Sunderland Royal Hospital

We rated it as requires improvement because:

• We rated safe and well led as requires improvement. We rated effective, caring and responsive as good.
• We rated four core services as requires improvement and four core services were rated as good.
• In some services mandatory compliance rates fell below the trust target. The facilities in the emergency department for conducting assessments of patients with mental health conditions were not compliant with national guidance. We were concerned about staffing levels across a number of core services. Some services did not always control infection risk well. In the emergency department waiting times from arrival to treatment and arrangements to admit, treat and discharge patients were not always in line with national standards. The maintenance and use of facilities and equipment did not always keep people safe. Some services did not always use the trust’s systems and processes to safely prescribe, administer, record and store medicines. We had concerns some staff did not always recognise incidents and near misses and reported them appropriately, for example, the use of mechanical or pharmacological restraint as a reportable incident. Staff did not always complete and update risk assessments for children.
• In some services identified risks had been on the risk registers for a number of years and mitigating actions were not sufficient to reduce their impact. We saw limited examples of cohesive working across the trusts two critical care units. Leaders in the surgical services did not have effective processes in place to actively and openly engage with patients and staff to plan and manage services. Whilst some services had a vision for what they wanted to achieve, the strategies were not yet developed. Some services needed more work to ensure effective governance processes were in place. In children and young people services it was not clear how information was shared more widely and acted upon and in critical care there was limited oversight in relation to medicines management.

However:

• Most staff had training on how to recognise and report abuse. Most services kept detailed records of patients’ care and treatment. Staff kept most areas visibly clean and well organised. Surgical services used systems to identify and prevent surgical site infections. Staff identified adult patients at risk of deterioration and there were clear escalation processes in place. Risk assessments were completed appropriately for adult patients.
• The service provided care and treatment based on national guidance and best practice. Staff gave patients enough food and drink to meet their needs and improve their health. Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way. Staff monitored the effectiveness of care and treatment. Key services were available seven days a week. In medicine the service achieved grade B overall in the Sentinel Stroke National Audit Programme. 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 and the communities served. The service was inclusive and took account of patients’ individual needs and preferences. The trust had a delirium and dementia outreach team (DDOT). The team was highly visible and easily accessible and supported ward staff to care for frail patients. 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.
• Local leaders had the skills and abilities to run the services. Staff told us 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 had an open culture where patients, their families and staff could raise concerns without fear.