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Provider: Chesterfield Royal Hospital NHS Foundation Trust Good

On 25 January 2019, we published a report on how well Chesterfield Royal Hospital NHS Foundation Trust uses its resources. The ratings from this report are:

  • Use of resources: Good  
  • Combined rating: Good  

Read more about use of resources ratings

We are carrying out checks on locations registered by this provider. We will publish the reports when our checks are complete.

Inspection Summary


Overall summary & rating

Good

Updated 25 January 2019

Our rating of the trust stayed the same. We rated it as good because:

  • We rated safe, effective, caring, responsive and well led as good. In rating this trust we took into account the four core services not inspected this time. We did not take into account the ratings from the core services providing primary medical services.
  • We rated well led for the trust as good. The leadership, management and governance of the organisation assured the delivery of high quality and person-centred care, supported learning and innovation and promoted an open and fair culture. Leaders had the capacity and capability to deliver high quality care. Leaders understood the challenges to quality and sustainability and they were visible and approachable. Leaders were visible and approachable. The strategic plans for the trust linked to those of the wider health and social care system which the trust played an active part. There were processes for managing risk issues and performance.
  • The medical service was rated as good overall. Effective, caring, responsive and well led were rated as good but the rating of safe domain required improvement. This was because, although the service generally controlled infection risk well, not all staff followed the infection control guidance or complies with trust’s policy. Outcomes for patients had been improving and there were action plans in place to improve outcomes even further. Services were planned to consider the individual needs of patients and adjustments were made for patients living with a physical disability. The service was committed to improving services by learning from when things went well and when they went wrong, promoting training research and innovation.
  • The surgical service was rated as good overall, with all five domains being rated as good. The service had enough staff to keep people safe and staff were supported by managers and had annual appraisals. The environment in the operating theatres was clean, tidy and equipment was readily available, clean and well maintained. There were thorough pre- assessment screening processes for patients requiring surgery and they considered patients individual needs. Managers supported staff, promoted learning from incidents and used available information to improve to the service. However, the systems that were in place to protect people from infection were not always robust. The trust took immediate action to rectify our concerns.
  • The children’s and young people’s service was rated as good in all of the five domains. The service had made improvements to all the areas that required improvement following our last inspection. Staff knew how to identify and respond to changing risks to babies and children in their care. This included deteriorating health, medical emergencies and challenging behaviour. There were reliable systems in place to prevent and protect people from a healthcare associated infection. Staff were observed adhering to trust policy regarding infection prevention and control. There were facilities appropriate for children and their families. This included child-friendly signage and play areas and rooms with en-suite facilities and space for a bed for a parent/carer to stay with their child for long-stay patients. There was a dedicated children’s outpatient service at the hospital, known as ‘The Den’ which included a same-day phlebotomy service. The Den was child friendly and members of the multidisciplinary team reviewed and treated children. The service investigated and responded to all serious events. We saw that the service had put additional measures in place to ensure that children who had their scheduled surgery cancelled due to being unwell were reviewed by the paediatric consultant for a full examination before going home. The service worked in partnership with the community nursing team, specialist nurses and GPs to provide a comprehensive discharge plan. There was a direct referral facility for GPs and other health professionals to admit a child directly onto the ward via the assessment unit. Children with a long- term condition and those recently discharged also had direct access to the unit. Some children with complex conditions could be self-referred on a long-term basis.
  • The end of life care service was rated as good with the caring domain rated as outstanding. Safe, responsive and well led were rated as good with the effective domain rated as requires improvement. Staff had a good understanding of how to protect patients from abuse and could describe what safeguarding was and the process to refer alerts. There were comprehensive risk assessments completed in the medical and nursing notes. We saw good examples of good multi-disciplinary working and involvement of other agencies and support services. Staff cared for patients with compassion. We saw several examples of staff from all disciplines being supportive and kind to patients and their relatives. Most patients and their relatives told us they were fully included in discussions around their plan of care. The majority, (49%) of Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders we viewed were not completed properly and reflected the information included in the patient’s mental capacity assessment.
  • The child and adolescent mental health service was rated as good. Safe, effective, responsive and well led were rated as good and caring was rated as outstanding. The service had suitable premises and equipment and looked after them well. The psychiatrists prescribed within guidance and any off-licence prescribing was done in discussion with the pharmacy team. Records were clear, up-to-date and available to all staff providing care. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. The service had enough staff with the right qualifications, skills, training and experience to provide the right care and treatment. There was good multi-disciplinary working within the team and good joint working with external professionals. However, Caseloads were high, particularly for core CAMHS staff and psychiatrists. Waiting lists were long for Attention Deficit Hyperactivity Disorder assessment, Autism Spectrum Disorder assessment and Cognitive Behavioural Therapy and EMDR (Eye movement desensitisation and reprocessing).

