Grantham and District Hospital

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Patients were safe because individual and environmental risks were assessed, and steps taken to reduce them. Risks were managed positively and did not restrict patients’ lifestyle choices unnecessarily. The service had procedures in place to protect patients from potential abuse and unsafe care. There were enough staff with the necessary skills, experience and qualifications to meet people's needs and preferences. Patients received their medicines on time and in a safe way. All areas we inspected, were safe and well maintained. Staff maintained safe levels of infection prevention and control.

However, not all staff had completed mandatory training.

We have not awarded this service a score for Safe.

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

Leaders promoted a culture of safety and learning within the trust.

Leaders and staff were fully aware of their responsibilities for reporting incidents and accidents. Staff reported incidents through the electronic reporting system which all staff had access to. Staff reported incidents in line with the trust policy.

On Harrowby Ward there was a learning from incidents folder which included the current incidents, feedback from previous incidents and the topic of the month, which the ward manager supervised and ensured staff read the contents.

Managers had implemented the NHS Patient Safety Incident Framework (PSIRF) to develop effective systems and processes to respond, learn and improve from patient safety incidents. Incidents were comprehensively investigated and there was clear analysis of incident data and trends with comparison to previous reporting periods.

Patients experienced care based on the latest updates and learning which followed national updates and safety incidents. Patients and staff were encouraged and supported to raise concerns. They felt confident they would be treated with compassion and understanding and would not be blamed or treated negatively if they did so.

Managers shared learning from incidents, and this was used to identify and embed best practice.

There was a standard operating procedure that provided guidance about the requirements of duty of candour, and all staff were knowledgeable about this.

As part of our inspection we took the ‘last journey’ with a member of staff to the mortuary. This was a long walk outside in all weathers. The pathway had potholes, an uneven surface and breaks in the surface dressing. We were advised the pathway was liable to flooding. The pathway was used in all weathers, day and night, including icy conditions as it was the only way to reach the mortuary. At night there was only one porter, so the nurses assisted.

We observed the pathway was neighbouring to a nearby school. We were told that the children had previously made comments when they were outside and had observed the transfer of the deceased on this pathway.

Following our inspection the trust provided us with assurance the concerns had been raised thoroughly through the appropriate governance processes.

Staff worked in partnership with external providers of end of life care in assessing, planning and delivering care and treatment. This included GP's, primary care nursing teams, allied health professionals, social care providers, secondary care and other voluntary sector workers.

Staff worked with patients and those close to them to establish and maintain safe treatment and care to eliminate risks and ensure continuity of care.

Staff used an electronic identification and referral system for patients who were identified as needing palliative and end of life care. However, although the service had an adequate referral pathway for patients, this lacked coordination and consistency, for example, there were two separate referral systems one for the hospital and for the hospice. This meant the referral process was more time consuming but was still safe.

We were advised during our inspection that work was proceeding to promote a standardised way of working for both the hospital and the hospice.

Staff kept detailed records of patients’ care and treatment. Records were clear, comprehensive up to date, stored securely and easily available to all staff providing care.

Patients were discharged safely, to the hospice or their preferred place of care or death. Discharge summaries including anticipatory medications were shared electronically if on the trusts’ system or if not by post with GPs.

We reviewed 3 discharge summaries and found they were completed correctly. For example, they included all the relevant clinical information, the DNACPR status and medication.

An ambulance was booked for the discharge of patients’ either to home or another place of their choice, such as a hospice or care home or a preferred place of care of death if they were at the end of their lives.

Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.

The trust had a comprehensive safeguarding policy with clear guidance for identifying and reporting concerns. Staff knew how to access the safeguarding team for advice and guidance when required. Staff knew how to make a safeguarding referral, had a good understanding of when they would need to report safeguarding issues and who to inform if they had concerns.

Staff received training specific for their role on how to recognise and report abuse, understood how to apply it and how to protect people from abuse. At the time of our inspection, data showed the specialist palliative care team (SPCT) had 100% compliance for safeguarding training, against the trust target of 90%.

The trust had a safeguarding team; staff knew the names of the safeguarding leads and told us they could approach them for advice if they needed to.

