You are here

We are carrying out checks at Freeman Hospital. We will publish a report when our check is complete.

Inspection Summary


Overall summary & rating

Outstanding

Updated 6 June 2016

We inspected the trust from 19 to 22 January 2016 and undertook an unannounced inspection on 5 February 2016. We carried out this inspection as part of Care Quality Commission's (CQC) comprehensive inspection programme.

We included the following locations as part of the inspection:

  • Freeman Hospital incorporating The Northern Centre for Cancer Care
  • Centre for Ageing and Vitality

We inspected the following core services:

  • Medical Care
  • Surgery
  • Critical Care
  • Services for Children and Young People
  • End of Life Care
  • Outpatients & Diagnostic Imaging

Overall, we rated the Freeman Hospital as outstanding.

Our key findings were as follows:

  • The trust had infection prevention and control policies, which were accessible, and used by staff. Patients received care in a clean, hygienic and suitably maintained environment.

  • Patients were able to access suitable nutrition and hydration, including special diets, and they reported that, overall, they were content with the quality and quantity of food.

  • The trust promoted a positive incident reporting culture. Processes were in place for being open and honest when things went wrong and patients given an apology and explanation when incidents occurred.

  • Patient outcome measures showed the trust performed mostly within or better than national averages when compared with other hospitals. Stroke pathways and long-term cancer outcomes were particularly effective. Death rates were within expected levels.

  • There were clearly defined and embedded systems and processes to ensure staffing levels were safe. The trust had challenges due to national shortages however; it was actively addressing this through a range of initiatives including the development of new and enhanced roles, and overseas recruitment. There were particular challenges in the provision of consultant to patient ratios and pharmacy cover in critical care.

  • The trust was meeting its waiting time targets for urgent and routine appointments.

  • The diagnostic imaging department inpatient and emergency image reporting turnaround times did not meet nationally recognised best practice standards or trust targets

  • Systems and processes on some wards for the storage of medicine and the checking of resuscitation equipment did not comply with trust policy and guidance.

  • Information written in clinical notes about the care patients received in the Emergency Department and on some wards was minimal.

  • Feedback from patients, those close to them and stakeholders was consistently positive about the way staff treated people. There were many examples of exceptional care where staff at all levels went the extra mile to meet patient needs.

  • The trust used innovative and pioneering approaches to deliver care and treatment. This included new evidence-based techniques and technologies. Staff were actively encouraged to participate in benchmarking, peer review, accreditation and research.

  • The trust worked hard to ensure it met the needs of local people and considered their opinions when trying to make improvements or develop services. It was clear that the opinion of patients and relatives was a top priority and highly valued.

  • There was a proactive approach to understanding the needs of different patients. This included patients who were in vulnerable circumstances and those who had complex needs.

  • There were strong governance structures and a systematic approach to considering risk and quality management. Senior and local site management was visible to staff. Staff were proud to work in the organisation and spoke highly of the quality of care provided.

  • There were consistently high levels of constructive engagement with patients and staff, including all equality groups.

We saw several areas of outstanding practice including:

  • There was an integrated model of care between the Specialist Palliative Care Team and the Cardiothoracic Transplant Team. The teams worked alongside patients with advanced disease including those waiting for transplant and those with ventricular assist devices.

  • A sleep checklist was developed for patients in critical care to optimise sleep. This included measures such as environmental factors, noise, temperature and light in patient areas.

  • Hydrotherapy rehabilitation after critical illness had been developed for patients who were ventilated which enabled them to move their limbs supported by water. This gave psychological support to patients and helped them engage with their rehabilitation programme.

  • Radiology facilities were adapted to meet the needs of patients with dementia or learning difficulties. This included distraction aids and mood lighting to help patients relax.

  • The trust Falls and Syncope Service was the largest of its kind in Europe and undertook research and treatment for patients presenting with a range of problems such as balance disorders, dizziness, low blood pressure, balance problems or unspecified lack of co-ordination and falls.

