The Care Quality Commission
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Gateshead Health NHS Foundation Trust

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

Overall: Good read more about inspection ratings

All Inspections

02 April to 11 April

During a routine inspection

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

  • There were systems and processes embedded to keep people safe within acute and community services. Staff received training in safety systems and had a thorough understanding of safeguarding procedures staffing levels were reviewed appropriately and regularly. Any staff shortages were escalated and responded to well. The trust had a strong track record of safety which was supported timely and accurate performance information. There were robust medicines management processes in place. When incidents occurred the trust demonstrated lessons were learnt and communicated to widely to staff.
  • Patients received effective evidence based care and treatment which met their needs. The trust ensured there was consistency of practice through the review of evidence based guidance, best practice standards, legislation and technologies. Staff and volunteers were appropriately qualified for their role. New staff were afforded a comprehensive induction and were supported to consolidate their skills as required. People were supported to make decisions and, where appropriate, their mental capacity was assessed and recorded. When people aged 16 and over lacked the mental capacity to make a decision, best interests decisions were made in accordance with legislation.
  • Patients and their families who received care at the trust were truly respected and empowered as partners in their care. Feedback from those receiving care was positive. We observed staff were highly motivated and offered care which was kind and promoted dignity. We found staff built strong relationships which were caring and respectful, and these were valued and promoted by leaders.
  • We found the needs of people were met and prioritised in the way in which services were configured and delivered. Patients and their families were given informed choice and continuity of care. Patients and their families could access the right care at the right time. Waiting times, delays and cancellations were minimal and managed appropriately. People were kept informed of any disruption to their care or treatment. The trust used learning from complaints and concerns as an opportunity for improvement.
  • There was a positive culture within the organisation which drove improvement and governance to support the delivery of high quality person centre care. Leaders from all levels within the organisation were visible and approachable. Service leaders actively promoted and empowered staff to drive improvement. Innovation was celebrated and quality improvement was embedded within the trust.

However:

  • We found a ward environment which was not clutter free, this could mean that patients were at risk for falling. In addition we were concerned with the storage of substances hazardous to health.
  • On the wards for older people with mental health problems we found patient records were not easily accessible for staff during the recent migration from paper to electronic system and some items were missing. This meant that staff were not always updating risk assessments following incidents of falls. Following the inspection the Trust provided information to confirm all missing documents had been located and added to the records. They also audited the records. Staff had followed the trusts falls protocol however, the risk assessment had not been updated or reviewed. In addition staffing levels had fluctuated requiring increased use of bank and agency staff.
  • We found the Sunniside Unit did not comply with guidance on eliminating mixed sex accommodation. This impacted on patient’s privacy and dignity. The trust did not have any general mitigation in place relating to the privacy and dignity of patients using dormitories and individual risk assessments had not been completed to identify and manage the risks. However, the trust has since confirmed all patients will have an individual risk assessment regarding the safe use of dormitories and it has plans in place to ensure full compliance with the Mental Health Act Code of Practice, 2015 in the future.

02 April to 11 April

During an inspection of Community health services for adults

We rated this service as good because:

  • The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
  • Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
  • The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.
  • The service had used its transformation programme to move focus from management of individual conditions to the overall, holistic wellbeing of patients.

02 April to 11 April

During an inspection of Community-based mental health services for older people

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

  • The service provided safe care. Clinical premises where patients were seen were safe and clean. The number of patients on the caseload of the teams, and of individual members of staff, was not too high to prevent staff from giving each patient the time they needed. Staff managed waiting lists well to ensure that patients who required urgent care were seen promptly. Staff assessed and managed risk well and followed good practice with respect to safeguarding.
  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment and in collaboration with families and carers. They provided a range of treatments that were informed by best-practice guidance and suitable to the needs of the patients. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • The teams included or had access to the full range of specialists required to meet the needs of the patients. Managers ensured that these staff received training, supervision and appraisal. Staff worked well together as a multidisciplinary team and with relevant services outside the organisation.
  • Most staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
  • The service was easy to access. Staff assessed and treated patients who required urgent care promptly and those who did not require urgent care did not wait too long to start treatment. The criteria for referral to the service did not exclude people who would have benefited from care.
  • The service was well led and the governance processes ensured that procedures relating to the work of the service ran smoothly.

