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Provider: Nottingham University Hospitals NHS Trust Good

On 14 March 2019, we published a report on how well Nottingham University Hospitals NHS Trust uses its resources. The ratings from this report are:

  • Use of resources: Requires Improvement  
  • Combined rating: Good  

Read more about use of resources ratings

Inspection Summary


Overall summary & rating

Good

Updated 14 March 2019

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

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

We rated five of the trust’s services as good and two as requires improvement. In rating the trust, we took into account the current ratings of the two services not inspected this time.

  • Managers at all levels in the trust had the right skills and abilities to run a service providing high-quality sustainable care. There was clear leadership of the trust to drive and improve the delivery of high quality person centred care.
  • Leaders understood the challenges to quality and sustainability; they could identify actions needed to address these.
  • The trust had a vision for what it wanted to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community.
  • Most managers across the trust promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
  • The trust had a ‘Best-of-Breed’ Strategy to become a ‘Paperless Hospital’ by 2020 and had a mission to be a global digital exemplar. The trust was very digitally orientated.
  • The trust engaged well with patients, staff, the public and local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively.
  • There was a strong culture of continuous improvement, driven through transformation work. The Institute of Nursing and Midwifery Care Excellence had seen the development of new knowledge, innovation and education.

However:

  • Not all services had enough medical and nursing to keep people protected from avoidable harm and to provide the right care and treatment.
  • Arrangements to admit, treat and discharge patients were not in line with national standards.
  • The Department of Health’s standard for emergency departments is that 95% of patients should be admitted, transferred or discharged within four hours of arrival in the emergency department. From October 2017 to September 2018 the trust failed to meet the standard and performed worse than the England average.
  • The Royal College of Emergency Medicine (RCEM) recommends that the time patients should wait from time of arrival to receiving treatment should be no more than one hour. From September 2017 to August 2018, the trust did not meet the standard for 11 months over the 12-month period.
  • In children’s services, outpatient appointments did not always run on time. Children and their families were not informed about delays in outpatients and the service did not monitor or analyse delays to outpatients. The outpatient environment could become very crowded for certain clinics
  • Lack of out of hours access to paediatric interventional radiology meant that some babies needed to be transferred to other hospitals.
  • In maternity, although the trust had made improvements to the leadership and governance structures, the changes had not yet been fully embedded and there was still a lack of oversight and assurance in some areas.
  • In maternity there was not a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.

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 – www.cqc.org.uk/provider/RX1/reports.

Inspection areas

Safe

Requires improvement

Updated 14 March 2019

Our rating of safe stayed the same. We took into account the current ratings of services not inspected this time. We rated it as requires improvement because:

  • Not all services had enough medical and nursing staff to keep people protected from avoidable harm and to provide the right care and treatment.
  • Not all services controlled infection risk well. Staff did not always keep equipment and the premises clean.
  • Staff did not always follow best practice when prescribing, giving, recording and storing medicines.
  • Compliance with mandatory training was low for nursing and medical staff in some core services.

However:

  • Staff understood how to protect patients from abuse and the 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.
  • There were good patient risk assessments in place and completed by staff, this included the escalation of patients who displayed signs and symptoms of deteriorating health.
  • Patient safety incidents were mostly managed well.

Effective

Good

Updated 14 March 2019

Our rating of effective stayed the same. We took into account the current ratings of services not inspected this time. We rated it as good because:

  • Staff delivered care and treatment based on national best practice, internal and external audits and research outcomes. This included evidence-based guidance such as that issued by the National Institute of Health and Care Excellence, World Health Organisation (WHO) and various royal colleges aligned with the specialty of each service.
  • Managers monitored the effectiveness of care and treatment and used the findings to improve them. They compared local results with those of other services to learn from them.
  • Staff worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.

However:

  • Mental Capacity assessments were not always reviewed as required.
  • Staff did not always demonstrate awareness of the Mental Capacity Act and the Deprivation of Liberty safeguards (DoLs).

Caring

Outstanding

Updated 14 March 2019

Our rating of caring improved. We took into account the current ratings of services not inspected this time. We rated it as outstanding because:

  • Feedback from people who use the services was continually positive.
  • There was a strong, visible person-centred culture.
  • Staff were motivated and inspired to deliver care that was kind and promoted dignity.
  • Staff were consistently compassionate about patient care and strived to go ‘ above and beyond’ where they could.

Responsive

Good

Updated 14 March 2019

Our rating of responsive stayed the same. We took into account the current ratings of services not inspected this time. We rated it as good because:

  • The service took account of patients’ individual needs.
  • Concerns and complaints were treated seriously, investigated and lessons learned from the results.

However:

  • People were not always seen or treated in a timely way.
  • Services were not always planned to meet the needs of patients.

Well-led

Good

Updated 14 March 2019

We rated it as good because:

  • Managers at all levels in the trust had the right skills and abilities to run a service providing high-quality sustainable care.
  • The trust had a vision for what it wanted to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community.
  • Managers across the trust promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
  • The trust used a systematic approach to continually improve the quality of its services and safeguarding high standards of care by creating an environment in which excellence in clinical care would flourish.
Assessment of the use of resources

Use of resources summary

Requires improvement

Updated 14 March 2019

Combined rating