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Provider: Sherwood Forest Hospitals NHS Foundation Trust Good

On 15 August 2018, we published a report on how well Sherwood Forest Hospitals NHS Foundation Trust uses its resources. The ratings from this report are:

  • Use of resources: Requires improvement  
  • 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 15 August 2018

  • Overall, we rated caring as outstanding, effective, responsive and well-led as good and safe as requires improvement. In rating the trust, we took into account the current ratings of the five services not inspected this time.
  • During this inspection we rated 10 core services with all being rated as good overall.
  • We rated well-led for the trust overall as good.

Inspection areas

Safe

Requires improvement

Updated 15 August 2018

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

Our requires improvement rating for safe was affected by ratings we have not inspected this time. During this inspection we found all of the 10 core services we inspected were good for safe because:

  • The trust had improved in relation to sharing learning from incidents. We found a culture which encouraged the sharing of learning from incidents.
  • Staff were knowledgeable about safeguarding and demonstrated an awareness of the trust’s safeguarding processes.
  • Staff managed and stored medicines safely and securely.
  • Although there remained challenges in recruiting and retaining staff evidenced by high nurse vacancies on some of the medical wards, teams had implemented strategies to reduce vacancies and increase retention.
  • We observed consistent standards of hand hygiene and infection control measures amongst clinical and ward-based staff. Staff were consistent in isolating patients at risk of spreading infection.
  • Delivery off the sepsis treatment bundle for adult emergency and inpatients consistently exceeded the 90% standard with February 2018 reported as 100%. This indicated staff were responsive to initial screening and treatment.
  • There were comprehensive risk assessments completed and evidence that risk assessments continued throughout the patient’s stay in hospital.

Effective

Good

Updated 15 August 2018

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

  • Staff provided care and treatment in line with national guidance and best practice standards.
  • The service monitored the effectiveness of care and treatment by participating in national and local audits and used the findings to drive improvements.
  • Staff were knowledgeable about and demonstrated a good awareness of consent, mental capacity and the Mental Capacity Act (2005). This was evidenced in our conversations and from looking at patient records.
  • Staff of all grades and responsibilities had access to a range of teaching, learning and development opportunities delivered by specialist teams.
  • There was effective multidisciplinary team (MDT) working

However;

  • Some of the Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders known as Allow a natural death (AND) forms were not completed in full and did not always reflect the information included in the patient’s mental capacity assessment.

Caring

Outstanding

Updated 15 August 2018

Our rating of caring improved. We rated it as outstanding because:

  • The caring in the at Mansfield Community Hospital and the maternity service at King’s Mill Hospital was rated as outstanding. Caring was rated as good for the other services we inspected this time.
  • Staff respected patients’ privacy and dignity at all times and always showed compassion and kindness. Feedback from patients and relatives confirmed this.
  • Feedback from patients and those close to them was mostly positive about the way staff treated them.
  • Staff provided emotional support to patients and relatives when required to minimise their distress and involved patients in decisions about their care.

Responsive

Good

Updated 15 August 2018

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

  • Services were generally delivered in a way that focused on people’s holistic needs.
  • Patients were able to access care and treatment in a timely way, although there were some delays for patients waiting for MRI scans.
  • The hospitals generally performed better than the England average for access to outpatient services. Referral to treatment times (RTT) for non-admitted pathways and incomplete pathways was generally better than the England overall performance.
  • For the period April 2017 to March 2018, less than 1% of patients were seen without their full set of medical records.
  • The trust had an integrated discharge assessment team (IDAT) who supported fast track continuing care and rapid discharge of patients to enable them to be cared for and die in the place of their choice.
  • The Department of Health and Social Care’s standard for emergency departments is that 95% of patients should be admitted or discharged within four hours of arrival in the department. From February 2017 until January 2018 the trust had performed better than the English average of between 85% and 91% and between March 2017 and August 2017 had performed in excess of 95%.

Well-led

Good

Updated 15 August 2018

Our rating of well-led improved. We rated it as good because:

  • There was compassionate, inclusive and effective leadership at all levels in the trust.
  • Leaders had the capacity and capability needed to deliver excellent care.
  • All staff were aware of the trust’s vision and values and were focused on constant improvement and delivering outstanding care to patients.
  • All leaders were highly visible and approachable.
  • There was a strong and palpable culture of team work and staff felt valued, with different disciplines working alongside other and showing respect for each other’s opinions.
  • Governance arrangements were proactively reviewed and reflected best practice.
  • There were systems in place for identifying risks with controls in place to manage them. Staff were encouraged to look at future risks.

Kingsmill Hospital

We rated the hospital as good because:

  • When concerns were raised or things went wrong, the approach to reviewing and investigating causes had improved.
  • Sharing learning from incidents had improved with a culture that encouraged shared learning.
  • Staff demonstrated a kind and caring approach towards patients and their families. It was obvious staff had a positive relationship with patients and we saw staff spending time talking to patients and their families.
  • There was effective clinical governance procedures and quality measurement processes.
  • The trust had effective systems for identifying risks, planning to eliminate or reduced them, and coping with both the expected and unexpected.
  • Managers across the trust promoted a positive culture which supported and valued staff, creating a common purpose based on shared values.
  • Peoples individual needs and preferences were central to the delivery of tailored services.
  • Staff understood their roles and responsibilities regarding the safeguarding of vulnerable adults and children.
  • Care was mostly delivered in line with national and best practice guidance.
  • The Department of Health and Social Care’s standard for emergency departments is that 95% of patients should be admitted or discharged within four hours of arrival in the department. From February 2017 until January 2018 the trust had performed better than the English average of between 85% and 91% and between March 2017 and August 2017 had performed in excess of 95%.

However;

  • Some of the Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders known as Allow a natural death (AND) forms were not completed in full and did not always reflect the information included in the patient’s mental capacity assessment.

Mansfield Community Hospital

Our rating of this hospital improved. We rated the hospital 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.
  • Audit and benchmarking programmes had been implemented to improve how the hospital evidenced patient outcomes.
  • 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.

Newark Hospital

Our rating of this hospital stayed the same. We took into account the current ratings of services not inspected at this time so we rated the hospital as requires improvement. However, during this inspection we found all the three core services we inspected were good because:

  • We saw staff providing compassionate care throughout our visit. Patients spoke highly of the care they received.
  • When concerns were raised or things went wrong, the approach to reviewing and investigating causes had improved.
  • Sharing learning from incidents had improved with a culture that encouraged shared learning.
  • There were effective clinical governance procedures and quality measurement processes.
  • The trust had effective systems for identifying risks, planning to eliminate or reduced them, and coping with both the expected and unexpected.
Assessment of the use of resources

Use of resources summary

Requires improvement

Updated 15 August 2018

Combined rating
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.