However:

  • The occupational therapy team had not received training in the Mental Health Act 1983 or the Mental Capacity Act 2005.
  • There were limited opportunities for patients who used the service and those close to them to provide feedback on the service.

02 April to 11 April

During an inspection of Wards for older people with mental health problems

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

  • Systems and processes in place were not effective to ensure care records were complete, up to date and contemporaneous.
  • Sunniside Unit did not comply with guidance on eliminating mixed sex accommodation. An action plan was in place to eliminate the use of dormitories however, this did not address all issues regarding patients’ privacy and dignity.
  • At the time of inspection, staff were not completing individual risk assessments for patients in dormitory accommodation on Sunniside Unit and there were no plans as to how the risks were managed.

However:

  • The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received training, supervision and appraisal. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
  • The staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice. A good range of activities for patients were also available.
  • Staff were caring, compassionate and professional in their interactions with patients, and understood the individual needs. They actively involved patients and families and carers in care decisions.
  • The service managed beds well so that a bed was always available locally to a person who would benefit from admission and patients were discharged promptly once their condition warranted this.

20 November 2018

During an inspection of Wards for older people with mental health problems

We did not rate wards for older people with mental health problems at this focussed inspection. Below are our overall findings from the visit:

  • Sunniside Unit had still not identified and mitigated all ligature risks. Blanket restrictions were still in place on both wards, which had not been identified by staff, this meant some restrictions were not being reviewed regularly and patients were not being individually risk assessed against the restrictions
  • Service managers did not have a full understanding of how to comply with guidance on eliminating mixed sex accommodation and action plans had not been put in place to eliminate the use of dormitories, both impacting on patients’ privacy and dignity
  • Staff were not reporting on the use of rapid tranquilisation when it was administered orally.
  • There were still gaps identified in documentation relating to care records

However:

  • There was an improvement in the quality of care plans and how often they were being reviewed and updated
  • Incident reporting and learning from incidents had improved across both wards
  • Psychological therapies were available to patients with the input of a full-time psychologist working across both wards. Availability of ward activities had also improved and patients had access to activities seven days a week and on the evenings.
  • Compliance figures in training, supervision and appraisal had improved across both wards and weekly group supervision had been introduced. Systems had been introduced to monitor, document and book training.

07-09 December 2016

During an inspection of Wards for older people with mental health problems

We rated wards for older people with mental health problems as inadequate because:

  • Cragside Court and Sunniside Unit were not safely identifying, assessing and mitigating risks to patients or staff. Staff did not review and update individual patient risk assessments regularly. Staff on neither ward had identified and assessed all ligature risks or identified how to mitigate the risks posed by potential ligature anchor points. Neither ward had undertaken an environmental risk assessment. Sunniside Unit was not regularly monitoring the temperature of fridges used to store medication. Cragside Court did not have enough personal alarms for all nursing staff to have one each.
  • Craigside Court and Sunniside Unit did not deploy a sufficient number of staff who were adequately trained, supervised and appraised. Staff sickness rates and turnover rates were high. Appraisal and supervision rates were low. Mandatory training compliance was low. Not enough staff were up to date with refresher training in cardiopulmonary resuscitation. Qualified staffing levels were consistently lower than planned on Cragside Court.
  • Care was not planned effectively on Cragside Court and Sunniside Unit. Care plans were not holistic, personalised or reflective of the patient’s voice or preferences. Patients and carers were not partners in their care. Care records were disorganised and documentation had gaps which meant staff could not rely on records as a defensible account of the care being provided.
  • The care and treatment at Cragside Court and Sunniside Unit did not seek to maximise the independence of patients. The wards had a number of blanket restrictions that applied to all patients regardless of their individual needs. Staff did not provide activities at evenings and weekends. Patients could not access facilities at all times to make their own hot drinks and snacks. The ward environments were ‘clinical’ and were not adapted to support older people and people with dementia.
  • Cragside Court and Sunniside Unit did not have an internal process of assurance which regularly identified and addressed areas of concern in the service. Managers had no oversight of staff supervision. There was no audit process for care records, care plans and risk assessments to identify gaps or improve quality. There was no audit of incidents to identify inconsistencies between reports and care records. Morale was mixed on both wards and several staff told us that there was a culture on the wards which needed to improve.

