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Norfolk and Norwich University Hospital Requires improvement

We are carrying out a review of quality at Norfolk and Norwich University Hospital. We will publish a report when our review is complete. Find out more about our inspection reports.

Inspection Summary


Overall summary & rating

Requires improvement

Updated 17 April 2020

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

  • We rated safe, responsive and well led as requires improvement and rated effective and caring as good.
  • Out of the four hospital services we looked at we rated two as requires improvement, one as good and one as outstanding.
  • The ratings for end of life care improved whilst the ratings for urgent and emergency care, surgery and outpatients remained the same.
  • Capacity and patient flow continued to impact services at the trust including the ongoing use of escalation areas.
  • Culture continued to improve but there remained pockets of a negative challenging culture that the trust continued to work on.
  • There were medicines management issues across the core services.

However;

  • Staff across all services we inspected treated patients with compassion, kindness, dignity and respect. We saw people actively involved with their care.
  • There was improved divisional leadership and nursing leadership in the emergency department.
  • There was improved knowledge of the Mental Capacity Act 2005 in the core services we inspected.
Inspection areas

Safe

Requires improvement

Updated 17 April 2020

Effective

Good

Updated 17 April 2020

Caring

Good

Updated 17 April 2020

Responsive

Requires improvement

Updated 17 April 2020

Well-led

Requires improvement

Updated 17 April 2020

Checks on specific services

Medical care (including older people’s care)

Requires improvement

Updated 15 May 2019

A summary of our findings about this service appears in the Overall summary.

Services for children & young people

Requires improvement

Updated 15 May 2019

A summary of our findings about this service appears in the Overall summary.

Critical care

Requires improvement

Updated 15 May 2019

A summary of our findings about this service appears in the Overall summary.

End of life care

Outstanding

Updated 17 April 2020

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

  • The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. The service managed medicines and safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
  • Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
  • Relationships between patients, those close to them and staff were strong, caring, respectful and supportive. Staff treated patients with compassion and kindness, respected their privacy and dignity and took account of their individual needs. They understood patients’ personal, cultural, social and religious needs; took them into account, and found innovative ways to meet them. Staff empowered and involved patients, families and carers to understand their condition, make decisions and become partners in their care and treatment. Patients’ individual preferences and needs were always reflected in how care was delivered. Staff provided emotional support to patients, families and carers which exceeded their expectations.
  • The service planned care to meet the needs of local people, was flexible, provided informed choice and ensured continuity of care. Patients’ individual needs and preferences were central to the delivery of services. There was a proactive approach to understanding the needs and preferences of different groups of people, for example travellers and homeless people, and to delivering care in a way that meets these needs. People could access the service and appointments in a way and at a time that suits them. The service can demonstrate where improvements have been made as a result of learning from feedback and that learning.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Leaders had a deep understanding of issues, challenges and priorities in their service, and beyond. The strategy was stretching, challenging and innovative, while remaining achievable and staff understood it. There was a systematic approach to monitoring, reviewing and providing evidence of progress and quality. Staff felt respected, supported and valued and there were high levels of staff satisfaction. Staff were proud of the organisation as a place to work and spoke highly of the culture. Staff at all levels were actively encouraged to speak up and raise concerns. Staff were clear about their roles and accountabilities. They were focused on the needs of patients receiving care. The service engaged well with patients and the community to plan and manage services and there was a demonstrated commitment at all levels to sharing data and information proactively to drive and support internal decision making as well as system-wide working and improvement.

