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Barnsley Hospital Requires improvement

We are carrying out checks at Barnsley Hospital using our new way of inspecting services. We will publish a report when our check is complete.

Reports


Inspection carried out on 14 to 17 and 26 July 2015

During a routine inspection

Barnsley NHS Foundation Trust provides a range of acute hospital health services at Barnsley Hospital. The trust serves the Barnsley area which has an estimated population of 236,000. In total the trust had 359 beds. Barnsley is in the 20% most deprived areas in the country.

We inspected Barnsley NHS Foundation Trust as part of our comprehensive inspection programme. We carried out an announced inspection of hospital between 14 -17 and July 2015. In addition, an unannounced inspection was carried out on 26 July 2015. The purpose of the unannounced inspection was to look at the Emergency department and medical wards at the weekend.

Overall, we rated this trust as requires improvement and we noted some outstanding practice and innovation.

However, improvements were needed to ensure that services were safe and well-led.

Our key findings were as follows:

  • Staffing levels were planned and monitored. There were some shortages; most notably there was a shortage of children’s nurses at the trust.
  • There had been no cases of hospital acquired MRSA since 2008. The rate of hospital acquired C.difficile was within the trust’s trajectory.
  • The adjusted mortality rates had reduced significantly in the trust over the past year. Analysis across a range of indicators showed there was no evidence of risk regarding mortality.
  • The trust performed mostly above the 95% standard for percentage of patients waiting to be seen within four hours since May 2014, with the exception of December 2014 and May 2015.
  • Assessments of patient’s nutritional needs were recorded. Across the trust, we found patients were supported to eat and drink.
  • Following transfer to a new IT appointment system, the trust had discovered a backlog of outpatients who potentially needed a follow-up appointment. Work was underway to clinically validate the list and ensure all relevant patients were offered a review appointment by 31 January 2016.
  • Leadership at the trust had been subject to significant change over the last 20 months. Staff spoke positively about the trust leadership.

We saw several areas of outstanding practice including:

  • The uro-gynaecology nurse specialist had introduced “percutaneous tibial nerve stimulation for overactive bladders” following a successful business case to the trust. This improved symptoms for patients and made cost savings for the trust. Audit data from 2014 demonstrated improved outcomes for women.
  • The dermatology service described a tele-dermatology project they were providing in conjunction with the local Clinical Commissioning Group whereby some GP practices could send in pictures of patient problems and receive an electronic treatment plan within three days. The service had also recently been approved to provide private cosmetic procedures (such as Botox) and was seeking to use these as a revenue generator for the trust.
  • We saw that staff in the breast clinic had developed a simple tool for patients to remind them to take their medication. The staff had developed a card, covered in a picture of brightly coloured tablets that could be hung from a door handle at their home such as a kitchen cupboard. This had been shared at an internal nursing conference and staff in other areas of the trust were using for their patients.
  • A midwife had won the prestigious 2015 Royal College of Midwifery’s (RCM) Philips AVENT National Award for Innovation in Midwifery. They created a secure staff social networking site called ‘Ward-book’ which was used by midwifery staff at the hospital to communicate important messages across the department. Each week the Head of Midwifery wrote a departmental update which gave staff the opportunity to feedback in real-time and this was posted on the system. The Ward-book was used as a virtual notice board. It helped communication between managers and staff and helped improve the outcomes for patient care.
  • Pharmacy robots had been introduced at the trust in July 2014. This has reduced errors and increased staff capacity.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

  • ensure all patients attending the emergency department, have an initial assessment undertaken by a suitably qualified healthcare professional in accordance with national guidance.
  • ensure that children attending the hospital are cared for by nursing staff who have the qualifications, competence, skill and experience to do so safely.
  • ensure oxygen is prescribed in line with national guidance.
  • ensure that medicines reconciliation is completed in 24hrs and meets local and NICE guidance.
  • ensure compliance with the five steps for safer surgery.
  • ensure suitable patients are offered laparoscopic colorectal surgery in accordance with NICE guidance.
  • address the backlog of outpatient follow-ups.

