Scarborough Hospital

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• 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

This meant the effectiveness of people’s care, treatment and support always achieved good outcomes and was consistent.

At our last inspection we rated this key question as requires improvement. At this assessment, the rating had improved to good. This meant people’s care, treatment and support achieved good outcomes and promoted a good quality of life.

We found that the introduction of Nucleus to the electronic patient record system supported staff in improving the accuracy and completeness of patient records. Care was delivered in line with evidence based and national standards and was routinely monitored, with effective multidisciplinary collaboration to benefit patients.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

The medicine care group ensured patients received effective care and treatment thorough assessment and regular review of their health, care and wellbeing.

Staff had improved the accuracy and completeness of patient records following the introduction of Nucleus to the electronic patient record system. They reported the process was well embedded in daily practice. Patient care records were clearly documented, and individualised care plans were consistently maintained to reflect each patient’s identified needs.

Staff displayed each patients needs on visual boards and charts which included information on mobility support and observation frequency.

On Lilac Ward (Acute Medical Admissions), we observed managers completing a daily log to assess each patient’s needs, providing an additional layer of assurance and oversight.

Staff used risk assessment tools to assess and monitor patients’ needs and took prompt action to escalate concerns about deteriorating patients. Patient records demonstrated early assessment of clinical risks, typically completed within six hours of admission.

Staff assessed patients with additional needs, including those approaching the end of life or with dementia, safeguarding, learning disabilities or mental health concerns. Care plans were adjusted to reflect changing needs, with risk assessments and onward referrals completed where required. Managers could implement enhanced observations to maintain safety.

Patient records showed that nutritional needs were accurately assessed and met, with detailed food and fluid charts in place. Staff made timely referrals to the newly established nutritional support team, who carried out daily ward visits to support assessment and management of patients’ dietary requirements.

The medicine care group planned and delivered care and treatment in line with current legislation, evidence based practice, and national standards. This ensured that patients received safe, effective, and person centred care.

Staff had access to up-to-date policies, procedures, and clinical care pathways that were comprehensive and aligned with national standards and best practice recommendations.

All policies reviewed were within their review dates, providing assurance that staff used current evidence to support consistent, high-quality care. Key clinical guidance was also displayed on posters across wards, serving as visual reminders for staff on topics such as enhanced supervision and safe swallowing practices.

Staff used a range of nationally recognised assessment and screening tools to support safe and effective clinical decision-making. These included:

• The National Early Warning Score (NEWS2) to identify and respond to patient deterioration.
• The Malnutrition Universal Screening Tool (MUST) to assess patients at risk of malnutrition.
• The Venous Thromboembolism (VTE) risk assessment to prevent thromboembolic events.

There was a clear and effective escalation policy for the management of deteriorating patients, ensuring staff took appropriate and timely action.

Staff completed falls assessments in line with national guidance to identify patients at risk and implement appropriate prevention measures.

Staff assessed and managed patients’ pain using recognised pain assessment tools and provided analgesia in line with individual needs and national best practice guidance.

Staff completed venous thrombosis (VTE) risk assessments for patients, using a recognised tool, and reviewed this regularly.

Staff used patient care passport booklets based on evidence-based national standards to record key clinical information and support continuity of care. Most paper documents were up to date however the Wound Care Passport (2017) and Discharge Checklist (2022) were overdue for review. Following the assessment, we escalated this to senior leaders who said the discharge checklist may have been an old paper copy as everything was now electronic.

Environmental risk assessments had been completed across all wards to support the safe management of high-risk patients. Staff were deployed to provide enhanced one to one observations when required, in line with risk management policies.

Staff upheld the rights of patients subject to the Mental Health Act 1983 and referred appropriately to the Mental Health Liaison Team when specialist input was required.

The service had recently achieved Joint Advisory Group (JAG) accreditation from the Royal College of Physicians for gastrointestinal endoscopy. This external accreditation recognised high-quality clinical leadership, effective governance, and strong team collaboration.

The medicine care group demonstrated effective multidisciplinary (MDT) collaboration with clear evidence of outstanding teamwork and collaboration across all roles and specialities. Staff worked together exceptionally well to benefit patients, supporting one another to deliver safe, high quality, and compassionate care.

We observed excellent communication and coordination between staff of all roles and grades. Patient information was shared promptly and effectively, ensuring continuity of care.

Managers held regular structured MDT meetings that promoted cohesive working, shared learning, and collaborative decision making. All relevant staff were invited to MDT meetings. Staff spoke positively about the strong culture of teamwork, describing it as fully embedded in daily practice.

We observed positive, open communication during daily board rounds, safety huddles, and handovers. This proactive approach supported timely escalation of issues, effective risk management, and smooth coordination of care.

