Scarborough 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

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant people did not always feel well-supported, cared for or treated with dignity and respect.

We looked for evidence that people and communities had the best possible outcomes. We checked that people’s care, support and treatment reflected these needs to ensure people were at the centre of their care. We saw that there was an inconsistent approach to the assessment of needs.

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 evidence showed an inconsistent standard. The service did not always make sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs.

We reviewed 10 sets of patient notes and found that 8 contained an omission or error. We saw examples of risk assessments not being fully completed or patient specific information being omitted. We saw examples, such as incomplete skin integrity risk assessments, diet and hydration recording and the assessment of pain.

Following the inspection, we reviewed patient care audits, including risk assessments, for the three months preceding the inspection. Compliance was low across all three months. Falls risk assessments averaged 64% compliance, and skin integrity assessments averaged 58%.

Staff developed care plans that met the needs identified during assessment. Whilst we saw omissions in the documentation, we did see good examples of care plans being utilised.

Care plans, when completed were personalised and holistic. We observed staff completing care plans with patients and their families.

The evidence did not consistently show a good standard. The service did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Staff did not consistently assess patients’ needs for food, drink, and specialist nutrition or hydration. We observed variation in how diet and hydration needs were recorded in patient notes. We requested any completed audits relating to diet and hydration, but none were provided.

We found an inconsistent approach to auditing. Following the inspection, we requested audit information; however, the information provided did not give assurance that audits were undertaken effectively or that findings were used to drive improvement. Some audits were missing, and others contained omissions in the information collected, which limited oversight and the provider’s ability to identify and address risks.

The department included or had access to the full range of specialists required to meet the needs of patients in the service. As well as doctors and nurses, we spoke with specialist staff who would work collaboratively within the department, for example the frailty team consisted of specialist therapists. Staff told us that they could access specialist input when required for their patients.

Managers provided staff with supervision (meetings to discuss care management, to reflect on and learn from practice, and for personal support and professional development) and appraisal of their work performance. All nursing staff reported that they were supported by their senior leaders.

Managers ensured that staff had access to regular team meetings. If staff were not available to attend, then senior leaders would ensure that all staff received meeting minutes by email.

Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge. Senior staff would regularly work with staff to help them develop and improve.

Managers ensured that staff received the necessary specialist training for their roles.

Managers dealt with poor staff performance promptly and effectively. We were given examples of how poor staff performance was identified and the steps taken to support that member of staff and help them improve.

The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Doctors, nurses, and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide safe care. Staff held regular and effective multidisciplinary meetings to review patients and improve their care. We saw multidisciplinary working with services, such as occupational therapy, psychiatric liaison, and diagnostics to identify the most appropriate care and treatment for patients.

We observed effective communication between staff when handing over patient care at the beginning and end of shifts. We also observed staff huddles throughout the day when patients were discussed, and any concerns were raised as appropriate. We also noted the use of a flow navigator who linked all areas of the department effectively.

We found the service supported people to manage their health and wellbeing and promoted independence, choice and control. The service aimed to help people to live healthier lives and, where possible, reduce future care and support needs. However, this was not always delivered consistently due to periods of high demand.

Staff aimed to support patients to live healthier lives, we saw multiple posters and patient information leaflets throughout the department. Staff told us that they would discuss health promotion with patients if there was opportunity, but this was not consistently available due to pressures within the department.

The evidence showed some shortfalls. The service did not always consistently monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

We were provided with a comprehensive audit schedule that detailed a wide range of audit topics. We requested completed audits and only received a limited response that did not provide assurance that care was consistently monitored, and the information was used to drive improvements.

Staff used recognised tools to improve the detection and response to clinical deterioration in patients as a key element of patient safety and improving patient outcomes. We saw staff using a nationally recognised early warning system (NEWS2), but we did not have assurances that all patients were monitored appropriately as we observed an inconsistent approach to the recording of observations and the subsequent escalation.

Staff used technology to support patients effectively (for example, for prompt access to blood test results).

The evidence showed an inconsistent standard. The service did not ensure all staff completed the training required, nor did it review the recording of consent within local audits. The service was previously in breach of the legal regulation in relation to staff compliance with dementia and learning disability. Improvements were not found at this assessment, and the service remained in breach of this regulation.

Information provided after inspection showed that 43% of medical staff had completed Deprivation of Liberty Safeguards and Mental Capacity Act training.

We reviewed local audits and found no reference to consent being audited to ensure compliance.

We saw that all staff had access to an up to date policy covering consent.

Staff were observed supporting patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent. Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. Due to a lack of training compliance, we could not be assured that all staff would be able to achieve this. 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.

When patients could not give consent, staff made decisions in their best interest, taking into account patients’ wishes, culture and traditions. The service had effective systems to ensure staff assessed the mental capacity of patients and recorded decisions made in service users’ best interest when applying to deprive the service user of their liberty.