Hull Royal Infirmary

Updated 9 August 2023

Pages 1 and 2 of this report relate to the hospital and the ratings of that location, from page 3 the ratings and information relate to maternity services based at Hull Royal Infirmary.

We inspected the maternity service at Hull University Teaching Hospitals NHS Trust as part of our national maternity inspection programme. The programme aims to give an up-to-date view of hospital maternity care across the country and help us understand what is working well to support learning and improvement at a local and national level.

We will publish a report of our overall findings when we have completed the national inspection programme.

We carried out an announced focused inspection of the maternity service, looking only at the safe and well-led key questions.

We reviewed the rating of the location, our rating of this hospital ​went down​

Maternity is rated inadequate.

How we carried out the inspection

You can find further information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

Updated 23 March 2023

Updated 15 February 2017

At the 2015 inspection, we rated the services for children and young people as ‘Requires improvement’.

At the 2016 inspection we saw improvements had been made and rated the services overall as ‘Good’ because:

• Nurse staffing was appropriate and was planned using an acuity tool. Multidisciplinary working took place and staff worked well as a cohesive team. Staff were passionate about their roles and were dedicated to making sure their patients had the best care possible.
• Requirements around the duty of candour were being met.
• The service performed positively in infection prevention and control audits.
• Policies were based on national and local guidelines. Consent to care and treatment was obtained in line with legislation and guidance.
• Staff treated children, young people and their relatives/carers with kindness, compassion, dignity and respect. Families felt informed about the care of their child, and involved in the decisions about care.
• Wherever possible mothers were not separated from their new-born baby and facilities were available for parents to be resident at the hospital with their child.
• We saw children and young people being assessed and treated in a timely way. A discharge liaison team was available to ensure babies were discharged from the neonatal unit in a timely way.
• Playrooms and a schoolroom were available to meet the learning needs of patients.
• Following our inspection, the trust informed us they had decided to commission an out of area review by an independent mental health provider trust. This was to make sure the service was meeting people’s needs.
• Staff spoke positively about their managers and the culture of the trust and were able to articulate the trust’s vision and values.

However,

• Not all incidents, including ‘near misses’ and some safeguarding incidents had been classified correctly and therefore not fully investigated or possible lessons learnt and four safeguarding children guidelines were out of date.
• The care documentation did not clearly reflect the mental health needs of the patients and how those needs would be met.
• We were not assured that staff had the knowledge and competencies to meet the needs of children and young people with mental health needs in their care.
• There were several unfilled junior doctors posts, which had resulted in the inability to meet the demands of the service.
• Records concerning the administration of medications were not appropriately completed.

Updated 24 June 2020

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

• We rated safe, effective, caring and responsive as good. We rated well led as requires improvement.
• The service provided mandatory training in key skills to all staff and made sure most staff completed it. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. The service controlled infection risk well. They kept equipment and the premises visibly clean. Staff managed clinical waste well. Staff completed and updated risk assessments for each patient and took action to remove or minimise risks. On the whole, the service had enough nursing and medical staff with the right qualifications, skills, training and experience to keep patients safe. Staff kept detailed records of patients’ care and treatment. The service used systems and processes to safely prescribe, administer, record and store medicines. The service managed patient safety incidents well.
• Staff gave patients enough food and drink to meet their needs and improve their health. Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way. Staff monitored the effectiveness of care and treatment. The service made sure most staff were competent for their roles. Most key services were available seven days a week. Staff supported patients to make informed decisions about their care and treatment. They used measures that limit patients' liberty appropriately. Staff protected the rights of patients subject to the Mental Health Act 1983.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. Staff provided emotional support to patients, families and carers to minimise their distress. They understood patients personal, cultural and religious needs. Staff supported patients, families and carers to understand their condition and make decisions about their care and treatment.
• The service planned and provided care in a way that met the needs of local people and the communities served. It also worked with others in the wider system and local organisations to plan care. The service was inclusive and took account of patients’ individual needs and preferences. Bedside diaries were used to support patients and their families during critical illness. People could access the service when they needed it and received the right care promptly.
• Leaders had the skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff. The service had a vision for what it wanted to achieve and a strategy to turn it into action. Staff felt respected, supported and valued. The service had an open culture.