Staff were able to describe situations which would prompt a safeguarding concern and lead to a referral being made. For example, one staff member told us of how a patient had disclosed some very concerning information which they reported to the local authority using the trust processes. The local authority took immediate action to safeguard the person concerned.

Staff understand their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. They know how to support patients experiencing mental ill health and those who lacked capacity to make decisions about their care.

Staff were trained to complete mental capacity assessments and Deprivation of Liberty Safeguards applications (DoLS) and used these where necessary to make best interest decisions to keep people safe'. A mental capacity assessment is a legal test used to determine if a person over the age of 16 can make a specific, important decision at a particular time. Based on the Mental Capacity Act 2005, it evaluates if an individual can understand, retain, weigh, and communicate information regarding their health, finances, or welfare.

DoLS stands for Deprivation of Liberty Safeguards. It is a legal framework in England and Wales designed to protect vulnerable adults in care homes or hospitals who lack the mental capacity to consent to their care arrangements and require restricted freedom for their own safety. DoLs existed to ensure that individuals were not unfairly deprived of their liberty without proper assessment and legal protection.

The service protected patient’s avoidable harm. Patients were risk assessed to ensure they were suitable for care and treatment at the service and staff monitored them appropriately.

Patient needs were escalated appropriately, within the context of end of life care services. Staff completed risk assessments for each patient on admission, using an appropriate tool.

Where patients were at the end of their life, staff did not complete clinical observations. However, staff did undertake ‘comfort observations’ to monitor for pain, distress, and symptom management.

Where patients did require clinical observations, for example, blood pressure heart rate and temperature, we observed these were undertaken correctly. Nursing staff were trained in the identification of sepsis. There was a lead nurse for sepsis within the trust who was part of the trust critical care outreach team (CCOT). The team were automatically alerted to patients who showed a National Early Warning Score (NEWS2). This is a standardised tool used in healthcare to identify and respond to clinical deterioration in acutely ill patients.

This meant the patients with Sepsis were identified as early as possible and treated by staff experienced in the treatment of sepsis.

Staff knew the process for making a referral to the mental health team should a patient present with acute mental health symptoms.

The design, maintenance and use of facilities, premises and equipment kept people safe. Hazardous items were out of reach, and there were no sharp corners. Equipment was visibly clean. We saw labels on equipment with the last service date.

Equipment used to deliver care was suitable for the intended purpose. Staff stored equipment securely and used it correctly. For example, daily checks took place on resuscitation trollies to ensure the safety seal had not been broken. Logbooks showed staff had signed to indicate the resuscitation equipment had been checked, the equipment was clean, well maintained and ready for use in an emergency.

Access to the hospice and chemotherapy suite was through a swipe card system. This meant the area was more secure than open access and minimised the risk of unauthorised access.

Leaders made sure that equipment, facilities and technology supported the delivery of safe care and treatment. We observed that facilities, equipment and technology were well-maintained and consistently supported staff to deliver safe and effective care.

Some patients required continuous medication administration through a syringe driver to control their symptoms. At the time of our inspection, 3 patients required a syringe driver. We inspected 7 syringe drivers; all were serviced yearly and in date. There were enough syringe drivers to meet the needs of the patients. Staff were knowledgeable about syringe drivers and the medicines that were administered through them. Staff told us some patients required more than one syringe driver due to incompatibilities between some medicines. All staff were required to undergo specific competency training for managing a syringe driver with a duration of supervised practice prior to being able to lead on this.

During our inspection, we found the chemotherapy suite, Harrowby ward, and the hospice clean and well maintained and the setting and design of the units aligned with best practice.

Not all staff completed mandatory training. Data showed for the SPCT appraisal rates of 100% with 67% for the chemotherapy suite, 77% for the hospice staff and 84% for Harrowby ward against the trust target of 90%.

However, after our inspection, the Trust told us that in April 2025, the Trust changed the appraisal process, with all appraisals required to be completed within the April–June appraisal window, this was to support the Trust’s and wards objectives. As a result, some staff who had already completed their appraisal in February/March 2025 were advised that they would not require another appraisal until the April – June appraisal window in 2026.