Inspection areas

Safe

Good

Updated 25 January 2019

Our rating of safe improved. We rated it as good because:

  • There were enough staff with the right qualifications, skills and experience to keep patients safe from avoidable harm and abuse and to provide the right care and treatment. The service assessed patient risks and responded appropriately where risks were identified.
  • There were robust procedures in place to identify and manage safeguarding concerns.
  • Systems were in place to ensure that all incidents were reported and investigated. Lessons learned were shared with staff. Staff were aware of the duty of candour.
  • Staff adhered to the trust policy for safe management of medicines which was in line with best practice guidelines.
  • Resuscitation equipment was suitable for all sized children including young adults.
  • There was improved oversight of children across the hospital. Matrons were consulted about any issues relating to a child who was being treated in non-paediatric areas of the hospital, and their advice was sought when required.
  • Young people on waiting lists were being monitored regularly to ensure any deterioration in their health was noticed.

However;

  • Mandatory training in the medical service was low.
  • Not all staff groups on the wards had an embedded culture of shared responsibility for infection prevention and control.
  • The service mostly controlled infection risks well. However, not all nursing and medical staff used appropriate control measures to prevent the spread of infection. We observed nursing staff not adhering to the trust dress code policy regarding the wearing of jewellery.
  • Staff kept appropriate records of patients care and treatment. However, not all records were kept in locked trolleys to maintain confidentiality.
  • Staff in the medicine service had little awareness of the processes and procedures should room temperatures exceed the recommended ranges.
  • The service had suitable premises in most areas and systems were in place to ensure equipment was well looked after. However, we did not see cleaning schedules or checklists to ensure equipment and environment was clean. We found some cleanliness concerns within some of the surgical wards. The trust took immediate action to address this.

Effective

Good

Updated 25 January 2019

Our rating of effective stayed the same. We rated it as good because:

  • Care and treatment was based on national guidance Managers assessed staff compliance with guidance and identified areas for improvement.
  • Staff gave patients enough food and drinks to meet their needs and improve their health. They used special feeding and hydration techniques when necessary.
  • patients’ pain was managed effectively and patients were provided or offered pain relief regularly.
  • The effectiveness of care and treatment was monitored and findings were used to improve performance. Where outcomes for patients were variable there were action plans in place to manage variances across the service for example; the stroke and diabetic service.
  • Staff worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.

However

  • The majority, (49%) of Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders we viewed were not completed properly and reflected the information included in the patient’s mental capacity assessment.

Caring

Good

Updated 25 January 2019

Our rating of caring stayed the same. We rated it as good because:

  • Staff cared for patients with compassion. We saw several examples of staff from all disciplines being supportive and kind to patients and their relatives.
  • We saw outstanding practice in the Children and Adolescent Mental Health core service in relation to how they had engaged with children and young people.
  • We saw outstanding practice in the End of Life Care Service in relation to how they had used volunteers to support patients and carers.
  • Staff involved patients and those close to them in decisions about their care and treatment. The trust’s April 2018 mini communication survey results showed that 96% of patients were happy with the care and information given.
  • Feedback from care givers and relatives told us that staff treated patients with dignity and respect, explained what was happening and were caring.
  • The chaplaincy team offered support to patients of all faiths and no faith. They were available to patients 24 hours a day.
  • Staff provided emotional support to patients to minimise their distress.
  • All the young people and parents we spoke with said that all the staff were kind, caring and showed a good understanding of their needs. They felt involved in their care and had crisis plans in place where appropriate.
  • There was good participation and involvement of young people in the service delivery and development and a ‘you said, we did’ board that showed changes had been made because of feedback from young people.

Responsive

Good

Updated 25 January 2019

Our rating of responsive stayed the same. We rated it as good because:

  • People could access the service close to their home when they needed it.
  • The service was accessible to all who needed it and took account of patients’ individual needs.
  • Patients could access the service when required and there was minimal waiting time for patients to receive their procedure. The referral to treatment time (RTT) for admitted pathways for medical care was consistently better than the England average for all specialities. The average length of stay was just below the England average of six days at five days.
  • Staff managed theatre admissions, responding to patient need.
  • Complaints and concerns were treated seriously, investigated and lessons were learnt from the results. Learning was shared with staff across the hospital.
  • Staff were aware of the adjustments which may be needed for children and young people with a learning disability and/or autism.
  • The children’s and young people’s team worked in close partnership with the community nursing team. This included specialist nurses and allied health professionals from children’s services who visited children and young people in school and at home where appropriate to provide additional support and advice.

However

  • Waiting lists were over 18 weeks for Attention Deficit Hyperactivity Disorder assessment, Autism Spectrum Disorder assessment and Cognitive Behavioural Therapy and EMDR (Eye movement desensitisation and reprocessing). These had not improved since the last inspection. Patients waiting on the waiting list were subject to a risk assessment so they could be prioritiorised.

