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Provider: Leeds Teaching Hospitals NHS Trust Good

On 15 February 2019, we published a report on how well Leeds Teaching Hospitals NHS Trust uses its resources. The ratings from this report are:

  • Use of resources: Outstanding  
  • Combined rating: Good  

Read more about use of resources ratings

Inspection Summary


Overall summary & rating

Good

Updated 15 February 2019

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

  • We rated effective, caring, responsive and well led as good, safe was rated as requires improvement. All five domains remained at the same rating from our inspection in 2016.
  • In rating the trust, we took in to account the current ratings of the services that we did not inspect during this inspection but that we had rated in our previous inspection.
  • We rated well led for the trust overall as good. This was not an aggregation of the core service ratings for well led

Our full inspection report summarising what we found and the supporting evidence appendix containing detailed evidence and data about the trust is available on our website –

Inspection areas

Safe

Requires improvement

Updated 15 February 2019

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

The trust did not always have appropriate numbers of staff to ensure that patients received safe care and treatment within some services. This resulted in some patients who had been assessed as requiring additional supervision not receiving an adequate level of care.

  • Effective infection prevention and control protocols were not consistently followed on all wards and theatres; we had concerns about the number of healthcare acquired infections in surgical services at St James’ hospital.
  • Environments in some services were compact and cluttered with variable results in hand hygiene compliance audits. We observed some examples of poor hand hygiene compliance and failure to use the appropriate personal protective equipment.
  • We observed that the mental health assessment room did not meet recommended standards and that staff understanding of mental capacity and consent was variable.
  • Several mandatory, safeguarding and resuscitation training modules had compliance rates below the trust target, particularly for medical staff.
  • Patient records and hazardous substances such as cleaning products and alcohol gels were not always stored securely. This was highlighted in previous inspection reports

However:

  • During handovers of patients and at safety huddles, staff identified risk and managed it; nationally recognised tools such as national early warning score (NEWS) were used to monitor for deterioration in patient’s conditions.
  • Patient observations and records were comprehensive. Risk assessments were completed and highlighted for escalation or review where appropriate.
  • There were clear procedures in place for the management of major incidents at the trust.
  • Services we inspected had appropriate escalation policies, guidance and care pathways in place.

Effective

Good

Updated 15 February 2019

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

  • The trust participated in local and national audits to improve patient outcomes. Audit results were used to benchmark and compare with other trusts locally and nationally.
  • Screening processes for sepsis and delirium were well-embedded.
  • We saw evidence of strong multi-disciplinary team working.
  • The nutritional and hydration needs of patients were well attended to across most services.
  • Policies, procedures and pathways were based upon national guidance.

However:

  • Patient outcomes in a number of audits such as surgical readmissions rates were higher than the England average.
  • Staff understanding of mental capacity was variable across services and documentation around decision making was not always in place.

Caring

Good

Updated 15 February 2019

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

  • We found staff to be polite, respectful and professional across services.
  • Staff responded to patients physical and emotional needs in a compassionate and timely manner, involving relatives and carers where appropriate.
  • Results from the Friends and Family Test were positive and based upon a higher than average completion rate.
  • Patient’s privacy and dignity were well protected in most services.

However:

  • We were concerned that privacy and dignity were not always maintained in the emergency department and the minor injuries unit due to the layout of the departments.

Responsive

Good

Updated 15 February 2019

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

  • There were effective systems in place to respond to complaints with learning and changes to the service being made in response to feedback from patients.
  • The trust worked with commissioners, external providers and local authorities to plan and provide services to meet the needs of local people.
  • Since our last inspection we observed that a standard operating procedure for out of hours surgery was in place for urgent procedures.
  • The trust’s 18-week referral to treatment time (RTT) for admitted pathways for surgery was similar to or better than the national average.
  • The trust’s number of bed days with a delay of more than eight hours on the general ICU was better than that of similar units and the number of delays had reduced significantly since the last inspection.

However:

  • Whilst there were systems in place to respond to complaints, some services were not timely in their response.
  • There were limited facilities in some services to support carers and families, such as washing and showering facilities.
  • Average length of stay for medical non-elective patients was higher than the England average.

Well-led

Good

Updated 15 February 2019

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

  • Clinical service units had cohesive, visible and approachable local leadership teams.
  • Staff generally reported a positive culture with good team working and a variety of opportunities to share information, learning and concerns.
  • Trust values and vision (“The Leeds Way”) was strongly embedded with staff across services and locations.
  • Each CSU had a bespoke clinical business strategy outlining key quality measures, current performance and a vision for service delivery.
  • There was strong evidence of stretch and challenge in critical care to achieve the highest standards of care for patients.

However:

  • Whilst staff morale was generally good, some services reported that concerns around nurse staffing had impacted upon morale.
  • The trust did not always have sufficient oversight of some compliance measures such as VTE risk assessment and deviations in WHO surgical safety checklists.
Assessment of the use of resources

Use of resources summary

Outstanding

Updated 15 February 2019

Combined rating