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Provider: Sherwood Forest Hospitals NHS Foundation Trust Good

Inspection Summary


Overall summary & rating

Good

Updated 14 May 2020

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

We rated safe, effective, responsive and well led as good and caring as outstanding for core services, the trusts well led was rated as good. We rated eight of the trust services as good and one, which was end of life care at Newark hospital as requires improvement overall.

We rated well led for the trust as good overall.

During this inspection, we did not inspect, urgent and emergency care, medical care including older people’s care service, maternity services, outpatients, diagnostic imaging, or community inpatient care.

The ratings we published following the previous inspections are part of the overall rating awarded to the trust this time.

Inspection areas

Safe

Good

Updated 14 May 2020

Surgery, critical care and services for children and young people at Kings Mill hospital were rated as good. Surgery and end of life at Newark hospital were also rated as good.

  • Staff had completed mandatory training. Staff were knowledgeable about safeguarding and demonstrated an awareness of the trust’s safeguarding processes.
  • Staff managed and stored medicines safely and securely.
  • We observed consistent standards of hand hygiene and infection control measures amongst clinical and ward-based staff.
  • The trust demonstrated learning from incidents and staff were aware of these.

We did not rate urgent and emergency care, medical care including older people’s care service, maternity services, out patients or community inpatient care on this inspection, they were all rated as good on the previous inspection.

Effective

Good

Updated 14 May 2020

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

Surgery, critical care and services for children and young people at Kings Mill hospital were rated as good. Surgery at Newark hospital was also rated as good.

  • The trust provided care and treatment based on national guidance and evidence of its effectiveness.
  • Staff assessed and monitored patients regularly to see if they were in pain.
  • Staff were competent for their roles.
  • staff understood their roles and responsibilities in relation to consent and under the Mental Health Act (MHA)1983, the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS).

End of life at Newark hospital was rated as requires improvement.

  • The trust did not undertake audits at Newark hospital to provide assurance that patients were receiving the right level of end of life care.
  • Staff we spoke with did not always know their roles and responsibilities under the Mental Capacity Act 2005 to support patients that lacked the capacity to make decisions about their care.
  • The end of life service did not provide a seven-day week 24 hour a day end of life or specialist palliative care team. Instead, the local hospice provided an out of hours non-patient facing advice service via a dedicated telephone advice line as part of an on-call rota.

We did not rate urgent and emergency care, medical care including older people’s care service, maternity services, out patients or community inpatient care on this inspection, they were all rated as good on the previous inspection.

Caring

Outstanding

Updated 14 May 2020

Surgery and services for children and young people at Kings Mill hospital were rated as good. Surgery and end of life at Newark hospital were also rated as good. Critical care was rated as outstanding.

  • Staff cared for patients with compassion.
  • Feedback from patients confirmed that staff treated them well and with kindness. Staff provided emotional support to patients to minimise their distress.
  • Staff involved patients and those close to them in decisions about their care and treatment.

We did not rate urgent and emergency care, medical care including older people’s care service, maternity services or out patients or on this inspection, they were all rated as good on the previous inspection. Community inpatients care was rated as outstanding on the previous inspection.

Responsive

Good

Updated 14 May 2020

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

Surgery, critical care and services for children and young people at Kings Mill hospital were rated as good. Surgery at Newark hospital was also rated as good.

  • The trust planned and provided services in a way that met the needs of local people.
  • Patients’ individual needs were taken into account.
  • The trust treated concerns and complaints seriously, investigated them and learned lessons from them.

End of life at Newark hospital was rated as requires improvement.

  • There was no evidence that managers monitored waiting times and made sure patients could access services when needed and received treatment within agreed timeframes and national targets.
  • Nursing staff told us fast track discharges usually took up to 72 hours to arrange but in some cases, this could take longer. However, the trust was not auditing their fast track discharges.
  • Staff told us patients could not always access face to face, the specialist palliative care service when they needed it.

We did not rate urgent and emergency care, medical care including older people’s care service, maternity services, out patients or community inpatient care on this inspection, they were all rated as good on the previous inspection.

Well-led

Good

Updated 14 May 2020

Surgery, critical care and services for children and young people at Kings Mill hospital were rated as good. Surgery at Newark hospital was also rated as good.