In addition the trust should:

  • review processes to enable staff to receive mandatory training on a regular basis.
  • confirm guidance to staff, based on best practice, as to the recording of verbal consent by patients in the clinical record.
  • review sign language interpretation availability for patients whose main or only means of communication is British Sign Language (BSL).
  • monitor the consistent use of the sepsis screening tool and timely completion of the interventions on the sepsis pathway.
  • review the out of hours medical staffing provision within medicine.
  • work with local services to reduce the number of medical outliers and medically fit patients in hospital to improve patient flow and reduce bed occupancy.
  • work with medical consultants to implement a robust system of timely mortality review.
  • work with ward staff to improve the understanding of the specific requirements associate with Duty of Candour.
  • undertake regular infection prevention and control ward audits.
  • improve the quality of medical record keeping and include this in the audit programme.
  • monitor and reduce the number of out of hours bed moves.
  • undertake a review of historic serious incidents and recommendations made to ensure learning is carried forward in to current areas of clinical practice
  • provide appropriate access to IT systems for appropriate staff, including temporary staff.
  • ensure medicines are stored at the correct temperature.
  • review medical note taking including prescription documentation.
  • review infection prevention and control practices within surgical areas including clinical stock rotation, environmental cleanliness and the changing rooms within main theatres environment
  • ensure there are sufficient numbers of staff with suitable qualifications, competence, skill and experience to provide care to patients within trauma and orthopaedics.
  • continue to take action to ensure the urology service meets patient need.
  • improve compliance with national emergency laparotomy audit.
  • undertake a full assessment of the area currently used for lucentis and its environmental and engineering suitability for service provision in the current facility.
  • consider the amount of sessions for ward rounds for surgeons.
  • consider undertaking a review of waiting facilities within theatre reception area.

  • store records in line with data protection requirements.
  • meet the government targets for antenatal screening between 10 and 12 weeks gestation relating to foetal abnormality.

  • consider monitoring of waiting times in the CAU.
  • support incident reporting and ensure timely response to investigations and clear lines of communication to staff in order that lessons are learnt in a transparent manner.
  • consider improving the environment in the POPD waiting area.
  • review the safe storage of patient records in the children’s outpatients department.

  • take action so advanced care planning and preferred place of care are considered by the MDT in a timely way in order that patients wishes at end of life can be met.

  • quality assure radiology reports generated by voice recognition.
  • take action to improve cancellation and DNA rates.
  • take action regarding the visibility of patient information on their electronic check in screens.
  • review the seating arrangements in the phlebotomy department and main outpatients’ areas to provide seating for patients with differing needs.
  • review the facilities and waiting areas for inpatients to improve the maintenance of privacy and dignity.
  • review processes for reporting of x-ray films and CT scans to ensure acceptable and consistent reporting times are achieved.
  • include the quality of record keeping in medical records and the use of WHO checklists in its audit programme.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection carried out on 28 January 2013

During a routine inspection

During our visit we spoke with 18 members of staff, 17 patients and four visiting relatives. We pathway tracked nine sets of patient medical and nursing notes. We visited four inpatient wards; ward 14 (gynaecology), ward 17 (cardiology and medicine), ward 23 (stroke unit and medicine) and ward 34 (orthopaedics).

Patients said that staff were approachable and explained their care and treatment to them in a way they could understand. Patients told us privacy and dignity had been respected by staff. They told us that staff were friendly, polite and respectful. We saw and heard staff treat patients with patience and respect. We saw staff took time to talk with people to offer support and reassurance. Staff were frequently heard to ask people’s opinions and check that they were satisfied.

Without exception, patients spoke very positively about the support, care and treatment they received. They felt that staff provided safe and appropriate care, treatment and support to meet their needs. Their comments included “a really good clean friendly hospital” and “all the staff here are polite and professional.” We found that medical and nursing records and risk assessments were in place and clearly recorded.

