Sunderland Royal Hospital

Updated 3 February 2023

Sunderland Royal Hospital has 35 maternity beds. They are split across two wards including the antenatal/postnatal ward which has 13 beds and the delivery suite which has 22 beds in LDRP (labour, delivery, recovery and postnatal) rooms.

Medical specialties include renal medicine, oncology, haematology, rheumatology, gastroenterology, metabolic medicine and thoracic medicine. Rehabilitation and elderly medicine include care of the elderly, neurology, neurophysiology, neurorehabilitation and stroke services. There are 356 beds located within 13 wards.

Updated 3 February 2023

Updated 10 June 2020

We rated the service as requires improvement because:

• Safe and well-led were rated as requires improvement. Effective, caring and responsive were rated as good.
• The service did not have enough nursing or medical staff to meet national guidance. Overnight, middle grade staff covered the neonatal unit, paediatric wards and emergency department.
• Staff did not always complete and update risk assessments. Records did not contain evidence that paediatric early warning scores (PEWS) had been escalated correctly and staff had not received any sepsis training.
• The ward environments were not suitable for children and young people with mental health concerns and the neonatal unit was cramped and had limited space. Staff did not always follow infection control measures correctly.
• There was a risk that staff were not providing care and treatment based on up to date evidence-based guidance because staff on the paediatric wards did not have access to any policies or procedures.
• The service did not have robust arrangements in place for identifying, recording, reviewing and managing risks. Although regular governance meetings were held there was no evidence that there was an effective process for reviewing incidents, complaints and risk.

However:

• The service provided mandatory training in key skills to all staff and made sure everyone completed it. The service made sure staff were competent for their roles.
• 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 knew how to apply it.
• Staff monitored the effectiveness of care and treatment. They used the findings to make improvements and achieved good outcomes for patients. Doctors, nurses and other healthcare professionals worked together as a team to benefit children, young people and their families.
• Staff treated children and their families with compassion and kindness, they provided emotional support and involved children, young people and their families in decisions about their care.
• The service planned and provided care in a way that met the needs of local people and the communities served. The service was inclusive and took account of children, young people and their family’s individual needs and preferences. Waiting times from referral to treatment and arrangements to admit, treat and discharge children and young people were in line with national standards.

Updated 10 June 2020

We rated it as requires improvement because:

• We rated safe and well led as requires improvement. We rated caring as outstanding. We rated effective and responsive as good.
• The maintenance and use of facilities and equipment did not always keep people safe. We found vital equipment in use, such as ventilators, which appeared to have not been service and maintained. When this was brought to the attention of staff they were not aware if the equipment has been serviced and maintained in line with manufacturers guidance.
• The service did not always have enough equipment to maintain patient safety. Some general ward beds were in use, due to a lack of equipment replacement. Staff told us the numbers of patients developing pressure damage had increased due to the unit not having appropriate profiling beds in place. This was logged on the risk register.
• Staff did not always use the trust’s systems and processes to safely prescribe, administer, record and store medicines. We saw occasions where staff had failed to follow the trust’s policy when managing controlled drugs.
• Staff did not always record incidents in line with trust policy. We had concerns that most staff did not recognise the use of mechanical or pharmacological restraint as a reportable incident.
• Whilst staff supported patients with capacity to make informed decisions about their care and treatment, they did not always follow national guidance when patients lacked capacity to give consent.
• They did not always use measures that limited patients' liberty appropriately. Staff showed limited understanding of the legislation around the deprivation of liberty safeguards and use of pharmacological and mechanical restraint.
• We found some folders with printed guidance documents which were out of date for review. Staff did have access to up to date resources on the trusts intranet.
• The service did not yet have a strategy to turn the vision into action.
• More work was needed to ensure leaders had effective oversight processes in place, for example in relation to maintenance of medical equipment and medicines management.
• We were concerned that some of the risks identified at our previous inspection had not been addressed.

However:

• The service provided mandatory training in key skills to all staff. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. The service controlled infection risk well. Staff completed and updated risk assessments for each patient. The service had enough nursing and medical staff with the right qualifications, skills, training and experience.
• Staff gave patients enough food and drink to meet their needs. Staff assessed and monitored patients regularly to see if they were in pain. Staff monitored the effectiveness of care and treatment. Doctors, nurses and other healthcare professionals worked together as a team to benefit patients. Key services were available seven days a week. Staff gave patients practical support and advice to lead healthier lives.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. Staff provided emotional support to patients, families and carers to minimise their distress. They understood patients personal, cultural and religious needs. Staff supported patients, families and carers to understand their condition and make decisions about their care and treatment.
• The service planned and provided care in a way that met the needs of local people. The service was inclusive and took account of patients’ individual needs and preferences. People could access the service when they needed it and received the right care promptly. It was easy for people to give feedback and raise concerns about care received.
• Leaders had the skills and abilities to run the service. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Leaders and teams used systems to manage performance effectively. The service collected reliable data and analysed it. Leaders and staff actively and openly engaged with patients, staff, equality groups, the public and local organisations to plan and manage services. All staff were committed to continually learning and improving services.

