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Bassetlaw District General Hospital Requires improvement

We are carrying out checks at Bassetlaw District General Hospital using our new way of inspecting services. We will publish a report when our check is complete.

Reports


Inspection carried out on 14 – 17 and 29 April 2015

During a routine inspection

Bassetlaw District General Hospital was one of the acute hospitals forming part of Doncaster and Bassetlaw NHS Foundation Trust. The trust served a population of around 420,000 people in the areas covered by Doncaster Metropolitan Borough Council and Bassetlaw District Council, as well as parts of North Derbyshire, Barnsley, Rotherham, and north-west Lincolnshire.

Bassetlaw District General Hospital provided a range of services including medical, surgical, maternity and gynaecology, services for children and young people, end of life and critical care. It had approximately 300 beds. The hospital also provided emergency and urgent care and outpatients and diagnostic imaging.

We inspected Bassetlaw District General Hospital as part of the comprehensive inspection of Doncaster and Bassetlaw NHS Foundation Trust. We inspected the hospital site on 16 and 29 April 2015.

Overall, we rated Bassetlaw District General Hospital as requires improvement. We rated it good for being caring and well-led and requires improvement for responsive, effective and safe care.

Our key findings were as follows:

  • We found that most areas at the hospital were visibly clean. However, the theatre sterile supply unit was found to have some areas that required cleaning.
  • Staffing levels were reviewed and monitored. There were some areas of the trust particularly in children’s services and medicine that were not adequately staffed. We found this had an impact on patient care.
  • Patients were assessed for their nutritional and hydration needs and referred to a dietician if required.
  • There was a lack of medical staff with the appropriate qualification as set out in the core standards for intensive care units. That is a consultant who is a Fellow/Associate Fellow or eligible to become a Fellow/Associate Fellow of the Faculty of Intensive Care Medicine.
  • The Summary Hospital-level Mortality Indicator (SHMI) (1 July2013 to 30 June 2014) showed no evidence of risk. The Hospital Standardised Mortality Ratio indicator (1 July 2013 to 30 June 2014) showed an elevated risk.
  • Records indicated compliance with mandatory training and appraisal rates were generally low across the services.
  • Within diagnostic imaging, there were some doors with no signage that had unrestricted entry to x-ray controlled areas.

We saw several areas of outstanding practice including:

  • The staff support and training packages provided by the clinical educators in all areas where children and young people were seen in the trust

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

  • The trust must review nurse staffing of the children’s inpatient wards to ensure there are adequate numbers of registered children’s nurses and medical staff available at all times to meet the needs of children, young people and parents.
  • The trust must ensure that the public are protected from unnecessary radiation exposure.
  • The trust must ensure that staff receive mandatory training.
  • The trust must ensure that staff receive an effective appraisal.
  • The trust must ensure that a clean and appropriate environment is maintained throughout the theatre sterile supply unit that facilitates the prevention and control of infection.

In addition the trust should:

  • The trust should reduce patient waiting times to meet the 95% target for patients seen within four hours.
  • The trust should review access to equipment in the emergency department.
  • The trust should continue to take steps to support and develop working arrangements between the emergency department and other specialities within the trust.
  • The trust should record and monitor daily temperatures of fridges used for storage of medicines.
  • The trust should review engagement of medical staff with training, particularly in Mental Capacity Act and emergency planning.
  • The trust should review monitoring procedures to record where and why a breach of mixed sex accommodation has occurred and actions taken to avoid a repeat.
  • The trust should review the pain evaluation tool incorporated within the NEWS score observations to measure the pain experienced by patients
  • The trust should consider the use of a staffing needs acuity tool to record staffing needs more accurately and on a more frequent basis.
  • The trust should continue to review staffing on ward C1.
  • The trust should review the how toilet facilities can be improved on the cardiology ward to ensure separate designated facilities are maintained for men and women.

