Doncaster Royal Infirmary

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

At our last assessment we rated this key question good. At this assessment the rating has lowered to requires improvement. This meant people’s needs were not consistently met through good organisation and delivery.
We looked for evidence that people were always treated with kindness, empathy and compassion. The evidence shows some shortfalls to ensuring patient needs were met.

We have not awarded this service a score for Caring.

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

Evidence shows some shortfalls. The service always aspired to treat people with kindness, empathy and compassion but were challenged in respecting their privacy and dignity due to pressures on the department.

Staff faced difficulties when caring for patients in temporary escalation spaces. At times of high pressure there were limited options for patients to ensure privacy and dignity. Medical assessments had been undertaken in non-clinical areas where privacy and dignity could not be maintained.

Staff and leaders acknowledged the difficulties in ensuring that dignified care was always upheld for patients and acknowledged the lengthy times some patients waited for treatment. Staff gave examples of how they understood and respected the individual needs of each patient, but all felt that they did not have enough time with each patient.

We observed kind, caring interactions between patients and staff. Staff explained to patients what they were doing when providing care and treatment. Patients said staff treated them well and with kindness.

Evidence shows some shortfalls. The service treated people as individuals and made sure people’s care, support and treatment met people’s needs and preferences but could not provide assurance that patients with additional communication needs were met.

We saw that the new self-directing computer booking in system did not consider patients’ differing needs and abilities. For example, it was only available in English and did not have any other languages or formats available. This system was discontinued following inspection.

Staff ensured that patients could obtain information on treatments, local services, patients’ rights and how to complain but we did not see nor were we told about any information in languages other than English nor in different formats.

When offered, patients had a choice of food to meet the dietary requirements of religious and ethnic groups and to account for allergies and intolerances. Staff were able to give examples of how differing needs were met but this was not consistently documented.

Evidence shows some shortfalls. The service did not consistently promote people’s independence, ensuring people knew their rights and had choice and control over their own care, treatment, and wellbeing.

Not all people were supported to understand their rights, care, and treatment as there were limited ways of communicating available to staff. Staff told us that due to high levels of patient demand that time was not always available to spend longer with patients with differing needs.

We did see some examples of staff supporting patients to enable choice and participation in decision making regarding their care, but we noted that 38% of negative patient feedback from patient care surveys was around care given.

Evidence shows some shortfalls. The service did not demonstrate that it consistently listened to and understood people’s needs, views and wishes. Staff inconsistently responded to people’s needs in the moment and acted to minimise any discomfort, concern, or distress.

Staff were aware but did not consistently assess and address any specific risk issues, such as falls or pressure ulcers. We observed staff assessing, completing and updating care records following ongoing assessment of patients within their care but when reviewing medical notes we saw omissions in risk assessments. We requested completed audits but not all areas for risk assessment were covered by local audit.

We saw that a lack of pain relief was highlighted in patient feedback. We also noted delays in the assessment of pain and the subsequent prescribing and administering of pain relief. This was an issue that had been highlighted by previously completed audits, but we saw no evidence of any ongoing actions to address this issue.

We saw a lack of intentional rounding for patients who had been waiting in excess of 4 hours. We spoke with 10 patients in the waiting room who had not been offered food or drink despite waiting in excess of 4 hours.

Due to increased demand within the department, we saw patients being looked after in areas outside of cubicles. We saw both clinical conversations and examinations being carried out in non-clinical areas, this did not ensure that patients had the required level of privacy and dignity.

Intentional rounding was introduced following the initial inspection visit and was being embedded into the practice at the time of the second inspection. It had been noted that an action plan had been introduced to improve the use of the intentional rounding.

Evidence shows some shortfalls. The service had failed to consistently demonstrate how they care about and promote the wellbeing of their staff.

Not all staff felt respected, supported and valued. Staff survey results showed 51% of nursing staff and 46% of medical staff reported not feeling valued or supported. All staff survey responses had declined compared to the previous year.

The service’s nursing staff sickness was 7% which was worse than the national average. Senior staff told us that mental health reasons featured prominently in those staff on long term sickness absence.

We did note that senior leaders had identified these issues and had created an action plan to monitor and drive improvement, but this was not fully embedded.

Staff had access to support for their own physical and emotional health needs through an occupational health service. We saw that a range of services were available that staff could self-refer and access.