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Inspection Summary


Overall summary & rating

Outstanding

Updated 29 May 2019

  • People were truly respected and valued as individuals and were empowered as partners in their care, practically and emotionally, by an exceptional and distinctive service. Staff went the extra mile to support their patients. Emotional and spiritual support for patients and their families was second to none. Patients told us the care they received exceeded all expectations.
  • Services were tailored to meet the needs of individual people and were delivered in a way to ensure flexibility, choice and continuity of care. Care and treatment were holistically planned in collaboration with patients, making them active partners in their care at all levels.
  • We saw evidence of strong, innovative multidisciplinary and multiorganisational working. There was a robust strategic plan in place which demonstrated how the hospital worked with other organisations to ensure care was planned and delivered to meet the needs of patients in a sustainable, future proof way.
  • Specialist knowledge and expertise was readily accessible. Staff were proactively supported to acquire new skills and share best practice. Research and quality improvement were embedded in practice. All staff were actively engaged in monitoring and improving quality and outcomes for patients.
  • The leadership, governance and culture were used to drive and improve the delivery of high-quality person-centred care. Leaders set stretching, innovative objectives and conducted in depth analysis and planning as to how they would be achieved.
  • Staff were empowered to suggest and deliver changes and were encouraged to be innovative. Staff told us they felt strongly supported and invested in by leadership.
Inspection areas

Safe

Good

Updated 29 May 2019

Effective

Outstanding

Updated 29 May 2019

Caring

Outstanding

Updated 29 May 2019

Responsive

Outstanding

Updated 29 May 2019

Well-led

Outstanding

Updated 29 May 2019

Checks on specific services

Medical care (including older people’s care)

Outstanding

Updated 6 June 2016

We rated medical care (including older people’s care) as outstanding overall because:

There was a good record of accomplishment in safety with no never events and measures implemented to address serious incidents. Staff understood their responsibilities to raise concerns and report incidents. Senior staff managed staffing shortfalls proactively.

Patient outcomes were better than targets recorded in local and national audit data. There was very good evidence of effective 24/7 multi-disciplinary team working.

There was a strong and visible patient-centred focus shown by both clinical and non-clinical staff. Patients had individual care plans and felt safe. Staff considered physical, emotional and social aspects of patient’s wellbeing. Patients and staff would recommend the service as a place to receive care.

The service was responsive to the internal and external demands placed upon it. Staff made reasonable adjustments in response to individual patient needs and to accommodate vulnerable patient groups.

Managers led the service well with an open and honest culture. Governance arrangements were set up to effectively identify, manage and plan service improvements, efficiencies and to implement actions to mitigate risks affecting service provision. The service was innovative, with strong well-established partner relations.

Services for children & young people

Outstanding

Updated 6 June 2016

Overall, we rated services for children, young people and families as outstanding because:

Managers and staff created a strong, visible, person-centred culture and were highly motivated and inspired to offer the best possible care to children and young people, including meeting their emotional needs.

Staff were very passionate about their role and, in some cases, went beyond the call of duty to provide care and support to families. Staffing levels were appropriate.

Families were very positive about the service they received. They described staff as being very caring, compassionate, understanding and supportive.

Services were flexible, provided choice and ensured continuity of care.

The care and treatment of children and young people achieved good outcomes and promoted a good quality of life. Staff proactively collected and monitored this data and used the information to improve the care they delivered.

The culture was open and transparent with a clear focus on putting children and young people at the centre of their care.

Staff protected children and young people from avoidable harm and abuse. Managers and staff discussed incidents daily, and took appropriate action to prevent them from happening again.

Staff were very positive about working for the trust and we saw some excellent examples of leadership. There was a clear management structure and managers were visible and involved in the day-to-day running of services. The trust provided opportunities for training and development and staff were well trained and highly motivated to offer the best possible care to children and young people.

Critical care

Outstanding

Updated 6 June 2016

Overall we rated critical care as outstanding because:

During our inspection, patients and staff consistently shared good experiences; it was evident that critical care had a good and safe reputation. The service demonstrated a balance between getting the basics right and innovation. There were excellent examples of sustained innovative practice.

The teams in critical care services were very well led. The service was consultant-led and we observed good relationships with nurses and the multi-disciplinary team. A genuine culture of listening, learning and improvement was evident amongst all staff.

Governance arrangements were clear. Critical care was represented at board and trust level and information was shared with perioperative and cardiothoracic services.

Patients and their families had access to an established range of support services. It was clear that patients were at the centre of decisions.

The critical care unit performed well or above national averages in governance and performance areas. Patient outcomes were the same as or better than the national averages and care and treatment was planned and delivered in line with current evidence based guidance and standards.

End of life care

Outstanding

Updated 29 May 2019

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

  • The service had fully implemented the care of the dying patient document and addressed all the issues we previously identified at our last inspection. Additionally, patient care and outcomes had improved and the team’s education and training for staff on wards had meant that at this inspection, we found that care of the dying really was everyone’s business.
  • People were truly respected and valued as individuals. Staff went the extra mile to support their patients and people were positive about their care and treatment. Emotional and spiritual support for patients and their families was of a very high standard. second to none.
  • The staff team were stable, experienced and committed. The team’s focus on continuous development meant that standards were constantly rising. Topic specific sub groups ensured that any areas in need of improvement remained ‘on the radar’ and progress was regularly checked. Staff were given sufficient time to develop new and innovative ways to improve.
  • There was a ‘can-do’ approach to end of life care when it came to people’s individual needs and preferences. The team were proactive in seeking solutions to barriers to fulfilling these and were willing not afraid to try new things to ensure patients’ care was right for them. People with protected characteristics under the Equality Act (2010) were offered care in a way that was tailored to suit them and empower them to make as many decisions about their care and their death as they wished.
  • Safety was a priority that the whole team were engaged with. Incidents were rare, and medicines appropriately managed. Information systems shared with local partners underpinned record keeping with paperless notes and clear audit trails.
  • Care and treatment were holistically planned in collaboration with patients and other local providers. Patients were identified earlier than at our last inspection, seen earlier by the specialist team, and discharged home earlier if this was their preference, leading to overall improvements in outcomes.
  • Leadership was strong and compassionate. The team’s vision and strategy were well articulated and progress against three-year plans was regularly checked. Ward staff had more awareness of the team’s key documents than at our previous inspection. Staff contributed to research and the development of national guidance and conducted regular audits of their service.