We found that people who used the service were protected from the risk of abuse. Patients spoken with told us that they felt safe in the hospital.

We found that relevant training and support was provided to staff so that patient's welfare and safety was promoted.

Inspection carried out on 4 October 2012

During an inspection to make sure that the improvements required had been made

This visit was a follow up inspection to the inspection we made in March 2012.Our Inspection in March 2012 was part of a targeted programme to inspect services that provide the regulated activity of terminations of pregnancy. The focus of that visit was to assess the use of the forms that are used to certify the grounds under which a termination of pregnancy may lawfully take place. We found the provider was not fully complying with the regulations at that visit. We asked the provider to send us a report within 7 days of them receiving that report, setting out the action they would take to improve.

We did not speak to patients who used this service as part of this visit. We looked at a random sample of medical records.

Inspection carried out on 21 March 2012

During a themed inspection looking at Termination of Pregnancy Services

We did not speak to people who used this service as part of this review. We looked at a random sample of medical records. This was to check that current practice ensured that no treatment for the termination of pregnancy was commenced unless two certificated opinions from doctors had been obtained.

Inspection carried out on 15 November 2011

During an inspection to make sure that the improvements required had been made

Some patients on the wards we visited have some conditions that mean we had difficulty talking with them. Other patients were able to express their views clearly, others we were not able to verbally communicate with. Due to patients communication needs we used informal methods of observation during our visit. We sat near patients, observed care practices and saw how staff and patients interacted with each other.

Throughout our observations we saw staff treat patients with respect and courtesy.

Patients that were able told us that overall they were very happy with the treatment and support they were receiving.Individual comments included :“I can’t praise the staff enough,they are wonderful.” “Excellent staff here.” “The staff are so helpful.”

Patients we spoke to said that overall they were satisfied with the quality and choice of food served on the wards. Patients’ individual comments included:” I’m offered lots of drinks during the day.”

“The quality and choice of food is good and it’s always piping hot when it comes.” “The ‘tea lady’ is great; she knows just how I like my cuppa.”

Inspection carried out on 31 March 2011

During a themed inspection looking at Dignity and Nutrition

Some patients on the wards we visited have conditions that mean they have difficulty talking with people and therefore have varied methods of communication. Some patients were able to express their views clearly, others were not able to verbally communicate with us. Due to people’s communication needs, during the site visit we sat near some patients and observed them closely. This meant we were able to ascertain the levels of care and support they received.

Staff spoke to people in a kind and friendly manner and carried out personal and nursing care tasks in a respectful way.

Patients we spoke with were very positive about their experiences of care and treatment. Patients stated that they were kept informed and were involved in making decisions about treatment options. They also commented that they were given enough information both written and verbally to help with this process. Patients also said that they had their care needs met and had been treated respectfully.

Individual comments from patients included:

“I’m very happy with my care”, “The staff are lovely, they really care”.

Patients we spoke to said they had no concerns or complaints about their care or treatment at the hospital.

Relatives said “The staff are fantastic at this hospital, the care is very good”.

On the wards we visited, they had strategies, policies and procedures in place to ensure patients’ nutritional needs were met. However these strategies were not always being fully implemented by staff which meant that some people’s nutritional needs were not being fully met.

We have asked the trust about the improvements they must make to ensure all patients are supported to receive adequate nutrition. The trust responded in a timely manner to the concerns we raised and submitted an action plan within 48 hours of the inspection highlighting how they are going to address these concerns.

The majority of patients said they were very happy with the quality and choice of the food provided. Those patients who needed assistance to eat were helped by staff in a very positive way. Staff took their time, communicated in a friendly way with patients and showed sensitivity when supporting them with their lunch.

The lunchtime meal time service in some areas of the wards was relaxed and patients were given time to enjoy their meals.

However, in other ward areas, meals were interrupted. During this period we heard staff asking patients what they wanted for breakfast the next morning. We also saw that staff were being interrupted from serving meals by having to frequently answer the telephone.