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Inspection Summary


Overall summary & rating

Good

Updated 14 November 2018

Our rating of the hospital stayed the same. We rated the hospital as good because we rated the domain of well-led as outstanding and we rated safe, effective, caring and responsive as good.

Inspection areas

Safe

Good

Updated 14 November 2018

Effective

Good

Updated 14 November 2018

Caring

Good

Updated 14 November 2018

Responsive

Good

Updated 14 November 2018

Well-led

Outstanding

Updated 14 November 2018

Checks on specific services

Critical care

Outstanding

Updated 9 June 2016

Openness and transparency about safety was encouraged and staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Performance showed a good track record and steady improvements in safety. Staffing levels and skill mix were planned and reviewed to keep people safe at all times.

There was a truly holistic approach to assessing, planning and delivering care and treatment to patients. The systems to manage and share the information (needed to deliver effective care) was fully integrated and provided real-time information across teams and services. Staff were qualified and had the skills they needed to carry out their roles effectively.

Patients were treated with kindness, dignity and respect. Governance and performance management arrangement were proactively reviewed and reflected best practice. There was collaboration and support across all areas with a common focus on improving quality of care and patient experience. Leadership strategies were in place to ensure good care delivery within a supportive and open environment. There were high levels of staff satisfaction. Staff were proud of their units and spoke highly of the culture. The services proactively engaged and involved staff and ensured that the voices of all staff were heard and acted on. Staff innovation was supported.

Outpatients and diagnostic imaging

Outstanding

Updated 9 June 2016

The services had a positive safety culture; there were clear management responsibilities and accountability for safety and governance. The services promoted continuous quality improvement.

There were enough qualified, skilled and experienced staff to meet people’s needs. Staff received good support, staff appraisals and mandatory training was up to date.

Radiology services provided well-established, highly regarded training programmes for medical staff at every stage of their five-year programme and for student radiographers from local universities.

All of the staff were passionate about their work and staff teams worked well together to provide an excellent experience for their patients. All of the patients and relatives we spoke with gave positive feedback about the staff and the services.

Staff were aware of the trust values; there was good staff engagement and an open culture. Staff participated in research activities and there were numerous examples of innovation and improvement.

Urgent and emergency services

Good

Updated 14 November 2018

Our rating of this service stayed the same. We rated it as good because:

  • The provision of urgent and emergency services at the RHH is of a consistently high standard. The service provided was safe, in that it protects service users from avoidable harm and abuse. Staff provided care in environments that were suitable and well maintained.
  • The care and treatment of those patients using the service had good outcomes, it was based on the best available evidence and promoted good quality of life. Staff were highly qualified, experienced and worked in specialist roles effectively and efficiently.
  • The services available were carried out by staff in a caring, compassionate and respectful way, with dignity underpinning the treatment offered
  • The urgent and emergency care services available at the RHH are not a 24 hour a day service but were available every day of the week except Christmas day. When open, the service provided met the needs of the community served, and alternative services were available when the unit was shut.
  • The service allowed for differing levels of need including those patients whose needs would be described as complex. It strived to remove barriers and offer timely, effective care to all.
  • The urgent and emergency services were run effectively, by dedicated leaders with a clear vision and strategy.

Maternity and gynaecology

Outstanding

Updated 9 June 2016

Overall we rated maternity and gynaecology services as outstanding. Patients were protected from the risk of avoidable harm and when concerns were identified staff had the knowledge and skills to take appropriate action. Incidents were recorded, investigated and, where necessary actions were taken to prevent reoccurrence.

Staff delivered evidence based care and treatment and followed NHS England and National Institute for Health and Care Excellence (NICE) national guidelines. Staffing levels were monitored and reviewed to keep women safe.

There was excellent multidisciplinary working that promoted integral care. Staff worked together to make changes to improve the outcomes for women and babies.

Staff were thoughtful and responded compassionately to women, treating them with kindness dignity and respect. Partner and relatives felt included in the care given.

The variety of specialist services in maternity and gynaecology met the needs of women both locally and nationally.