Managers made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. Staff worked together effectively to provide safe care that meets people’s individual needs.

The service had enough staff to keep patients safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed and adjusted staffing levels and skill mix. All new members of staff underwent a structured and comprehensive induction training programme appropriate to their role. For example, one staff member told us about falls prevention which was part of mandatory training, and how they put that training into practice when caring for patients and in their general work on the ward.

The ULTH specialist palliative care team (SPCT) is comprised of clinical nurse specialists and palliative care consultants. The palliative care consultants are hosted by the local hospice and work across community, hospice and hospital settings.This was a team of advisory clinical specialists who improved the identification, quality of care and experience for inpatients with deteriorating, complex palliative needs.

During handover we observed that arrangements were made for patient safety during these periods and adequate numbers of staff were observed to be left on the ward to care for patients. Staff attending handover would advise staff of all updates once handover was completed.

Competence was monitored and maintained through annual appraisal and competency reviews. The service made ‘Reasonable Adjustments’ under the current Equality legislation for those staff as required.

We observed that staff were visible in all areas and did not appear to be rushed in the hospice or the chemotherapy suite, however, on Harrowby ward 2 patients told us the nurses were busy but always had time for them. Staff told us on Harrowby ward they were busy, but this did not impact on patient care or safety.

The service controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment visibly clean.

Staff followed infection control principles including the use of personal protective equipment (PPE). Staff were observed to be following the service’s ‘bare below the elbows’ protocol. We saw staff regularly utilise the alcohol hand rubs and washing their hands in accordance with the World Health Organisation’s (WHO) ‘5 Moments for Hand Hygiene’. These guidelines are for all staff working within healthcare environments and define the key moments when staff should be performing hand hygiene to reduce risk of cross contamination between patients.

We saw the use of hand sanitising gel was standard practice across the hospital. The hand gel was available at all exit and entry points and signs encouraged visitors to make use of it.

Data showed that hand hygiene audits had a 100% compliance for Harrowby ward, the chemotherapy suite and the hospice.

All areas of Harrowby ward, the chemotherapy suite and the hospice were observed to be visibly clean and tidy. During our inspection, we observed several pieces of equipment with green ‘I am clean stickers’. This meant the equipment had been cleaned.

Staff managed clinical waste safely.

Staff made sure that medicines and treatments were safe and met patients' needs, capacities and preferences. Staff made sure patients were involved in planning for their medicine needs, including when changes happened as appropriate.

During our inspection we found that staff managed medicines safely when ordering and the receipt of them. Staff stored medicines safely in locked cupboards and fridges if needed. Fridge temperatures were monitored, and staff checked to ensure these were within the required range. We saw evidence these were monitored and recorded daily.

Staff stored and administered controlled drugs (CDs) in line with National Institute for Health and Care Excellence (NICE) guidance, including the double locking of cupboards and the practice of two nurses checking-in CDs. A record of the signatures of staff authorised to give out CDs was maintained and had been updated monthly. We observed 2 nurses checking controlled drugs. These were undertaken appropriately and signed by both nurses. We reviewed the controlled drugs book and found all medicines was signed and dated by 2 nurses.

Controlled drugs are prescription medicines and other substances subject to strict legal controls due to their potential for misuse, addiction, and harm. They are often essential for treating medical conditions such as severe pain; however, they can cause a high risk of harm if taken incorrectly or used by someone other than the person they were prescribed for.

All prescription charts we reviewed were completed correctly with anticipatory prescribing in place and within the adequate dose ranges. Anticipatory prescribing is the proactive, "just-in-case" prescribing of medicines for patients in their last days or weeks of life to manage expected symptoms such as pain, agitation, nausea, or breathlessness. It ensures essential drugs are available for patients to prevent delays in treatment, improve comfort, and avoid a crisis. All entries were signed and dated and discontinued medicine crossed out.

Leaders completed medicine management audits. For the period February 2026, data showed 100% compliance for medicine audits on Harrowby ward, the chemotherapy suite and the hospice.