Doncaster Royal Infirmary

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained Requires Improvement. This meant people’s needs were not always met.

We looked for evidence that people and communities were always at the centre of how care was planned and delivered. We checked that the health and care needs of people and communities were understood. We saw areas that needed to be improved.

We have not awarded this service a score for Responsive.

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

Evidence showed some shortfalls. The service did not always demonstrate that people were at the centre of their care and treatment choices.

We saw an inconsistent approach to the completion of risk assessments, during the inspection we saw staff completing appropriate risk assessments and documenting appropriately but when we reviewed previously completed patient notes we saw omissions. We also saw that the most recent audit of risk assessments did not provide full assurance that they were undertaken in a timely manner.

We found an inconsistent approach to the recording of care within patient notes. We reviewed 10 sets of patient notes and saw examples of care plans that lacked evidence of patient input or personalised goals and incomplete or generic records that did not reflect changing needs or preferences.

Evidence shows a good standard. The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

All staff could articulate how their local communities had diverse health and care needs. All staff could give examples of patients who had varying levels of need and could describe how they would accommodate them. This included patients with chronic and long-standing conditions that required a different approach.

Evidence shows some shortfalls. The service did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Staff did not ensure that patients could obtain information on treatments, local services, patients’ rights and how to complain, information was only in English and wasn’t available in alternative formats or languages.

The information provided was not always in a form easily accessible to the patient groups such as easy-read or braille, but these were available if needed.

We saw that the layout through the department did not have clear signage which made the patient journey through the department difficult. We saw a number of patients and relatives asking for directions. Following inspection, a review was undertaken to assess how signage could be improved.

Patients did not have access to any automated system that informed patients of waiting times. We saw this information recorded by staff, but we did not see this being regularly updated, therefore patients would not know how long their predicted wait would be.

We did see patients in the main department being given updates when they had asked staff, but we did not see any process for updating patients in the waiting areas. Following the initial inspection visit, a visual screen was introduced into the waiting room which displayed current wait times.

Staff had access to telephone interpretation services. However, staff told us that, due to the time it could take to arrange this support, they would often rely on family members to translate. This approach is not recommended because it may present potential risks, including issues with accuracy, confidentiality and impartiality.

Following inspection, we were told that a program of work was ongoing to improve access to interpreter services.

Evidence shows some shortfalls around the complaints policy, which did not provide assurance that complaints were resolved and learning shared without delay.

We reviewed recent complaint activity and found that the trust had received 193 complaints in the 6 months prior to the inspection. We examined the five most recent complaints and the trust’s subsequent responses. None of these were managed within the timeframes set out in the trust’s Complaints Policy, which stated that all complaints should be completed within 6 months.

We also reviewed 5 examples of feedback provided to patients who had raised complaints or concerns. In all cases, feedback was not provided within the trust’s required timescales and therefore did not meet the trust’s standards for providing a timely response. Staff told us that they did not receive feedback on the outcome of investigation of complaints. We were told that any learning from complaints was discussed during safety huddles but as none were held during the inspection, we were not assured that this occurred regularly.

All staff we spoke with were able to articulate the complaints process and how they would facilitate patients making a complaint.

All staff were aware of their responsibilities under duty of candour and were able to give examples of when they had applied these principles. There was an up-to-date policy covering duty of candour.

Evidence shows some shortfalls. The service was unable to ensure that people could access the care, support and treatment they needed when they needed it.

The percentage of patients admitted, transferred or discharged within four hours of arrival at the trust was 70% which was worse than the England average.

In the 12 months prior to inspection, an average of 422 patients per month waited more than four hours but less than 12 hours from decision to admit to ward admission. We requested specific site level data, but this was not available as this was not recorded by the trust.

In the 12 months prior to inspection, an average of 80 patients per month waited over 12 hours from decision to admit to ward admission. We requested specific site level data, but this was not available as this was not recorded by the trust.

In the 12 months preceding inspection all patients received on average an initial assessment within 57 minutes which was worse than current national average.

Ambulance handovers were consistently better than the national target of all handovers completed in 30 minutes as the average over the 12 months preceding inspection was 22 minutes.

We did note that 5% of patients left the department without being seen, which was the same as the national average.

The unplanned reattendance rate was 4% which was better the national average of 9%.

Evidence shows a good standard. We saw ongoing work to address any health inequalities.

We saw that there was system wide group meeting that addressed high intensity users of the department. We noted this also involved work with the local mental health trust and learning disabilities team.

All staff had the opportunity to undertake training in equality, diversity, inclusion and human rights, we saw that 99% of staff had completed the training.

Evidence shows a good standard. People were supported by planning for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

We saw examples of staff supporting patients to make decisions about their care and treatment and their future. We saw the use of treatment escalation plans which were completed with patients.

Staff were able to articulate how they would care for people who were nearing the end of their life and how they would ensure that it was managed and communicated in a sensitive and dignified way. We saw that the trust had introduced a designated area for patients at the end of life which had increased privacy for the patient and their family.

Staff ensured all relevant healthcare professionals and other relevant bodies were involved in planning the care and treatment of people with complex needs. We observed patients being referred to appropriate specialities.