The York Hospital

Updated 30 June 2023

York and Scarborough Teaching Hospital NHS Foundation Trust provides a comprehensive range of acute hospital and specialist healthcare for approximately 800,000 people living in York, North Yorkshire, Northeast Yorkshire, and Ryedale.

The York Hospital is the Trust’s largest hospital. It has over 700 beds and offers a range of inpatient and outpatient services. It provides acute medical and surgical services, including trauma, intensive care, and cardiothoracic services.

Updated 30 June 2023

Updated 8 October 2015

Overall the service was good. However, there were not always adequate numbers of registered children’s nurses available to meet the needs of children, young people and parents within the inpatient areas. Children’s services did not have all the necessary individual risk assessment tools in place so that members of staff could conduct a robust, individualised risk assessment if required. We found that all children’s clinical areas were kept clean and were regularly monitored for standards of cleanliness. Training records submitted by the trust prior to the inspection showed varying levels of training uptake by members of staff, but not all were achieving the 75% compliance set by the Trust.

Children’s services had made improvements to care and treatment where a need had been identified using assessment programmes or in response to national guidelines.

Children, young people and parents told us that they received compassionate care with good emotional support. Parents felt informed and involved in decisions relating to their child’s treatment and care.

The service was responsive to children’s and young people’s needs and was well led. The service had a clear vision and strategy and was led by a positive leadership team.

Updated 28 February 2018

Our overall rating of this service improved. We rated it as good because:

• We rated safe, effective, caring, responsive and well led as good.
• We found that all staff had received mandatory training and most had undergone a recent appraisal. The appointment of a clinical practice educator had further supported the learning and development of staff. This fostered an environment focused on improvement, with involvement in research and projects evident from different members of the multidisciplinary team.
• The systems and processes in place for management of medicines, infection prevention and control, patient records and the assessment of patient risks were reliable and followed national guidance.
• Nurse staffing levels and medical care was delivered in line with Guidelines for the Provision of Intensive Care Services 2015 (GPICS) standards and patient outcomes were in line with those of similar units.
• Care was patient focused and individual needs were considered when planning and delivering care. The feedback from patients and relatives we were able to speak with was consistently positive and we were given examples of staff ‘going the extra mile’ with regards to patient care. Patient diaries and a follow up clinic helped support patients and families following discharge from the unit.
• Access to care was based on patients’ needs and beds within the unit were flexed between level two and level three as required. The number of delayed discharges and non-clinical transfers were in line with those of similar units.
• There was strong nursing and medical leadership evident on the unit and within the critical care outreach team. Staff felt supported and valued and morale was high. We observed an open culture within the multidisciplinary team.

However:

• The service did not meet all GPICS standards, for example pharmacy provision and the number of nursing staff with a post registration certificate in critical care nursing. However mitigation and actions to address this had been put in place.
• Safety thermometer data was variable. The results of this were not publically displayed. We also found patient feedback was not displayed on the unit.
• Access and flow had been affected by patients requiring non-invasive ventilation who would normally be cared for on the ward, requiring to be cared for on the unit.
• Whilst the risk register was reflective of the risks we identified, it was felt mitigating actions did not always address the cause of the issue. There were no review dates on the register.
• The service strategy had not been finalised and this had been identified as an issue at the previous inspection.

Updated 8 October 2015

We saw that end of life care services were safe, effective, caring and responsive, with elements of outstanding practice in terms of being well led. Staff were caring and compassionate and we saw the service was responsive to patients’ needs.

There was good use of auditing to identify and improve patient outcomes and we saw measures in place to monitor key areas that had been identified. The trust had a clear vision and strategy for end of life care services and participated in regional and locality groups in relation to strategic planning and implementation. There was consistent leadership relating to end of life care and a number of positive developments had been implemented, for example, non-cancer end of life care and the development of training to improve advance care planning discussions, including those relating to DNA CPR.

Updated 30 June 2023

Updated 8 October 2015

Overall the care and treatment received by patients in York Hospital outpatients and diagnostic imaging departments was effective, caring, responsive and well led. However the safe domain required improvement.

The managers told us that they continued to report any radiation incidents to the Care Quality Commission under Ionising Radiation (Medical Exposure) Regulations (IR(ME)R). We requested information about IR(ME)R reportable incidents from York Hospital, but this was not provided to us. This meant we were unable to judge the outcomes for the incidents and whether corrective action had been taken by the unit to promote safety. The trust did not provide at the inspection evidence that it was consulting and receiving regular advice and reporting from its radiation protection adviser (RPA) to comply with the Ionising Radiations Regulations 1999 (IRR99). Post inspection the trust informed us they had an RPA and issues were discussed.

The information on staff training especially on mandatory training was kept as departmental records. This meant outpatients staff training records were with theatres, anaesthetics and critical care unit training records. Therefore we were unable to separate out and report on the compliance within the outpatients department. Data indicated that the diagnostic imaging services staff training were not compliant with training.

There was a 14% vacancy rate for consultant and registrar radiologists in York. Some of the vacancies were covered by locumsThe trust informed us that there were 3.5 WTE specialist registrar vacancies. There was no formal tool or mechanism used to decide on staffing levels.

Staff worked within nationally agreed guidance to ensure that patients received the most appropriate care and treatment for their conditions. Patients were protected from the risk of harm because staff were aware of the policies and how to follow them.

Patients told us that staff working in the outpatients and radiology departments were caring and compassionate at every stage of their journey. People were treated respectfully and their dignity and privacy was maintained at all times by staff. We found the services were well led and care and treatment was delivered in response to patients’ needs and to ensure that the departments ran effectively and efficiently.

Updated 28 February 2018

Our overall rating of this service stayed the same. We rated it as good because:

• We rated safe, effective, caring, responsive and well led as good.
• There had been an improvement in nurse staffing levels since our last inspection and evidence of continuing recruitment and the development of nurse associates.
• We saw that wards and theatre areas were visibly clean and staff observed infection prevention and control measures.
• There had been an improvement in the discharge process with the recruitment of three discharge co-ordinators for the surgical unit. Patients did not have to wait so long for their discharge medications.
• There was direct pharmacy support to the wards to support staff in prescribing and review prescription charts. Staff were aware that oxygen should be prescribed except in an emergency.
• Nursing staff said that there was good teamwork and morale had improved.
• Nursing and care staff achieved the trusts target for mandatory and safeguarding training.
• We observed good compassionate care and emotional support.
• We observed good local leadership.

However:

• There was difficulty in recruiting medical staff. This was mitigated by the use of locum staff. This had an impact on mandatory and safeguarding training.
• Referral to treatment times had initially improved since our last inspection but then deteriorated in most directorates.
• Staff did not always have access to clinical supervision as part of their learning and development.

Updated 30 June 2023