Updated
8 March 2024
Mid Yorkshire Teaching NHS Trust provides care for over half a million people every year, in their homes, in the community and across three hospital sites at Pontefract, Dewsbury and Pinderfields. In addition, the trust provides two specialist regional services: burns and spinal injuries. The trust is made up of a team of 9,200 staff.
The Pinderfields Hospital building was opened in 2011; is the largest of the trust’s three hospitals and is the main site for patients requiring acute care. A range of inpatient, outpatient, diagnostic and maternity services are provided. The hospital provides both urgent and emergency care as well as services such as elective surgery. Pinderfields is the busiest hospital within the trust. In any one year there may be over 127,000 attendances to the A&E and over 58,000 emergency admissions.
Dewsbury and District Hospital provides services, usually for patients living in the North Kirklees district. The hospital provides urgent and emergency care, diagnostics, elective care, midwife services and care of the elderly services. The hospital treats over 340,000 patients every year.
The trust works in partnership with two local authorities, two integrated care system (ICSs) commissioners and a wide range of other providers, including voluntary and private sector organisations. It also works as a member of the West Yorkshire and Harrogate Partnership, which is the Integrated Care System within which the Trust resides.
We carried out an unnanounced focussed inspection of medicine (including older peoples services) and urgent and emeregency care at Pinderfields Hospital and Dewsbury and District Hospital. Our inspection was a follow up on concerns about the quality and safety of urgent and emergency care and medical services raised during the last inspection in April 2022. At this inspection we found the core service overall ratings of emergency care and medicine remained the same, requires improvement. However, at Pinderfields Hospital the domains of effective and well led in urgent and emergency care had improved to good. The domain of responsive had improved in medical services to good. At Dewsbury and District Hospital the rating of the well led domain for urgent and emergency care improved to good. We also saw other improvements since our last inspection although the overall and domain rating did not change.
The team that carried out the inspection of urgent and emergency care services comprised of an inspector, assistant inspector and 2 specialist advisors with expert clinincal knowledge in the areas inspected.
The team that carried out the inspection of the medicine service comprised of 2 inspectors and 2 specialist advisors plus an inspector who carried out a short observational framework on one of the medical wards.
An inspection manager oversaw the inspection of both services.
You can find further information about how we carry out our inspections on our website: www.cqc.org.uk/what-we-do/ how-we-do-our-job/what-we-do-inspection.
Updated
13 October 2017
Nurse and consultant staffing levels for the specialist palliative care team were at full complement and reviewed daily to keep people safe at all times. Any staff shortages were responded to quickly and adequately. Staff delivering end of life and specialist palliative care understood their responsibilities with regard to reporting incidents. Staff we spoke with told us that when an incident occurred it would be recorded on an electronic system for reporting incidents.
We viewed body store protocols and spoke with body store and porter staff about the transfer of the deceased. Staff told us that the equipment available for the transfer of the deceased was adequate and we saw that this included bariatric equipment.
The trust had developed a care of the dying patient (CDP) care plan that provided prompts and guidance for ward based staff when caring for someone at the end of life. We observed the use of these and saw that information was recorded and shared appropriately and that the plans were completed.
We saw that the specialist palliative care nurses worked closely with medical staff on the wards to support the prescription of anticipatory medicines The guidance the specialist nurses provided was in line with the end of life care guidelines and was delivered in a way that focused on developing practice and confidence in junior doctors around prescribing anticipatory medicines.
Staff used a community-wide electronic patient record system accessible to the multidisciplinary team caring for the patient including hospital staff, community staff and most GPs. They also had access to EPaCCS (Electronic Palliative Care Coordination System), which enabled the recording and sharing of people’s care preferences and key details about end of life care.
We observed the use of syringe drivers on the wards and saw that regular administration safety checks were being recorded. Ward staff told us that syringe drivers were available when they needed them.
For those palliative care patients who were already known to the service and admitted to the hospital for care and treatment, 93% were followed up by contacting the ward within 24 hours to assess the need for specialist palliative care assessment.
Staff were able to demonstrate compassion, respect and an understanding of preserving the dignity and privacy of patients following death. Body store staff told us there was always a member of staff on call out of hours. This service was available for families who requested to visit during an evening or a weekend.
We observed staff caring for patients in a way that respected their individual choices and beliefs and we saw that records included sections to record patient choices and beliefs so that these were widely communicated between the teams.
The quality of leadership for end of life care had improved since the last inspection. Structures, processes and systems of accountability, including the governance and management of joint working arrangements were clearly set out, understood and effective.
However:
Staff we spoke to were not all familiar with the Duty of Candour and when it was implemented.
An end of life care plan had been introduced, but there was no regular audit to determine what percentage of end of life inpatients had the care plan in place. There was no regular internal performance reporting to directorate or board management to demonstrate improvement in areas such as quality of care, preferred place of death, referral management and rapid discharge of end of life patients.
The weekly specialist palliative care team (SPCT) multidisciplinary meeting included SPCT nurses and palliative care consultants but no other discipline such as allied health care professionals, pharmacy or the chaplaincy.
We were unable to assess the level of performance in achieving fast track discharges for end of life patients due to lack of evidence; no audit work had been done to measure performance in this area since the last inspection. The service reported that 73% of all new referrals were seen within 24 hours of being referred to the team.
Updated
7 December 2018
We rated this service as requires improvement because:
- Although the backlog of patients waiting for follow up appointments had improved slightly since our last inspection, there was still a backlog of 18,374 at 22 July 2018.
- There was a process in place for administrative and clinical validation of waiting lists. However, the trust could not provide evidence that clinical validation had taken place on all patients in the backlog.
- Despite specialities having agreed response plans, it was not clear what the trajectories were for clearing the backlogs.
- Referral to treatment times (RTT) were worse than the England overall performance, however there had been a steady increase in performance and there had been an improvement since the last inspection.
However:
- Staff were aware of the processes to follow to report incidents and safeguarding concerns. Learning was shared between teams.
- Staffing levels were flexed to cover clinics and the outpatient departments were staffed by multidisciplinary teams that worked effectively together.
- Patients attending the department received care and treatment that was evidence based and followed national guidance. Staff had access to policies and guidance.
- Staff provided compassionate care to patients and patients were kept informed and given choices in their care.
- The service was well led with leaders who were visible and approachable.
- Staff spoke positively about working for the service, they felt well supported and spoke about good teamwork.
- Leaders were aware of the issues within the service and there were good governance processes in place.
Updated
13 October 2017
Senior nursing staff had daily responsibility for safe and effective nurse staffing levels and staffing guidelines with clear escalation procedures were in place. Appropriate risk assessments were completed accurately for falls, pressure ulcers National Early Warning Scores (NEWS), sepsis screening and malnutrition. Staff were aware of escalation procedures.
We saw evidence that Root Cause Analyses (RCA) of serious incidents were comprehensive and highlighted immediate actions taken, chronology of events, findings, care and delivery problems, root causes, recommendations, lessons learned and action plans.
We observed the ‘Five Steps to Safer Surgery’ checklist being used appropriately in theatre and saw completed preoperative checklists and consent documentation in patient’s notes.
Patients had good outcomes as 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.
Leadership at each level was visible, staff had confidence in the leadership. There were clear governance processes in place to monitor the service provided. The division handled 97% of complaints within trust timescales (95% target).
However:
Medical staff did not reach the trust 95% target for mandatory core training completion, this included safeguarding.
Across the division, NEWS audits (March 2017) showed that 59% of observations were recorded which were worse than the 67% compliance rate in the previous audit. There were 108 missed medications recorded between March 2016 and February 2017 across the surgical division.
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.