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Pontefract Hospital Requires improvement

Reports


Inspection carried out on 11 May, 16-19 May, 22 May and 5 June 2017

During an inspection to make sure that the improvements required had been made

The Mid Yorkshire Hospitals NHS Trust is an integrated trust, which provides acute and community health services. The trust serves two local populations; Wakefield which has a population of 355,000 people and North Kirklees with a population of 185,000 people. The trust operates acute services from three main hospitals – Pinderfields Hospital, Dewsbury and District Hospital and Pontefract Hospital. At Pontefract, the trust had approximately 61 general and acute beds and four beds in Maternity. The trust also employed 7,948 staff, of which 536 were based at Pontefract. This included 28 medical staff and 261 nursing staff.

We carried out a comprehensive inspection of the trust between 16 and 19 May 2017. This included unannounced visit to the trust 11 and 22 May and 5 June 2017. The inspection took place as part of our comprehensive inspection programme of The Mid Yorkshire Hospitals NHS Trust and to follow up on progress from our previous comprehensive inspection in July 2014, a focused inspections in June 2015, and unannounced focused inspection in August and September 2015. Focused inspections do not look across a whole service; they focus on the areas defined by the information that triggers the need for the focused inspection.

At the inspection in July 2014 we found the trust was in breach of regulations relating to care and welfare of people, assessing and monitoring the quality of the service, cleanliness and infection control, safety, availability and suitability of equipment, consent to care and treatment and staffing. We issued two warning notices in relation to safeguarding people who use services from abuse and management of medicines.

At the inspection in July 2015 and our follow up unannounced inspections, we found that the trust was in breach of regulations relating to safe care and treatment of patients, addressing patients nutritional needs, safe staffing, and governance. We issued requirement notices to the trust in respect of these breaches.

Our key findings from our inspection in May 2017 are as follows.

We rated Pontefract Hospital as requires improvement because:

  • Nursing and medical staffing in some areas was a concern. In the emergency department nurse staffing was not always meeting planned staffing levels or national guidance. Nursing staff were frequently being moved to wards to cover staffing shortages. Midwifery staffing was below nationally recommended levels and community midwifery caseloads were above the national recommendations.

  • Access and flow was a challenge at this hospital. We saw that the hospital was failing to meet the majority of national standards relating to Accident and Emergency performance, including: four hour waits, re-attendance rates, time from decision to admit to admission, median time to treatment and ambulance handover times. However, recent information showed that performance was improving.

  • Patients had long waits in the emergency department once a decision to admit them had been made. This was predominantly due to the lack of beds available to admit patients in to the trust, although mental health patients were also affected. Women experienced long waits at the antenatal clinic, and some were required to stand, as there was not enough seating.

  • There were issues regarding referral to treatment (RTT) indicators and waiting lists for appointments. There was an appointment backlog which had deteriorated since the last inspection and was at 19,647 patients waiting more than three months for a follow up appointment. Staff told us clinical validation had occurred on some waiting lists, for example in ophthalmology. However, this had not occurred on all backlogs across the trust. Between February 2016 and January 2017 the trust’s referral to treatment time (RTT) for admitted pathways for surgical services had been worse than the England overall performance.

  • Staff across most specialties were not meeting the trust’s mandatory training and appraisal targets. We were not assured of the competence of midwifery staff with regard to basic skills such as cannulation and perineal suturing.

  • Recording of pain scores and National Early Warning Scores (NEWS) was not consistent and some audits identified a deterioration in compliance with recording NEWS scores.

  • We were not assured that all staff were competent to use medical devices. There was also limited assurance that electronic equipment had annual safety checks.

  • Although there was a newly implemented governance process, this was yet to be embedded in practice. The emergency department did not take part in RCEM or clinical audits and therefore there was no assurance that standards of care were being met. The maternity risk register contained a large number of risks, and many had a review date in the past. This led to concern that the risk register was not being appropriately scrutinised. Duty of candour was not well understood across all staff groups; however senior managers could describe the duty of candour.

However,

  • Patients received care and treatment that was caring and compassionate from staff who were working hard to make sure that patient experience was positive and supportive. Staff were able to meet the physical and emotional needs of patients. There was access to pastoral support for patients of any or no religion.

  • A trust incident reporting system was used to report incidents and staff we spoke with were aware of how to report incidents. Staff were aware of how to report safeguarding concerns. We saw evidence that Root Cause Analysis (RCA) and investigations of serious incidents were comprehensive .

  • Patients had good outcomes from surgery and they received effective care and treatment to meet their needs. The trust had made changes to the way services are organised to the provision of surgery, concentrating emergency and complex surgery on the Pinderfields Hospital site. This met national guidance of separating planned and urgent care.

  • There were clear governance processes in place. Management could describe the risks to the service and the ways they were mitigating these risks. Services were engaged in reviewing staffing levels and considering how staffing concerns could be addressed via recruitment and the introduction of new staff roles.

  • Staff praised the executive management team of the trust and told us that since our last inspection the atmosphere of the trust felt different. Staff were positive about the future and felt that problems were now more open and being addressed by leaders.