Well-led

Good

Updated 25 January 2019

Our rating of well-led stayed the same. We rated it as good because:

  • Managers at all levels in the trust had the right skills and abilities to run a service providing high-quality sustainable care.
  • The trust had a vision for what it wanted to achieve and workable plans to turn it into action.
  • Managers across the trust promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
  • The trust used a systematic approach to continually improve the quality of the service and safeguard high standards of care.
  • The trust had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected.
  • The trust collected, analysed, managed and used information well to support all its activities.
  • The trust effectively engaged with its staff and the public, kept people informed and listened to people’s views.

However, we also found that:

  • The systems to ensure clinical areas were kept clean were not robust.
Assessment of the use of resources

Use of resources summary

Good

Updated 25 January 2019

Combined rating
Checks on specific services

Community health services for children, young people and families

Good

Updated 4 August 2015

Overall rating for this core service Good l

Chesterfield Royal Hospital NHS Foundation Trust provided a range of community health services for children, young people and families in Chesterfield and north Derbyshire. The services were managed from Chesterfield Royal Hospital and clinics were held in The Den, a dedicated facility for children and young people.

We inspected the following regulated activities that the trust is registered with CQC to provide:

• Diagnostic and screening procedures

• Treatment of disease, disorder or injury

During our inspection we spoke with 30 people using the service, including children, young people and their families. We spoke with 44 staff including nurses, doctors, speech and language therapists, occupational therapists, physiotherapists, administration staff and health care support workers. We visited clinics at various locations including The Den at Chesterfield Royal Hospital, and Buxton Health Centre. We accompanied community nurses visiting children and young people in their own homes or at school. We looked at a total of 15 records of care and treatment.

There were reliable systems, processes and practices in place to keep children and young people safe and safeguarded from abuse. Staff understood their responsibilities to raise concerns and to record and report safety incidents, although near miss incidents were not always reported. Lessons were learned from incidents and action taken to improve the service. Staff demonstrated a sound awareness of safeguarding issues and knew the procedures to follow if abuse was alleged or suspected.

Staffing levels and caseloads were planned and reviewed so that children and young people received safe care and treatment. There were identified problems with staffing levels in some teams. Appropriate action was being taken to monitor the risks and to resolve the issues.

Children and young people had care and treatment in line with legislation, best practice and evidence based guidance. The outcomes of care and treatment were monitored through local and national audits. Results of audits were used to improve outcomes for children and young people using the service. There was collaborative and effective multi-disciplinary and multi-agency working to understand and meet the needs of children and young people using the service. This included the arrangements for young people moving to adult services. Children, young people and their families were treated with dignity, respect and kindness and were involved in their care and treatment.

Staff had the relevant skills, knowledge and experience to deliver effective care and treatment. Staff were supported through supervision and annual appraisal, though not all staff had received an appraisal in the last year. Services were planned to take account of the needs of the local population and of the individual needs of children, young people and their families. The leadership, governance and culture promoted and supported the delivery of high quality person centred care. There was a clear and effective governance structure for this service.

Specialist community mental health services for children and young people

Good

Updated 25 January 2019

Our rating of this service improved. We rated it as good because:

  • The service had suitable premises and equipment and looked after them well.
  • The psychiatrists prescribed within guidance and any off-licence prescribing was done in discussion with the pharmacy team.
  • Records were clear, up-to-date and available to all staff providing care.
  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.
  • The service had enough staff with the right qualifications, skills, training and experience to provide the right care and treatment.
  • The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.
  • The service monitored the effectiveness of care and treatment and used the findings to improve them.
  • The service made sure staff were competent for their roles. Staff received regular managerial and clinical supervision.
  • There was good multi-disciplinary working within the team and good joint working with external professionals.
  • Staff always had access to up-to-date, accurate and comprehensive information on young peoples ‘care and treatment. All staff had access to an electronic records system that they could all update.
  • Staff understood their roles and responsibilities under the Mental Capacity Act 2005. They knew how to support young people who lacked the capacity to make decisions about their care.
  • Staff showed compassion and warmth towards young people. Feedback from young people and their parents confirmed that staff treated them well and with kindness.
  • Staff involved young people and those close to them in decisions about their care and treatment and took account of young peoples’ individual needs.
  • The service planned and provided services in a way that met the needs of local people.
  • The service had managers at all levels with the right skills and abilities to run a service providing high quality sustainable care.
  • Managers promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
  • The service collected, analysed, managed and used information well to support all its activities, using secure electronic systems with security safeguards.
  • The service engaged well with young people, staff and local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively.
  • The service was committed to improving services by learning from when things go well and when they go wrong, promoting training, research and innovation.

However:

  • Caseloads were high, particularly for core CAMHS staff and psychiatrists.
  • Mandatory training rates were low.
  • IT issues were impacting on staff’s ability to do their job effectively.
  • Technology was not being used to support the care and engagement of young people.
  • Appraisal rates were low.
  • Confidentiality could be compromised as it was possible to hear from the waiting area, reception staff responding to phone calls.
  • Waiting lists were long for Attention Deficit Hyperactivity Disorder assessment, Autism Spectrum Disorder assessment and Cognitive Behavioural Therapy and EMDR (Eye movement desensitisation and reprocessing).