Durham Diagnostics and Treatment Centre

• We rated outpatients as good. We rated surgery as requires improvement.
• 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. Staff had training on how to recognise and report abuse and they knew how to apply it. The service controlled infection risk well. They kept equipment and the premises visibly clean. The service had enough staff with the right qualifications, skills, training and experience. The service used systems and processes to safely prescribe, administer, record and store medicines. The service managed patient safety incidents well.
• There was insufficient activity for us to rate effective in surgery at the time of the inspection. In addition, the service did not provide any information to show us how they monitored the effectiveness of surgical care and treatment.
• We do not currently rate effective in outpatients. However, the service provided care and treatment based on national guidance and evidence-based practice. The service made sure staff were competent for their roles. Staff supported patients to make informed decisions about their care and treatment.
• There was insufficient activity for us to rate caring in surgery at the time of the inspection. However, in outpatients we found 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.
• In outpatients 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 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. In both services waiting times from referral to treatment and arrangements to admit, treat and discharge patients were in line with national standards.
• Leaders understood and managed the priorities and issues the service faced. The service had a vision for what it wanted to achieve and a strategy to turn it into action. Staff felt respected, supported and valued. Leaders operated governance processes. Leaders and teams used systems to manage performance effectively. They identified and escalated relevant risks and issues. The service collected data and analysed it. Leaders and staff engaged with patients, staff and the public to plan and manage services.

However:

• Outpatients was underutilised and had capacity to provide more clinics. At the time of our inspection, it was not clear how the trust intended to proceed to improve this. 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 the service.
• In surgery leaders and staff did not always actively engage with patients, staff, equality groups to plan and manage services. Despite there being systems to monitor and manage activity, these were not utilised effectively to make an impact on performance and theatre utilisation.