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Provider: Calderdale and Huddersfield NHS Foundation Trust Good

On 20 June 2018, we published a report on how well Calderdale and Huddersfield NHS Foundation Trust uses its resources. The ratings from this report is:

  • Use of resources: Requires improvement  

Read more about use of resources ratings

Inspection Summary


Overall summary & rating

Good

Updated 20 June 2018

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

  • We rated effective, caring and well-led as good and safe as requires improvement.
  • At this inspection, we inspected six core services and rated five of them as good and one as requires improvement overall.
  • In rating the trust we took in to account the current ratings of the services we did not inspect. We inspected and rated the maternity core service separately from gynaecology; therefore the previous rating for the combined services was not used.
  • We rated well-led for the trust overall as good and this was not an aggregation of the core service ratings for well-led.
Inspection areas

Safe

Requires improvement

Updated 20 June 2018

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

  • Medical care services were rated as requirement improvement for safe during our previous inspection. We did not inspect medical care as part of this inspection so the previous rating remains in place.We rated safe as requires improvement in the urgent and emergency care services and the critical care service at Calderdale Royal Hospital during this inspection. We rated safe as inadequate in the community inpatients services.

  • We rated safe as requires improvement in the urgent and emergency care services and the critical care service at Calderdale Royal Hospital during this inspection. We rated safe as inadequate in the community inpatients services.
  • We found shortfalls in the critical care consultant cover at Calderdale Royal Hospital because consultants had other areas of responsibility when on call and the rota did not provide continuity of care for patients.
  • The urgent and emergency care services did not have sufficient consultants to staff a full weekend rota. This did not meet the Royal College of Emergency Medicine guidance of consultant presence 16 hours a day.
  • In the community inpatient service, patient risks relating falls, pressure care, infection nutrition were not managed effectively. We identified shortfalls in staffing within the service. We also found that only 40% of staff had completed basic life support training in the last 12 months.
  • Medicines, including controlled drugs were not managed effectively in critical care and the urgent and emergency services. We found expired medicines and consumable items, errors and omissions in the controlled drugs log books and medicine fridge temperatures were not always recorded.
  • In the critical care and urgent and emergency services, we found that emergency equipment checks were not carried out and documented effectively.
  • The emergency care services did not have suitable rooms to accommodate patients presenting with mental ill health. A risk assessment of the facilities had been completed but at the time of our inspection action had not been taken to minimise risks to patients such as ligature risks. We also found there were ligature risks in the toilets and the small waiting room areas.
  • Most staff had completed mandatory training but the training completion rate was below the trust target of 95% across most of the services we inspected.

However,

  • Staff assessed and responded to patient risks appropriately. There were systems in place to protect vulnerable adults and children from abuse.
  • Most staff understood the process for reporting incidents. Incidents were investigated and shared with staff to aid learning.

Effective

Good

Updated 20 June 2018

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

  • We rated effective as good in five of the six core services we inspected.
  • Care and treatment provided was based on national guidance such as the National Institute for Health and Care Excellence (NICE) guidelines and the Royal College’s guidance.
  • 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. The emergency department.
  • The critical care services performed similar to other trusts for patient outcome measures in the Intensive Care National Audit and Research Centre (ICNARC) audit. Staff in the emergency department had carried out follow up audits to improve compliance with Royal College of Emergency Medicine (RCEM) national audits.
  • The maternity services showed improvements in stillbirth rates and the proportion of women who experienced a third or fourth degree tear.
  • Patients received care and treatment by qualified and competent staff that worked well as part of a multidisciplinary team. Most staff had completed their annual appraisal and the trust’s appraisal compliance target of 95% had been achieved by most services.
  • The electronic patient record (EPR) enabled staff to securely access up-to-date, accurate and comprehensive information on patients’ care and treatment.
  • Staff sought consent from patients before delivering care and treatment. Most Staff understood the legal requirements of the Mental Capacity Act 2005 and deprivation of liberties safeguards. Staff working with children and young people received training in and understood Fraser guidelines and Gillick competence.
  • Patient’s nutritional needs were met and pain score tools were used to identify and manage pain symptoms. Patients spoke positively about the choice and availability of food and drink offered to them.

