• Organisation
  • SERVICE PROVIDER

Sheffield Teaching Hospitals NHS Foundation Trust

This is an organisation that runs the health and social care services we inspect

Overall: Requires improvement read more about inspection ratings
Important: Services have been transferred to this provider from another provider

All Inspections

20-22 September 2022

During a routine inspection

Sheffield Teaching Hospitals NHS Foundation Trust provides acute and community health services to a population of 640,000 people in Sheffield and the surrounding areas. The trust provides specialist services for the populations of Yorkshire & Humber, parts of Mid-Yorkshire and North Derbyshire. The trust delivers services from sixteen locations:

  • Beech Hill
  • Central Health Clinic
  • Firth Park Clinic
  • Heeley Dental Clinic
  • Jessop Wing
  • Jordanthorpe Health Centre
  • Limbrick Dental Clinic
  • Manor Clinic
  • Norfolk Park Dental Clinic
  • Northern General Hospital
  • Royal Hallamshire Hospital
  • Sheffield Dialysis Unit
  • Talbot Dental Clinic
  • The Charles Clifford Dental Hospital
  • Weston Park Hospital
  • Wheata Place Dental Clinic

We carried out this unannounced inspection of six of the acute services provided by this trust to check that the trust had made improvements since our last inspection.

We looked at all key lines of enquiry in the core services we inspected. We checked that the trust had taken action to comply with the Warning Notice we served under Section 29A of the Health and Social Care Act following the last inspection which told the trust to make significant improvements in the quality of healthcare provided. We also carried out an inspection of the well-led question which focussed on the specific areas of concern for the trust overall which were identified in the Warning Notice.

We inspected the trust’s medical wards (including services for older people) and surgery at the Royal Hallamshire Hospital and Northern General Hospital. We inspected urgent and emergency care at Northern General Hospital and maternity services at the Jessop Wing.

We did not inspect services provided by the trust which were not cited as a concern in the Warning Notice we served following our last inspection. We are monitoring the progress of improvements to all of the trust’s services and will re-inspect them as appropriate.

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

  • There was further improvement required to ensure services were consistently safe. In surgery and medicine, the trust had not identified and addressed environmental risks including risks presented through unsafe storage of equipment, cleaning supplies and medical gases. Equipment was not clearly identified as being clean or appropriately maintained and serviced. In surgery, the trust had continued to experience never events and had not implemented a consistent approach to ensure staff learn and share lessons learnt from these incidents. In urgent and emergency services, intentional rounding was not always recorded and did not always occur with the consistency required.
  • The trust had not trained sufficient numbers of staff to ensure physical restraint was undertaken safely and appropriately. The trust continued to rely on untrained staff to restrain patients when needed. Staff did not consistently undertake and record the required physical health monitoring after administering rapid tranquilisation to keep patients safe.
  • There continued to be inconsistencies in practice in relation to the Mental Capacity Act. In medicine, patients subject to the Deprivation of Liberty Safeguards did not always have a recorded capacity assessment and/or decision recorded in their best interest.
  • The trust did not always provide care which was responsive to the needs of people who used services. People could not always access services when they needed them and receive the right care promptly.
  • There remained risks in services which had not been identified. In some instances we found leaders had not acted to reduce the impact of risks, and risks were not always reviewed in a timely manner. The trust had not made significant improvement in identifying and reporting serious incidents. There remained a backlog of serious incidents requiring investigation.

