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Provider: University Hospitals of Derby and Burton NHS Foundation Trust Good

Inspection Summary


Overall summary & rating

Good

Updated 16 June 2021

Inspection areas

Safe

Good

Updated 16 June 2021

Effective

Good

Updated 16 June 2021

Caring

Good

Updated 16 June 2021

Responsive

Good

Updated 16 June 2021

Well-led

Good

Updated 16 June 2021

Checks on specific services

Community health services for adults

Requires improvement

Updated 31 March 2015

Derby Hospitals NHS Foundation Trust provided a range of community health services for adults in Derby City, including district nursing, intermediate care, specialist rehabilitation and early supported stroke discharge. Services were managed at London Road Community Hospital and delivered in a range of locations, including patients’ own homes, the community hospital and community clinics. We visited several community clinics, met with staff, visited the rehabilitation centre at the community hospital and went on home visits with community nurses and therapists.

Staff did not always report patient safety incidents and the uptake of training on incident reporting was low in some teams. Staff received good feedback about incident investigations, but there was little sharing and learning across the service in order to improve practice.

District nursing teams, in particular, were under-staffed and taking on increasing workloads. Recruitment was not successful in filling vacancies, and teams were delivering far more activity than they were contracted for. Staffing shortfalls meant that nurses could not attend mandatory and other training. Although there were governance structures in place to monitor and manage risks, long-standing risks associated with district nursing staffing levels and demands on the service had not been reduced.

Staff felt well supported by their immediate line managers, but there was a lack of clarity about wider management structures and roles, and communication needed to improve. Community staff felt disconnected from the rest of the trust, and services tended to work in silos. Opportunities for sharing learning and engaging with other staff as part of community-wide services were not well established.

There were suitable arrangements for the prevention and control of infection, maintenance of the environment and equipment, and the safe management of medicines. However, staff working in the community were not always able to access current information about their patients’ care and treatment plans.

Patients received compassionate and respectful care. Patients felt involved in making decisions about their care plans. Care and treatment were evidence based and staff monitored the quality of the service they provided with a range of outcome measures. Community health services for adults were delivered through effective multidisciplinary teams. Most staff we spoke with were passionate about their jobs and were proud of their work. There were a number of successful innovative community programmes taking place both in the trust and with partners in the local health and social care sector.

Community health inpatient services

Good

Updated 22 October 2020

We carried out this short notice announced focused inspection as a result of concerns relating to patient harm from falls. This was in response to concerns which were initially raised following serious incidents that had happened at the trust. We visited Phillip ward at Sir Robert Peel community hospital and Darwin ward at Samuel Johnson community hospital. During the inspection, we inspected falls assessment and management. We reviewed information and spoke with staff in relation to patient falls.

During this inspection, we used our focused inspection methodology. We had identified concerns in relation to how the provider managed patients’ risk in relation to falls. We did not, therefore cover all key lines of enquiry. Focused inspections can result in an updated rating for any key questions that are inspected if we have inspected the key question in full across the service and/or we have identified a breach of a regulation and issued a requirement notice or taken action under our enforcement powers; in these cases the ratings will be limited to requires improvement or inadequate.

Previous ratings were not updated during this inspection.

At the time of our inspection, there were changes to community inpatient services due to the COVID-19 pandemic. We planned to visit Anna ward at Samuel Johnson community hospital, but this ward had been closed for cleaning and they had merged with Darwin ward. There were no plans for this to change after our inspection. Both wards we visited were not operating at full capacity due to a reduction in referrals during the COVID-19 pandemic. There were 15 patients on Phillip ward, which could admit up to 23 patients. There were 13 patients on Darwin ward which could admit up to 26 patients. A number of these patients had a diagnosis of dementia.

We spoke with 17 members of staff, these staff included both registered nurses, nursing assistants, allied health professionals and the matron who oversaw both hospitals. We looked at a random sample of eight patients’ care records, visited the ward, attended a ward board meeting where staff discussed patients’ care and progression and reviewed a range of documentation related to the care and treatment of patients and the running of the service. Due to risks associated with COVID-19, we did not speak with patients and their families about the care and treatment they had received at the trust.

We found:

  • The service had enough staff to care for patients. The service managed infection risks well. They managed safety incidents well and learned lessons from them.
  • The service provided care and treatment based on national guidance and evidence-based practice. Staff worked well together for the benefit of patients and supported them to achieve discharge. There was accessible information about falls and dementia for patients and carers.
  • Local leaders ran services well and were visible. Managers appraised staff’s work performance and held supervision meetings with them.
  • The service was focused on the individual needs of patients receiving care and staff were committed to improving.

