinically validated their waiting lists. This meant there was limited oversight of clinical risk in waiting lists across the specialities. Clinical validation was not consistently documented on the risk registers for outpatients.
  • The information provided by the trust regarding overdue appointments showed this performance had deteriorated between April 2019 and June 2019. Although the trust provided information stating recovery plans and trajectories were being developed, these were not in place at the time of the inspection.
  • There had been two serious incidents relating to patient appointment delays in the ophthalmology department. The trust provided the root cause analysis for one of the incidents and this highlighted the backlog of follow up patients. This had an action plan attached.
  • People could not always access the services when they needed to receive the right care promptly. There were a high number of cancelled clinics for non-clinical reasons.

However:

  • The service provided mandatory training in key skills to all staff and made sure everyone completed it. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
  • The design, maintenance and use of facilities, premises and equipment kept people safe.
  • The service had enough nursing and support staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Staff kept detailed records of patients’ care and treatment.
  • The service provided care and treatment based on national guidance and evidence-based practice. Doctors, nurses and other healthcare professionals worked together as a team to benefit patients.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.

Reference: effective not found

Good

Updated 16 October 2019

We previously inspected outpatients jointly with diagnostic imaging so we cannot compare our new ratings directly with previous ratings.

We do not rate effective in outpatients, however during the inspection we found:

  • The service provided care and treatment based on national guidance and evidence-based practice.
  • Staff gave patients enough food and drink to meet their needs and improve their health.
  • Staff monitored the effectiveness of care and treatment.
  • The service made sure staff were competent for their roles.
  • Doctors, nurses and other healthcare professionals worked together as a team to benefit patients.
  • Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent.

Reference: caring not found

Good

Updated 16 October 2019

  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
  • Staff provided emotional support to patients, families and carers to minimise their distress.
  • Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.

Reference: responsive not found

Requires improvement

Updated 16 October 2019

  • People could not always access the services when they needed to receive the right care promptly. Waiting times from referral to treatment were not always in line with national standards.

  • There were patients waiting past their appointment dates for follow up patients. For example, the trust provided information on the follow up waiting list stating as at April 2019 there were 10,972 patients who were overdue their appointment.
  • Referral to treatment indicators were not always met across all the specialties. For example, in thoracic medicine and ophthalmology for incomplete pathways. For cancer waiting times, the trust performed worse than the 85% operational standard for patients receiving their first treatment within 62 days of an urgent GP referral.
  • At the time of the inspection, there were no recovery plans or trajectories for improvement for the various specialities. However, the trust provided information highlighting the recovery plans and trajectories were being developed and that this work would be complete by the middle of July 2019.
  • The service had cancelled 209 clinics within fourteen days in March 2019 and 180 clinics were cancelled within fourteen days in April 2019. The target was less than 180 clinics cancelled within fourteen days.
  • The lack of clinical validation of waiting lists meant that there was the risk of patients being re-appointed unnecessarily and patients not being seen on time or in line with their clinical need.

However:

  • The service was inclusive and took account of patients’ individual needs and preferences.
  • It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff.

Reference: wellled not found

Requires improvement

Updated 16 October 2019

  • Clinical Validation (Clinical Prioritisation) and assessment of risk within outpatients waiting lists had not been implemented across all specialties. The trust had started to clinical validate some waiting lists, for example ophthalmology, however this was inconsistent and not complete across all specialties.
  • Although leaders and teams used systems to manage performance, they did not always identify relevant risks and issues. Clinical validation (Clinical Prioritisation) was not consistently documented on the risk registers for outpatients.

  • The information provided by the trust regarding overdue appointments showed this performance had deteriorated between April 2019 and June 2019. Although the trust provided information stating recovery plans were being developed, these were not in place at the time of the inspection.

However:

  • Leaders were visible and approachable in the service for patients and staff. They supported staff to develop their skills and take on more senior roles.
  • Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service had an open culture where patients, their families and staff could raise concerns without fear.

Medical care (including older people’s care)

Updated 24 March 2020

We carried out an unannounced focused inspection of the medical care services in response to concerning information we had received in relation to care of patients in this department. We inspected using our focused inspection methodology, focusing on the concerns we had. We did not cover all key lines of enquiry. We did not change the rating of the service at this inspection.

We found breaches of regulations from previous inspections had not been effectively acted upon. The quality of health care provided by York Teaching Hospital NHS Foundation Trust required significant improvement.

