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Inspection Summary


Overall summary & rating

Good

Updated 15 April 2016

We inspected Northern Lincolnshire and Goole NHS Foundation Trust (the trust) from 13 – 16 October 2015. This inspection was to review and rate the Trust’s community services for the first time using the Care Quality Commission’s (CQC) new methodology for comprehensive inspections. It was also an acute hospital focused inspection to follow up our concerns from the April 2014 comprehensive inspection and highlighted through other information routes.

Focused inspections do not look across a whole service; they focus on the areas defined by the information that triggers the need for the focused inspection. We therefore did not inspect all the core services at Goole hospital for this follow up inspection. Additionally not all of the five domains: safe, effective, caring, responsive and well led were inspected for each of the core services we inspected. For the 2015 inspection we inspected the effective domain for the emergency and urgent core service (the minor injuries unit). This was because it had not been rated in 2014. We inspected maternity services because of concerns we had received. Diagnostic services were inspected for the first time and we followed up the responsive domain in outpatients from our 2014 inspection.

Overall at the 2015 inspection we rated Goole hospital as good. We rated Goole minor injuries unit (MIU) as ‘good’ for being effective. Maternity services and diagnostic imaging services were rated as ‘good’ overall.

Our key findings were as follows:

  • There was good evidence-based care and treatment within the MIU although some of the guidelines were past their review dates; work was taking place to action this.
  • Given that this was a small MIU in a small hospital there was good access to services seven days a week.
  • Women who chose to give birth at the hospital received two midwives to one woman care during labour and escalation procedures were in place to ensure there were sufficient staff. The unit provided individualised care and patients were treated with privacy, dignity and respect.
  • The maternity birthing pool and antenatal clinic were visibly clean.
  • The rates for patients who did not attend appointments in outpatients had improved since our last inspection, but clinic cancellation rates were worse, apart from in ophthalmology.
  • Outpatients and diagnostic imaging patients received harm-free care and treatment in a clean and well-equipped hospital from staff who had received appropriate training. Although radiology was short of medical staff across the trust, this did not affect patient care.
  • Patients in ophthalmology outpatients and radiology told us they were happy with the care and treatment they received. They told us staff were kind, caring and compassionate.

However, there were also areas of poor practice where the trust needs to make improvements at this hospital. Importantly, the trust must:

  • seek and act on feedback from service users in radiology in order to evaluate and improve the service.
  • ensure it acts upon its own gap analysis of maternity services to deliver effective management of clinical risk and practice development.
  • review the rate of cancellations of outpatient appointments and rates of ‘did not attend’ at Goole and take action to improve these in order to ensure safe and timely care and to meet the trust’s own standards of 6%.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection areas

Safe

Good

Updated 15 April 2016

Effective

Good

Updated 15 April 2016

Caring

Good

Updated 15 April 2016

Responsive

Good

Updated 15 April 2016

Well-led

Good

Updated 15 April 2016

Checks on specific services

Maternity and gynaecology

Good

Updated 15 April 2016

Overall we rated the service as good. Staff were encouraged to report incidents and systems were in place following investigation to help rapidly disseminate learning. Women during labour received two midwives to one woman care and escalation procedures were in place to ensure there were sufficient staff. The unit provided individualised care and patients were treated with privacy, dignity and respect. Women received care according to professional best practice clinical guidelines. Pain relief of choice was available for women in labour.

Services were planned and delivered to enable women to have the flexibility, choice and continuity of care wherever possible. A supervisor of midwives was available for all women who had chosen to have a home birth and this included a home visit to discuss their birth plan.

Staff were clear about the vision of the service they provided and were committed to providing midwife led, holistic care. Staff told us their manager was approachable, supportive; teamwork was good and they felt listened to.

The trust’s gap analysis based on the findings of the Kirkup Report, identified the need for a clinical risk midwife and a practice development midwife; the management team were working to address these shortfalls. We found in the midwife led unit the refrigerator temperature had not always been maintained at the desired temperature of between 2 to 8°C.

Medical care (including older people’s care)

Good

Updated 16 July 2014

We found that the care and treatment patients received was safe, caring, effective, responsive to people’s needs and well-led. There were some nursing and medical staff vacancies, which meant there was pressure on nursing staff to cover shifts, and medical staff to work extended hours. Bank, agency and locum staff were used to make sure that staffing levels remained safe on the ward.

Staff felt that they were well-led and supported to carry out their role to the best of their abilities. They thought the trust was working to improve the care patients received and supported staff by listening to them and making changes.

There were mechanisms in place to make sure that the care people received was of a good standard. These included the use of nationally recognised tools such as the patient safety thermometer, which monitored any harm to patients such as falls or pressure ulcers. From the information we saw, there were no concerns about the quality of care delivered by the ward.

Minor injuries unit

Good

Updated 15 April 2016

We found the minor injuries unit at Goole and District Hospital to be good for the effective domain. We did not rate the service in relation to the other four domains.

Evidence-based care and treatment was provided although some of the guidelines were past their review dates; work was taking place to action this.

We found the unit fully supported all grades of staff in their development. There was good multidisciplinary working. However, there was no service level agreement with the local mental health trust as to how long it would take them to come and assess a patient.

Given that this was a small unit in a small hospital there was good access to services seven days a week. Staff we spoke with showed a good knowledge of consent procedures, the Mental Capacity Act, and the associated Deprivation of Liberty Safeguards.

We were told of a recently conducted mental health audit. Apart from this, there was no further evidence presented to us regarding the measurement of patient outcomes.

Surgery

Good

Updated 16 July 2014

Surgical services at this hospital were safe. The environment on the surgical wards and theatres was clean and there was evidence of learning from incidents in most areas. Medical and nursing staffing levels were adequate. There was adequate equipment to ensure safe care and records were appropriately maintained. The World Health Organisation safety checklist was used at this hospital. Services were based on evidence-based care and treatment and there was evidence of multidisciplinary working. Patients received care and treatment from competent staff and there were robust on-call and transfer arrangements in place between this site and Scunthorpe General Hospital.

The surgical services provided at this hospital were caring. Most staff reported good leadership at all levels within surgery.

Outpatients

Good

Updated 15 April 2016

We rated the safe, caring, responsive and well-led domains as good; the effective domain for diagnostic imaging was inspected but not rated.

When we inspected outpatients at this location in April 2014, the service overall was rated as good and the responsive domain was rated as requires improvement. This was because the hospital had a relatively high did not attend (DNA) rate (10%) and levels of cancellations of outpatient appointments (6.6%).

We did not inspect diagnostic imaging at the last inspection; therefore, all five domains were included at this inspection visit.

Following the last inspection, we asked the provider to make improvements. We went back on this inspection to check whether the provider had made these improvements.

We found the DNA rates in outpatients had improved overall but clinic cancellation rates were worse, apart from in ophthalmology.

Patients received harm-free care and treatment in a clean and well-equipped hospital from staff who had received appropriate training. Although radiology was short of medical staff across the trust, this did not affect patient care.

We found patients in ophthalmology outpatients and radiology were happy with the care and treatment they received. They told us staff were kind, caring and compassionate.

Staff were competent and worked to national guidance, which made sure patients received the best care and treatment. Patients were protected from the risk of harm, because policies and procedures were in place to ensure this was managed appropriately.

Patients received follow-up appointments when they should receive them and there were no issues identified with backlogs at the GDH site. Staff told us they liked working at GDH, their managers were supportive and there was good teamwork.

Outpatient, phlebotomy and radiology services offered at GDH met patients’ needs and ensured the departments worked effectively and efficiently.