16 December 2016

During an inspection of Community-based mental health services for older people

We rated community mental health services for older people as requires improvement because:

  • Both the Central Gateshead and East Gateshead community mental health nurses teams were using an electronic patient record system which was not fit for purpose
  • Neither team maintained a record of attendance for supervision. This meant that the service was not monitoring whether staff received supervision in line with the trust’s policy.
  • Staff did not review and update Risk assessments routinely in ether the Central Gateshead and East Gateshead community mental health nurses team.
  • Risk assessments did not include evidence of how staff planned to mitigate identified risks.
  • Care plans were not always personalised, holistic or recovery focussed. There was little evidence of personalisation or active involvement of patients in care planning. Patients were not given copies of their care plans.

However:

  • The service had no staff vacancies.
  • All staff had undertaken the training deemed by the trust to be mandatory.
  • Feedback from patients about the service was entirely positive. Staff had a good understanding of the individual patient needs and a detailed knowledge of their previous history.
  • The trust was aware of some of the areas of concern in the service and had started a project which aimed to make improvements. 

29 September – 2 October 2015

During a routine inspection

We inspected the trust from 29 September to 2 October 2015 and undertook an unannounced inspection on 23 October 2015. We carried out this comprehensive inspection as part of the CQC’s comprehensive inspection programme.

We inspected the following core services:

  • Emergency & Urgent Care

  • Medical Care

  • Critical Care

  • Maternity & Gynaecology

  • Services for Children and Young People

  • End of Life Care

  • Outpatients & Diagnostic Imaging

Overall, the trust was rated as good. Safety, effectiveness, responsive and well-led were rated as good. Caring was rated as outstanding.

Our key findings were as follows:

  • The majority of areas inspected were clean: however, we did identify some infection control issues in the critical care unit and the waste disposal unit.

  • Rates of infection were within an expected range for the size of the trust.

  • Patients were able to access suitable nutrition and hydration, including special diets, and they reported that, overall, they were content with the quality and quantity of food.

  • There were processes for using and monitoring evidence-based guidelines and standards to meet patients’ care needs. Although policies and care pathways held electronically on the trust systems were in-date, some paper copies held in ECC and SCBU were out of date or had no review date.

  • The trust promoted a positive incident reporting culture. Processes were in place for being open and honest when things went wrong and patients given an apology and explanation when incidents occurred.

  • The trust was not meeting all its waiting time targets. The national target for two week cancer waiting times had not been met for a number of tumour sites for four consecutive quarters. This was identified by the trust as a governance concern.

  • Systems and processes on some wards for the storage of medicine and the checking of resuscitation equipment did not comply with trust policy and guidance.

  • Nurse staffing was maintained at safe levels in most areas. However, there were occasions on ward 23 where staff had asked for additional support to provide ‘special’ nursing care (individual attention) to meet the physical and mental health needs of patients and shifts had not been covered. The trust had a business case to increase staffing levels on ward 23 and had escalation processes when staffing fell below recommended levels.

  • The trust had gaps in medical staffing because of national shortages in certain specialties. However, the trust was actively recruiting to these including international recruitment. This risk was further reduced by the use of advance nurse practitioners to support doctors.

  • Safeguarding procedures were in place and staff could demonstrate an understanding of their role and what action to take if they were concerned about a person

  • Feedback from patients and their relatives was very positive about the care they received and there were examples of some outstanding caring practice.

  • Patient outcome measures showed the trust performed mostly within or better than national averages when compared against other hospitals. Death rates were within expected levels.

