Scunthorpe General Hospital

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

This means we looked for evidence that people were protected from abuse and avoidable harm.

We checked that risks to people’s safety were identified, assessed and managed well, and that systems were in place to prevent mistakes and reduce the likelihood of harm. We also looked for evidence that when things went wrong, the service learnt from incidents and took action to improve safety. We considered how leaders promoted a culture where people’s safety was prioritised, concerns were listened to, and improvement in safe practice was part of everyday work.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good.

This meant people were safe and protected from avoidable harm.

We have not awarded this service a score for Safe.

Find out about when we will not publish a key question score and what we look at when we assess Safe.

The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The service demonstrated a positive approach to learning and continuous improvement. Leaders and staff understood the importance of learning from daily practice, incidents, feedback and complaints to improve the quality and safety of care.

Staff told us they felt encouraged to reflect on their practice and to speak openly about what was working well and what could be improved. They said managers were approachable and supportive, and that learning was viewed as an opportunity to improve rather than to blame. This helped to create an open and honest learning culture. Managers debriefed and supported staff after any serious incident.

The service had systems in place to learn from incidents, accidents and near misses. Records showed these were reviewed, with clear actions identified to reduce the risk of reoccurrence. Where appropriate, learning points were shared with the wider staff team through team meetings, handovers and written communications to support shared learning.

Incidents were analysed to identify trends or themes and potential links to individual practitioners. There had been repeated themes of pressure damage, falls, and medication errors.

Staff received induction, training and ongoing development that supported safe and effective care. Supervision and appraisals were used to reflect on practice, identify learning needs and agree development goals.

Managers monitored quality and performance through audits and checks. Findings from audits were used to inform learning and service improvement. Action plans were developed where shortfalls were identified, and progress was reviewed to ensure improvements were sustained.

The service provided mandatory training in key skills to all staff. Managers monitored mandatory training and alerted staff when they needed to complete updates. Staff kept up to date with their mandatory training. The data showed an overall completion rate of 87% across all mandatory training subjects at both hospitals delivering end-of-life care at the trust.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

At the previous CQC inspection, there was no effective system to accurately identify end-of-life and palliative care patients across the hospital. At this inspection, we found clear improvements. The service had established effective systems to support safe admission, care transitions and discharge. Referral pathways were clearly defined and well understood by staff. Referrals from appropriate professionals, including hospitals, GPs and community services, were reviewed by clinicians to enable timely and appropriate decision-making.

The service had effective systems to support safe admission, care transitions and discharge. Referral pathways were clear and understood by staff. There were twice daily huddles with a local hospice, health care coordinators and community nursing teams to discuss all patient flow into and out of hospital. Staff worked closely with external professionals, including other acute hospitals, GPs, community teams and social care, to ensure information was shared in a timely way. This supported coordinated care and safe transitions between services.

Clinical nurse specialists visited all palliative and end-of-life patients and their families to check on the delivery of care. These specialist nurses also offered guidance and support to staff on wards. The team aimed to provide continuity of care by ensuring patients were reviewed by the same specialist. Documentation was completed using a system that was visible and accessible to community teams and hospice providers.

There were safe handover processes at each stage of the patient pathway, including admission from hospital and the community, ongoing care and discharge. Relevant clinical, psychosocial and social care information was shared to support continuity of care and risk management.

Staff supported people to make decisions about future care, including preferred place of care, and these preferences were recorded and reviewed. Advance care plans were documented and staff were aware of patients’ wishes and used these to guide care and decision making.

Arrangements for post‑death care were respectful and well organised. Patients’ dignity was maintained, and families were given time and support following bereavement.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

The service had effective safeguarding systems in place to protect patients and others from abuse and neglect. There was a clear safeguarding policy that reflected current national guidance, and staff were aware of how to access and follow it in practice.

Staff understood how to raise safeguarding concerns and were confident in identifying and reporting abuse, neglect or exploitation. Safeguarding concerns were shared appropriately within the team and managed by a named safeguarding lead, with learning discussed and used to improve practice.

Clear arrangements were in place to liaise with local authority social work teams and other safeguarding partners. The service engaged with local safeguarding systems and shared relevant information when required.

Staff received safeguarding training appropriate to their role and knew what action to take if they had concerns. Compliance with safeguarding training both levels 2 and 3 was between 86% and 100% for nursing staff which met trust compliance targets. Staff considered the safeguarding needs of people other than the patient, including relatives and children, and took action when risks were identified.

The service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

The service supported patients to make informed decisions about their care and activities, including where there were potential risks. Staff worked with patients to understand their wishes and balanced risk appropriately, respecting individual choice where patients had capacity. This included supporting people to fulfil preferences at the end of life while taking reasonable steps to reduce harm.