However,

  • The critical care outreach team were not collecting data for the national critical care outreach activity outcome data set due to time constraints within the team.
  • The critical care outreach team were not compliant with a number of standards in relation to the teams’ professional development.
  • In the community inpatient services, patients’ nutrition and hydration needs were not always met, patient outcome data was not collated or monitored and staff induction and competency training processes were not effective.

Caring

Good

Updated 20 June 2018

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

  • Staff were caring and provided compassionate care. Patients were treated with dignity and respect and their privacy was respected. Patients spoke positively about the care they received.
  • Staff involved patients and those close to them in decisions about their care and treatment and supported their emotional needs.
  • Friends and family test feedback was positive across the core services we inspected. Test scores were in line with national averages and showed most patients would recommend the trust’ services to their friends and family.

However,

  • The response rates for the friends and family test across some services (such as urgent and emergency care and community services) were lower than the national average which does affect the significance of the results. The trust had plans in place to try and address this.

Responsive

Good

Updated 20 June 2018

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

  • We rated responsive as good in five of the six core services we inspected.
  • Staff understood the needs of the local population and were able to identify and plan care to meet people’s individual needs. There were systems in place to support patients with mental health needs and patients with a learning difficulty or living with dementia.
  • Staff could access interpreter services and British sign language services if needed.
  • There had been improvements with the access and flow through the critical care services. This had resulted a reduction of the number of bed days with a delay of more than eight hours and the percentage of non-clinical transfers was in line with that of similar units.
  • The trust did not achieve the emergency care four hour wait times standard. However, the urgent and emergency services performed better than the England average with performance between 89% and 97% across the previous 12 months.
  • Follow up care for critical care patients following discharge from hospital had been implemented through a clinic. This was in line with the guidelines for the provision of intensive care services (GPICS) standard.
  • Specialist midwives were available for pregnant women who might require additional help or support; for example, with respect to smoking cessation, substance misuse, and domestic violence.
  • The community sexual health services held clinics six days a week and also held evening clinics at all three locations to enable timely access. The service was able to provide tests and treatments at the clinics. Microscopy was undertaken on site at the main clinic which meant some test results were available immediately.

However,

  • Complaints were investigated and shared with staff to aid learning. However, complaint responses were not always completed within the specified timelines.
  • Three closures of Huddersfield birth centre had taken place since January 2018 due to insufficient medical and surgical capacity across sites.
  • The community inpatients service was not responsive to patient’s needs. The service aimed to discharge patients within seven days but 54% of patients had stayed longer than 14 days. We also found that care plans did not fully meet the needs of patients that required additional support, such as those with a learning disability.

Well-led

Good

Updated 20 June 2018

Our rating of well-led improved. We rated it as good because:

  • We rated well-led as good in five of the six core services we inspected.
  • Governance systems in the critical care, maternity and children and young people services had been strengthened and we found significant improvements had been made since our last inspection.
  • There was strong, visible and effective leadership across the majority of services we inspected. There was an open culture and most staff felt supported by their line managers.
  • The trust routinely engaged with staff, patients and the public. We found examples of innovation and improvement across most of the services we inspected.
  • There were effective governance and quality monitoring processes across most of the services we inspected. Key risks were identified and escalated effectively.

However,

  • The governance and monitoring processes in the community inpatients service were not effective. The leadership model was confusing, roles and responsibilities were not clear and there was insufficient clinical oversight of patients.
Assessment of the use of resources

Use of resources summary

Requires improvement

Updated 20 June 2018

Combined rating
Checks on specific services

Community end of life care

Good

Updated 15 August 2016

Overall we rated the service as good. We rated the end of life service in the trust as good for safe, effective, caring responsive and well-led. The service understood how to identify safety concerns and risks to patient safety. Incident reporting was embedded in the service and learning from incidents was shared across the service to ensure improvements were made.

Medicines were effectively managed and improvements from incidents were used to improve care and treatment of patients.

Patients could access services out of hours staff worked well with GP practices to ensure patients who were receiving end of life care and their relatives were cared for and supported in the last days of life.

Staff worked within multi-disciplinary teams to allow co-ordination of care and there were meetings held with every GP practice in the area where the team provided end of life care.