However:

  • Staff did not always undertake mental capacity assessments in line with the Mental Capacity Act. Not all staff were up-to-date with their training in manual handling and falls prevention. The trust had suspended their training programme due to the COVID-19 pandemic and this was due to restart in September 2020.
  • Staff did not manage all risks that could impact on falls, we saw that staff had not labelled walking aids on Phillip ward and on Darwin ward, staff did not always follow bed rails assessments. There were areas on wards where the environment was worn, and floors were uneven, which meant there were potential trip hazards for patients.
  • Not all staff were not clear that cohorted patients should be constantly within eyesight.
  • The trust had a trustwide action plan for falls. There were actions that needed the trust still needed to embed. However, the COVID-19 pandemic had impacted on these. We saw differences in governance across the wards, which could be confusing for staff who worked across wards. There were missed opportunities for consistency and for sharing good practice
  • Not all information in patients’ records was easy to locate and nursing assistants did not have access to electronic records and so relied on a limited amount of information.

Community urgent care services

Requires improvement

Updated 6 June 2019

This service had not previously been inspected under our community health methodology we are not therefore able to compare to past ratings of this service.

We rated it as requires improvement because:

  • We did not see evidence that robust safeguards were in place to ensure that patients who required immediate attention had an assessment by a clinician when waiting for longer than one hour to be seen. There was a first contact protocol in place to identify patients who needed seeing urgently, however the effectiveness of this was not monitored or audited.
  • We reviewed patient group directions on the Samuel Johnson Minor Injuries Unit and found them to be incomplete and inconsistent. The service were taking action to put this right.
  • Incidents and near miss events were not being reported in line with trust policy. This had previously been identified as a concern, but staff provided examples of incidents that had occurred and not been reported. Incident reporting numbers were low.
  • We did not see evidence of effective governance, including assurance and auditing systems or processes in the minor injuries units.

However:

  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they provided examples of how they applied it.
  • The service controlled infection risk well and systems were in place to maintain standards of cleanliness and hygiene. Both minor injuries units were visibly clean and tidy, with completed cleaning schedules in place.
  • The service had access to a range of clinical pathways and assessment tools based on national guidance and we saw these in use.
  • Staff were caring and treated patients with compassion.
  • Both minor injuries units met the standard for admitting, transferring or discharging patients within four hours of attending and staff worked across services to coordinate people’s involvement with families and carers.
  • Staff were supportive of each other and proud of the service they provided.

Community end of life care

Requires improvement

Updated 31 March 2015

Derby Hospitals NHS Foundation Trust delivered community based services to people requiring palliative and end of life care throughout South Derbyshire. The community palliative care team was part of an integrated team, working alongside colleagues from the specialist palliative care team based at the Royal Derby Hospital.  The community end of life care service provided palliative and end of life care in a range of environments such as people’s own homes, London Road Community Hospital and the Nightingale Macmillan Day Unit. We visited these sites and went on home visits, the community palliative care team. We spoke with patients, carers and staff including community nurses, district nurses, community matrons, matrons, health care assistants, volunteers and doctors.

Community palliative care staff received good feedback about incident investigations, but there was little sharing and learning across the service in order to improve practice. Staff working in the community caring for people at home were not always able to access current information about their patients’ care and treatment plans, which meant they might not be fully prepared to care for a patient.

District nursing teams and the specialist palliative care team were under-staffed and taking on increasing workloads. There were high levels of sickness absence. Recruitment was not successful in filling vacancies, and teams were delivering far more activity than they were contracted for. Staffing shortfalls meant that nurses did not attend mandatory and other training.  We have included more detailed findings about the district nursing teams within our inspection report, "Community health services for adults." 

Care and treatment were evidence based and staff followed current best practice recommendations. Community staff were appropriately qualified, skilled and competent to carry out their roles, and worked well to meet the needs of patients. Community teams worked in a multidisciplinary manner and there was good team working to ensure patients received effective care in the community. Patients received compassionate care and we witnessed positive interactions between patients and staff. Staff provided emotional support for patients and their carers.

All of the staff we observed demonstrated compassion and were passionate about providing good end of life care. Community end of life care services were responsive to people’s needs. The trust had a number of initiatives to ensure patients received the care they needed in the most appropriate place.

Leadership at a local level was good and managers demonstrated a clear understanding of their services and were aware of the risks and challenges their service faced. Staff spoke positively about the contribution they made to patient care. There was some engagement with staff but this needed to improve.