However:

  • Although there was more to do to sustain and embed improvements, the trust had complied with the requirements of the Section 29A Warning Notice by making significant improvements in the quality of healthcare provided to people who used services within the timeframe specified by our notice.
  • Our overall rating for safe improved from inadequate to requires improvement. Our overall ratings for effective and caring improved from requires improvement to good. Whilst our rating of well-led stayed the same because we did not undertake a full review of the well-led key question, we found some improvements since our last inspection.
  • The improvements we found meant that none of the trust’s services were now rated as inadequate for safe, effective, caring, responsive or well-led. Our ratings for urgent and emergency care, medicine at Royal Hallamshire Hospital and maternity at Jessop Wing improved from inadequate to requires improvement. Our ratings for effective and caring improved in several services from inadequate or requires improvement to good.
  • In rating the trust, we took into account the current ratings of critical care, end of life, outpatients. community services including community nursing, end of life, dental and services delivered at Beech Hill, Sheffield Dialysis Unit, The Charles Clifford Dental Hospital and Weston Park Hospital which were not inspected this time.
  • Staff had the training to keep people safe including training in how to recognise and respond to abuse. Staff assessed and managed the risk to patients including the risks presenting due to deterioration in patients’ physical or mental health. Staff managed the risk of falls appropriately. Medicines were mostly managed safely, and the risk of infection was controlled and managed. Most services 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 trust now provided effective care which achieved good outcomes, promoted a good quality of life, and was based on good practice. Managers ensured staff were competent and supported. Staff worked together as a team to benefit patients. Most key services were available seven days a week to support timely care. The trust had implemented new and regular audits and reviews to ensure care met fundamental standards.
  • Staff were caring. We saw staff treating patients with compassion and kindness. Staff respected patients’ privacy and dignity and took account of their individual needs. Staff supported and involved patients, families, and carers to understand their conditions.
  • Services were planned to meet the needs of local people and took account of patients’ individual needs. It was easy in most services for people to give feedback and raise concerns about care they received.
  • Leaders had reviewed and improved governance systems and oversight of risk, issues and performance in frontline services. Fit and proper person checks were now in place for all directors.
  • The trust had implemented systems to identify incidents involving restrictive interventions including restraint and rapid tranquilisation.
  • The trust had also worked to improve culture in services and most staff told us they felt respected, supported, and valued. Staff and managers demonstrated consistent awareness of the improvements made to services and the areas requiring further improvement.

How we carried out the inspection

The inspections of the trust’s core services and the focussed inspection of the trust’s well-led key question was overseen by Sarah Dronsfield CQC Head of Hospitals Inspection and supported by two CQC inspection managers, eight CQC inspectors, a CQC assistant inspector, a CQC inspection planner and seven specialist professional advisors.

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.

12 to 14 June and 11 to 13 July 2018

During an inspection of Community end of life care

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

  • We rated safe, effective, caring, responsive and well-led as good.
  • Staff caring for patients at the end of their life were aware of how and when to report incidents, including safeguarding concerns. We saw that staff received feedback and lessons learned were shared.
  • Staff practiced safe infection control techniques.
  • Staff caring for patients at the end of their life assessed patients and escalated their care to the specialist team when necessary.
  • Guidelines, pathways and policies were produced in line with national best practice guidelines and recommendations.
  • There was sufficient numbers of skilled staff to care for patients at the end of their life. The service was available seven days a week 24 hours a day.
  • Staff understood the importance of seeking patient consent before providing care and treatment and showed a good understanding of the mental capacity act and deprivation of liberty safeguards.
  • Relatives we spoke with gave consistently positive feedback. Staff spoke about the patients they cared for in a caring, compassionate and respectful way.
  • Patients and their relatives told us that they were involved in planning their care and that communication with staff was good.
  • Staff provided emotional support to patients and their loved ones.
  • Services were planned in conjunction with external partners, across the whole of the health system to meet the needs of local people.
  • We saw numerous positive examples of initiatives to meet the individual needs of patients at the end of their life.
  • There was a clear leadership structure and strategy for end of life care. Staff told us that their line managers were visible, approachable and supportive.
  • Local governance arrangements were robust and the team was aware of the risks to their service.
  • We saw numerous examples of engagement, improvements and innovation.

