South Tyneside and Sunderland NHS FT

Updated 3 February 2023

South Tyneside and Sunderland NHS Foundation Trust provides acute, community and specialist learning disability services for over 430,000 people across Sunderland and South Tyneside, as well as Gateshead and County Durham. The trust also provides specialist acute services for people across the North East and employs over 8,000 people.

The trust was formed in 2019 following the merger of City Hospitals Sunderland NHS Foundation Trust and South Tyneside NHS Foundation Trust. The trust provides services from the following locations:

• Durham Diagnostic and Treatment Centre
• Intermediate Care Assessment and Rehabilitation (Houghton Primary Care Centre)
• Palmer Community Hospital
• South Tyneside District Hospital
• St Benedict’s Hospice
• Sunderland Eye Infirmary
• Sunderland Royal Hospital

We inspected maternity services and medical wards at Sunderland Royal Hospital and South Tyneside District Hospital on 21-22 June 2022. We undertook further inspections of the trust’s core services on 08 August 2022 and inspected the well-led key question for the trust overall on 9-11 August 2022. We carried out these unannounced inspections of services provided by this trust because we had concerns about the quality of services.

We identified concerns in relation to patient safety during the inspection of the trust’s core service and we shared these concerns with the trust’s senior leadership team. The trust provided details of the immediate action taken to address these concerns. During our inspection of the trust’s leadership and governance we carried out a second inspection of the trust’s core services to check whether the trust had addressed, sustained and embedded the improvements required.

Our return visit found that the trust had not made significant improvement in some of the areas of concern identified in our June inspection which resulted in continued breaches of several regulations. We identified further breaches of regulation during our review of the trust’s well-led.

Our rating of services went down. We rated them as requires improvement because:

• We rated safe, effective, responsive and well-led as requires improvement. We rated caring as good.
• The trust provides 30 services from seven locations which we inspect and rate. We rated 18 of these services as good, nine as requires improvement, and three as outstanding. We inspected the maternity services at South Tyneside District Hospital but did not re-rate this service at this inspection. In rating the trust, we took into account the services we inspected at this inspection as well as the current ratings of the 26 services we did not inspect this time.
• The trust did not have effective systems to ensure patient risk assessments were completed, and the care provided was in line with risk assessments.
• In medicine, we found did not always staff identify and escalate deteriorating patients for medical review. Staff did not consistently undertake intentional rounding or demonstrate adherence to the Mental Capacity Act. Medicines were not always stored appropriately. Patients with suspected sepsis did not always receive timely assessment and treatment. Patients with a learning disability were not consistently identified and assessed and they did not always receive care that met their needs.
• In maternity, the service could not consistently provide one to one care for patients in active labour. Staff did not consistently complete fresh eyes assessments of cardiotocographies, or the WHO safety checklist. Medicines were not always stored appropriately. The service had significant environmental risks and risks to infection prevention and control which had not been identified by the trust.
• The trust’s systems for identifying, escalating and managing risks, issues and performance were not always effective and had resulted in significant unmitigated risks developing in frontline services. Leaders did not consistently identify, understand and manage the priorities and issues the trust faced. The trust had not taken effective action to address several areas of concern identified in previous inspections.
• The trust did not consistently operate effective governance processes to ensure all patients received high-quality care which met their needs. The trust did not have oversight of the quality and safety of care provided to patients with mental health needs. There were examples where failures in governance systems had resulted in unmitigated risks.
• The trust was slow to recognise and declare serious incidents which increased the risk of repeat incidents and reduced opportunities for learning, timely actions to reduce risk to patients and effective monitoring of quality and safety by external organisations. Unexpected deaths were not always appropriately and consistently screened.
• Not all staff felt respected, supported and valued. Staff were not clear about ways to raise concerns and did not know about the trust’s Freedom to Speak Up Guardian.
• The trust had not maintained appropriate records to evidence adherence to the fit and proper persons regulation for directors.