Patients and their families were involved in discussions about care, treatment options and future decision making. Staff explained treatment plans, when to escalate concerns and when care would focus on palliation rather than active treatment. Families were kept informed and supported, including where views differed, and decisions were made in the patient’s best interests.

Individual risk assessments were completed and reflected people’s specific needs and conditions. These covered key risks such as falls, pressure damage, moving and handling, continence and communication. Risk assessments were regularly reviewed and used to inform personalised care planning. Risks and agreed mitigation measures were shared with patients and families.

There were arrangements to identify and manage patient deterioration. Staff were trained to recognise acute and reversible deterioration and understood escalation processes. Patients were observed to receive prompt assessment and review by the most appropriate person for their needs. There were identified ceilings of care, observations and monitoring were carried out in line with policy and individual care plans.

Staff received training to support people with additional needs, including those with mental health conditions, learning disabilities or autism.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

At the last inspection, the service was found to be in breach of regulation for not ensuring that equipment used to deliver care was being used in accordance with trust policy and best practice. At this inspection we saw that a procurement of additional syringe drivers meant that there was now enough in circulation to meet patient need. A rolling procurement programme to replace older syringe pumps with newer models had also been established. Leaders told us that at the time of inspection, 76% of staff had been trained in syringe driver management against a trust compliance target of 85%. Leaders told us that the target had not been met as bank staff numbers had recently been added to the compliance metrics, however. it was still a considerable improvement from the previous inspection

The service provided a safe, clean and well‑maintained environment. Patients who were receiving palliative or E0L care treatment were to be found on various wards of the hospital dependent on the nature of their symptoms at admission. The wards seen by the inspection team were visibly clean and well organised

Incidents related to the environment or equipment were reported and reviewed, and actions were taken to reduce future risk.

Clinical Nurse Specialists (CNS) worked with others to ensure that equipment was provided for patients when being discharged into the community or own homes  

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The team consisted of a matron and 6 clinical nurse specialists who covered the service every day. There was one palliative care consultant and a dedicated lead nurse for end-of-life care. There was also a lead nurse for community-based services and a team leader who were based outside of the hospital premises.

The chaplaincy team were responsible for offering spiritual and religious support to patients, relatives and staff.

Since the previous CQC inspection, the teams had merged to become a single Specialist Palliative Care and End of Life Care Team and staffing had increased to enable this to become a 7-day service.  The team criteria had also changed from just reviewing patients with advanced, progressive, life limiting illness with specialist palliative needs, to include supporting all patients on wards recognised as being in the last days of their life.

The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The trust had infection prevention and control (IPC) systems in place to reduce the risk of infection and protect patients, staff and visitors. An up‑to‑date IPC policy and plan aligned with national guidance, and staff understood their responsibilities.

The trust had clear arrangements to identify and manage infection risks, including for people with known or suspected infectious conditions. There were systems to communicate new or emerging IPC risks promptly to staff.

Staff followed infection control practices in line with policy, including hand hygiene, use of personal protective equipment and bare‑below‑the‑elbows guidance. Compliance was monitored through audits and observations, and learning was shared with staff.

Ward staff would always try to prioritise side rooms for palliative and end-of-life patients however, this was not always possible due to bed occupancy limitations.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

At the last inspection, we observed delays in the prescribing of anticipatory medicines as not all staff were aware of a priority alerting system for the ordering of anticipatory medicines. The service now had a consistent approach to the monitoring of pain relief and the reassessment of pain which they did not have at the previous CQC inspection.

The trust provided medicines management training as part of mandatory training and staff induction. Nurses were required to complete additional training and competency assessment for intravenous administration. The team had created a policy for anticipatory drug prescribing to guide staff when and how to prescribe medicines to end-of-life patients, even those not started on the pathway, to provide symptom and pain relief. We observed staff adhering to this policy when prescribing predetermined selection of anticipatory medicines. We reviewed electronic medicine charts which showed staff regularly reviewed, and prescribed, medications.

Medicines were stored safely, securely and were well organised. Controlled drugs were stored securely with restricted access, record keeping was accurate and there was a process in place to report any discrepancies. Temperature monitoring for areas where medicines were stored was completed daily and there was a process in place to review expiry dates of medicines.

Details of patient allergies were documented well in all patient records. Patient weights to ensure appropriate doses of medicines were prescribed were also well documented as a result of audit improvement work. Where medicines had been prescribed for short term use, such as antibiotics, or had specific dosing regimes, this was marked clearly on prescription charts.