Importantly, the trust must:

  • Ensure that mandatory training levels are meeting the trust standard.

  • Ensure that there are suitably skilled staff available taking into account best practice, national guidelines and patients’ dependency levels.

In addition the trust should:

  • Ensure that there are suitably skilled staff available taking into account best practice, national guidelines and patients’ dependency levels.

  • Ensure that all staff have annual appraisals.

  • Continue to focus on achieving A&E standards and ensure that improved performance against standard is maintained.

  • Ensure that records are completed fully and that records are stored securely.

  • Ensure that staff triage training is robust and that staff carrying out triage are experienced ED clinicians.

  • Continue to address issues of non-compliance with referral to treatment indicators and the backlog of patients waiting for appointments.

  • Ensure work to improve the completion of consent forms in line with trust expectations.

  • Review the risk registers and remove or archive any risks that no longer apply.

  • Increase local audit activity to encourage continuous improvement.

  • Ensure it continues to address capacity and demand across all outpatient services.

  • Consider ways of ensuring team meetings in main outpatients are regular and consistent.

  • Consider ways of ensuring environmental compliance issues with carpets in departments.

  • Improve the assessment and recording of patient pain scores.

  • Ensure there are appropriately qualified or experienced children’s nurses in ED.

  • Undertake clinical audit in ED to ensure that national and local standards of care are being met.

  • Improve the reliability of the blood diagnostic service.

  • Ensure that robust recruitment and retention policies continue, to improve staff and skill shortages; with particular emphasis on theatre recruitment.

Professor Edward Baker

Chief Inspector of Hospitals

Inspection carried out on 23-25 June 2015, 3 July 2015

During an inspection to make sure that the improvements required had been made

The Mid Yorkshire Hospitals NHS Trust is an integrated trust, which provides acute and community health services. The trust serves two local populations; Wakefield which has a population of 355,000 people and North Kirklees with a population of 185,000 people. The trust operates acute services from three main hospitals – Pinderfields Hospital, Dewsbury and District Hospital and Pontefract Hospital. At Pontefract, the trust had approximately 61 general and acute beds and four beds in Maternity. The trust also employed 7,948 staff, of which 536 were based at Pontefract. This included 28 medical staff and 261 nursing staff.

We carried out a comprehensive inspection of the trust between 16 and 19 May 2017. This included unannounced visit to the trust 11 and 22 May and 5 June 2017. The inspection took place as part of our comprehensive inspection programme of The Mid Yorkshire Hospitals NHS Trust and to follow up on progress from our previous comprehensive inspection in July 2014, a focused inspections in June 2015, and unannounced focused inspection in August and September 2015. Focused inspections do not look across a whole service; they focus on the areas defined by the information that triggers the need for the focused inspection.

At the inspection in July 2014 we found the trust was in breach of regulations relating to care and welfare of people, assessing and monitoring the quality of the service, cleanliness and infection control, safety, availability and suitability of equipment, consent to care and treatment and staffing. We issued two warning notices in relation to safeguarding people who use services from abuse and management of medicines.

At the inspection in July 2015 and our follow up unannounced inspections, we found that the trust was in breach of regulations relating to safe care and treatment of patients, addressing patients nutritional needs, safe staffing, and governance. We issued requirement notices to the trust in respect of these breaches.

Our key findings from our inspection in May 2017 are as follows.

We rated Pontefract Hospital as requires improvement because:

  • Nursing and medical staffing in some areas was a concern. In the emergency department nurse staffing was not always meeting planned staffing levels or national guidance. Nursing staff were frequently being moved to wards to cover staffing shortages. Midwifery staffing was below nationally recommended levels and community midwifery caseloads were above the national recommendations.

  • Access and flow was a challenge at this hospital. We saw that the hospital was failing to meet the majority of national standards relating to Accident and Emergency performance, including: four hour waits, re-attendance rates, time from decision to admit to admission, median time to treatment and ambulance handover times. However, recent information showed that performance was improving.

  • Patients had long waits in the emergency department once a decision to admit them had been made. This was predominantly due to the lack of beds available to admit patients in to the trust, although mental health patients were also affected. Women experienced long waits at the antenatal clinic, and some were required to stand, as there was not enough seating.

  • There were issues regarding referral to treatment (RTT) indicators and waiting lists for appointments. There was an appointment backlog which had deteriorated since the last inspection and was at 19,647 patients waiting more than three months for a follow up appointment. Staff told us clinical validation had occurred on some waiting lists, for example in ophthalmology. However, this had not occurred on all backlogs across the trust. Between February 2016 and January 2017 the trust’s referral to treatment time (RTT) for admitted pathways for surgical services had been worse than the England overall performance.

  • Staff across most specialties were not meeting the trust’s mandatory training and appraisal targets. We were not assured of the competence of midwifery staff with regard to basic skills such as cannulation and perineal suturing.

  • Recording of pain scores and National Early Warning Scores (NEWS) was not consistent and some audits identified a deterioration in compliance with recording NEWS scores.

  • We were not assured that all staff were competent to use medical devices. There was also limited assurance that electronic equipment had annual safety checks.