However:

• Senior leaders had the necessary knowledge, skills and abilities to effectively lead the trust. Leaders including the board were visible and approachable in the trust for patients and staff. They supported staff to develop their skills and take on more senior roles.
• The trust had a vision for what it wanted to achieve and had recently launched a new strategy to turn it into action, developed with all relevant stakeholders. The trust was committed to communicating effectively and plainly with all stakeholders including patients.
• The trust collected reliable data and analysed it. Staff could find the data they needed, in easily accessible formats, to understand performance, make decisions and improvements.
• Information systems were integrated and secure. The trust’s commitment to digital innovation had received national and international recognition.
• Staff were committed to continually learning and improving services. Leaders encouraged innovation and participation in research. The trust had started to implement a quality improvement methodology to support and drive improvement in services.

Updated 10 June 2020

Updated 10 June 2020

Updated 10 June 2020

We rated it as outstanding because:

• The service had enough staff to care for patients and keep them safe. Staff understood how to protect patients from abuse. The service controlled infection risk well. The premises and equipment kept people safe. Staff assessed risks to patients, acted on them and kept good care records. Medicines were safely prescribed, administered, recorded and stored. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• The service provided care and treatment based on national guidance and evidence-based practice. Staff regularly checked if patients were eating and drinking enough to stay healthy and help with their recovery and gave pain relief in a timely way. Managers monitored the effectiveness of care and treatment and made sure staff were competent. All those responsible for delivering care worked together as a team to benefit patients. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.
• People were truly respected and valued as individuals and were empowered as partners in their care, practically and emotionally. Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers. We saw many examples where staff had provided support to patients above what was expected.
• The service proactively planned and provided care in a way that met the needs of local people and the communities served. The service was fully inclusive and took account of patients’ individual needs and preferences. It was easy for people to give feedback and raise concerns about care received. People could access the service when they needed it and receive the right care in a timely way. There was out of hours emergency cover ensuring people received timely access to initial assessment and treatment.
• Leaders had the experience, skills and abilities to run the service. Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff felt respected, supported and valued. Leaders and teams used systems to manage performance effectively. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually. All staff were committed to continually learning and improving services.

However:

• Not all staff were not up to date with mandatory training.

Updated 10 June 2020

We rated it as good because:

• The service had enough staff to care for children and young people and keep them safe. Staff had training in key skills, understood how to protect children and young people from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to children and young people, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of children and young people, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Staff received supervision and training relevant to their role.
• Staff treated children and young people with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to children and young people, families and carers.
• The service planned care to meet the needs of local people, took account of children and young people’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of children and young people receiving care. Staff were clear about their roles and accountabilities. The service engaged well with children and young people and the community to plan and manage services and all staff were committed to improving services continually.

Updated 10 June 2020

We rated this service as good because:

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well.
• Patient care and treatment was based on national guidance and evidence-based practice. New evidence-based techniques were used to support the delivery of high-quality care, and there was evidence of this being used to support development of other services within the trust. The service had also developed a number of regional policies and guidelines.
• Staff monitored the effectiveness of care and treatment. The service actively engaged in activities to monitor and improve quality and outcomes. This was evident from the comprehensive oral health promotion programme and the nasal inhalation sedation offered. Data showed sustained good outcomes for patients.
• The service ensured staff were competent for their roles. There was a clear focus on training and development, and it was a key priority for the service. Staff were proactively supported to learn and develop their skills and competence and described a range of formal and informal training opportunities. A structured programme of clinical supervision for staff was in place and a high percentage of clinical staff had undertaken competency training in dental sedation. Lead clinicians and managers provided a range of education both within the service, the wider trust and regionally and had specialist knowledge in a number of areas. Managers appraised staff’s work performance and held supervision meetings with them to provide support and development.
• All those responsible for delivering care worked together as a team to benefit patients. The dental team was committed to working collaboratively with other services including the oral health promotion team and vulnerable adults in the community. There was a holistic approach to the assessing, planning and implementation of care using innovative and efficient ways to deliver it.
• The service provided care and treatment based on national guidance and evidence-based practice. All those responsible for delivering care worked together as a team to benefit patients. The dental team was committed to working collaboratively with other services including the oral health promotion team and vulnerable adults in the community. There was a holistic approach to the assessing, planning and implementation of care using innovative and efficient ways to deliver it.
• Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent. Consent practices and records were actively monitored and reviewed to improve how people are involved in making decisions about their care and treatment. Consent was always sought, and this was documented clearly on all the records we reviewed. Staff protected the rights of patients in their care.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• 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. People’s individual needs and preferences were central to the planning and delivery of services. The services were flexible and provided choice, including those with multiple or complex needs.
• The service was inclusive and took account of patients’ individual needs and preferences. The service was focused on meeting the individual needs of their patients and the local population. There was a proactive approach to understanding the needs of different groups of people and to deliver care in a way that met these needs and promoted equality. This included an understanding of people’s cultural beliefs, younger adults and those who were in vulnerable circumstances or who had complex needs.
• People could access the service when they needed it and received the right care in a timely way. There were a range of locations and appointments available. The service worked flexibly to ensure those requiring urgent treatment on the day were always seen.
• It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff. The service included patients in the investigation of their complaint. There had been no formal complaints about the service in the 12 months leading up to the inspection. Staff proactively managed any concerns to resolve any issues at the time.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