  • The Northern Centre for Cancer Care (NCCC) in partnership with Macmillan was providing chemotherapy in three community health centres enabling access for non-complex treatments closer to home. Chemotherapy nurses from the NCCC ran this service.

  • The perioperative care team at the Freeman were national leaders in pre-operative assessment, cardiopulmonary exercise testing after major intra-abdominal surgery (including shared decision making in the pre-operative counselling process).

  • The pancreatic service had developed a remote care service to assist clinicians in outlying hospitals to manage their patients. This was to avoid transferring ill patients to Newcastle when they could be managed at their base hospital. This service was coordinated by a nurse specialist and saved patients being unnecessarily transferred to Newcastle. It also ensured that those patients who may require specialist care were transferred at the correct time.

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

Importantly, the trust MUST:

  • Ensure that care documentation in the Emergency Care Department and on some wards are fully completed to reflect accurately the treatment, care and support given to patients, and is subject to clinical audit.

In addition the trust SHOULD:

  • Ensure processes are in place to meet national best practice guidelines for diagnostic imaging reporting turnaround times for inpatients and patients attending the Emergency Care Department.
  • Ensure that all groups of staff complete mandatory training in line with trust policy particularly safeguarding and resuscitation training. Ensure that all staff are up to date with their annual appraisals.
  • Ensure that the departmental risk register in End of Life Care accurately reflects the current clinical and non-clinical risks faced by the service.
  • Ensure that all housekeeping staff who undertake mattress contamination audits are aware of the trust policy relating to mattress cleanliness and the criteria for when to condemn a mattress.
  • Ensure staff follow the systems and processes for the safe storage of medicine and the recording and checking of resuscitation equipment.
  • Ensure that the storage of patient records is safe to avoid potential breaches of confidentiality.
  • Ensure that arrangements are robust to enable patients to transfer safely with continuity of syringe drivers in place from hospital to the community to avoid the risk of breakthrough pain being encountered.
  • Ensure that the Care for the Dying Patient documentation is fully implemented and embedded across acute hospital sites.
  • Ensure that processes are developed to identify if patients achieved their wish for their preferred place of death.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection areas

Safe

Good

Updated 6 June 2016

Effective

Outstanding

Updated 6 June 2016

Caring

Outstanding

Updated 6 June 2016

Responsive

Outstanding

Updated 6 June 2016

Well-led

Outstanding

Updated 6 June 2016

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

Good

Updated 6 June 2016

Overall end of life care was rated as good with well-led rated as requires improvement because:

The Caring for the Dying Patient document to replace the Liverpool Care pathway, although fully embedded in the community had only been piloted on a small number of wards in the acute hospitals. Interim guidance was available for ward staff and plans were in place to roll out training for the new documentation across all wards but there were no formal timescales to specify this at the time of inspection.

Although risks were identified in the End of Life and Palliative Care update reports to the Board, there was no end of life care risk register used to identify and monitor risks.

Whilst ward staff were engaged in the provision of end of life care there appeared to be a lack of understanding of the strategies and priorities for end of life care by ward staff. The trust had taken steps to engage with staff to increase awareness of the strategy.

Although there was some audit for monitoring if, patients achieved their wish for their preferred place of death this was limited and was not routinely identified. The trust acknowledged that future audits would include this.

The Specialist Palliative Care Team and End of Life Care Team were highly visible and accessible and ward staff had a clear referral process in place for patients.

The results of the End of Life Care Dying in Hospitals Audit 2016 showed that the trust met all clinical audit indicators and seven of the eight organisational indicators.

Patients received compassionate care and their privacy and dignity was respected. The chaplaincy and mortuary staff demonstrated examples of outstanding care provided to patients and their families.

Nursing staff told us that they had sufficient staff to prioritise good quality end of life care when needed and that they had the processes in place to escalate staffing concerns should they arise.

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.