However:

  • The trust had implemented processes to record whether patients preferred place of death was achieved and if not why not, they had not completed any audits of this data. Therefore, whilst a system was now in place the trust was still not measuring if patients achieved their wishes. However, we found establishing patients’ preferred place of care was seen as a priority.

7-8 December 2015

During an inspection of Community health inpatient services

Overall rating for this core service. Good 

We rated Beech Hill as good overall, however we rated the unit as requires improvement for safe. The unit used an electronic reporting system for incidents and near misses. All staff we spoke with knew how to use the system. We found that medicines were securely stored on the unit. All areas of the unit looked visibly clean, well maintained and infection prevention and control measures were embedded on the unit. Staff took a proactive approach to safeguarding. We saw effective handovers and shift changes; however, we had some concerns about staffing levels. Rosters for night duties indicated that there was one registered nurse and one care support worker on each ward, with a second care support worker who worked between the two wards. Rosters also showed that the minimum planned staffing levels were not always met. The wards were on separate floors. Senior staff we spoke with told us that increased numbers of patients were being referred back to the acute hospitals because they were not medically fit. Staff were not using a recognised early warning tool to recognise a deteriorating patient. This was because there was an expectation on the unit that patients were medically fit. Therefore staff used their observations and clinical judgement. We also found that resuscitation equipment was not always checked in line with the trust’s policy and it was not always possible to identify if equipment was clean.

We rated effective as good because people’s care and treatment was planned and delivered in line with current evidence-based guidance, standards, best practice and legislation. Patients were receiving adequate pain relief, nutrition and hydration. There was participation in relevant local and national audits, including clinical audits and other monitoring activities such as reviews of services, benchmarking, peer review and service accreditation to improve services for patients. There was a centrally hosted clinical computer system, which allowed all members of the MDT to access and share records. Staff received a comprehensive trust induction programme and timely appraisals. Staff were also supported with professional development. Consent to care and treatment was obtained in line with legislation and guidance, including the Mental Capacity Act 2005. We saw evidence that patients were supported to make decisions and, where appropriate, their mental capacity was assessed and recorded. Deprivation of Liberty was recognised and acted on in a timely and appropriate manner.

We rated caring as outstanding. We found that feedback we received from patients was consistently positive about the way nursing and therapy staff treated them. Patients told us that staff went the extra mile. Staff and patients confirmed that the unit had a flexible approach to care. We saw that the staff were highly motivated and inspired to offer care that was kind, promoted people’s dignity, and involved them in planning their care. Patients said that staff were lovely, could not do enough for them, attended to every wish and were caring, compassionate, sensitive and supportive. Relationships between patients, those close to them and staff were strong, caring and supportive. Patients and their families’ personal, cultural, social and religious needs were seen as a priority by all staff. Activities such as singing, arts and crafts were arranged to prevent social isolation and boredom. Patients said that they felt ‘safe and secure’.

We rated responsive as good. We found that the services were planned and delivered in a way that meets the needs of the local population. The needs of different people were taken into account when planning and delivering services. Staff told us that they respect the equality and diversity of their patients. Patients and families we spoke with confirmed this. The facilities and premises were appropriate for the services being delivered. We spoke with the matron and found that there was an openness and transparency in how complaints were dealt with. Complaints and concerns were taken seriously, responded to in a timely way and listened to. Improvements were made to the quality of care as a result of complaints and concerns.

We rated well led as good because the trust had a clear statement of vision and values, driven by quality and safety, which was recognised and integrated within the unit. Staff we spoke to were aware of and based their care around the trusts PROUD values. There was good interaction between the board and the unit. Senior staff shared details of the board and governance meetings with staff on the unit. Senior staff were visible, approachable and supportive to staff and patients. Leaders were actively engaged with staff, people who used services and their representatives and stakeholders. Therapy staff told us that they were proud of how the team worked together to achieve targets and ’go the extra mile’. There was a strong focus on continuous learning and improvement at all staff levels. Staff shared innovations and improvement work that they were involved with.

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.