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Chesterfield Royal Hospital Requires improvement

We are carrying out a review of quality at Chesterfield Royal Hospital. We will publish a report when our review is complete. Find out more about our inspection reports.
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Inspection report

Date of Inspection: 17 May 2011
Date of Publication: 12 July 2011
Inspection Report published 12 July 2011 PDF

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People should get safe and coordinated care when they move between different services (outcome 6)

Meeting this standard

We checked that people who use this service

  • Receive safe and coordinated care, treatment and support where more than one provider is involved, or they are moved between services.

How this check was done

Our judgement

There are systems in place to ensure that people have safe and coordinated care when they move between services. These systems are not always effective when people are moving between care homes and the hospital.

User experience

We spoke with some people who were about to be discharged from hospital. They were all aware of their discharge procedure and of any follow-up appointments arranged. One person told us they were pleased that the stoma care nurse would be visiting them at home to provide help and support.

On one ward we visited, one person’s discharge had been delayed following a review by medical staff. The person was due to return to the care home where they lived. We heard a nurse telephone the person’s relative and the care home to inform them of the changes to the discharge arrangements and the reason for this.

In the surveys and other information we looked at people usually felt they were given sufficient information when they were discharged from hospital.

Other evidence

We saw leaflets on the wards about the range of conditions treated and found the same information was available through the hospital’s website. The information included details of how people could access other available services, for example, local groups for conditions such as multiple sclerosis, diabetes, and Parkinson’s disease.

From meetings we had attended with hospital staff and Derbyshire County Council Adult Care we saw that there were processes in place to ensure that relevant information about people was shared between services. We found some instances where these processes had not been effective when people were moving between care homes and the hospital.

We saw a report from 2010 by Derbyshire Local Involvement Network (LINk) about the poor experience of some people when being discharged from the hospital to care homes. We asked the provider what action they had taken to address the issues raised in the report. The provider sent us a copy of their letter dated 15 December 2010 in response to the Derbyshire LINk report giving details of action they said they had already taken. This included changes to nursing documentation, introduction of a discharge pathway to ensure timely and appropriate discharge planning, and improved quality of information regarding care and treatment received, discharge medication and follow-up arrangements. The provider said that they were aware that further work was needed to improve communication between hospital and care home staff.

We had information from Derbyshire County Primary Care Trust (PCT) in June 2011 about discharges from the hospital to care homes since January 2011. The PCT had asked care homes to send in forms with details of any problems with discharge of people from the hospital. Seven forms had been received. The problems described were mainly about poor communication and lack of relevant information. There were also instances of inadequate provision of medication and people being discharged inappropriately dressed.

We spoke with the managers from four local care homes about their experience when people were admitted to the hospital from the care home and also when they were assessing people for admission to the care home. Two managers said they had no problems with assessing people on the wards and found the staff helpful. They said they usually had all the relevant information when people were discharged from the hospital to the care home. One of these managers said that occasionally people had returned from the hospital in unsuitable clothing or looking unkempt. Two managers said they sometimes had difficulty in assessing people at the hospital as staff did not always have time to discuss the person’s needs with them. They said they had experienced people being discharged to the care home without all the relevant information and without sufficient medication. Two managers said they thought communication between hospital and care home staff had improved recently.

The information from the PCT and from the care home managers indicates that people from care homes do not always experience coordinated care when they move between services.