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Provider: Hull University Teaching Hospitals NHS Trust Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 1 June 2018

We rated effective, caring and well-led as good, and safe and responsive as requires improvement.

Our rating of Hull Royal Infirmary stayed the same. We rated it as requires improvement. We rated seven of the hospital’s eight services as good and one as requires improvement.

Our rating of Castle Hill Hospital improved. We rated it as good. We rated three of the hospital’s five services as good and two as requires improvement.

In rating the trust, we took into account the current ratings of the four services not inspected this time.

  • We rated well-led for the trust overall as good. This was not an aggregation of the core service ratings.
Inspection areas

Safe

Requires improvement

Updated 1 June 2018

  • At the previous inspection, we had highlighted that the five steps to safer surgery including the World Health Organisation (WHO) surgical safety checklist was not used effectively within the surgery health group. During this inspection we did not observe consistency across the trust with five steps to safer surgery including the WHO surgical safety checklist. For example from our observations in surgery it was apparent the five steps to safer surgery checklist, was not embedded as a routine part of the pathway. The trust had reported three never events associated with wrong site surgery or the wrong prosthesis being inserted. We could therefore not be assured that the checklist was being used correctly and consistently.
  • The trust had completed work towards improving compliance with risk assessments: particularly nutrition and falls risk assessments and actions taken in response to patients’ National Early Warning Score (NEWS). Staff in medical care did not always complete this in line with the trust’s policy.
  • Patients’ records were not always stored securely or in an organised manner. There was a risk that patient’s records could go missing or that staff did not have access to information they required to provide patient care.
  • Services did not always have appropriate numbers of staff to ensure patients received safe care and treatment. The trust had introduced some additional staff and roles to provide cover and mitigate some of the risk. However, despite the shortage of registered nurses in particular, the trust managed staffing well and had a robust escalation and review process.

However:

  • The trust had systems in place for reporting, monitoring and learning from incidents. Staff we spoke with knew how to report incidents.
  • Staff we spoke with understood how to protect patients from abuse and services worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.
  • We found wards and departments we visited visibly clean and tidy, and we saw ward cleanliness scores displayed in public corridors.
  • The trust had completed work and improvements in regards to medicines and checking of fridge temperatures and emergency equipment.

Effective

Good

Updated 1 June 2018

  • Policies and procedures were based on evidence based practice, and national guidance, for example, from the National Institute for Health and Care Excellence (NICE).
  • The trust participated in national and local audits, patient outcomes in a number of national audits showed variable performance in the four core services we inspected. We saw action plans and spoke with leadership teams who understood where performance needed to improve.
  • Patients were provided with adequate food and drink. Individual preferences were taken into account. Initiatives had been implemented to try and improve patient’s nutrition. Pain relief was offered to patients and reviewed to identify its effect.
  • We observed and saw that patient’s records had evidence of effective multi-disciplinary working. We observed effective information sharing at daily huddles.
  • Staff received additional training to ensure that they were competent. Staff understood the need to gain consent and understood the relevant consent and decision making requirements.
  • Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. They knew how to support patients experiencing mental ill health and those who lacked the capacity to make decisions about their care

However:

  • Records we reviewed showed that surgical in-patients were being fasted for too long prior to surgery. Eight out of eight records we reviewed all showed that patients had fasted for longer than national guidance.
  • The number of staff who had an up to date appraisal was worse than the trust’s target in three of services we inspected.

Caring

Good

Updated 1 June 2018

  • Staff cared for patients with care and compassion. Feedback from patients confirmed that staff respected patients’ wishes and provided individualised care.
  • Staff involved patients and those close to them in decisions about their care and treatment. Patients and relatives we spoke with told us they felt well informed by doctors and nursing staff about their condition, treatment options and plan of care.
  • Patients were provided with emotional support from staff to minimise their distress.
  • The trust had a multi-faith chaplaincy service and bereavement service and patients had access to specialist nurses for further information and support when required.

Responsive

Requires improvement

Updated 1 June 2018

  • The trust showed variable performance against the constitutional standards, for example, in urgent and emergency care, referral to treatment times and cancelled operations in surgery.
  • There was a lack of consistency in reviewing medical outlier patients in line with the trust policy. The referral criteria list for moving patients to non-medical wards was not adhered to at all times.
  • The trust identified a tracking access issue in July 2017 where patients may not have received follow up appointments or interventions following the introduction of an electronic patient record in June 2015. The trust declared this as a serious incident and established a validation and clinical harm review process involving an external healthcare company, commissioners and NHS Improvement (NHSI).

However:

  • Services were planned and provided services in a way that met the needs of local people. The trust worked effectively with commissioners, external providers and local authorities.
  • Patient’s individual needs were met. The electronic patient record was endorsed with an alert identifier to aid staff caring for vulnerable patients or those with additional needs. Systems were in place for patients living with dementia and learning difficulties to support them through their hospital stay.
  • People using services felt they could raise concerns and complaints and they would be listened to. Complaints and concerns were taken seriously by the trust and were acted on in a timely manner.

Well-led

Good

Updated 1 June 2018

  • We rated well led as good in all of the core services we inspected.
  • Positive leadership was noted at all levels in the health groups. Senior staff were visible and supportive to staff.
  • Health groups had clear strategies that all staff understood and put into practice. Staff we spoke with were aware of the trust’s vision and values.
  • All health groups had governance and risk management processes and quality measures in place to improve patient care, safety and outcomes. The governance framework in surgery had been strengthened to monitor performance and risks. This meant that health group leadership teams were able to escalate issues to the board in a timely way.
  • Staff morale was good overall and teams worked well together and supported each other. Managers were proud of their staff and success was celebrated through local and trust wide events. The trust invested in supporting staff in completing and providing extra training to advance in their career.

However:

  • There was a lack of pace in addressing some of the issues from the last inspection in medical care: for example risk assessments and the escalation of the deteriorating patient.
  • The surgery health group could have moved with more pace to address issues from the previous inspection, particularly processes to embed the safer surgery checklist in practice.