Doncaster hospital trust told it must improve after latest inspection

Doncaster Royal Infirmary has been told it must improve by official Government inspectors.

The Care Quality Commission report into the hospital published today had praise for some areas of the Doncaster and Bassetlaw Teaching Hospitals (DBTH) hospital's work, but ultimately, the core services inspected have not changed the overall trust rating of ‘Requires Improvement’ from the previous inspection which took place in 2015.

Doncaster Royal Infirmary. Picture: Dean Atkins

Doncaster Royal Infirmary. Picture: Dean Atkins

Since the last visit, the Trust has made a number of improvements, highlighted within the report:

But the report highlights some areas of improvement, including staffing levels, as well as ensuring certain standards are met, such as one-to-one care during labour for 90 per cent of women – something which has subsequently been achieved at Bassetlaw Hospital since the report was written and continues to improve at Doncaster Royal Infirmary, according to bosses.

The report also found issue with Statutory and Essential Training and appraisal rates within the trust, both of which managers say have improved in recent months now standing completed by staff at 80 per cent and 70 per cent respectively.

Inspectors also highlighted a need for improvement within the organisation’s Emergency Departments. The trust says steps have since been taken to improve ‘booking-in’ arrangements to reduce queues, in addition to improving staffing levels as required after the 2015 inspection. To sustain continued development within Urgent and Emergency Care, an innovative system called ‘Smart-ER’ has recently been implemented which makes diagnosis much more efficient, while further development bids are also being explored to complement the service, which is often the highest performing of its kind in the region.

However, the trust has been has been recognised as a well-led organisation, following the CQC assessment which took place in December and January., and it recognised a number of areas of quality care and practice. Overall, 72 per cent of the services inspected at Doncaster Royal Infirmary and 77 per cent at Bassetlaw Hospital were judged to be ‘Good’ with no service at DBTH rated as ‘Inadequate’.

The CQC assessed whether the Trust’s services were safe, effective, caring, responsive and well-led across the four core services of Urgent and Emergency Care, Medical Care, Children and Young People and Maternity Services.

The visits were undertaken during a period of increasing winter pressures and attendance, which saw the CQC suspend inspections nationally in January 2018. Despite this, inspectors highlighted a number of positives, with ‘Medical Care’ coming in for particular praise. The inspectors found this service within DBTH to be ‘Good’ across the five domains, pointing to an emphasis on infection control, patient assessment and seven day service, all of which are supported by a culture of staff development.

The organisation’s leadership team were also the recipients of praise, with the report evidencing a strong working relationship between the Trust’s Chief Executive and Chair. The inspectors also pointed to training and development opportunities for leaders within DBTH with a goal to further improve patient care and treatment.

The report also acknowledged:

* Services were planned to meet the needs of local people

* Good examples of multidisciplinary working, with the Trust performing better than the national average in a number of national audits

* Staff provide emotional support to patients

* Staff are aware of when incidents should be reported and robust processes are in place for reviewing, sharing and learning about incidents

* All areas visited were clean and well-maintained.

Mr Sewa Singh, Medical Director at DBTH, said: “On behalf of the Trust, I welcome the CQC’s scrutiny of our services and we are pleased that they have recognised good practice and the fantastic work which takes place here. We also recognise that there are areas where we could improve further and have started work to deliver this.

“Our patients told inspectors that members of Team DBTH are caring, compassionate and communicate well. Importantly, those staying with us expressed a feeling of safety as well as involvement within their care and treatment, and this is very important to us as an organisation.”

Mr Singh added: “We accept the recommendations from the CQC, and, with the creation of a detailed action plan, we will be taking the required steps to make further improvements to our service as well as address the issues highlighted by the inspection teams. I would also like to express my thanks to our staff who work tirelessly each and every day caring for patients.”

