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Archived provider: City Hospitals Sunderland NHS Foundation Trust Good

On 23 August 2018, we published a report on how well City Hospitals Sunderland 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

Inspection Summary


Overall summary & rating

Good

Updated 23 August 2018

Inspection areas

Safe

Requires improvement

Updated 23 August 2018

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

  • There had been consistently poor levels of nurse staffing on some wards with low fill rates of staffing on shifts. Senior leaders told us pressure ulcer development in patients had been related to poor staffing levels.
  • There was no acuity tool in place to align nurse staffing with patient dependency. Staff were moved around on a shift by shift basis to staff clinical areas where numbers were low.
  • Resuscitation equipment was not regularly checked and equipment and resuscitation medication were at risk of expiry. There was some out of date equipment when we carried out random checks in store cupboards.
  • There was inconsistency around medicines management. Controlled drugs were not always checked and recorded daily. Fridge temperatures were not always checked and recorded daily.
  • There had been inconsistent learning after serious incidents and never events. Three key members of staff who should have known about never events in their area did not know about them.

However;

  • Nursing, midwifery and medical staff vacancies had improved overall.
  • The emergency department had designated mental health assessment facilities that met best practice guidance for a safe mental health assessment room.
  • During handovers of patients, staff identified risk to patients, and they documented risks using nationally recognised tools.
  • Incidents were reported and investigated. Staff described a positive reporting culture and said they were encouraged and supported to report incidents; the majority of incidents resulted in no harm to patients.
  • There were systems in place to protect adults and children from abuse. Staff were generally compliant with safeguarding training, and were supported by a multidisciplinary safeguarding team.
  • The psychiatric liaison team supported front line staff in keeping patients with mental health needs safe.
  • There were dedicated pharmacists on each ward daily. Pharmacy services were available seven days a week, 12 hours per day with on-call support out of hours.
  • Clinical areas were clean, tidy and well organised.

Effective

Good

Updated 23 August 2018

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

  • Patients’ needs were assessed and care and treatment was delivered in line with legislation, such as the mental capacity act and mental health act; evidence-based guidance was used to achieve effective outcomes.
  • There were positive examples of multidisciplinary working in all the clinical areas we inspected. Staff worked well together to deliver effective care and treatment for patients.
  • There were positive examples of seven day working to support patient care and treatment.
  • There was effective collaboration with external agencies to support safe and timely discharges, and to prevent hospital admissions.
  • Wards and clinical areas took part in national, local and regional audits and used the results to improve patient outcomes.

However;

  • Some clinical dashboards were not fully developed so there was limited assurance around patient outcomes.
  • Some clinical guidelines and policies were past their review date. This meant staff did not always have the most up to date guidance to follow.
  • A variety of results from national audits showed services were not always meeting the required standards; examples including royal college of emergency medicine audits, lung cancer audits and heart failure audits.
  • Unplanned reattendance rates in emergency department were more than twice the national average. There were plans in place however to improve this.
  • Appraisal rates for staff did not always meet the trusts own targets.

Caring

Good

Updated 23 August 2018

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

  • There were commendable examples of compassionate care; we saw staff go the extra mile several times and their care and support exceeded good care standards in some circumstances.
  • Discussions between staff and patients were carried out in a compassionate and supportive way; staff provided reassurance and information appropriate for the individual patient and their family. Information was provided to allow patients to make informed decisions.
  • Staff were motivated to offer care that was kind and promoted people’s dignity. Patients’ privacy and confidentiality were respected. Patients’ individual preferences and needs were reflected in how care was delivered.
  • We saw evidence that patients and families were involved in care planning. Staff discussed care with patients in a way that they could understand. People’s emotional and social needs were assessed by staff and included in their care and treatment.
  • Families were encouraged to be involved in the care of vulnerable patients such as those with learning disabilities or dementia.
  • Staff responded in a compassionate, timely and appropriate way when patients experienced physical pain, discomfort or emotional distress.
  • Feedback from patients and their families was consistently positive.
  • There were several examples of tender supportive care for those who had been bereaved.

However;

  • There were a small number of occasions when patients told us staff had not always seemed very caring, friendly and showed a lack of empathy for the patient’s situation.
  • A small number of relatives told us they weren’t able to stay with the patients in the emergency department and had found this upsetting and stressful.

Responsive

Good

Updated 23 August 2018

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

  • Services were planned to meet the needs of patients; pathways were in place across clinical areas to meet individual needs. There was close working between services to provide continuity of care.
  • Access to services was generally good and there were positive examples of collaborative work to respond to the needs of patients when being discharged or transferred from hospital.
  • Some of the environments had been designed or adapted to meet the needs of patients, including patients with additional needs such as those living with dementia or patients with learning disabilities.
  • There was joint working to support frail older patients and comprehensive assessments which led to thorough care plans.
  • Average length of stay was lower than the national average for some patient groups.
  • Some clinical areas provided comprehensive support for patient with additional communication needs; for example, a braille translation service, induction loop, and British sign language signing service. Information leaflets were available in an easy-read format for patients with a learning disability.

However;

  • The emergency department had not met the four hour target for eight of the 12 months from February 2017 to January 2018. Performance deteriorated from November 2017 to January 2018.
  • The length of stay for some medical patients was longer than the England average.
  • Some areas had not investigated and closed complaints within the trusts own timeframe of 25 days.
  • Over the last two years, the percentage of cancelled operations at the trust was generally higher than the England average.
  • Not all services were compliant with legislation around the accessible information standard for people with a disability, impairment or sensory loss to ensure they were given information that they can easily read or understand with support so they can communicate effectively with services.

Well-led

Good

Updated 23 August 2018

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

  • We saw several positive examples of strong local leadership. Leaders were visible, approachable, and supportive.
  • Leaders encouraged a positive patient focused culture. All areas were motivated to provide good patient care.
  • Staff told us they were empowered to consider ways to improve services for patients.
  • There were clear lines of accountability and responsibility, staff were aware of their roles.
  • Staff told us they were kept up to date with information about service changes.
  • Staff felt valued and supported, they were encouraged to report incidents, and they were open and honest.
  • Local risk registers were in place; there were actions in place to mitigate against risk and individuals were responsible to carrying out action plans.
  • Staff were able to articulate the values of the organisation and could mostly describe how they contributed to achieving the aims.
  • We saw examples of innovative care, for example in bariatric surgery and in the therapeutic care offered to patients living with dementia.

However;

  • There was limited governance or assurance in some clinical areas; for example around medicines management, resuscitation equipment checks, patient outcomes, infection prevention and control, and in ensuring clinical guidance was up to date.
Assessment of the use of resources

Use of resources summary

Good

Updated 23 August 2018

Combined rating