Chesterfield Royal Hospital

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

This means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant the service was consistently managed and well-led. At this inspection, we assessed one quality statement within this key question: Governance, management and sustainability.

The service was supported by clear governance and assurance arrangements, with established accountability from wards to board level. Leaders used audits, assurance reporting, ward visits and governance processes to monitor quality, safety and performance. They shared learning from incidents, complaints and safeguarding concerns that enabled improvements.

Leaders had oversight of risks through governance structures, risk registers and regular operational meetings. These enabled concerns to be escalated and improvement actions taken and monitored. Staff and leaders identified similar risks, which indicated the leadership team was aware of the key challenges staff faced.

The service used new technology, helped protect the environment, and took part in research projects to improve the way it helped patients.

Leaders recognised opportunities to strengthen audit activity and clinical pathway review processes.

We have not awarded this service a score for Well-led.

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

We did not look at Shared direction and culture during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Capable, compassionate and inclusive leaders during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Freedom to speak up during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We scored the service as 3. The evidence showed a good standard. The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

The service had a clear system for managing staff and responsibilities. There were set ways to report risks, performance problems, and concerns about the quality of care. Managers regularly checked how well services were working through monthly care audits, quality accreditation programmes, and visible leadership. There was also a clear reporting structure, with information and concerns passed from ward staff to matrons and then to senior directors.

Ward based champions supported governance and quality improvement. These champions covered key elements such as tissue viability, deteriorating patient, medicines management, safeguarding, dementia, end of life care and patient experience. These roles supported the learning, the implementation of best practice, local quality improvement activity and provided ward teams with specialist support and expertise.

There was governance systems to support learning from incidents, complaints, safeguarding concerns and external reviews. Leaders described how findings were reviewed and used to inform improvement activity. Activities included strengthened education and prevention work following a coroner's case and retrospective reviews of pressure ulcer concerns identified after discharge.

During our inspection, we observed some handheld devices and computers on wheels left unattended with patient records visible. This presented a potential risk to patient confidentiality. However, this was not indicative of a wider governance concern, and leaders had systems in place to promote the secure management of patient information.

The service used information relating to risk, performance and safety to inform decision-making and prioritise improvement activity. Risks were monitored through formal risk registers.

Leaders described using daily operational meetings to review performance, escalate concerns and support discharge planning. They also conducted weekly reviews of patients experiencing long lengths of stay. We observed daily operational meetings where ward managers reviewed staffing gaps, patient flow and risks. These meetings enabled leaders to identify pressures, coordinate resources and escalate concerns across the division. Ward leaders described using workforce and operational information to support decision-making and maintain an appropriate level of service for patients. The service had established a dedicated ward and strengthened therapy input for patients awaiting discharge to support patients’ independence while arrangements were made.

The digital optimisation programme enabled staff to identify, prioritise, and implement service improvements. The programme included clear ownership, monitoring and tracking of requests and involved clinical teams in its development. The programme included medical service improvements in critical medications, nutrition and hydration assessments, referral pathways and prescribing functionality. However, leaders recognised the need to strengthen audit activity, further develop clinical pathway reviews and improve specialty engagement to support service’s development and quality assurance.

The service demonstrated that governance arrangements supported sustainability. The trust had set up a number of initiatives aimed at reducing waste and improving environmental sustainability while maintaining patient safety. These included a cannula pack redesign project that delivered recurrent financial savings and reduced carbon emissions by an estimated 102.6 tonnes CO2e. They had also introduced reusable blood pressure cuffs that reduced clinical waste by 4,522kg and carbon emissions by at least 14.3 tonnes annually. A new hospital linen return scheme was piloted that resulted in 233 items returned during a 12-week period, that reduced replacement costs and achieved an estimated carbon reduction of nearly 3.5 tonnes. These projects demonstrated the use of environmental, financial and performance information to support service improvement and resource stewardship.

The service demonstrated a commitment to innovation and continuous improvement through its active research portfolio. Staff could take part in multiple research studies were across medical specialties including cardiology, respiratory medicine, gastroenterology, dermatology and haematology. There were also additional studies progressing through set-up stages. This supported the delivery of evidence-based practice and provided opportunities for medical patients to participate in research.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Learning, improvement and innovation during this assessment. The score for this quality statement is based on the previous rating for Well-led.