However:

  • The service was not meeting the trust’s 90% target for staff receiving an annual appraisal. Medical staff appraisal rates were 62.5% and qualified nursing staff 77% at the time of our inspection.
  • Leadership was shared by medical and nursing staff in different directorates. While this was working effectively, the lack of an operations manager had the potential to restrict future development of the service.

Outpatients and diagnostic imaging

Good

Updated 6 June 2016

Overall we rated outpatient and diagnostic imaging as good because:

Patients were happy with the care they received and found it to be caring and compassionate. Staff worked within nationally agreed guidance to ensure that patients received the most appropriate care and treatment.

There were sufficient staff of all specialties and grades to provide a good standard of care in all departments.

There was good leadership of staff to provide good patient outcomes in the outpatients and diagnostic imaging departments. There were well-organised systems for organising clinics.

The departments learned from complaints and incidents, and developed systems to stop them happening again.

However, diagnostic imaging reporting turnaround times for inpatients and A&E patients did not match national best practice guidance.

Surgery

Outstanding

Updated 6 June 2016

Overall we rated surgery as outstanding because:

Surgical services showed a proactive approach to identifying and developing improvements in safety, full investigations were undertaken. Staff understood the process for reporting and investigating incidents, actions were identified and communicated widely to support improvement.

Staffing levels and skill mix were planned, implemented and reviewed to keep patients safe. Staff shortages were responded to quickly.

We found that surgical outcomes for patients were mostly similar or better than expected when compared with other similar services.

There was a holistic approach to assessing, planning and delivery of care with safe use of innovative and pioneering approaches encouraged.

Patients were supported and treated with dignity and respect. Feedback from patients, relatives and stakeholders was consistently positive.

The complaints process was well embedded, thorough and managed in a way that ensured good investigations and outcomes were achieved.

Leaders had an inspiring shared purpose and strived to deliver and motivate staff to succeed.

Diagnostic imaging

Good

Updated 29 May 2019

We previously inspected diagnostic imaging jointly with outpatients, so we cannot compare our new ratings directly with previous ratings.

We rated this service as good because:

  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse, and they knew how to apply it.
  • The service controlled infection risk well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection.
  • The service had suitable premises and equipment and looked after them well.
  • The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.
  • Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date and easily available to all staff providing care.
  • The service followed best practice when prescribing, giving, recording and storing medicines. The service managed patient safety incidents well.
  • The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers monitored the effectiveness of care and treatment and used the findings to improve them. Staff of different kinds worked together as a team to benefit patients.
  • Staff understood how and when to assess whether a patient had the capacity to make decisions about their care.
  • Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness. Staff provided emotional support to patients to minimise their distress. Staff involved patients and those close to them in decisions about their care and treatment.
  • The service planned and provided services in a way that met the needs of local people. The service took account of patients’ individual needs. People could access the service when they needed it.
  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with all staff.
  • Managers at all levels in the service had the right skills and abilities to run a service providing high-quality sustainable care. The service had a vision for what it wanted to achieve and workable plans to turn it into action.
  • Managers across the service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
  • The service systematically improved service quality and safeguarded high standards of care by creating an environment for excellent clinical care to flourish.
  • The service had good systems to identify risks, plan to eliminate or reduce them, and cope with both the expected and unexpected.
  • The service collected, analysed, managed and used information well to support all its activities, using secure electronic systems with security safeguards.
  • The service engaged well with patients, staff, the public and local organisations to plan and manage appropriate services and collaborated with partner organisations effectively.
  • The service was committed to improving services by learning from when things went well or wrong, promoting training, research and innovation.

However:

  • The service did not meet the diagnostic imaging reporting time targets. To assist in addressing challenges with reporting times, the trust had recently started to outsource some MRI and CT elective reporting work.
  • The service did not always meet the two-week urgent waiting time targets.
  • While mandatory training was provided to all staff and managers told us staff were being asked to complete it, mandatory training compliance rates were not achieving the 95% target the trust set. Mandatory safeguarding training compliance did not achieve the trust target. Mandatory training and safeguarding training compliance was between April 2018 and April 2019 and therefore was expected to improve as the year progressed.
  • Resuscitation trolley checks had not been consistently between 1 October 2018 and 16 January 2019.
  • The service had challenges with paediatric radiologist staffing levels and were under resourced by around three paediatric radiologists.
  • The interventional radiology department used the World Health Organisation (WHO) safety checklist. However, audit of the checklist had only recently commenced.
  • While privacy and dignity was maintained in department areas visited. There were occasions during the inspection where patients were waiting to be seen on beds in the corridors on the main x-ray department which did not support a patient’s privacy and dignity whilst in the department.
  • During the inspection there was limited evidence staff had access to communication aids to enhance communication with people with additional needs where required.
Other CQC inspections of services

Community & mental health inspection reports for Freeman Hospital can be found at The Newcastle upon Tyne Hospitals NHS Foundation Trust.