Updated 10 June 2020

We have not inspected this service before. We rated it as good because:

• The service was safe. The service had enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. The service controlled infection risk well. Staff completed and updated risk assessments for each patient and removed or minimised risks.
• The service provided care and treatment based on national guidance and evidence-based practice. Staff monitored the effectiveness of care and treatment. The service made sure staff were competent for their roles. All those responsible for delivering care worked together as a team to benefit patients.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. Patients felt that staff went the extra mile and their care and support exceeded their expectations. Patients felt really cared for and that they mattered. Staff recognised and respected the totality of patient’s needs. Patient’s emotional and social needs were seen as being as important as their physical needs.
• The service planned and provided care in a way that met the needs of local people and the communities served. The service was inclusive and took account of patients’ individual needs and preferences. Staff made reasonable adjustments to help patients access services.
• Staff felt respected, supported and valued. The service had an open culture where patients, their families and staff could raise concerns without fear. Leaders had the skills and abilities to run the service. Leaders operated effective governance processes, throughout the service and with partner organisations.

Updated 10 June 2020

We rated it as good because:

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them.
• Staff provided good care and treatment, checked patients ate and drank enough to stay healthy, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, supported them to make decisions about their care, and had access to good information.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

Updated 10 June 2020

We rated it as good because:

• Staff understood how to protect patients from abuse. Staff had training on how to recognise and report abuse, and they knew how to apply it.
• The service provided mandatory training in key skills including the highest level of life support training to all staff and made sure everyone completed it.
• The service controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean.
• The service had enough nursing, medical and support staff with the right qualifications, skills, training and experience 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, and gave bank and agency staff a full induction.
• The service provided care and treatment based on national guidance and evidence-based practice. Staff protected the rights of patients in their care.
• Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
• 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. Staff made reasonable adjustments to help patients access services. They coordinated care with other services and providers.
• 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.
• Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service promoted equality and diversity in daily work and provided opportunities for career development. The service had an open culture where patients, their families and staff could raise concerns without fear.
• The vision and strategy were focused on sustainability of services and aligned to local plans within the wider health economy. Leaders and staff understood and knew how to apply them and monitor progress.
• Leaders operated effective governance processes, throughout the service and with partner organisations. Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service.
• Leaders and teams used systems to manage performance effectively. They identified and escalated relevant risks and issues and identified actions to reduce their impact. They had plans to cope with unexpected events. Staff contributed to decision-making to help avoid financial pressures compromising the quality of care.

