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Provider: Sheffield Teaching Hospitals NHS Foundation Trust Good

On 14 November 2018, we published a report on how well Sheffield Teaching Hospitals 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

Reports


Inspection carried out on 12 to 14 June and 11 to 13 July 2018

During a routine inspection

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

  • We rated responsive as outstanding and we rated safe, effective, caring and well-led as good.
  • The Northern General hospital was rated as Good overall as both urgent and emergency care and end of life had improved. Responsiveness was outstanding at this site which was an improvement.
  • In rating the trust, we took into account the current ratings of the other services not inspected this time.
  • Our decisions on overall ratings take into account, for example, the relative size of services and we use our professional judgement to reach a fair and balanced rating.
  • We rated well-led at the trust level as good.


CQC inspections of services

Service reports published 14 November 2018
Inspection carried out on 12 to 14 June and 11 to 13 July 2018 During an inspection of Community end of life care Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Service reports published 9 June 2016
Inspection carried out on 8 – 11 December 2015 During an inspection of Community dental services Download report PDF (opens in a new tab)
Inspection carried out on 07 - 11 December 2015 During an inspection of Community health services for adults Download report PDF (opens in a new tab)
Inspection carried out on 07-11 December 2015 During an inspection of Community end of life care Download report PDF (opens in a new tab)
Inspection carried out on 7-8 December 2015 During an inspection of Community health inpatient services Download report PDF (opens in a new tab)
See more service reports published 9 June 2016
Inspection carried out on 7– 11 Dec and 23 Dec 2015

During a routine inspection

We inspected Sheffield Teaching Hospitals NHS Foundation Trust from 7 -11 December 2015 and undertook an unannounced inspection on 23 December 2015. We carried out this inspection as part of the Care Quality Commission (CQC) comprehensive inspection programme.

We included the following locations as part of the inspection:

  • Northern General Hospital
  • Royal Hallamshire Hospital, including Jessop Wing
  • Weston Park Hospital
  • Charles Clifford Dental Hospital
  • Community services including adult community services, community inpatients, community dentists, renal dialysis unit and end of life care.

We did not inspect the GP out of hours service based at the Northern General Hospital site.

We rated the trust as good. Royal Hallamshire Hospital, Northern General Hospital, Charles Clifford Dental Hospital and the community services were rated as good. Weston Park Hospital was rated as requires improvement.

Our key findings were as follows:

  • The trust was led by a stable and respected board.
  • We found the hospital was clean and staff adhered to infection control principles. The trust scored 99% for cleanliness in the patient-led assessments of care environments (PLACE) report for 2015.
  • There was a trust infection control accreditation programme in place. This programme set standards for infection prevention and control practice. Most clinical areas had achieved accreditation; plans were in place where this was not the case.
  • There had been four cases of MRSA reported by the trust between June 2014 and June 2015.
  • There had been 88 cases of C.difficile between June 2014 and June 2015. This was a rate in line with the England average per 10,000 bed days. The trust’s rate of C.difficile was below the trajectory target with 42 cases against a stretch target of 52 cases at the end of November 2015.
  • The trust had a well-established governance framework in place and incidents were reported and actions taken in response.
  • The trust used the safer nursing care tool, professional judgement and nursing hours per patient day to determine appropriate levels of staffing. There were some areas where staffing fell below planned levels on a regular basis, particularly in the Emergency Department and Weston Park Hospital wards, although the trust was mitigating risks as far as possible. Recruitment to vacancies was in progress. Staff were able to use bank or agency staff, where available, to fill staffing shortfalls.
  • The trust was committed to the development of advanced nurse practitioners to ensure patient care was maintained and the potential recruitment difficulties to junior doctor posts mitigated. This also allowed good advancement opportunities for nurses.
  • Mortality indicators showed no evidence of risk.
  • Patients were assessed for their nutritional needs. The trust had introduced HANAT (hydration and nutrition assurance toolkit) to encourage good nutrition and hydration best practice in the hospital environment.
  • We saw patients being cared for with kindness, dignity and respect and many services across acute and community patients told us they were very happy with their care.
  • We saw examples of effective multi-disciplinary working across both acute and community services
  • There was a well-established culture of continuous quality improvement. This was supported and assured by robust governance, risk management and quality monitoring. The trust used a Microsystems Coaching Academy which worked well to support small scale service improvements.
  • The trust’s vision and values were embedded in practice. These informed performance reviews and staff felt they were meaningful.
  • Clinical directorates had individual five year strategies that were linked to trust’s strategy, aims and objectives. The directorate strategies had consideration of the other clinical departments they worked with to deliver high quality care and the assistance required from corporate directorates and other partners. There was, however, no local end of life care strategy that provided an integrated acute and community vision of care for patients who were at the end of life.
  • The trust did not record the preferred place of death for those patients coming to the end of life and there were occasions when patients had to wait for up to two weeks to access a bed on the palliative care unit.
  • A culture of innovation and improvement was evident throughout all levels of the organisation.
  • There were concerns regarding the emergency department at the Northern General Hospital this included the clinical decision unit. Specifically we had concerns regarding the quality of care of patients during times when the department was busy.
  • There were concerns regarding the clinical decision unit specifically regarding the monitoring and escalation of deterioration patients in the seated area of this unit. We raised this with the trust at the time of inspection and a protocol was put in place.
  • The introduction of a new IT system had resulted in the trust not being able to record performance targets in the emergency department.
  • There were variable levels of compliance across both community and acute services for mandatory training levels. In the dental hospital staff had not received any training in Mental Capacity Act or Deprivation of Liberty standards.
  • We were concerned about the use of the teenage and young adult unit for patients who required an acute bed.
  • There was variation in the quality and completeness of Do Not Attempt Resuscitation (DNACPR) forms across all of the acute hospital sites.
  • In medicine there were concerns regarding the access to nursing guidelines that were held electronically and could not always be accessed by agency nurses. Care was conveyed between nurses using the handover sheets rather than referring to the nursing care plan.

