Scunthorpe General Hospital

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. We saw that continuous learning and improvement was not embedded in the service, however there was an inclusive and positive culture. This meant the service was not always meeting the needs of people who used services and wider communities. We saw that leaders proactively supported staff and collaborated with partners.

We have not awarded this service a score for Well-led.

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

The service had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

Staff we spoke with told us they felt confident in raising concerns or suggestions and that they felt listened to by leaders.

Staff were aware of the provider’s vision and values and could tell us how they were applied in the work of their daily work within the department. The focus of the department to improve performance against national targets so that patients received the right care, in the right place, at the right time.

Staff had the opportunity to contribute to discussions about the strategy for their service, and to have input into changes within the service. We were given examples of how staff were given the opportunity to ask questions regarding plans for the future and the trusts overall strategy. An example of this was staff having provided input into the redesign of the department.

The trust provided evidence that work was ongoing to implement and improve culture within the North Lincolnshire and Goole NHS Cultural Transformation Plan.

The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Nursing and medical staff understood the key risks to patients within the department. Staff told us the emergency departmental leads and senior managers were approachable, visible, and provided them with good support.

Staff understood the departments leadership structure and who to report to if issues arose. Department leaders were able to demonstrate understanding of their roles and responsibilities.

Leaders were able to demonstrate how they worked as part of a multidisciplinary team for example, a good working relationship was seen between the department and the local NHS ambulance trust.

Leaders understood, but did not always have resources and space to manage, the priorities and issues the service faced. Capacity constraints and issues with partnership working with other specialities within the trust and across other parts of the hospital, impacted on patient flow in the emergency department.

Leaders had effective support and opportunities to develop and maintain their credibility and skills. All staff had opportunities to develop including for future leadership roles. There was inclusive recruitment and succession planning. The trust had effective recruitment processes and ongoing checks to ensure all staff met the legal requirements to work in the trust

The service fostered a positive culture where people felt they could speak up and their voice would be heard.

Leaders were committed to a positive culture where people felt that they could speak up and that they would be listened to. Leaders were able to describe how staff reported concerns and how these were investigated and feedback given.

The trust had appointed a Freedom to Speak Up (FTSU) Guardian, and staff across the department had an awareness of the role. Leaders described an open-door policy and an eagerness to support staff, detailing how concerns were investigated and fed back. All staff we spoke with reported feeling able to raise concerns.

We saw staff offer patients opportunities to provide feedback. Patient surveys were collected, and the results were used to implement improvements.

Staff we spoke with were aware of the trusts whistleblowing policy.

The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

The service promoted equality and diversity in daily work and provided opportunities for all staff to develop. Staff survey results showed that staff felt there were opportunities for career development.

Policies and processes were in place to ensure the service was inclusive and fair in the way it operated. Staff received training in equality and diversity and had a good understanding of cultural, social and religious needs of patients and demonstrated these values in their work.

Governance structures were in place but inconsistently applied and was not always used effectively. The service was previously in breach of the legal regulation in relation to governance, management and sustainability. Insufficient improvements were found at this assessment, and the service remained in breach of this regulation.

Staff had sufficient resources to support effective governance and risk management. However, data collection processes were inconsistent. In addition, some completed audits were either not provided or were of insufficient quality to support effective oversight. As a result, there was limited assurance that reliable information was consistently available to monitor performance, quality, and service improvement.

We highlighted issues during assessment, such as staff compliance with the principles of infection prevention and control. Senior leaders had been aware of the issue as it had been repeatedly highlighted in audit, but we were not assured that the pace of action for improvement was effective. Senior leaders described enlisting the involvement of Human Resources to combat repeated non-compliance in a more formalised manner with staff, however this was not fully developed at the time of our visit.

We highlighted areas of concern where the department did not meet national guidance for example, the paediatric waiting room was non-compliant. Senior leaders were aware of the issue but offered no explanation as to why national guidance had not been followed when redesigning the department.

The department had a divisional risk register. Risks were rated in terms of likelihood and consequence. Senior leaders were able to describe current risks within the department. The highest risk at time of the inspection was overcrowding in the department, and flow. The trust had risk management processes which meant that risks were escalated appropriately from the emergency department up to board level when required, however not all risks were evidenced, for example the paediatric waiting room being non-compliant.

The department held a significant portion of risk for the whole hospital. There was inconsistent support across the hospital, and medical speciality reviews remained a barrier to flow. Senior leaders were aware of this and work to improve external review times was ongoing, however this was not yet fully embedded.

There were regular meetings for safety, audit, quality, and governance. Management had started to address key areas of performance, risk, audit and workforce. We saw that recorded minutes of these meetings had highlighted the areas of concern and actions were being taken to learn and improve, however some actions were overdue.

Monthly governance meetings were held to discuss governance, risk, and performance. Risk registers were reviewed during these meetings. The governance and reporting processes enabled leaders to understand the key risks and challenges to the service and to identify improvement actions to address key risks, that included capacity, flow and issues that had been identified on audits, for example, mandatory training compliance.

Processes were in place to escalate issues to the hospital leadership team. We saw evidence of effective escalation from the department to senior leaders and then to the executive team.

Daily safety huddles and bed management meetings enabled sharing of information and escalation of patient risks and capacity and resource issues. Risks were discussed at safety huddles, board rounds and bed management meetings and staff and leaders were proactively managing and escalating any concerns.

Staff and leaders at all levels demonstrated a good understanding of the risks that were on the risk register within the emergency department. We discussed the top risks for the service with the leadership team and reviewed the emergency department risk register. The main risks identified by senior leaders were capacity, demand and flow.

Staff received feedback from incident reporting and risks during nursing huddles. We saw examples of meeting minutes held for all grades which provided a forum for learning from incidents and risks. Good practice was recognised and celebrated.

The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

Leaders understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement. The leadership team understood how their staff felt about delivering care that met both the physical and mental health needs of patients.

Staff and leaders worked in partnership with key organisations to support care provision, service development and joined-up care, such as the local NHS ambulance service. For example, working closely with the local ambulance service to improve handover times. Staff we spoke with informed us although communication between services was challenging at busy times, teams worked well together.

The trust’s strategy aligned to local plans in the wider health and social care economy, and services were planned to meet the needs of the relevant population.

The service did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research.

The service did not always translate learning into sustained improvements. Evidence included the shortfalls in mandatory training completion, compliance with infection prevention and control principles, and the ongoing known environmental risk around the paediatric waiting room. This indicated improvement efforts were not sustained at the level necessary to always guarantee safe care.

All senior leaders were aware of the issues that faced the department and the areas that required improvement following the previous inspection.

Staff were given the time and support to develop opportunities for improvements and innovation and this led to changes in care delivery.