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Newark Hospital Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 15 August 2018

Our rating of services stayed the same. We rated them as requires improvement.

A summary of this hospital appears in the overall summary above.

Inspection areas

Safe

Good

Updated 15 August 2018

Effective

Requires improvement

Updated 15 August 2018

Caring

Good

Updated 15 August 2018

Responsive

Good

Updated 15 August 2018

Well-led

Requires improvement

Updated 15 August 2018

Checks on specific services

Urgent and emergency services

Good

Updated 15 August 2018

Our rating of this service improved. We rated it as good because:

  • Safety was given a high priority, people were protected from avoidable harm and abuse. Lessons were learnt when things went wrong and staff were open and honest with patients. Performance showed a good track record and steady improvements in safety.
  • There were clearly defined and embedded systems, policies and procedures to keep people safe and safeguarded from abuse. Staffing levels and skill mix were planned and reviewed. Patients were assessed appropriately and their condition monitored for signs of deterioration.
  • People had good outcomes because they received effective care and treatment that met their needs. There was participation in local and national audits and information was used to improve care. Staff were competent to carry out their roles and had annual appraisals to determine training and development needs.
  • There was evidence of good multidisciplinary working particularly when elderly or vulnerable patients were discharged and needed ongoing care.
  • Staff had a good understanding of the Mental Capacity Act and consent to care and treatment was obtained in line with legislation and guidance.
  • People were treated with dignity and respect and were involved as partners in their care. Staff responded passionately when people needed help and support and helped patients and those close to them to cope emotionally with their care and treatment.
  • Services were planned and delivered in a way that met the needs of the local population. Reasonable adjustments had been made and action taken to remove barriers for people who had difficulty using or accessing services. It was easy for patients to complain or raise a concern.
  • There was a clear statement of vision and values driven by quality and safety and the strategic objectives were monitored and reported to the board.
  • Good governance procedures and structures were in place which interacted with each other appropriately. Risks were managed and understood by all staff.
  • Leaders were visible and supportive, staff were complimentary about local leaders. There was a culture of openness and honesty and mechanisms were in place to support staff and promote positive wellbeing.
  • There was effective engagement with local stakeholders and staff, staff actively raised concerns and those who did were supported. Staff proactively sought ways to innovate and improve.

However:

  • Two nurse call bells in one of the treatment rooms were attached to extension cables which represented a ligature risk.
  • There were no local safety standards in place for invasive procedures.
  • The controlled drug storage area was shared with the GP out of hours service which could result in stock control errors.
  • Staff were still uncertain about the future of Newark Hospital and the UCC.

Outpatients and diagnostic imaging

Requires improvement

Updated 9 November 2016

Outpatients

Good

Updated 15 August 2018

We rated it as good because:

  • Mandatory training including safeguarding adults was higher than the trust target for mandatory training.
  • Staffing levels showed minimum vacancies and a low staff turnover rate.
  • Medical records were available for over 98% of the time for clinic appointments.
  • There was safe handling and storage of medical records.
  • There was evidence of shared learning following incidents and there was a positive culture related to incident reporting.
  • Care and treatment was given in line with national evidence based guidance.
  • There was a range of facilities to meet peoples nutritional and hydration needs.
  • Staff were suitably trained and competent to deliver care effectively.
  • Appraisal rates were 98% for outpatients services at Newark Hospital
  • There were processes in place to obtain consent in line with policies.
  • We saw staff providing compassionate care throughout our visit. Patients spoke highly of the care they received from staff.
  • Staff and volunteers provided emotional support to patients during visits to outpatient services.
  • A variety of services were being offered which supported the local population.
  • There was a large active voluntary service which supported patients, families and staff.
  • The ‘did not attend’ (DNA) rate was lower than both the national and trust average.
  • Patients were offered a choice of appointments and there had been an increase in attendances for both new attendances (7.4%) and follow up appointments (8.8%).
  • Clinic utilisation had improved from 77% to 88.9%.
  • There was a clear vision and strategy for the hospital which was shared by leaders, staff and the public. There was evidence of progress and delivery of key objectives within the strategy.
  • Leaders were visible and changes that had been made in senior leadership had had a positive impact on staff.
  • There was a governance structure and processes that enabled the hospital to monitor and measure performance and to manage risks.
  • There were high levels of staff satisfaction. Staff were proud of the hospital as a place to work and spoke highly of the culture.
  • There was evidence of a continuous learning culture and progressions of innovation to improve outpatients service at Newark Hospital.

