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Goole & District Hospital Requires improvement

Reports


Inspection carried out on 8 May 2018

During an inspection to make sure that the improvements required had been made

Our rating of services went down. We rated them as requires improvement because:

  • We rated safe, effective, responsive and well led as requires improvement and caring as good.
  • At this inspection we saw improvements in some of the hospital’s services but some services had deteriorated since our previous inspection
  • We rated three of the hospital’s five services as good, one as requires improvement and one as inadequate.
  • There was limited evidence that staff had the skills, training and experience to provide the right care and treatment. For example, appraisal rates for a number of staff groups were worse than the trust target and mandatory training rates in four of the five services at the hospital were below the trust target of 85%.
  • We found examples in medical care and outpatients where there had not been sufficient effective senior clinical oversight to manage risk and respond to urgent or changing patient needs.
  • The total number of patients on outpatient waiting lists had increased since the previous inspection.
  • Services at the hospital did not have a vision, strategy or business plan. We saw examples where service delivery did not seem to have been addressed, for example, the delayed discharges in medical care and utilisation of the birthing suite.
  • The hospital did not engage effectively with patients, staff, and the public to plan and manage services.

However:

  • Staff cared for patients with care and compassion and respected patients’ wishes. Staff provided individualised care and involved patients and those close to them in decisions about their care and treatment
  • Staff worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.
  • Staff felt well-supported by their local leaders and the culture of the hospital was patient-centred.

Inspection carried out on 13 – 16 October 2015

During a routine inspection

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 carried out on To Be Confirmed

During a routine inspection

Goole and District Hospital is one of three acute hospitals within Northern Lincolnshire and Goole NHS Foundation Trust. This trust has been selected as one of the first trusts to be inspected under CQC’s revised inspection approach. It was selected for inspection as an example of a ‘high-risk’ trust.

Goole and District Hospital is a small, purpose-built, community hospital providing care and treatment for the people of East Riding. This hospital has a minor injuries unit but does not provide accident and emergency, emergency medical or surgical services. These are provided at the trust’s two other hospitals located at Scunthorpe and Grimsby. The hospital has approximately 30 inpatient beds as well as day beds providing medical and elective surgical services. There is a midwifery-led outpatient maternity service with a home from home delivery facility and an outpatient’s facility.

We inspected Goole District Hospital (GDH) as part of the comprehensive inspection of Northern Lincolnshire and Goole NHS Foundation Trust, which included this hospital, Diana, Princess of Wales Hospital (DPOW) and Scunthorpe General Hospital (SGH).

We inspected Goole District Hospital on 24 April and 8 May 2014.

We carried out this comprehensive inspection because the Northern Lincolnshire and Goole NHS Foundation Trust was placed in a high risk band 1 in CQC’s Intelligent Monitoring system.

Overall, Goole and District Hospital provided good care in all its services and we found that were safe, effective, caring, responsive and well-led.

Our key findings were as follows:

  • There were arrangements in place to manage and monitor the prevention and control of infection, with a dedicated team to support staff and ensure policies and procedures were implemented. We found all areas we visited were clean. MRSA and C. difficile rates were within an acceptable range for the size of the trust.
  • There were no significant vacancies with nursing or medical staff. Bank, agency and locum staff were used to fill any deficits in staff numbers. Staff could also work extra hours.
  • Patients were able to access suitable nutrition and hydration including special diets. Patients reported that on the whole they were content with the quality and quantity of food provided.
  • Mortality rates were improving.

We sawsome areas where the trustshould make improvements.

The trust should:

  • Consider the relocation or refurbishment of the birthing room within the maternity unit at this hospital.
  • Consider a more proactive approach to outpatient waiting times and Did Not Attend (DNA) rates and put plans in place to improve the patient experience.

Professor Sir Mike Richards

Chief Inspector of Hospitals

During a check to make sure that the improvements required had been made

The inspection carried out in February 2013 showed a large number of staff had not received mandatory training, appraisal or clinical supervision. Staff morale was low and staff engagement in problem solving and raising concerns about patient care was inadequate.

We reviewed records relating to training for staff working at Goole Hospital. These showed 85% of staff had completed mandatory training.

Improvements were evident in ensuring staff received personal appraisal. The trust had re-launched appraisal documentation which had been disseminated trust wide and was linked to the trust's visions and values. Plans were in place for 75% of staff to receive appraisal by the end of the year.

The trust had introduced a number of initiatives to improve staff morale. This included reward and recognition for areas of good practice and clinical innovation. Staff engagement was encouraged by the trust. There were opportunities for staff to meet with the Chief Executive and make suggestions. Confidential and closed meetings were provided to staff who wanted to raise concerns. The staff morale survey for September 2013 showed improvements in certain areas such as managerial relationships, training and appraisal. Further work was noted to be required in areas of communication, staff engagement and attitudes and behaviours. Data showed staff morale for Goole was higher compared to the other trust hospital sites.

Inspection carried out on 13 February 2013

During a routine inspection

We inspected the ward that had four beds identified for stroke rehabilitation care. We found that patients who were admitted to the hospital for stroke rehabilitation received care and treatment that met their needs. The hospital had facilities to enable patients to improve their health and wellbeing.

We found that not all staff we spoke with had up to date certificates in training the trust considered mandatory and other important training relevant to their role. There was limited formal staff supervision and not all staff we spoke with had received appropriate development and appraisal. We found the trust had recognised this and started to address it by completing a training analysis.