“Over the past number of years, the Trust has been on an improvement journey. The next 12 months will bring with it another set of challenges, and it’s paramount that, as an organisation, we remain focused upon our goals, ensuring that our patients remain at the centre of all we do, that our staff remain focused on continuous improvement and that as an organisation we make the best use of public money. We have a fantastic team at DBTH and I believe we will only continue to make good progress to become an outstanding organisation.”

The inspection came at a time when the local hospitals have made significant strides in financial control. For 2017/18, DBTH ended the year £5.2m ahead of plan with cost savings of over £11 million delivered. In May 2018, NHS Improvement (NHSI) confirmed that significant improvements had been made by DBTH in response to the financial governance issues that had arisen during 2015. These actions alongside the strengthening of board and management capacity and capability has led to the regulator removing the breach of licence, imposed three years earlier, acknowledging the increased confidence in the trust in providing financially sustainable high quality services for patients.

The Trust has also reported record lows of preventable harms such as pressure ulcers and falls with significant harm. These achievements are further complimented by sustained improvements in relation to meeting national targets for Clostridium Difficile infection rates, as well as maintaining a better than average performance in the organisation’s Hospital Standardised Mortality Ratio (an indicator of safety) to 87.42, well within the expected range of 100.

The reports published today (10 July) by the CQC are based on a combination of its inspection findings, information from the CQC’s Insights (intelligence monitoring system), and information provided by patients, the public, trust staff and other organisations.

England’s Chief Inspector of Hospitals has told Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust that it must continue to make improvements following an inspection by the Care Quality Commission.

A team of CQC inspectors visited the trust in December 2017 and January 2018 to check the quality of four core services: urgent and emergency services, medical services, maternity services and children and young people services. In January CQC looked specifically at management and leadership to answer the key question: Is the trust well led?

As a result of this inspection the trust has again been rated Requires Improvement overall, although it was rated Good for being well-led, caring and responsiveness.

Inspectors found there was limited assurance about safety, especially within the urgent and emergency care services at Doncaster Royal Infirmary and Bassetlaw District General Hospital.

At the last inspection CQC had identified the need to improve triaging and initial assessment of patients in both emergency departments. At this inspection, the process had changed, although patients were still not receiving a timely assessment. There were extended waits for patients who walked into the department and those who arrived by ambulance which were a potential risk to patient safety.

Although staffing in the emergency departments had increased since the last inspection, neither department was meeting national guidance for the levels of consultant or paediatric trained nursing staff.

On medical wards, all areas visited were clean and well-maintained and staff practised safe infection control techniques. Staff assessed patients for risk of deterioration and escalated their care when necessary. There were safe medical and nurse staffing levels in place and staff said they were supported to develop professionally.

In maternity, the service was not meeting their target of 90% for women receiving one to one care in labour. Doctors and midwives were not up to date with mandatory training or appraisals. Some staff said morale was low.

In services for children and young people, staff cared for patients with kindness and compassion, ensuring they involved patients and their families. But there were significant gaps in the medical staffing.

At trust level, there had been a number of changes within the Board including a new chief executive and chairman who worked well together. The leadership team recognised the training needs of managers at all levels, including themselves, and worked to provide development opportunities for the future of the organisation.

The Chief Inspector of Hospitals, Professor Ted Baker, said:

“Since we last inspected, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust there has clearly been improvement in some areas.

“However it is disappointing that some significant concerns remain, particularly in emergency care where we found the service did not always have enough doctors or nursing staff of the right level to keep patients safe from avoidable harm.

“We found the ambulance handover bays and the overflow areas were cramped and did not provide confidentiality or dignity for patients, who were being nursed in close proximity to each other in an open area.

“I note that since our previous inspection, the trust has appointed a new Chair and Chief Executive who, together with other executive team members, have made efforts to improve services- but we do need to see further progress and improvements embedded.

“We will return in due course to monitor and check that these significant improvements have been made.”

CQC has identified 19 areas where the trust must take action to meet its legal requirements. Full reports including the latest ratings are available at:https://www.cqc.org.uk/provider/RP5

The reports are published on the CQC website at https://www.cqc.org.uk/provider/RP5