Updated 10 June 2020

• Nursing and medical staff received and kept up to date with mandatory training. All areas we inspected were clean and well maintained. There were sufficient numbers of nursing and medical staff to keep patients safe. Incidents were appropriately reported, investigated and shared with the wider team, to prevent further occurrence.
• Care and treatment was planned and delivered in line with national guidance and best practice. Staff were competent for their roles and received constructive appraisals. We saw evidence multidisciplinary and multiorganisational working, to ensure care was planned and delivered to meet the needs of patients in a sustainable, future proof way.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. Staff provided emotional support to patients, families and carers to minimise their distress. They understood patient's personal, cultural and religious needs. Staff supported patients, families and carers to understand their condition and make decisions about their care and treatment.
• The service planned and provided care in a way that met the needs of local people and the communities served. The service was inclusive and took account of patients’ individual needs and preferences. People were truly respected and valued as individuals. Patients could access the specialist palliative care service when they needed it. It was easy for people to give feedback and raise concerns about care received.
• The leadership, governance and culture were used to drive and improve the delivery of high-quality person-centred care. Leaders set stretching, innovative objectives and conducted in depth analysis and planning as to how they would be achieved.

Updated 3 February 2023

Updated 10 June 2020

We rated it as good because:

• The service provided mandatory training in key skills to all staff and made sure everyone completed it. 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 knew how to apply it. The service controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean. The design, maintenance and use of facilities, premises and equipment kept people safe. Staff identified and quickly acted upon patients at risk of deterioration.
• The service had enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date, stored securely and easily available to all staff providing care. The service used medicines safely. The service managed patient safety incidents well. Staff always had access to up-to-date, accurate and comprehensive information on patients’ care and treatment.
• The service provided care and treatment based on national guidance and evidence-based practice. Staff were competent for their roles. Doctors, nurses and other healthcare professionals worked together as a team and supported each other to provide good care. Key services were available five days a week with some weekend and evening clinics
• Staff gave patients practical support and advice to lead healthier lives.
• Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent. They knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. Staff provided emotional support to patients, families and carers to minimise their distress. They understood patient's personal, cultural and religious needs. Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.
• The service planned and provided care in a way that met the needs of local people and the communities served. The service was inclusive and took account of patients’ individual needs and preferences. Staff made reasonable adjustments to help patients access services. They coordinated care with other services and providers. People could access the service when they needed it and received the right care promptly. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were in line with national standards. It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff.
• Leaders understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service promoted and provided opportunities for career development. Leaders operated governance processes and staff at all levels were clear about their roles and accountabilities. Staff had regular opportunities to meet, discuss and learn from the performance of the service.
• Leaders and teams used systems to manage performance effectively. The service collected data and analysed it. The information systems were integrated and secure. Leaders and staff actively and openly engaged with patients, staff and the public to plan and manage services. All staff were committed to continually learning and improving services. They had a good understanding of quality improvement methods and the skills to use them.

However:

• There were some areas where signage could be improved and staff had requested additional signs to be made and installed to help people find areas of the department more easily.
• There was a list of patients overdue a review appointment extending to 14,844 patients across all specialties and sites within the trust. Clinicians and senior managers had strong oversight of all patients waiting for appointments and outpatient leaders worked with directorates regarding capacity and demand.
• Some staff within the department were not aware of an overall strategy for outpatients, however we were told the plan for the future was to work more closely as a department across all sites.
• Although clinical governance activities were carried out, no formal outpatient service clinical governance meetings had taken place since the trust merger. We were made aware that speciality governance meetings took place. Leaders acknowledged the need to embed the governance systems further across outpatients and were working to do this.

Updated 10 June 2020

We rated it as good because:

• We rated safe, effective, caring, responsive and well-led as good.
• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and staff collected safety information and used it to improve the service.
• Staff gave patients pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service was committed to improving services.

Updated 10 June 2020

We rated it as requires improvement because:

• Mandatory training levels for medical staff did not meet the trust’s compliance target of 90%. The service did not always control infection risk well. Times to initial assessment were higher than the England average and we saw an increasing number of ambulance handover delays.
• Patients diagnosed with sepsis did not always receives antibiotics in a timely manner. We were not assured there was oversight of safety in the mental health assessment room. Patients with long waits for admission did not always have access to their regular medication.
• We saw staff utilising different versions of trust guidance.
• Waiting times from arrival to treatment and arrangements to admit, treat and discharge patients were not always in line with national standards. We saw a consistent deterioration in performance in both areas.

However:

• The service had enough staff with the right qualifications, skills, and experience to keep patients safe from avoidable harm. Records, medicines and incidents were managed safely within the department.
• Staff always had access to up-to-date, accurate and comprehensive information, and care and treatment was based on national guidance.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service took account of patients’ individual needs. It was easy for people to give feedback and raise concerns about care received.
• Leaders had the skills and abilities to run the service. Staff felt respected, supported and valued. The service had clear governance and risk management systems in place. Information was managed well in the department.