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Northern General Hospital Good

The provider of this service changed - see old profile

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 responsive as outstanding and we rated safe, effective, caring and well-led as good.

Inspection areas

Safe

Good

Updated 14 November 2018

Effective

Good

Updated 14 November 2018

Caring

Good

Updated 14 November 2018

Responsive

Outstanding

Updated 14 November 2018

Well-led

Good

Updated 14 November 2018

Checks on specific services

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 service was safe because staff compliance with mandatory training, and safeguarding, had improved. Nursing and midwifery staff exceeded the trust target of 90% for five out of 11 mandatory training modules. The other six training areas were all above 83%. Medical staff exceeded the trust target of 90% for six out of 11 mandatory training modules. The other five training areas were all above 82%.
  • Infection rates were low. The wards appeared to be clean and were wheelchair accessible. There was enough equipment for staff to perform their role. Nurse staffing was much better compared to when we inspected last time. 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 service was 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 had actioned several initiatives to improve patient outcomes. Practice development nurses oversaw a programme to ensure staff remained competent. Staff worked effectively as a multi-disciplinary team and had good knowledge about consent and mental capacity.
  • The service was caring, with response rates in the friends and family test better than the England average. The inpatient score for 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 signpost patients to a local charity for further support. Staff tried to understand and involve patients and their carers where it was safe to do so. Patients and relatives, we spoke with told us of the positive
  • The service was responsive, making changes to its service to benefit patients with life changing conditions, such as changes to its pathways. It was compliant with all referral to treatment standards apart from the GP 62-day pathway, but it had plans to improve compliance in this area. The service was responsive to complaints and had made changes to its service, such as the improvements to the telephone service, in response to feedback received.
  • The senior leadership team running the service were visible, approachable, and responsive and worked as a cohesive team to promote a positive culture. The service had clear governance processes in place to drive patient safety forward. Staff and the public were engaged through meetings, clinics and focus groups. The service was working with partners to improve the service provision for the region.

However:

  • A review of the staffing on the wards we visited showed that between 1/6/18 – 30/6/18 the average fill rate for registered nurses/midwives on nightshift and day shift was below 75%.
  • We saw no evidence of any best interest decision making in any of the eight patient records we reviewed.
  • During the inspection, we looked at the patient records of those who had been identified as having a learning disability. In the two patient files we reviewed at Northern General Hospital, we saw no capacity assessments or best interest decision making.
  • From February 2017 to January 2018 the average length of stay for medical elective patients at Northern General Hospital was 9.9 days, which is higher than England average of 5.8 days. For medical non-elective patients, the average length of stay was 7.5 days, which is higher than England average of 6.4 days.

Critical care

Outstanding

Updated 9 June 2016

Performance showed a good track record and steady improvements in safety. Staffing levels and skill mix were planned and reviewed to keep people safe. Systems, processes and standard operating procedures for infection control, medicines management, patient records and the monitoring and assessing and responding to risk were mostly reliable and appropriate.

Patients had comprehensive assessments of their needs. Staff worked collaboratively to understand and meet the range and complexity of patient’s needs. Staff were qualified and had the skills they needed to carry out their roles effectively. Information about patients care and treatment, and their outcomes, was not routinely collected or monitored in within the cardiac intensive care unit therefore the service was unable to benchmark itself against other similar services.

Patient’s emotional and social needs were highly valued by staff and were embedded in their care and treatment. Feedback from patients who used the service was continually positive about the way staff treated them. There was a strong, visible patient centred culture. Services were tailored to meet the needs of the individual patient. There was a proactive approach to understanding the needs of different groups of people.

Leaders prioritised safe, high quality person-centred care. There was a clear statement of vision and values, driven by quality and safety. There was a strong focus on continuous learning and improvement. 

End of life care

Good

Updated 14 November 2018

Our rating of this service improved. We rated it as good because:

  • We rated safe, effective, caring and well led as good. We rated responsive as outstanding.
  • The service managed patient safety incidents well. Staff knew how to report incidents and gave examples of recent incidents they had reported.
  • 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 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. We were inundated with outstanding examples of staff meeting patients’ individual needs.
  • 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:

  • Whilst mandatory training compliance had improved we found low compliance amongst some staff groups for some subjects. Staff reported delays obtaining pressure relieving equipment.
  • The trust had processes in place to ensure patients care preferences at the end of their life were documented. However, they were unable to evidence improvements for patient outcomes because they were not auditing outcomes. The trust did not have gold standards framework accreditation and did not provide any indication this was planned.
  • Despite implementing positive initiatives to ensure patients preferred place of care was achieved there were 259 delayed fast track discharges at this hospital.
  • 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.