We saw several areas of outstanding practice including:

Community dental service

  • A collaboration between the Sheffield Community Dental Services, NHS commissioners, Dental Public Health consultants and local general dental practitioners led to the development of the Residential Oral Care Sheffield service for residents living in care homes. This collaboration was cited as good practice by the British Society for Disability and Oral Health. This service now covers 80 out of the 88 residential care homes who participate in the scheme in the city of Sheffield.
  • The clinical lead was instrumental in developing a national benchmarking tool used by other community dental services and NHS dental commissioners for describing the complexity of patients treated by community dental services. An evaluation of the outcomes of the pilot project was delivered at the National Association for Dentistry in Health Authorities and Trusts in 2014.
  • Collaboration between the Clinical Lead of Sheffield Community Dental Services and the Head of Psychotherapy Services within Sheffield NHS Foundation Trust developed a dental nurse led Pain and Anxiety Service. This led to a reduction in the numbers of patients needing intra-venous sedation for dental treatment and the overall waiting times for intra-venous sedation.
  • Sheffield Community Dental Service provided a service for the Sheffield homeless under the auspices of the ‘Archer Project at the Cathedral’.
  • Sheffield Community Dental Service had developed a communication tool known locally as ‘the widget sheets’ enabling children with autistic spectrum disorders and other communication difficulties to accept dental treatment. An evaluation of this audit tool was published in the peer reviewed international scientific publication ‘Journal for Disability and Oral Health in 2014.
  • The development of a number of nationally recognised clinical benchmarking tools by Sheffield Community Dental Service was a result of exceptional leadership provided by the current Clinical Lead of the Service.

Community Adults

  • The active recovery service was a responsive service, which aimed to reduce un-necessary hospital admissions and facilitate the timely discharge of more complex patients from hospital. The team was multidisciplinary and multiagency with health and social care working closely together. The service had redesigned the traditional model of assessing to discharge to the more patient centred approach of discharge to assess resulting in reduced length of stay for patients and improved patient flow within the hospital.
  • The Single Point of Access (SPA) service managed referrals from patients and health professionals into all community health services. The service used a call routing system to direct patients to the right professional from the start. The team had extensive local knowledge and specialist expertise and were able to access to up to date information on service capacity. This meant that they could ensure patients were seen by the right professional at the right time at a venue of their choice.
  • We thought the person centred care planning was outstanding. The aim of this was to provide support for patients considered to be at high risk of hospital admission at an early stage. Community nurses and GPs worked together to develop patient and carers confidence in managing their own health. The community matron supported this. There were locality champions for person centred care planning in each of the four localities.

Northern General Hospital

  • The patient care and experience delivered by staff in the Bev Stokes Day Surgery Unit was outstanding, particularly in relation to patients living with learning disabilities and dementia.
  • The duty floor anaesthetist role in theatre developed in Sheffield was going to be used by the Royal College of Anaesthetists as a beacon of good practice.
  • The development of a relative’s room in the theatre complex.
  • On general intensive care unit /general high dependency unit there was the use of an electronic patient information system to ensure timely and accurate records, access to trust and local policies, procedures and guidelines The system ensured effective care was delivered and it was fully integrated and provided real-time information across teams and services.
  • An advanced clinical pharmacy service which included a consultant pharmacist and pharmacy prescribers had been developed to improve the safety and efficacy of medicines used in critical care.
  • The use of the Enhanced Recovery After Thoracic Surgery (ERAS) programme had resulted in marked improvements in the quality of care for patients on cardiac intensive care unit (CICU).
  • The laboratory team had introduced a ‘Patient Safety Zone’ project into the inpatient wards and in the community. The aim was to reduce labelling errors. Disturbance or distraction while taking blood samples has been identified as a major risk factor for errors. This initiative had been introduced to improve patient safety. Pathology staff showed us lots of publicity material, including branded biro pens.
  • In laboratory medicine, we observed large screens above the bench dealing with urgent samples. It contained a full list of patients waiting for results in the accident and emergency (A&E) department. The same screens were on display in A&E. This meant laboratory staff could see exactly who was waiting in A&E and gave context and ‘humanity’ to the samples they were analysing. Urgent results for A&E samples were available in one hour because of the use of this management tool.
  • Radiology provided an excellent service of ‘hot reporting’ for reporting x-rays for A&E patients; results were ready within 20 minutes.
  • Geriatric medicine had historically been part of acute medicine but was now combined with community services to provide an integrated service.