Updated 10 June 2020

We rated it as outstanding because:

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service-controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided a holistic patient centred approach to planning and delivering care and treatment, proving high quality care. All staff were actively engaged in monitoring the effectiveness of the service to improve quality and outcomes for patients. Innovative and evidence-based techniques were used to improve the service. Staff development was a priority for the service and there was evidence of strong collaborative working.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned and provided care in a way that met the needs of local people and the communities served. People’s individual needs and preferences were central to the planning and delivery of services. There was active engagement with other agencies to support those most vulnerable to access services at the right time and there was a proactive approach to understanding the needs of those using the service. Key performance indicators demonstrated targets being met and exceeded in relation to timeliness of patients attending and being seen. The service worked flexibly to ensure those requiring urgent treatment on the day were always seen.
• Leaders were visible and approachable. Staff were proud of the service they provided and felt valued and supported. Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service. The service engaged well with patients and there was strong evidence of collaborative working with other teams and agencies.

Updated 10 June 2020

We have not inspected this service before. We rated it as good because:

• The service provided safe care. Premises where patients were seen were safe and clean. The number of patients on the caseload of most of the teams, and of individual members of staff, was not too high to prevent staff from giving each patient the time they needed. Staff assessed and managed risk well and followed good practice with respect to safeguarding.
• Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment and in collaboration with families and carers. They provided a range of treatments that were informed by best-practice guidance and suitable to the needs of the patients. Staff engaged in clinical audit to evaluate the quality of care they provided.
• The teams included or had access to a range of specialists required to meet the needs of the patients. Managers ensured that these staff received training, supervision and appraisal. Staff worked well together as a multidisciplinary team and with relevant services outside the organisation.
• Staff understood the principles underpinning capacity, competence and consent and managed and recorded decisions relating to these well.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
• The service was easy to access. The criteria for referral to the service did not exclude patients who would have benefitted from care.
• The service was well-led and the governance processes ensured that procedures relating to the work of the service ran smoothly.

However:

• There was no physiotherapy team at the time of our inspection which impacted on patients’ access to assessment and treatment. Limited capacity in the speech and language therapy team meant that patients waited longer than the trust target to access some treatment interventions.
• Management capacity in the service was stretched, although the trust had recognised this and had plans in place to address this issue.
• There was no formal system in place to monitor waiting lists for access to assessment and treatment. Staff working into the service from a local mental health trust used a separate case management system. This meant that staff did not always have easy access to patient information.
• Staff in the service felt disconnected from the trust and felt that more senior leaders were not visible.
• There was no service level risk register. The divisional risk register did not reflect concerns of staff, including staff vacancies and management capacity within the service.

Updated 10 June 2020

We rated it as requires improvement because:

• The environmental risk assessment for the wards failed to provide an appropriate assessment and mitigation of ligature risks within the environment. Including ligature cutters and staff sufficiently trained to use these, if required.
• The provider failed to provide patients with an appropriate system to call staff in the event of an emergency.
• The provider failed to provide a risk assessment for emergency equipment including emergency medication required on the ward for resuscitation, in line with the patient group and current national guidance.
• Leaders did not use systems to identify, understand, monitor, and reduce or eliminate risks for the new safe haven service. The environmental risk assessment for the ward failed to provide an appropriate assessment and mitigation of ligature risks within the environment, patients were not provided with an appropriate system to call staff in the event of an emergency and the provider failed to provide a risk assessment for emergency equipment including emergency medication required on the ward for resuscitation.
• Leaders did not ensure robust structures, and processes were in place to identify, manage, mitigate and if appropriate escalate risks for the new safe haven unit. As such senior managers and board members did not have full oversight of the key service risks.
• Management capacity in the service was stretched and as such staff were not receiving regular clinical supervision in line with the trusts policy and team meetings were not taking place on a regular basis. The trust recognised this and had plans in place to address the issue.
• Staff in the service felt disconnected from the trust and felt that more senior leaders were not visible.

However:

• Staff followed holistic, recovery-oriented care plans during respite care. They provided care suitable to the needs of the patients in a ward for people with a learning disability (and/or autism) and in line with national guidance about best practice.
• The respite ward team had access to the range of specialists required to meet the needs of patients. Managers ensured that the staff received training and appraisal. The ward staff worked well with community staff who had primary responsibility for the patients care, assessment and treatment.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.