People’s individual needs and preferences were central to the planning and delivery of tailored services. The importance of flexibility, choice and continuity of care was reflected in the services.

Leaders and senior managers had an inspiring shared purpose, they strove to deliver and motivate staff to succeed. They were motivated, visible and accessible and participated in the day-to-day running of the service.

Medical care (including older people’s care)

Good

Updated 14 November 2018

Our rating of this service stayed the same. We rated it as good because:

  • The services were safe because staff completed mandatory training and safeguarding training. Nursing and midwifery staff exceeded the trust target of 90% for eight out of 11 mandatory training modules. The other three areas were all above 83% compliance. Medical and dental staff met or exceeded the trust 90% completion target for seven out of 10 modules. The other three subjects were 82% or above.
  • Infection rates were low, and many of the wards had benefited from a recent refurbishment or were due to receive one. The environment was clutter free, wheelchair accessible with enough equipment for staff to perform their role. Nurse staffing was managed using recognised tools and professional judgment. Staff had access to records which were stored securely. Medicines, including intravenous fluids, were stored and managed safely. Staff knew how to report incidents and tools such as the safety thermometer, were used to keep patients safe.
  • The services were effective because it had processes in place to ensure that guidance used by staff complied with national guidance, such as that issued by National Institute for Health and Care Excellence (NICE). Patients’ food, hydration and pain management needs were met. The service used audits within the specialities we visited to improve patient outcomes. Practice development nurses oversaw a programme of training to ensure staff remained competent. Staff worked effectively as a multi-disciplinary team and had good knowledge about consent and mental capacity.
  • The services were caring, with response rates in the friends and family test better than the England average. The inpatient score for recommending the service to friends and family in March 2018 was 97% which was above the trust’s internal target of 95%. Staff supported the emotional needs of patients and could, for example, signpost patients to patient support associations for further support while other services had specialist nurses. Staff tried to understand and involve patients and their carers where it was safe to do so.
  • The services were responsive, with a process in place at directorate to trust level to plan services. The trust ran a series of improvement programmes such as the ‘get people home’ programme. Average length of stay for both elective and non-elective procedures were lower than the England average. Wards had link nurses to champion the needs of patients with additional needs. Wards used various approaches to respond to challenges with access and flow. The service was responsive to complaints and had made changes to services, such as adaptations to the ward environment.
  • The senior leadership team running the specialities were visible, approachable, and responsive and worked as a cohesive team to promote a positive culture. The trust had clear governance processes in place to drive patient safety forward; these were implemented and monitored at directorate and group level. Staff and the public were engaged through meetings and surveys. The specialities we visited had access to directorate dashboards to help monitor patient sensitive indicators and act when necessary. The specialities we visited all had examples of innovation, learning and continuous improvement.

However:

  • While only occurring when patient numbers were low, staff told us patients on the clinical investigation unit were moved, at times, for non-clinical reasons, so the trust could use staff on the unit within the wider hospital. This had been reported by staff, but staff told us the practice was continuing.
  • We saw no evidence of any best interest decision making in any of the eight patient records we reviewed.
  • During the inspection, we visited two wards (H2 and P3) to look at the patient records of those who had been identified as having a learning disability. In the two patient files, we saw no capacity assessments or best interest decision making.

Surgery

Good

Updated 14 November 2018

Our rating of this service stayed the same. We rated it as good overall because:

  • We rated safe, effective, caring, responsive and well- led as good.
  • Staff were aware of how and when to report incidents, including safeguarding concerns. We saw that staff received feedback and lessons learned were shared.
  • All areas we visited were clean and well maintained.
  • Guidelines, pathways and policies were produced in line with national best practice guidelines and recommendations.
  • We saw many good examples of multidisciplinary working.
  • Patients, relatives and carers we spoke with gave consistently positive feedback: patients told us they felt safe on the wards and that staff were caring and compassionate.
  • Patients and their relatives told us they were involved in planning their care and that communication with staff was good.
  • Staff provided emotional support to patients and their loved ones.
  • There was a clear leadership structure and strategy for surgical services. Staff told us that management were visible, approachable and supportive.
  • Local governance arrangements were robust, and the team was aware of the risks to their service.

