Updated 24 January 2024
This report describes our judgement of the quality of care provided by this trust. We base it on a combination of what we found when we inspected and other information available to us. It includes information given to us from staff at the trust, people who use the service, the public and other organisations.
We rated well-led (leadership) from our inspection of trust management, taking into account what we found about leadership in individual services. We rated other key questions by combining the service ratings and using our professional judgement.
We carried out this unannounced inspection of six acute services provided by this trust as part of our continual checks on the safety and quality of healthcare services. These were urgent and emergency care, medicine, surgery, maternity, children and young people, and NECTAR, the trust’s ambulance service.
We carried out an unannounced focused responsive inspection of the maternity service in response to six whistleblowing concerns about patient safety and the culture in the service. We reviewed some of the safe, effective, responsive, and well led key lines of enquiry.
We also inspected the well-led key question for the trust overall.
We carried out a further targeted inspection into surgical cardiothoracic services on 28 September 2023 in response to increased concerns raised by whistleblowers following the core services inspection. The details of this are reported in a separate report dated the same.
We did not inspect critical care, diagnostic and imaging, outpatients, end of life and community.
The Newcastle upon Tyne Hospitals NHS Trust received NHS Foundation Trust status in June 2006. The trust provided a full range of acute and specialist hospital and community services.
The Trust serves the City of Newcastle upon Tyne for secondary health services, and also provides specialist tertiary and quaternary services to the region and nationally. 14% of the population of Newcastle upon Tyne are aged 65 and over, compared to 18% nationally. The Local Authority (LA) had a similar breakdown by ethnicity to the national average, with 13% of the population being BAME (Black, Asian, and Minority Ethnic) residents.
Newcastle upon Tyne performed significantly below the England average for most of the indicators in the Local Health Profile, particularly on the mortality indicators. The health of people in Newcastle upon Tyne was generally worse than the England average.
Newcastle upon Tyne was one of the 20% most deprived districts/unitary authorities in England and about 25% (12,000) of children live in low income families. Life expectancy was 12.9 years lower for men and 10.4 years lower for women in the most deprived areas of Newcastle upon Tyne than in the least deprived areas.
The trust had approximately 1729 beds and employed 14710 members of staff. Activity at the trust was in the highest 20% of trusts nationally for inpatient admissions, outpatients and UEC (Urgent and Emergency Care) attendances. In the second highest quintile for deliveries (Mar 21 to Feb 22).
It is one of the largest teaching hospitals in England providing academically led acute, specialist and community services for adults and children to a large and diverse population across the North East and Cumbria as well as nationally and internationally.
The trust operated from six registered locations.
The Royal Victoria Infirmary (which includes the Great North Children’s Hospital)
The Freeman Hospital which includes the Northern Centre for Cancer Care and Institute of Transplantation
Campus for Ageing and Vitality
The Dental Hospital
The Centre for Life
The Regional Drug and Therapeutics Centre
Various community sites
The CQC had carried out a number of inspections of the trust; the last comprehensive inspection of the acute services was in January 2016. We rated effective, caring, responsive and well led as outstanding safe was rated as good.
Following that inspection, we inspected Emergency Care, End of Life and Diagnostic and Imaging services in May 2019. We rated effective, caring, responsive and well led as outstanding. Safe was rated as good.
In November 2022 we carried out an unannounced focused inspection which looked specifically at the quality and safety of care provided to patients with a mental health need, a learning disability or autism. We carried out inspection activity in five of the acute services provided by this trust because we had concerns about the quality of services provided to people with a mental health need, a learning disability or autism.
Following our inspection of the trust’s services in December 2022, we formally wrote to the trust to share our concerns about our inspection findings. The trust provided details of the immediate steps taken to ensure patient safety. In response to our findings, we served the trust with a Warning Notice under Section 29A of the Health and Social Care Act 2008. The Warning Notice told the trust that they needed to make significant improvements in the quality and safety of healthcare provided in relation to patients with a mental health need, a learning disability or autism. We asked the trust to take action to improve the quality and safety of services.
In January 2023, we inspected maternity services as part of the CQC national programme. The service was rated requires improvement for safe and good for well led. This inspection report was published in May 2023.
After this inspection we have used our enforcement powers to impose conditions on the trust's registration. The conditions require the trust to make specific improvements within a specified timescale, and to submit monthly reports to CQC showing progress with actions taken to improve quality and safety. The conditions required the trust to:
Implement an effective governance system. This must assess, monitor, and drive improvement in the quality and safety of the services provided, including the quality of the experience for service users in line with the regulations.
Our rating of services went down. We rated them as requires improvement because:
We rated well led as inadequate, safe, effective, and responsive as requires improvement, and caring as good.
We rated 5 of the trust’s 9 services as requires improvement and 1 as inadequate. In rating the trust, we took into account the current ratings of the 8 services not inspected this time.
Some of the services did not always have enough staff to care for patients and keep them safe. However, we saw evidence of staffing escalation frameworks to maintain patient safety. Staff did not always assess monitor or manage risks to patients, act on them or keep good care records. They did not always store and manage medicines safely. Not all staff reported incidents in a consistent and standardised way. Services did not always define the correct levels of harm according to the NRLS (National Reporting and Learning System) definition. Staff we spoke to did not always receive feedback or learning from incidents. However, the CQC noted the results of the national staff survey which showed that the trust was above sector average in scores relating to reporting of errors, incidents and near misses.
Care and treatment was not always delivered in accordance with national guidance or evidence-based practice. Managers did not always monitor the effectiveness of the service or always work well together for the benefit of patients.
People could not always access the services when they needed it to receive the right care promptly. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were not always in line with national standards.
Senior staff were not always visible and approachable in the services for patients and staff. They did not always use systems to manage performance effectively or make decisions and improvements. They did not have clear oversight of the key risks and had not always mitigated immediate risks. Staff did not always feel respected, valued, and supported. The trust did not have a culture where staff could raise concerns without fear as they were not always managed appropriately. Although the NHS Staff Survey showed that in 2022 74% of staff felt secure about raising concerns about unsafe clinical practice. This is the same as the regional average for acute Trusts and higher than the national statistic of 71%. However, CQC staff survey indicated that the trust did not have a culture where staff could raise concerns without fear.
It should be noted that the NHS staff survey was completed in 2022, a different time period to the CQC staff survey completed as part of this inspection.
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.
Staff had training in key skills and understood how to protect patients from abuse.
There were ongoing examples of innovation and research.
How we carried out the inspection
The team that carried out the core services and well led inspection included two deputy directors of operations, an operations manager, 10 hospital inspectors, three mental health inspectors, two pharmacy inspectors and an inspection planner. In addition, there were 10 specialist advisors with clinical expertise in the core services areas. There was an executive reviewer plus four specialist advisors experienced in executive leadership of NHS trusts. The inspection team was overseen by Sarah Dronsfield, Deputy Director of Operations.
During the inspection we spoke with a variety of staff including consultants, doctors, therapists, nurses, healthcare support workers, pharmacy staff, domestic staff and administrators. We held staff focus groups attended by representatives of all grades of staff across nursing, midwifery, allied health professions and medical staff networks. We also carried out a confidential staff survey. This was to enable staff to share their views with the inspection team.