  • The trust had managers at all levels with the right skills
  • The trust collected, analysed, managed, and used information well to support all its activities
  • They had effective systems for identifying risks, planning to eliminate or reduce them
  • The trust engaged well with patient, staff and stakeholders.

End of life at Newark hospital was rated as requires improvement

  • Leaders did not always operate fully effective governance processes
  • Leaders and teams did not use systems to manage performance effectively
  • The service did not collect reliable data and analysed it.

We did not rate, medical care including older people’s care service, maternity services, or community inpatient care on this inspection, they were all rated as good on the previous inspection.

Urgent and emergency care and outpatients were rated as outstanding on the previous inspection.

Assessment of the use of resources

Use of resources summary

Requires improvement

Updated 14 May 2020

Our rating of use of resources stayed the same. We rated it as requires improvement because:

  • Although the NHS foundation trust has maintained the track record of delivering services within its financial plans, this has been increasingly supported by non-recurrent measures, and as a result, the NHS foundation trust’s underlying financial deficit has remained significant.
  • For 2018/19 the NHS foundation trust reported a deficit of £46.3 million without PSF (15.5% of turnover) and £26.8 million deficit with PSF (8.4% of turnover) against control totals of £46.4 million deficit and £34 million deficit respectively. This included £16.5 million CIP, of which 40% was reported as non-recurrent, representing an increase from previous years (20%).
  • Whilst the NHS foundation trust expects to achieve its 2019/20 financial plan of £41.52 million deficit, before PSF, FRF and MRET and £14.87 million deficit with the additional funding (13.8% and 4.5% of turnover respectively), at the time of the assessment there were significant risks to achieving this and mitigating actions had not been finalised. CIP delivery was reported as £8.1 million (2.6% of operating expenditure) with 56% achieved non-recurrently.
  • The NHS foundation trust is reporting an improvement of £5.4 million against its underlying deficit, from £55.8 million in 2017/18 to £50.41 million in 2019/20, however at £50.41 million (14.9% of the 2019/20 planned income), the underlying deficit remains substantial, and there remains scope for the NHS foundation trust to address the proportion of the deficit that is within its control,
  • The NHS foundation trust’s overall cost per WAU at £3,651 for 2018/19, remains materially above the national median of £3,500 and in the highest cost quartile. This indicates that the NHS foundation trust spends more to deliver the same activity, when compared to other non-specialist acute trusts.
  • The NHS foundation trust is ranked 102 out of 133 NHS trusts in the Procurement League Table, for the period July to September 2019. This indicates there remain significant opportunities to drive down cost of purchases.

Combined rating

Combined rating summary

Good

Updated 14 May 2020

Our rating of combined quality and resources stayed the same. We rated it as good because:

Checks on specific services

Community health inpatient services

Good

Updated 15 August 2018

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

  • There were multiple examples of how staff exceeded patient expectations and provided individualised, compassionate care that significantly improved individual experiences.
  • There had been demonstrable, substantial improvements in the areas we previously found for improvement that were under each ward team’s control. This included stabilised leadership, improvements in training and induction and a reduction in the use of agency staff.
  • All areas of the patient-led assessment of the care environment in 2017 demonstrated improvements from the previous year.
  • Audit and benchmarking programmes had been implemented to improve how the hospital evidenced patient outcomes.
  • Improvements in discharge coordination were being led by a complex discharge specialist and there was evidence of consistent, embedded multidisciplinary liaison to improve patient care.
  • Rehabilitation was at the heart of care and treatment in the hospital and staff, both clinical and non-clinical, had taken on additional training to be able to provide extended roles.
  • Services and ward environments were structured to facilitate socialisation amongst patients, reduce the risk of isolation and promote a welcoming environment for relatives.
  • Opportunities for staff progression and development had significantly improved and a dedicated clinical nurse educator was leading a substantial education programme for trainee nurse associates.

However:

  • At our last inspection in July 2016 we found therapies teams were unable to provide services outside of core Monday to Friday hours. This remained the case and patients admitted at weekends had limited access to care planning and therapies exercises. Some nursing staff had completed training to provide basic interim therapies assessments for patients.
  • Local governance processes worked well but there was limited evidence that some of the overarching governance strategies at a trust level had a positive impact. This included the morbidity and mortality arrangements and the use of the divisional risk register.
  • The Chatsworth ward therapies team were unable to carry out audits or research due to restrictions on their capacity.