Medical care (including older people’s care)

Good

Updated 15 August 2018

Our rating of this service improved. We rated it as good because:

  • There were good processes in place to prevent avoidable harm.
  • Patient risk assessments were routinely completed and nursing records were clear and comprehensive.
  • Care and treatment was delivered in line with evidence based, best practice guidance.
  • There was a positive multi-disciplinary team (MDT) approach on the wards and departments we visited.
  • Consent was well managed and staff understood their responsibilities in relation to the Mental Capacity Act and associated Deprivation of Liberties Safeguards (DoLS).
  • Staff demonstrated a kind and caring approach towards patients and their families. It was obvious that staff had positive relationships with patients and we saw them spend time talking to patients and their families and friends.
  • Staff took their time to respond to the individual needs of patients, including those living with a cognitive impairment such as dementia and those living with a learning disability.
  • Services were in place to support patients with spiritual and cultural needs.
  • All staff we spoke with were enthusiastic and passionate about the work they did.
  • There was evidence of clinical governance procedures and quality measurement processes.

However;

  • Patients’ medical records were not always clear or legible and it was difficult to find and follow the latest episode of care.
  • Some staff we spoke with at the time of the inspection were still unsure of the direction of travel for this hospital. In addition, some staff were unclear about the plans for the Fernwood Unit.

Minor injuries unit

Requires improvement

Updated 9 November 2016

Surgery

Requires improvement

Updated 20 October 2015

Outcomes for patients using the service were not monitored regularly or robustly. There was limited evidence of local audits taking place.

There was a lack of clear vision or strategy for Newark Hospital and limited communication from senior management to the staff working within Newark Hospital. Monitoring of quality and safety of the service was not always robust or effective. Staff did not always feel actively engaged or empowered.

There was an effective patient safety incident reporting system and evidence of sharing and learning so as to improve care. There were sufficient staff to deliver safe care and treatment. Staff followed the trust policy to manage medicines safely, and all medicines were stored appropriately and recorded accurately. Good infection control practices were in place.

Care and treatment were evidence based and pain management was effective. A multi-disciplinary team approach was evident with good multi-disciplinary working in all the wards and well attended multidisciplinary team meetings.

Patients were positive about the individual care and treatment they received both on the ward and within theatre. There were processes in place to support patients living with physical or learning disabilities when coming to hospital for procedures.

Once referred for surgery at Newark Hospital, patients were able to attend within a reasonable timescale. The surgical services met the national target for treating people within 18 weeks of referral. Patients were satisfied with their care and appreciated a local service. Staff supported patients with individual needs and provided patients with useful information before their surgery.

End of life care

Requires improvement

Updated 22 July 2014

The trust had not implemented guidelines, protocols or documentation to all wards that provided end of life care.

There was no trust-wide co-ordinated multidisciplinary training in end of life care.

Discussions about the decisions relating to end of life care were not always documented in the medical notes. Patient’s choice for their place of care was not always documented.

There were systems in place to provide planned discharges; however, there were no systems in place for a rapid discharge at end of life.

There was no evidence of learning from complaints, incidents or audit of the care patients received at end of life.

Staff had 24-hour access to the John Eastwood Hospice by telephone, for symptom control and advice. There were systems in place to refer patients to the Palliative Care team.

There was no named executive director with a responsibility for end of life care, which meant that end of life care was not represented at board level or in the trust’s vision or strategy.