  • Following an external review of governance processes, the trust was reviewing its service strategies to ensure that they remained achievable and relevant. The board had the experience, capacity and capability to ensure that the strategy was delivered.

We saw several areas of outstanding practice including:

  • A combined referral pathway document was being used by GP practices to refer into the trust’s integrated diabetes service. It included advice and guidance for GPs, a specialist nursing helpline and multi-disciplinary clinical assessment. There were clear protocols to identify when a patient could be managed within primary or secondary care and when care transfer was appropriate and possible.

  • The Rehabilitation after Critical Illness Team (RaCI) led by nurses, health care assistants and physiotherapists had developed new pathways to help patients recover from critical illness. The team provide rehabilitation while a patient was in the critical care unit, throughout their stay and following discharge.

  • Therapy staff were part of the frailty model and worked in the emergency care centre to support elderly patients with mobility aids and discharge plans avoiding unnecessary admissions to hospital.

  • Pathology services had achieved the national external quality assurance scheme (NEQAS) accreditation for cellular pathology and had been recognised as a national centre for excellence.

  • Ward 23 was a 24 bedded acute ward providing specialist care to older people with physical and mental health illness (predominantly dementia care) in a dementia friendly therapeutic environment, respecting patients' dignity while also promoting their independence in preparation for discharge from hospital. A team of specialists who had both physical and mental health skills and knowledge cared for patients, their philosophy was to deliver holistic, timely care to patients and their carers.

  • The design of the Emergency Care Centre was innovative and recognised by NHS England as a best practice model providing a single point of access for emergency care.

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

An action that a provider of a service MUST take relates to a breach of a regulation that is the subject of regulatory action by the Care Quality Commission. Actions that we say providers SHOULD take relate to improvements that should be made but where there is no breach of a regulation.

The trust MUST

  • Ensure that a clean and appropriate environment is maintained throughout the critical care department and waste disposal unit for the prevention and control of infection, including the provision of appropriate personal protective clothing for staff working in the waste disposal unit.

The trust should

  • Take action to meet the national 2-week cancer waiting time targets in all tumour sites.

  • Ensure that staffing and skill mix is reviewed on ward 23 to take account of the dependency of patients and ensure that sufficient staff are in place, particularly where special one to one support is identified as being required.

  • Ensure that processes are consistently followed in all areas for checking the storage of medicines particularly the recording of fridge temperatures and the signing and dating of medication entries.

  • Ensure that SCBU moves towards introducing a National Early Warning Score chart.

  • Ensure that there is a strategy for optimising patient outcomes from medicines in line with best practice guidance from the Royal Pharmaceutical Society that has Board approval and is reviewed regularly.

  • Ensure processes are consistently followed particularly in SCBU and critical care for the checking of resuscitation equipment.

  • Ensure where required, staff are up to date with Paediatric Immediate Life Support (PILS) and Advanced Paediatric Life Support (APLS) training.

  • Review processes to reduce the number of clinic appointments cancelled.

  • Continue to implement and strengthen governance processes in response to recommendations following an external independent review including strengthening the board assurance framework, clinical engagement and management of performance and risk.

  • Review version control arrangements for the updating of paper copies of polices and care pathways held in clinical areas to ensure staff are using policies which are in date and reflect the latest best practice guidelines.

  • Ensure cause for concern-safeguarding forms identify if a child is, or is not, subject to a child protection plan to enable swift and appropriate action.

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.

Mental Health Act Commissioner reports

Each year, we visit all NHS trusts and independent providers who care for people whose rights are restricted under the Mental Health Act to monitor the care they provide and check that patients' rights are met. Immediate concerns raised by patients on those visits are discussed, if appropriate, with hospital staff.

Our Mental Health Act Commissioners may carry out a number of visits to each provider over a 12-month period, during which they talk to detained patients, staff and managers about how services are provided. In the past, we summarised themes from the visits and published an annual statement followed by the provider's response where applicable. We are looking at different ways to indicate the outcomes of our monitoring in the future.