However:

  • The trust had made improvements to the ward environments; however, we found more could have been done for people with additional needs.
  • During our inspection, we saw carpet in some clinical areas which is not best practice for infection control.
  • We reviewed four sets of paper and electronic records and found incomplete documentation.

Services for children & young people

Good

Updated 9 June 2016

Overall, we rated the service as good. The service had a good culture of incident reporting, and there was evidence of lessons learnt from incidents. The neonatal unit had implemented a programme of simulation training to apply changes in practice following learning from incidents. The service promoted a culture of improvement. There were competency frameworks for nursing staff and medical staff received good clinical support and training.

The neonatal unit worked in a family centred way, to promote the confidence of parents in caring for their baby. This helped facilitate the unit’s strategy of early discharge, with the support of the neonatal outreach team and the rapid access clinic.

Staff working at the trust were aware of the trust’s values and there was a strategy to promote staff engagement. There was a supportive culture, with open door access to senior management. Staff participated in the research activity of the service.

The neonatal unit had gaps in medical staffing; however these gaps were being covered by advanced neonatal nurse practitioners. Nurse staffing levels did not meet the current national guidelines and were not achieving national recommendations for staff having a qualification in speciality.

The environment of the unit was not ideal and was not compliant with Government best practice guidelines. However, work was underway to commence reconfiguration of the unit to address the constrictions on space.

End of life care

Good

Updated 14 November 2018

  • We rated safe, effective, caring, responsive and well led as good.
  • The service managed patient safety incidents well. Staff knew how to report incidents and gave examples of recent incidents they had reported. Overall mandatory training compliance had improved.
  • The service provided care and treatment based on national guidance and evidence of its effectiveness. For example, the ‘Guidance for the care of the person who may be in the last hours to days of life’ document, which reflected ‘Five priorities for care of the dying person’, and rapid discharge pathways for general wards.
  • Staff ensured patients received pain relief appropriate to their needs. Where patients had complex pain, staff ensured that they were reviewed regularly, and that pain was brought under control using a range of analgesia.
  • The service undertook local audits, such as the DNACPR forms, assessment of the use of intravenous/subcutaneous fluids in patients in the last days of life and the whiteboard e-handover process and compiled achievable action plans and implemented standard operating processes (SOPs) to improve performance and services offered.
  • Staff involved patients and those close to them in decisions about their care and treatment. Patients, families and carers gave positive feedback about their care.
  • The mortuary had a dedicated viewing room for recently deceased patients and staff told us they could facilitate requests to wash and prepare the body in line with religious, spiritual and cultural beliefs.
  • There was a multi-faith chaplaincy department who could provide support to patients, relatives and staff regardless of their faith or belief.
  • The service took account of patients’ individual needs.
  • The specialist palliative care team were responsive to referrals and saw patients within 24 hours of receiving a referral.
  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, which were shared with all staff.
  • The service had managers at all levels with the right skills and abilities to run a service providing high quality sustainable care
  • The department had an end of life strategy with a focus on educating, developing and growing a strong and competent nursing workforce with the right skills to deliver quality end of life care.
  • The service engaged well with patients, staff, the public and local organisations to plan and manage appropriate services and collaborated with partner organisations effectively.

However:

  • Staff mandatory training compliance was lower than the trust target for some subjects.
  • Whilst the trust had implemented processes to ensure that patients care preferences at the end of their life were documented, the trust were unable to evidence improvements as they were not auditing patient outcomes.
  • We asked the trust about gold standards accreditation and were told Sheffield Teaching Hospital NHS Foundation Trust does not have the Gold Standards Framework accreditation. No further information was provided by the trust.
  • The trust performance in the national End of life care Audit: Dying in Hospital 2016 was worse than the England average for three of the five agreed clinical indicators and the trust answered no for five of the eight organisational indicators.