  • The trust should ensure that they follow best practice in terms of medical staff with appropriate intensive care qualifications.
  • The trust needs to ensure that there is appropriate out of hours cover for the critical care unit and that any risks associated with cross cover of services is mitigated.
  • The trust should ensure that appropriate delirium and sedation scores are undertaken and recorded.
  • The trust should ensure that appropriate access is available from supporting clinical services where required, including pharmacy, dietetics and the ear, nose and throat departments. 
  • The trust should review maintenance and deep cleaning schedules.
  • The trust should review documentation of wastage of Controlled Drugs (CD) on delivery suite.
  • The trust should review the provision of the service available from the teenage pregnancy midwife and substance misuse midwife at the hospital.
  • The trust should consider employing a specialist diabetes midwife.
  • The trust should review 24 hour availability of an obstetric anaesthetist.
  • The trust should make sure front line staff are aware of their responsibilities in relation to MCA and DOLS.
  • The trust should review the individual risk assessment tools with in the children’s service. For example, the service should ensure the initial nursing assessment includes nutritional status and nutritional risk assessments.
  • The trust should identify a board level director who can promote children’s rights and views. This role should be separate from the executive safeguarding lead for children.
  • The trust should agree a system for recording mental capacity assessments for patient’s unable to be involved in discussions about DNACPR decision
  • The trust should make available appropriate equipment for the care of bariatric patients after death.
  • The trust should review equity of access to palliative and end of life care services across both Bassetlaw DGH and Doncaster Royal Infirmary.
  • The trust should identify clear systems and processes to evidence post incident feedback, shared learning and changes in practice resulting from incidents.
  • The trust should review the audit programme in outpatients and diagnostics to monitor the effectiveness of services.
  • The trust should continue improvements to meet the 6 week target referral to treatment target for medical imaging.
  • The trust should review the processes for identifying and managing patients requiring a review or follow-up appointment.
  • The trust should further develop the outpatient’s services strategy to include effective service delivery.
  • The trust should identify and monitor key performance indicators for outpatients.
  • The trust should implement plans to ensure radiology discrepancy and peer review meetings are consistent with the Royal College of Radiology (RCR) Standards.
  • The trust should consider auditing the call bells within the diagnostic imaging departments.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection carried out on 1 October 2013

During a routine inspection

The inspection team consisted of one compliance manager, six compliance inspectors, two specialist professional advisors (one in A&E and one in orthopaedics) and an expert by experience who obtained patient views. The focus of the inspection was how older people with a fractured hip experienced care and treatment from the moment they attended A&E, to inpatient care and through to discharge to their home.

We found patients were asked to provide their consent verbally (and in writing for surgical interventions) prior to care and treatment being carried out. Staff did not always record verbal consent had been given. Patients told us they were treated with dignity and respect and staff listened to their views. Comments included, “I was consulted every step of the way” and “They are very polite and they ask permission for everything.”

We found patients who had fractured their hip had their needs assessed. Care and treatment was delivered in line with their care plan and also in line with clinical guidelines. Comments included, “They have treated us really well”, “Everyone was nice, helpful and compassionate”, “The care has been brilliant” and “They are very professional, always treat you with dignity and as a human being and always make sure your privacy is maintained.”

We found that staff worked with other agencies involved in patients care and treatment. This helped to ensure important care wasn’t missed for patients during admissions to the hospital and discharges to their home environment.

We found staff had access to essential training, additional training relevant to their role and annual performance development assessments (PDAs). We found data regarding training and PDAs had not been recorded fully although some gaps in training had been identified and steps taken to address them. Staff told us managers were supportive and they felt able to raise concerns knowing they would be listened to. They also told us there had been a positive change in the culture of the organisation which was described as 'encouraging' and 'open'.

We found there was evidence the trust had a governance infrastructure which was adequately resourced and with the appropriate level of expertise. We saw that audits were carried out which meant that shortfalls could be identified and addressed. Surveys were also carried out to obtain patients views about the service they received. We found the trust recorded and investigated serious incidents and complaints as part of governance procedures.

Inspection carried out on 13 December 2012

During a routine inspection

We carried out an unannounced inspection of maternity services at Bassetlaw Hospital. We visited the antenatal clinic, labour ward and postnatal ward. We spoke with patients, managers, midwives and doctors.

Women we spoke with told us they were given sufficient information to help them make decisions. One woman said: "I have been kept fully informed of all decisions made and been involved in the decision making." Another woman told us: "You are not pressured into making choices and everything is explained clearly."

Care and treatment was planned and delivered in a way that ensured people's safety and welfare. Women spoke positively about the care and support they received. Two women told us they had received an excellent service.

We observed there were enough qualified, skilled and experienced staff to meet people's needs on the labour ward and in the antenatal clinic. None of the women we spoke with expressed concerns about the numbers of staff available.

We found women were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Women told us staff were well trained and competent at carrying out nursing and medical interventions.

There was an effective system to regularly assess and monitor the quality of service that patient's received. There was evidence that learning from incidents and investigations took place and appropriate changes were implemented

Inspection carried out on 22 March 2012

During a themed inspection looking at Termination of Pregnancy Services

We did not speak to people who used this service as part of this review. We looked at a random sample of medical records. This was to check that current practice ensured that no treatment for the termination of pregnancy was commenced unless two certificated opinions from doctors had been obtained.