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The Royal Stoke University Hospital Requires improvement


Inspection carried out on 05 Jun to 01 Aug 2019

During a routine inspection

Our rating of services went down. We rated them as Requires Improvement because:

  • Our rating of safe was Requires Improvement overall. Risks within the emergency department were not always identified and escalated appropriately. We were not assured that all patients allocated to wait on the corridor were safe. Not all staff had completed all of the required mandatory training. Not all staff had training on how to recognise and report abuse. However, despite the low training figures, staff we spoke with were knowledgeable on how to recognise and report abuse. Both nursing and medical staff throughout the core service did not meet the trusts targets for safeguarding training. The service did not always have enough nursing staff with the right qualifications, skills and experience to keep patient's safe from avoidable harm and to provide the right care and treatment on all wards. Staff did not always undertake observations of patients’ vital signs in a timely manner. Risk assessments relating to patient malnutrition were not undertaken in line with the trust target
  • Our rating of effective was Requires Improvement overall. The service did not always provide care and treatment based on national guidance and evidence of its effectiveness. The service did not always ensure staff were competent for their roles. Managers sometimes appraised staff’s work performance to provide support and monitor the effectiveness of the service. Staff did not always assess and monitor patients regularly to see if they were in pain. Staff did not always understand their roles and responsibilities under the Mental Capacity Act 2005. They did not always know how to support patients experiencing mental ill health and those who lacked the capacity to make decisions about their care.
  • Our rating of caring was good overall. Staff provided emotional support to patients to minimise their distress. Staff involved patients and those close to them in decisions about their care and treatment. Staff cared for patients with compassion however, patient dignity was sometimes compromised.
  • Our rating of responsive was requires improvement overall. People could not always access services when they needed. The service treated concerns and complaints seriously however, complaints were not always responded to within appropriate time frames or learning effectively shared.
  • Our rating of well led was requires improvement overall. Not all managers had the right skills and abilities to run services providing high-quality sustainable care. Departments did not always have effective systems for identifying risks.

Inspection carried out on 3 October to 16 November

During a routine inspection

Our rating of services improved. We rated it them as good because:

  • We rated safe and responsive as requires improvement, effective and well-led as good, and caring as outstanding. All ratings improved, apart from safe which stayed the same.
  • Our decisions on overall ratings take into account, for example, the relative size of services and we use our professional judgement to reach a fair and balanced rating.
  • We saw the trust had taken steps to improve patient flow through both hospitals, including a range of initiatives in the Emergency Departments and in medicine.
  • Processes around the management of medicines had been improved in some areas.
  • Staff were very caring and compassionate, universally put the patient first despite facing huge pressure on capacity.
  • Staffing levels had improved and the trust had less reliance on temporary workers.
  • Services in critical care and end of life care had been transformed since our last inspection.

Inspection carried out on 21 April 2015

During Reference: R6 not found

Inspection carried out on April 2015

During a routine inspection

The Royal Stoke Hospital is part of University Hospitals of North Midlands NHS Trust. The trust was created on 1 November 2014, following integration with Stafford Hospital from the Mid Staffordshire NHS Foundation Trust. The hospital is based in Stoke on Trent and provides general acute hospital services as well as some specialised services.

We recognise that the leadership of the new trust has had the significant task of bringing together two organisations at a challenging time. We have seen that progress has been made but there is still more to be achieved.

We inspected this service in April 2015 as part of the comprehensive inspection programme. We inspected all core services provided by the trust at both hospital sites.

We visited the hospital on 22, 23 and 24 April 2015 as part of our announced inspection. We also visited unannounced to the trust until Tuesday 5 May 2015. Our unannounced visit included A&E, Medical Care Services and Critical Care.

Overall we have rated this hospital as requiring improvement. We saw that services were caring and compassionate. We saw a number of areas that required improvement for them to be assessed as safe and effective. We saw that leadership of services also required improvement at both a local and an executive level. The responsiveness of services was assessed as inadequate.

Our key findings were as follows:

  • Staff were caring and compassionate towards patients and their relatives, we saw a number of outstanding examples of good care right across the hospital.
  • There was a strong culture of incident reporting and staff were encouraged and supported by their managers to engage in this. This made staff feel empowered.
  • Achieving safe staffing levels was a constant challenge for the organisation and there was a heavy reliance on agency and locum staff to support this.
  • Systems and processes did not support patients flow through the organisation.

We saw several areas of outstanding practice including:

  • A range of initiatives in services for children and young people to enhance their patient experience

  • Diagnostic imaging services had received accreditation from the Royal College of Radiologists through the imaging services accreditation scheme (ISAS).
  • The hospital Alcohol Liaison team had reduced hospital stay for patients with alcohol related issues by an average of 1 day per patient. This equated to 2762 hospital days saved during the last two years.
  • A specialist one stop clinic had been developed for women with substance misuse issues where they could obtain the script for their medicines and then see the consultant and specialised midwife for their antenatal care.

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

Importantly, the hospital must:

  • Review systems and processes to ensure patients flow through the organisation in a timely manner
  • Address high waiting times in the emergency department
  • Review the capacity and adequacy of the critical care services.
  • Review the sustained use of recovery to accommodate critically ill patients
  • The hospital should review staffing arrangements in medicine and the emergency department to ensure there are sufficient numbers of nurses and that the planned and actual staffing levels for each shift are displayed.
  • The hospital should ensure that resuscitation trolleys throughout the hospital are appropriately stocked and are checked as regular intervals
  • There must be sufficient and appropriately experienced staff to provide safe and effective patient care.
  • There must be appropriate systems in place and available to respond to deteriorating patients and the outreach team must be able to provide a service to all parts of the hospital.
  • Implement the individualised care plan as soon as possible so that patients who are actively dying are supported holistically.
  • Improve must be made to the discharge process for patients who wish to go home to die so that fast track discharges can be completed within 48hrs.
  • Patients preferred place of death should be recorded and monitored so that the hospital can meet patients’ choices.
  • The hospital must review the sustained use of recovery to accommodate critically ill patients
  • The hospital must review arrangements for gynaecology patients to ensure they are provided with a safe service and are cared for by staff with the relevant skills and expertise.
  • Out of hours medical cover and arrangements for emergencies in critical care must be reviewed.
  • Multi-disciplinary working in critical care must be reviewed to ensure that effective working arrangements are in place.
  • Patients who appear to lack capacity should be assessed appropriately when decisions about their care are being discussed.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection carried out on 11 December 2013

During a themed inspection looking at Dementia Services

During our inspection we visited the Emergency Department, the Frail Elderly Assessment Unit (FEAU), two elderly frail wards and two orthopaedic wards. We spoke with patients who had dementia or possible dementia and their relatives. We also looked at the care records of seven patients with dementia, and we spoke with the staff who were on duty in all of the areas we visited.

We saw that patients were assessed and placed on an appropriate �dementia� or �possible dementia� care pathway. This pathway sets standards of care and treatment to ensure that patients received the right care when they needed it.

We saw that patients were kept safe because their risks were appropriately managed by the staff. Staff worked closely with other providers and services to ensure that specialist assessments were completed and safe hospital discharges were facilitated.

Patients and their relatives told us they were treated with care and compassion. One patient said, �The staff here are wonderful. Everyone has been wonderful�. We saw that staff provided care in a responsive and unrushed manner. One relative told us, �They�ve saved her life. They wouldn�t leave her, the nurse was pumping her full of fluids. It could have gone either way but now my relative is great�.

The service was well led. A plan was in place to improve dementia care and systems were in place to assess and monitor the improvement plan.