There was a 24 hour telephone service and referrals to the service were acknowledged within 10 minutes of referral and contacted by telephone within one hour of the referral. Patients and their relatives were contacted by the service within 3 hours.

There was a clinical educator post within the service to co-ordinate and provide training and staff had access to specialist training. Staff had one to ones with their manager and yearly appraisals. Staff understood their roles and responsibilities for providing end of life care.

Care was provided based on national guidance such as The National Institute for Health and Care Excellence (NICE). The trust had developed and was implementing an Individual care of the dying document (ICODD) which was based on the five priorities of care document in the community.

The service had developed an end of life dashboard and they monitored patient outcomes. Information about patient care and outcomes were shared with the trust and commissioners of the service to continue to improve patient care.

The service had a vision for the service which was understood by all staff and staff felt the service was well managed and patient care was a priority for all staff.

Community health inpatient services

Requires improvement

Updated 20 June 2018

This was our first inspection of this service. We rated it as requires improvement because:

  • Risk assessments not carried out routinely to ensure patients received appropriate care and treatment on the unit.
  • Some patients, families, and carers told us their needs were not recognised or monitored while on the unit.
  • There was insufficient clinical oversight and staff were not equipped to identify and manage deteriorating patients.
  • Not all staff had the skills they needed to carry out their role effectively and in line with best practice. Staffing did not always meet defined minimum staffing levels.
  • We were not assured that governance systems were effective in escalating potential risks and issues, or that learning from incidents was embedded.
  • The issues we raised had not been identified within the provider’s own monitoring or audit systems. These were similar to issues identified following a previous serious incident on the unit which meant the service had not put in sufficient measures to ensure patients received high quality, safe care.
  • Patient information was not always consistently recorded and staff did not always have access to the information they needed. There were inconsistencies between information recorded in electronic and paper based patient records.
  • Staff did not always recognise, report or record incidents and not all incidents were effectively investigated. This meant opportunities for learning from incidents were missed.
  • The leadership model was confusing, roles and responsibilities were not clear and there was insufficient clinical oversight of patients.

However:

  • Most patients, families, and carers gave positive feedback about the service and felt staff communicated with them effectively.
  • Managers and healthcare professionals worked collaboratively with partner organisations and other agencies to arrange onward care for patients in their own homes e.g. carrying out home visits to assess individual needs.

Community health services for adults

Good

Updated 15 August 2016

Overall we rated this service as good because:

  • We found this was a service where the patient was put first and holistic care was delivered.

  • The service had a system in place to report incidents and staff were able to use this.

  • Staff were able to give examples of where they had learned from incidents and how improvements had been implemented.

  • Staff sickness levels were lower than the trust target and staff morale was high.

  • Staff delivered evidence based care and treatment and followed appropriate national guidance.

  • We observed kind and compassionate care being delivered by knowledgeable staff and patients told us they were happy with the service they received.

  • There were fully integrated multidisciplinary teams that worked effectively in a variety of settings. A seamless service was provided with a combination of health and social care input.

  • There was a range of services offered and patients did not have to wait long for care and treatment.

  • There were a low number of complaints received by the service.

  • There was a well-managed risk register with action plans and control measures in place.

  • Despite a recent significant change in the trust structure and management arrangements staff told us they felt well supported and that managers were approachable.

However:

  • Mandatory training levels were below the trust target.

  • We found there had been some staff shortages but the service had managed this well.

  • Some documentation required updating and standardising across the service.

  • There was a lack of comprehensive performance data within the community services. This was impacting on their ability to properly measure effectiveness and responsiveness of the services within the division.

  • Complaint responses and lessons learned were not always shared with staff in an effective or meaningful way but plans were in place to improve this.

  • Community equipment was not well managed therefore staff were not aware of what equipment was available or if it was safe to use.

  • Staff felt that senior managers in the trust did not fully understand the pressures on staff who worked in the community.

Community health services for children, young people and families

Good

Updated 15 August 2016

  • The trust had established risk reporting structures in place. Incidents were investigated and reported in line with policy. We saw evidence of the service sharing learning with staff. Staff were knowledgable and experienced in safeguarding children and recognising risk. There were safeguarding systems in place to protect children and young people from harm.