However:

• Whilst there had been some improvement to the numbers of staff in the critical care outreach team, this was still not adequately staffed out of hours and at weekends.
• The overnight stay facilities for families were not adequate. The service did not have enough allied health professionals with the right qualifications, skills, training and experience. Records were not always clear and organised.
• We were concerned that care and treatment might not always be based on national guidance and best practice. Not all staff had an up to date appraisal and less than the 50% of nurses had a post registration qualification in critical care.
• The service was still not providing a formal follow up clinic in line with GPICS standards and the National Institute of Health and Care Excellence (NICE) CG83 best practice guidance.
• Leaders did not always operate effective governance processes. We were concerned about the lack of oversight in relation to the review of policies and procedures relevant to the units. There had been a lack of pace to address risks on the risk register. For example, we were told a business case to address the isolation facilities had been submitted for consideration but this had not been approved consistently.

Updated 15 February 2017

At the comprehensive inspection of end of life care services in February 2014 we found the service to be ‘Good’ overall. In 2016 the rating remained ‘Good’ overall because:

• Patients were protected from avoidable harm and abuse. Staff understood and fulfilled their responsibilities to raise concerns and report incidents and managers shared the learning from incidents.
• Mandatory training across most services was above the trust targets and medicines were prescribed and administered safely in line with policy. Staffing levels were appropriate for the services provided.
• People’s care and treatment was planned and delivered in line with current evidence-based guidance. Information about people’s care and treatment, and their outcomes, were routinely collected and monitored. Staff providing care at the end of life were highly skilled and competent. There was evidence of multi-disciplinary working across all teams. The trust had recently employed more resources to provide seven-day specialist palliative care nursing availability. Consent to care and treatment was obtained in line with legislation and guidance.
• Feedback we received from patients was consistently positive about the way staff treated them. We observed a number of staff and patient interactions during our inspection. We observed consistently caring and compassionate staff. Patients and their families were supported emotionally. We saw an initiative that had been implemented by the bereavement team that we thought was outstanding.
• Services were planned and delivered in a way that meets the needs of the local population. All teams involved in caring for patients at the end of life were highly responsive to the needs of the patients in their care and those close to them. Care and treatment was coordinated with other services and other providers to ensure that specialist teams saw patients in a timely manner and patients’ choice in relation to where their care was delivered was achieved. We saw evidence that staff were responsive to meeting the needs of vulnerable patients including those living with dementia.
• All teams were aware of the trust vision and values. Whilst there was no trust end of life strategy at the time of our inspection, the Specialist Palliative Care Team (SPCT) were working collaboratively with other providers and using the national End of Life Care strategy to benchmark and influence the care and treatment they provided to patients. Robust governance, risk management and quality measurement processes were embedded. Staff told us that senior staff were visible and supportive. There was a lead consultant for end of life care and a director who provided representation at the trust board. We found that staff in all teams were consistently positive, friendly, helpful and approachable in all areas we visited. All staff were team focused and we saw examples of innovation, improvement and sustainability.

Updated 9 August 2023

Updated 1 June 2018

We previously inspected outpatients jointly with diagnostic imaging so we cannot compare our new ratings directly with previous ratings. We rated the service as good because:

• The previous inspection identified a lack of effective governance processes within outpatients. At this inspection we saw the trust had strengthened these processes by introducing performance reports, performance and access meetings and a trustwide outpatients governance committee.
• The majority of staff we spoke with knew how to report incidents and about learning lessons from incidents within the individual health groups.
• All staff we spoke with felt positive about the new management changes and the future of outpatients.
• Some work had been undertaken to look at staff skills and develop training specific to the needs of individual staff.
• Most patients we spoke with told us that staff were caring and friendly.
• Complaints were investigated thoroughly and in a timely manner.
• Mandatory training compliance figures were high.

However:

• The previous inspection identified that the trust must ensure the effective use and auditing of best practice. We saw inconsistent completion of safety checklists when carrying out surgery in outpatients and no audit activity to review this or drive improvement.
• Some problems with the storage of patient records remained. Patient records were not always stored securely in some clinics visited.
• The trust was not meetings its internal appraisal standard.
• The previous inspection found issues with waiting times for patients and referral to treatment indicators not always being met. During this inspection, we found that referral to treatment indicators were still not always met.
• We saw high numbers of patients waiting for first and follow up appointments across several outpatient areas, resulting in backlogs. This issue was also identified within the previous inspection report.

Updated 23 March 2023

Updated 23 March 2023