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, care and the treatment they received.

Space was limited in the fracture clinic and was not designed to meet the needs of patients.

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.

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 that 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.

Urgent and emergency services

Good

Updated 14 November 2018

  • Leadership of the department was recently strengthened, and the care group leadership team included the nurse director, an operations director and clinical director which formed a clinical delivery leadership triumvirate. A clear vision, three-year strategy and operational plan was in place for the continued development of the department.
  • The emergency department’s culture was clearly positive, which a visitor could sense, and which staff told us about. Staff we spoke with felt valued, appeared happy and enthusiastic and spoke positively about working in the department.
  • The department had made a number of changes to strengthen the arrangements for governance linked to the ‘ward to board’ governance of the trust. The nurse director was the accountable lead for governance. Clinical governance arrangements had been strengthened with the clinical director having overall responsibility for clinical governance.
  • Our observation of the emergency department showed patient flow was effective. Since our previous inspection the initial assessment unit had been upgraded and a new helipad had been opened adjacent to the emergency department front door and resuscitation area.
  • Actual nurse staffing levels coincided with planned level following a £1.2m investment in additional staffing approved by the trust board in February 2016 which had meant increased nursing and support staff had increased by 25% since our previous inspection.
  • Senior managers had devised an operational plan “Action 95” which examined the patient pathway through the department and an integrated performance scorecard was prepared daily which reported on accident and emergency waiting times.
  • A revised ‘front door’ arrangement was implemented from November 2017 which supported timely diagnostics, decision-making and prompt treatment for the patient. If there were delays in the department and ambulance handover times increased, a senior nurse would undertake a rapid assessment and handover process. In triage, ambulance crew informed nursing staff of any dementia or mental health needs.
  • The mental health liaison team provided cover within the department 24 hours a day, seven days a week.
  • The department supported patients who become distressed. Medical and nursing staff clearly understood the emotional impact of the patients’ care and treatment potentially had on the patient’s and their relative’s overall wellbeing.
  • The department and the wider hospital had developed incident reporting and investigation since our previous inspection. There were just four incidents awaiting investigation.
  • Staff applied safeguarding procedures for adults appropriately supported by the safeguarding lead, a senior member of nursing staff so that patients presenting with complex safeguarding needs were safely protected from abuse.
  • Personal development reviews included interaction to support the staff member’s development and an action log was completed and signed within two weeks of the appraisal. A structured induction programme was in place for new staff. A planned career progression plan was available for all staff. The clinical education programme was externally endorsed.
  • Sepsis outcomes showed a considerable improvement. Outcomes for sepsis patients included the patient’s experience of their stay in hospital. A sepsis study day was in development.
  • Collaborative working with external partners was effective and included arrangements with the local NHS ambulance service, the local authority and the local NHS children’s hospital as to the admission of children requiring urgent and emergency care.
  • The department liaised effectively with the police in supporting integrated inter-agency working. The department had a dedicated police liaison officer. The department worked with the police to develop tools to deter knife crime, mainly in young people.

However:

  • We did not see evidence that the trust board were appropriately sighted on the risks that were classed as ‘extreme’ by the emergency department.
  • Despite the electronic patient records we found that paper notes continued to be used in the department.
  • NHS England’s quality dashboard for June 2018 showed that for May 2018, 88.8% of patients were seen within four hours of arrival, which was worse than other trusts in the South Yorkshire area.
  • When all cubicles were in use we observed that one patient on a trolley, and a second patient sitting on a chair, were treated in the centre of the department, although blankets were used to maintain the patient’s dignity.
  • Although we were informed that the trust was reviewing the requirements for the major trauma centre to include consultant staff 24 hours and seven days per week, we remained concerned that the major trauma standards were being breached and this had not been resolved in a timely way following our previous inspection.
Other CQC inspections of services

Community & mental health inspection reports for Northern General Hospital can be found at Sheffield Teaching Hospitals NHS Foundation Trust.