  • Staffing levels were appropriate for services provided and were in line with commissioned levels. There had been problems of recruitment in childrens therapy services. The risks had been mitigated by temporary actions.

  • Staff had received mandatory training at trust level of expectation. There was a broad understanding of the duty of candour and some staff had received training.

  • Staff practiced evidence based care and treatment. There was good evidence of multi- disciplinary working within the trust and with external agencies. Staff were aware of the principles of consent and we observed them practising it in their work. There were clear and accessible routes into other services. Some staff reported that the transition between health visiting services and school nursing was not as smooth now that this service was under the umbrella of a social enterprise company.

  • The trust was meeting recognised targets set by NHS England for this year and it’s Commissioning for Quality and Innovation (CQUIN) target for breastfeeding post delivery. However this figure decreased significantly on discharge from maternity care. The service had identified this issue and mitigating actions were being taken to address them.

  • There were good appraisal rates throughout the service and systems in place to identify dates of reappraisal.

  • We spoke with children and their families, and observed care taking place. We found evidence that staff practiced compassionate care and provided emotional support. People who used the service told us that they felt involved with their care. They had understood the care and advice offered to them.

  • The trust planned and delivered services that met peoples needs and were responsive to the changing needs of the population. We saw evidence of innovation in care to meet the needs of the local population and hard to reach groups. This included one health visitor who services for parents who misused substances. This service took into account equality and diversity needs and that of vulnerable groups.

  • There was access to translation and interpreting services and staff said that they had knowledge of the trust’s interpreting policy. Staff were aware of local links into services for new migrants and lesbian, gay, bisexual and transgender (LGBT) community.

  • Services were easily accessible for children and their families. There was flexibility in how these were provided to suit individual need. There were minimal complaints about the service and these had been dealt with in a timely manner.

  • There was a clear vision for the service that was child and family focussed and demonstrated innovation. There were systems in place linking governance, risk management and quality measurement at service and board level. Staff said that they were aware of these and that all levels of management, including the chief executive were visible and accessible.

  • Although the community management level was currently interim pending re-configuration, this had not affected staff morale. Staff told us that they worked in an open culture and were given the opportunity to develop individually and as teams. There was evidence of engagement with both the public and staff members. We saw evidence of staff and public feedback. This was used to drive and improve services.

  • There were many examples of innovative practice aimed at increased access to services for children and their families. These were evaluated to ensure that staff understood and could learn from both successes and failures.

Reference: Community health (sexual health services) not found

Good

Updated 15 August 2016

  • Staff were able to use the incident reporting system and knew when they should report. The service had robust adult and children’s safeguarding processes in place.
  • Medicines were stored securely and supply and administration processes were safe.
  • All areas were visibly clean. Staff followed infection control policies. Mandatory training compliance was good.
  • We saw appropriate staffing levels and skill mix in place.
  • Policies and standard operating procedures were written with reference to appropriate best practice guidance. Staff were able to administer pain relief and local anaesthetic where necessary.
  • Appraisals were 100% for medical, nursing and non-nursing staff. Staff had appropriate additional competencies and learning for their roles.
  • We received consistently positive feedback. Patients told us that the staff were kind, caring and compassionate. We observed staff treating patients compassionately and with dignity and respect.
  • Services were planned to meet the needs of the local population. Staff also visited many other areas, in an effort to reach the most vulnerable members of society who may not be able to readily access services.
  • Services were accessible to patients through a range of routes and patients were seen by staff in a timely manner.
  • The service offered booked appointments and also drop in clinics. There were specific clinics for a number of client groups. There had been no formal complaints.
  • We found the service manager experienced, knowledgeable and approachable.
  • The trust had a patient centred vision and strategy.
  • There was a defined governance process for the service. The service manager was aware of the risks to the service and attended the divisional governance meetings.
  • All staff we spoke with reported a positive team culture. Staff worked flexibly to meet the needs of the service across all three sites.
  • The service were proactive in looking at ways to engage with hard to reach groups, such as street workers and the travelling communities.
  • Team meetings were held regularly. This was used to provide feedback and also to gain staff views about how the service could develop.
  • We saw numerous examples of improvement and innovation.

However;

  • We found that the service website needed updating.
  • Signage to the clinics was not always clear.