Hull Royal Infirmary

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

At our last assessment we rated this key question inadequate. At this assessment the rating has changed to requires improvement. This meant people did not always feel well-supported, cared for or treated with dignity and respect.

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

At our last assessment we rated this key question inadequate. At this assessment the rating has changed to requires improvement. This meant people’s outcomes were inconsistent.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We reviewed 10 sets of patient notes and found that all contained an omission or error. We saw examples of risk assessments not being fully completed or patient specific information being omitted. We saw examples such as incomplete skin integrity risk assessments, diet and hydration recording and the assessment of pain.

Information provided following inspection confirmed issues with the completion of risk assessments and this had been identified as an area for improvement. We saw up to date action plans that had been created to address this.

Staff would develop care plans that met the needs identified during assessment. Whilst we saw omissions in the documentation, we did see good examples of care plans being utilised.

Care plans were personalised and holistic. We observed staff completing care plans with patients and their families.

The evidence did not consistently show a good standard. The service did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. The service was previously in breach of the legal regulation in relation to delivering evidence-based care and treatment. Improvements were not found at this assessment, and the service remained in breach of this regulation.

Staff did not consistently assess patients’ needs for food, drink, and specialist nutrition or hydration. We observed variation in how diet and hydration needs were recorded in patient notes. Local audit data showed that only 70% of patient records included reference to dietary needs. However, this issue was reflected in local action plans for improvement.

The team included or had access to the full range of specialists required to meet the needs of patients in the service. As well as doctors and nurses, we spoke with specialist staff who would work collaboratively within the department, for example the frailty team consisted of specialist therapists. Staff told us that they could access specialist input when required for their patients.

Staff were experienced, qualified and had the opportunity to gain and consolidate the right skills and knowledge to meet the needs of the patient group. We did observe gaps in training compliance but noted that this featured in department action plans as an area for improvement.

Managers provided new staff with appropriate induction, all staff we spoke with had received a full induction when joining the department.

Managers provided staff with supervision (meetings to discuss care management, to reflect on and learn from practice, and for personal support and professional development) and appraisal of their work performance. All nursing staff reported that they were supported by their senior leaders.

Managers ensured that staff had access to regular team meetings. If staff were not available to attend then senior leaders would ensure that all staff received meeting minutes by email.

The percentage of nursing staff that had had an appraisal in the last 12 months was 88% at the time of inspection

Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge. Senior staff would regularly work with staff to help them develop and improve.

Managers ensured that staff received the necessary specialist training for their roles.

Managers dealt with poor staff performance promptly and effectively. We were given examples of how poor staff performance was identified and the steps taken to support that member of staff and help them improve.

The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Doctors, nurses, and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide safe care. Staff held regular and effective multidisciplinary meetings to review patients and improve their care. We saw multidisciplinary working with services, such as occupational therapy, psychiatric liaison, and diagnostics to identify the most appropriate care and treatment for patients.

We observed effective communication between staff when handing over patient care at the beginning and end of shifts. We also observed staff huddles throughout the day when patients were discussed, and any concerns were raised as appropriate. We also noted the use of a flow navigator who linked all areas of the department effectively.

Multidisciplinary working was evident and effective within the department; however, we were given examples of communication between the department and other specialities within the hospital being less effective which impacted the patient journey and reduced access to specialist services.

The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff supported patients to live healthier lives, we saw multiple posters and patient information leaflets throughout the department. Staff told us that they would discuss health promotion with patients if there was opportunity, but this wasn’t consistently available due to pressures within the department.

The evidence showed some shortfalls. The service did not always consistently monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves. The service was previously in breach of the legal regulation in relation to monitoring and improving outcomes. Improvements were not found at this assessment, and the service remained in breach of this regulation.

We were provided with a comprehensive audit schedule that detailed a wide range of audit topics. When we reviewed specific local audits such as ward manager’s compliance checks, we requested the previous six months data but were only provided with the two most recent months. The lack of completed audits and the subsequent missed opportunities to drive improvement did not provide assurance that the department was effectively or consistently using audits to monitor and improve care and outcomes.

Staff used recognised tools to improve the detection and response to clinical deterioration in patients as a key element of patient safety and improving patient outcomes. We saw staff using a nationally recognised early warning system (NEWS2). We also noted that all patients had been assessed and escalated appropriately in all cases that we reviewed

Staff used technology to support patients effectively (for example, for prompt access to blood test results).

The evidence showed an inconsistent standard. The service did not ensure all staff completed the training required, nor did it review the recording of consent within local audits. The service was previously in breach of the legal regulation in relation to consent. Limited Improvements were found at this assessment, and the service remained in breach of this regulation.

Dementia training had only been completed by 78% of medical staff and only 70% of medical staff had completed deprivation of liberty safeguards (DOLS) and mental capacity act (MCA) training.

Learning disability training for medical staff was also below trust targets, with 58% of medical staff completing level one training and 20% of medical staff completing level two training. Nursing staff compliance for level one was 87% and 58% of staff had completed level two training.

We reviewed local audits and found no reference to consent being audited to ensure compliance.

Dementia training had been completed by 94% of nursing staff and 97% of nursing staff had completed deprivation of liberty safeguards (DOLS) and 92% had completed mental capacity act (MCA) training.

Staff were observed supporting patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent. Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. Due to a lack of training compliance, we could not be assured that all medical staff would be able to achieve this.

Staff gained consent from patients for their care and treatment during triage in line with legislation and guidance and this was clearly recorded in the patients’ records.

When patients could not give consent, staff made decisions in their best interest, taking into account patients’ wishes, culture and traditions. The service had effective systems to ensure staff assessed the mental capacity of patients and recorded decisions made in service users’ best interest when applying to deprive the service user of their liberty.