We observed multiple examples of staff at all levels feeling confident to contribute to discussions and appropriately challenge clinical decisions when needed reflecting a culture of psychological safety and mutual respect.

There were consistently strong examples of cross specialty collaboration across the service. Within the Enhanced Care Unit (ECU), staff from acute medicine, cardiology and respiratory specialties worked seamlessly together to deliver coordinated, high quality care. Staff were proactively supported to rotate across specialty wards to develop the advanced respiratory skills required for ECU, and managers worked closely with training teams to ensure bespoke training programmes were designed around identified staff development needs.

Another well-embedded example of effective collaboration was on Beech Ward, which transitioned in April 2025 from a respiratory ward to a step down area for respiratory, cardiac and medical patients. Although the transition initially presented challenges, staff adapted well and now function as a cohesive, multidisciplinary team, demonstrating resilience and a strong commitment to integrated patient care.

In addition, managers worked proactively and in close collaboration with occupational health services and external psychology teams to provide comprehensive support for staff.

There were strong working relationships between ward teams, discharge coordinators, and specialist therapy teams, ensuring smooth patient flow and well coordinated discharge planning.

Consultants provided oversight of medical outlier patients cared for on non medical wards. Between October 2024 and September 2025, 209 outlier patients were identified and tracked to ensure they remained visible to the site management team, supporting continuity, safety, and oversight of care.

The medicine care group supported patients to manage their health and wellbeing effectively.

Staff promoted healthy lifestyles and provided practical advice and support to encourage recovery and independence.

Specialist nurses regularly visited wards to offer expert guidance on specific conditions, ensuring patients received tailored and targeted support. This included education on disease management, safe medication use, and lifestyle changes to promote long term wellbeing.

Physiotherapy staff focused on preventing deconditioning by encouraging mobility, exercise, and independence throughout each patient’s hospital stay. This proactive approach supported faster recovery, improved outcomes, and enhanced overall wellbeing.

We observed a wide range of patient information materials, including leaflets, posters, and display boards across the wards. These resources promoted healthy living, discharge planning, and signposted patients to relevant local and national support services and charities.

The medicine care group routinely monitored patient care and treatment to drive continuous improvement. Staff used audit results, incident data, and patient feedback to identify areas for development and ensure outcomes remained positive and consistent across wards.

The care group participated in a range of national clinical audits and took appropriate action in response to findings, including where performance outliers were identified.

The most recent National Dementia Audit (published in December 2024) showed positive results and significant improvement in key areas:

• 100% of patients had a discharge plan completed within the first 24 hours of admission (an improvement from 8% previously)
• 75% of carers rated the quality of care as high
• 80% of eligible patients underwent delirium screening
• 88% had their pain assessed

In relation to this audit the care group implemented additional staff training on delirium awareness.

A nationally recognised pain assessment tool was being integrated into the electronic patient record system to support consistent, accurate documentation and monitoring of pain management.

Each ward completed local clinical audits to assess compliance with key standards and identify opportunities for improvement. Findings showed that some wards still had further work to do to achieve full compliance. However, compliance with the malnutrition universal screening tool (MUST) had improved across the care group with several wards achieving rates up to 90%.

Ward managers maintained improvement action plans which captured learning from multiple sources, including audit results, incident reports, and electronic patient record data. These plans were reviewed monthly with matrons to monitor progress against agreed actions and ensure continuous improvements.

Staff supported patients to make informed decisions about their care and treatment and followed national guidance to gain patients' consent.

Staff demonstrated a good understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) principles to protect patients’ rights. Where patients lacked capacity to make specific decisions, staff acted in their best interests, taking into account the person’s wishes, feelings, culture, and history.

On most elderly care wards, patients were observed giving verbal consent before receiving treatment or personal care,

Staff recorded consent appropriately in patient records. In addition, documentation evidenced that MCA assessments, DoLS applications, and Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions were completed accurately and reviewed in line with national guidance. Staff told us these processes were well embedded in daily practice to ensure decisions remained in each patient’s best interests.

During board rounds, staff discussed patients who had lasting power of attorney (LPA) arrangements, those approaching end of life, and best interest decisions. Staff described attending best interest meetings with families to ensure decisions were made collaboratively and respectfully.

We observed positive examples of shared decision making and understanding of patient consent. Staff fully respected the decisions of patients especially those who declined further diagnostic tests or treatment.

Training compliance for MCA (basic and high-level) was high across most staff groups; however, compliance for medical staff was 43%, indicating the need for targeted support and improvement. One staff member told us they would value more practical, face to- face training sessions to build confidence and reinforce understanding.

The trust had a therapeutic restrictions (including restraint) policy which was available on their intranet. However, staff we spoke with were not aware of this policy indicating that further awareness and training may be required to ensure consistent understanding and application across all wards.