Critical care

Requires improvement

Updated 28 February 2018

Our overall rating of this service stayed the same. We rated it as requires improvement because:

  • We rated safe and caring as good, and effective, responsive and well led as requires improvement.
  • The service had not taken action on some of the issues raised in the 2015 inspection. For example, the unit still did not have a clinical educator which was not in line with the guidelines for the provision of intensive care services (GPICS) standard and the service had not undertaken patient or relative surveys or any public engagement. At the time of this inspection, it was still not clear what critical care would look like across York and Scarborough hospitals, as the service strategy had not been finalised.
  • The risk register was not reflective of all the risks in the service. There was no record of the date the risks were added to the risk register, the date the risk should be reviewed and the controls and mitigating actions recorded were limited and did not always appear to address the cause of the risks.
  • The rehabilitation after critical illness service was limited and was not in line with GPICS or the National Institute for Health and Care Excellence (NICE) CG83 rehabilitation after critical illness. The service did not have access to patient and relative support groups.
  • Staff were not always supported to maintain and develop their professional skills. The number of nursing staff who had an up-to-date appraisal was worse than the trust’s target. The service did not meet GPICS recommendations for the number of nurses that had a post registration award in critical care nursing.
  • Senior staff acknowledged that service improvement and innovation was limited on the unit and the pace of change was slower at Scarborough than in critical care at York Hospital.

However:

  • The service had taken action on some of the issues raised in the 2015 inspection. For example, medical staffing was now in line with GPICS, mandatory training rates were better than the trust target and there had been a focus on cross-site working which had improved.
  • Systems and processes in safety, infection control, medicines management, equipment, patient records and the monitoring, assessing and responding to risk were reliable and appropriate.
  • Care and treatment was planned and delivered by a cohesive multidisciplinary team in line with current evidence based guidance.
  • All the feedback from patients and relatives was positive about the way staff treated them.

Surgery

Requires improvement

Updated 28 February 2018

Our overall rating of this service stayed the same. We rated it as requires improvement because:

  • We rated effective, caring and responsive as good and safe and well led as requires improvement.
  • Registered nurse and care staff were not always at optimum levels and we saw that there were a significant number of registered nursing shifts which could not be filled despite active recruitment. This was mitigated by the use of agency staff and those redeployed from other wards.
  • Medical staff vacancies were higher than the York Hospital despite active recruitment. This was mitigated by the use of locums.
  • Referral to treatment times (RTT) improved following our last inspection, however this had fallen back to below the national average during 2017 in most surgical directorates.
  • There was a significant amount of medical staff who had not received safeguarding adults and children’s training, and some mandatory training modules which included ‘do not attempt cardiopulmonary resuscitation’.
  • We saw gaps in record books of checking emergency trolleys and anaesthetic machine log books in theatre areas.
  • Staff did not always have access to clinical supervision as part of their learning and development. This was linked to professional revalidation.
  • None of the staff groups at Scarborough Hospital met the trust target for appraisals

However:

  • We saw that wards and theatre areas were visibly clean and staff observed infection prevention and control measures.
  • Nursing staff we spoke with said that there was good teamwork.
  • The trust had set up a urology ‘one stop shop’ at Malton Community Hospital where patients were seen and had appropriate tests carried out and discharged with a clear plan of care prior to going home. This prevented the patient having to attend several appointments.
  • Staff we spoke with told us that they felt well supported by local leadership who tried to address the short and long term staffing problems.
  • We observed good compassionate care and emotional support.
  • Scarborough Hospital had better than the national average for readmissions in all surgical directorates.

Urgent and emergency services

Inadequate

Updated 24 March 2020

We carried out an unannounced focused inspection of the emergency department in response to concerning information we had received in relation to care of patients in this department. At the time of our inspection the department was under adverse pressure.

During this inspection we inspected using our focused inspection methodology, focusing on the concerns we had. We did not cover all key lines of enquiry.

We found breaches of regulations from previous inspections had not been effectively acted upon. The quality of health care provided by York Teaching Hospital NHS Foundation Trust required significant improvement.

Reference: improvement not found

Updated 16 October 2019

We found areas for improvement in this service. See the Areas for Improvement section above.

Reference: keyfacts not found

Updated 16 October 2019

Scarborough hospital is the second largest hospital in the York Teaching Hospital NHS Foundation Trust. The hospital provides a range of outpatient services and is based in Scarborough.

The trust had 976,357 first and follow up outpatient appointments from February 2018 to January 2019. From February 2018 to January 2019 there were 246,658 outpatient appointments at Scarborough Hospital.

During the inspection we visited the main outpatients’ departments. During the inspection we visited the ophthalmology, general medicine clinics, general surgery clinics, ear, nose and throat and phlebotomy.

We spoke with 21 staff, 23 patients and relatives and reviewed eight records during the inspection.

Reference: outstandingpractice not found

Updated 16 October 2019

We found examples of outstanding practice in this service. See the Outstanding practice section above.