Royal Hallamshire Hospital

  • Staff in theatre had introduced a learning disability pathway. An operating list was dedicated to patients with a learning disability, if the patient needed more than one procedure this was carried out on the same operating list under the same general anaesthetic.
  • The use of duty floor anaesthetist role in theatre, developed in Sheffield, was going to be used by the Royal College of Anaesthetists as a beacon of good practice.
  • Radiology provided an excellent service of ‘hot reporting’ for reporting x-rays for minor injury patients; results were ready within 20 minutes
  • Histopathology was using cross-site digital pathology to speed up processing time for frozen sections.
  • On GICU and NICU there was the use of an electronic patient information system to ensure timely and accurate records, access to trust and local policies, procedures and guidelines The system ensured effective care was delivered and it was fully integrated and provided real-time information across teams and services
  • An advanced clinical pharmacy service which included a consultant pharmacist and pharmacy prescribers had been developed to improve the safety and efficacy of medicines used in Critical care.
  • The one to one team and specialist midwife clinics gave greater assurance that high risk women continued to have a choice on the care they received in pregnancy.
  • The rapid access clinic reduced readmissions of babies with feeding problems.
  • The GRIP project responsible for getting research into practice improved services for maternity and gynaecology.
  • The termination of pregnancy service gave women continuity of care in an appropriate caring environment. The seven day service gave women choice and improved accessibility.
  • The use of the Enhanced Recovery programme in both maternity and gynaecology improved the service for women.

Weston Park Hospital

  • Specialised cancer services provided a patient-centred holistic approach to patient care where the whole multidisciplinary team worked together to ensure the patient’s experience of the service was the best that it could be.
  • The teenage cancer unit had a number of innovations which had been paid for out of charitable funds. These included a ‘couples retreat’ for end of life patients and their partners. They could spend time away from home and explore issues about coming to the end of life.

Community end of life care

  • The intensive home nursing service provides support for patients and their families in the last days and hours of life. Relatives consistently praised the service and the staff who provided it.

Community inpatients

  • Feedback we received from patients was consistently positive about the way nursing and therapy staff treated them. Patients told us that staff go the extra mile. Staff and patients confirmed that the unit had a flexible approach to care.
  • Patients were supported emotionally. Activities such as singing, arts and crafts were arranged to prevent social isolation and boredom.

Charles Clifford Dental Hospital

  • An holistic approach to individual patient’s requirements was modelled within CCDH, and anxious patients had the option of utilising cognitive behavioural therapy (CBT), acupuncture, hypnosis, inhalation, or intravenous or oral sedation to assist with their dental treatments.
  • Staff were sensitive to the needs of vulnerable patients, making reasonable adjustments to ensure that effective two-way communication was achievable to allow patients to be fully empowered to make decisions about their treatment options.
  • The service worked with a local dental unit to provide an out of hours (17:00 – 20:00) oral surgery Consultant led clinic for patients who were unable to be released from work within core hours, enabling them to attend one evening each week.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

  • The trust must ensure patients do not wait longer than the recommended standard for assessment and treatment in the emergency department.
  • The trust must ensure that on initial assessment in the “pit stop area” in the emergency department patient’s vital signs are taken and recorded consistently.
  • The trust must monitor performance information to ensure 95% of patients are admitted, transferred or discharged within four hours of arrival in the emergency department.
  • The trust must ensure the safe storage of intravenous fluids.
  • The trust must ensure doctors follow policy and best practice guidance in relation to the prescription of oxygen therapy.
  • The trust must ensure that guidance is followed in the documentation of foetal heart rate monitoring.
  • The trust must ensure there are sufficient numbers of suitably qualified, competent, skilled and experienced staff on duty at Weston Park Hospital.
  • The trust must ensure the divisional risk registers reflect issues in the emergency department demonstrate evidence of actions and reviews.
  • The trust must ensure there is a clear strategy for the end of life care which is implemented and monitored.
  • The trust must ensure that staff implement individualised, evidence based care for patients at the end of life.
  • The trust must ensure that DNACPR records are fully completed.
  • The trust must ensure that staff complete mandatory training in accordance with the trust policy

Professor Sir Mike Richards

Chief Inspector of Hospitals

Use of resources

These reports look at how NHS hospital trusts use resources, and give recommendations for improvement where needed. They are based on assessments carried out by NHS Improvement, alongside scheduled inspections led by CQC. We’re currently piloting how we work together to confirm the findings of these assessments and present the reports and ratings alongside our other inspection information. The Use of Resources reports include a ‘shadow’ (indicative) rating for the trust’s use of resources.


Intelligent Monitoring

We use our system of intelligent monitoring of indicators to direct our resources to where they are most needed. Our analysts have developed this monitoring to give our inspectors a clear picture of the areas of care that need to be followed up.

Together with local information from partners and the public, this monitoring helps us to decide when, where and what to inspect.


Organisation Review of Compliance