Surgery

Requires improvement

Updated 17 April 2020

Our rating of this service stayed the same. We rated it as requires improvement because:

  • Staff had training in key skills but not everyone completed it. The service did not always have suitable facilities or enough equipment. The service did not always safely and effectively manage, store and dispose of medicines. Records were not always kept in good order, complete or secure.
  • People could not always access the service when they needed it and had to await treatment for long periods. They did not always receive the right care promptly. Waiting times from referral to treatment (RTT) and arrangements to admit, treat and discharge patients were varied and not always in line with national standards.
  • The service provided mandatory training in key skills to all staff but not everyone completed it. Nursing staff were close to the 90% trust target for mandatory training in all but two of their twelve modules but medical staff were still further below trust target for seven modules. Medical staff did not meet the trust target in any safeguarding training modules for which they were eligible
  • The service did not always have suitable facilities or enough equipment.
  • The service had less medical staff, nurses and health care assistants than planned.
  • Staff did not always keep detailed records of patients’ care and treatment. Records were not always up-to-date or stored securely.
  • The service did not use systems and processes to safely prescribe, administer, record and store medicines.

However;

  • The service had enough staff to care for patients and keep them safe. Staff understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients and acted on them. Staff learned lessons from incidents. Staff collected safety information and used it to improve the service.
  • Staff provided good care and treatment and gave patients enough to eat and drink. Managers monitored the effectiveness of the service and made sure staff were competent. Key services were available seven days a week. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
  • The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s values, and how to apply them in their work. Staff felt respected and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

Urgent and emergency services

Requires improvement

Updated 17 April 2020

Our rating of this service stayed the same. We rated it as requires improvement because:

  • The service provided mandatory training in key skills including life support training and safeguarding, however not all staff completed it.
  • The service did not have enough or medical staff with the right skills mix and experience to keep patients safe from avoidable harm and to provide the right care and treatment.
  • The service did not use systems to record and store medicines safely and staff did not complete safety checks on all emergency equipment.
  • People did not always access the service when they needed it. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were not in line with national standards.
  • Staff monitored the effectiveness of care and treatment but outcomes for patients were not always positive, consistent or met expectations, such as national standards.
  • The service did not meet national performance targets for seeing and treating patients, which impacted on patient outcomes.
  • The recent changes in leadership were not fully imbedded and required additional time to improve the department’s overall performance.
  • The culture within the medical staff team was challenging and impacted on relationships, decision making and patient flow.

However;

  • Staff understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
  • Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
  • The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

Outpatients

Good

Updated 17 April 2020

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

  • The service provided care and treatment based on national guidance and evidence-based practice. Staff competence was monitored, and staff development was supported. Doctors, nurses and allied health professionals worked collaboratively and provided patients with access to key services 24 hours per day. Staff promoted healthier lifestyles and supported patients to make decisions. Staff had a good understanding of mental capacity and worked with colleagues to ensure care was provided in the patients’ best interest. However, compliance with appraisals did not meet the trust target for all staff groups.

  • Staff treated patients with compassion and kindness, respected their privacy and dignity. Emotional support was available for patients and their relatives and patients’ preferences were taken into consideration. Staff supported patients and their families to understand conditions and make informed decisions.

  • Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were varied and not always in line with national standards. However, the service worked collaboratively with the wider health system to provide individualised patient care and treatment. Services were inclusive and considered any special requirements, adjusting services to meet patients needs where possible. Patients were able to give feedback, and when they did, it was considered and acted upon by the clinical team. Patients were given feedback about their concerns.

  • Leaders had skills and abilities to run the service. They were visible and approachable and supported staff. There was a vision and a strategy which had been developed with relevant stakeholders. Staff felt respected, supported and valued. The service had effective governance processes and performance was reviewed. Risks were escalated, and actions taken to reduce their impact. The service collected reliable data and analysed it. Leaders and staff actively and openly engaged with patients, staff, equality groups, the public and local organisations. All staff were committed to continually learning and improving services.

However;

  • We found several sterile equipment items which were out of date and therefore not safe to use. There was not always safe and effective management of medicines and records were not always kept in good order or securely. Staff did not always report incidents. However, services managed infection control risks well, and environments were clean and suitable for their use. There was adequate staff, who were trained appropriately for their roles. Staff were inducted into clinical areas and supported.

Maternity

Requires improvement

Updated 15 May 2019

A summary of our findings about this service appears in the Overall summary.

Diagnostic imaging

Requires improvement

Updated 19 June 2018