  • Although there was a newly implemented governance process, this was yet to be embedded in practice. The emergency department did not take part in RCEM or clinical audits and therefore there was no assurance that standards of care were being met. The maternity risk register contained a large number of risks, and many had a review date in the past. This led to concern that the risk register was not being appropriately scrutinised. Duty of candour was not well understood across all staff groups; however senior managers could describe the duty of candour.

However,

  • Patients received care and treatment that was caring and compassionate from staff who were working hard to make sure that patient experience was positive and supportive. Staff were able to meet the physical and emotional needs of patients. There was access to pastoral support for patients of any or no religion.

  • A trust incident reporting system was used to report incidents and staff we spoke with were aware of how to report incidents. Staff were aware of how to report safeguarding concerns. We saw evidence that Root Cause Analysis (RCA) and investigations of serious incidents were comprehensive .

  • Patients had good outcomes from surgery and they received effective care and treatment to meet their needs. The trust had made changes to the way services are organised to the provision of surgery, concentrating emergency and complex surgery on the Pinderfields Hospital site. This met national guidance of separating planned and urgent care.

  • There were clear governance processes in place. Management could describe the risks to the service and the ways they were mitigating these risks. Services were engaged in reviewing staffing levels and considering how staffing concerns could be addressed via recruitment and the introduction of new staff roles.

  • Staff praised the executive management team of the trust and told us that since our last inspection the atmosphere of the trust felt different. Staff were positive about the future and felt that problems were now more open and being addressed by leaders.

Importantly, the trust must:

  • Ensure that mandatory training levels are meeting the trust standard.

  • Ensure that there are suitably skilled staff available taking into account best practice, national guidelines and patients’ dependency levels.

In addition the trust should:

  • Ensure that there are suitably skilled staff available taking into account best practice, national guidelines and patients’ dependency levels.

  • Ensure that all staff have annual appraisals.

  • Continue to focus on achieving A&E standards and ensure that improved performance against standard is maintained.

  • Ensure that records are completed fully and that records are stored securely.

  • Ensure that staff triage training is robust and that staff carrying out triage are experienced ED clinicians.

  • Continue to address issues of non-compliance with referral to treatment indicators and the backlog of patients waiting for appointments.

  • Ensure work to improve the completion of consent forms in line with trust expectations.

  • Review the risk registers and remove or archive any risks that no longer apply.

  • Increase local audit activity to encourage continuous improvement.

  • Ensure it continues to address capacity and demand across all outpatient services.

  • Consider ways of ensuring team meetings in main outpatients are regular and consistent.

  • Consider ways of ensuring environmental compliance issues with carpets in departments.

  • Improve the assessment and recording of patient pain scores.

  • Ensure there are appropriately qualified or experienced children’s nurses in ED.

  • Undertake clinical audit in ED to ensure that national and local standards of care are being met.

  • Improve the reliability of the blood diagnostic service.

  • Ensure that robust recruitment and retention policies continue, to improve staff and skill shortages; with particular emphasis on theatre recruitment.

Professor Edward Baker

Chief Inspector of Hospitals

Inspection carried out on 29 May 2013

During a routine inspection

Pontefract Hospital is part of the Mid Yorkshire Hospitals NHS Trust. This inspection was carried out over one day by a team of inspectors and an Expert by Experience as part of our scheduled programme.

We visited the stroke rehabilitation unit, an orthopaedic ward and the outpatients department.

We found that patients were receiving good care in the areas of the hospital that we visited. Overall patients gave positive feedback on the care and treatment they received. We found that the relocation of the stroke unit had had an impact on how therapy services were delivered, which we consider should be reviewed. We also found that communication about delays in appointment times in outpatients could be improved. We reviewed staffing in the areas we visited and found staffing levels were sufficient. We found satisfactory systems were in place to manage complaints and no evidence to suggest that quality assurance processes were not being implemented, for example, assessing and managing risk.

Inspection carried out on 12 November 2012

During a routine inspection

Pontefract Hospital is part of The Mid Yorkshire Hospitals NHS Trust. This inspection was carried out by a team of inspectors as part of our scheduled programme. We had received information in the form of complaints and statutory notifications since the last inspection which lead us to follow up on reports of poor discharge planning and poor care delivery.

We visited the Accident and Emergency Department, Care Closer to Home and the Day Surgery Unit.

People told us they were spoken to respectfully by staff and that their privacy and dignity was maintained as much as possible.

We spoke with two people who were due for discharge and they told us they had been informed about ongoing help they would receive once they had returned home

Two people in the day surgery unit told us they were provided with information about their care and that their opinions were taken into account when the day surgery was planned.

We spoke with staff who were knowledgeable about their area of expertise and could demonstrate a good understanding and applications of policies and procedures to support effective service delivery. Our observations of staff over all departments visited were that of a competent work force which provided dignity, privacy and respect to patients.

We looked at a number of records including patient records and found them to be relevant to the treatment the patient was receiving, up to date and accurate

Inspection carried out on 31 August and 18 October 2010

During a routine inspection

This section was not completed for this inspection. More information about what we found during the inspection is available in the report below.