The James Cook University Hospital

Updated 19 January 2024

Pages 1 to 3 of this report relate to the hospital and the ratings of that location, from page 4 the ratings and information relate to maternity services based at The James Cook University Hospital.

We inspected the maternity service at The James Cook University Hospital as part of our National Maternity Inspection Programme. The programme aims to give an up-to-date view of hospital maternity care across the country and help us understand what is working well to support learning and improvement at a local and national level.

The James Cook University Hospital provides maternity services to the population of Middlesbrough, Redcar and Cleveland and Northallerton.

Maternity services include an early pregnancy unit, maternal and fetal medicine, outpatient department, maternity assessment unit, antenatal ward (ward 19), central delivery suite, midwifery led birthing centre (ward 16, Marton suite), 2 maternity theatres, and a postnatal ward (ward 17). Between April 2021 and March 2022 4630 babies were born at The James Cook University Hospital.

We will publish a report of our overall findings when we have completed the national inspection programme.

We carried out a short notice announced focused inspection of the maternity service, looking only at the safe and well-led key questions.

This location was last inspected under the maternity and gynaecology framework in 2015. Following a consultation process CQC split the assessment of maternity and gynaecology in 2018. As such the historical maternity and gynaecology rating is not comparable to the current maternity inspection and is therefore retired. This means that the resulting rating for Safe and Well-led from this inspection will be the first rating of maternity services for the location. This does not affect the overall Trust level rating.

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

• Our rating of Requires Improvement for maternity services did not change ratings for the hospital overall. We rated maternity services requires improvement for safe and well-led.

We also inspected 1 other maternity service run by South Tees Hospitals NHS Foundation Trust. Our reports are here:

The Friarage Hospital – https://www.cqc.org.uk/location/RTR45

How we carried out the inspection

We provided the service with 2 working days’ notice of our inspection.

We visited maternity assessment (triage), delivery suite, the midwifery led unit, the antenatal and postnatal wards, obstetric theatres, and the day assessment unit.

We spoke with approximately 30 members of the maternity staff at all levels of the service.

We reviewed 6 patient care records, 6 observation and escalation charts and 5 medicines records.

Following our onsite inspection, we spoke with senior leaders within the service; we also looked at a wide range of documents including standard operating procedures, guidelines, meeting minutes, risk assessments, recently reported incidents as well as audits and action plans. We then used this information to form our judgements.

You can find further information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

Updated 24 May 2023

Updated 28 October 2016

We rated safe for children and young people as good because:

Staff ensured the ward environment and clinical areas were ‘child-friendly’, secure, clean and well maintained. Equipment was checked, labelled and safely stored.

Medicines and clinical records were stored securely. Documentation was good with each child and young person having an individualised plan of care.

The service had good local procedures to monitor changes in a child’s condition and arrangements with network colleagues to escalate care when a child deteriorated.

Staff followed trust mandatory training requirements. Managers were working to ensure all staff completed necessary training and to meet trust targets.

There had been an improvement in staffing levels in all paediatric areas since the inspection in December 2014. Additional recruitment was planned to re-enforce staffing in the neonatal unit to ensure compliance with national staffing guidelines. Staffing levels were managed appropriately to ensure they were safe.

Staff reported concerns and incidents where they felt this compromised a child’s safety and wellbeing. Outcomes and lessons learnt from investigations were shared with all staff.

Updated 24 May 2023

Updated 2 July 2019

We rated it this service as requires improvement because:

• The service did not have enough radiologists which impacted on the service provision.
• The service was below the trust’s compliance rate of 90% for mandatory training.
• Performance for achieving the timescales for provision of diagnostic radiology for cancer patients were not achieved.
• Incidents were not always being reported or when incidents were reported the correct process was not always being followed. We saw a lack of evidence of the service monitoring trends and themes. There was limited learning from incidents.
• There were limited provisions/support for patients who had additional/complex needs such as dementia or learning difficulties.
• Not all risks which managers told us about were documented on the risk register although the service had procedures in place to report and manage risks.
• We saw no evidence to demonstrate engagement with patients who used the diagnostic and radiology services.

However:

• The service provided care and treatment based on national guidance.
• Staff of different kinds worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.
• Staff cared for patients with compassion.

Updated 28 October 2016

We rated safe, effective and well-led for end of life care as good because:

The service had made significant improvements in audit and completion of DNACPR forms. Nutrition and hydration assessments were included in an individualised patient assessment tool for patients at the end of life.

Staff delivering end of life care understood their responsibilities with regard to reporting incidents and ensured information and lessons learnt were shared proactively with other colleagues within the hospital.

We saw clear, well-documented and individualised care of the dying documents. The referral process was clear and responsive and staff ensured that patient’s wishes were central to the care planning process.

However, although there was a clear vision for the service, which specialist palliative care staff had developed, the trust specific strategy for end of life care was in draft and under review and it was not clear when Board approval would be finalised.

The trust did not have an overall strategic lead for palliative care but this was identified as a future development. There was no action date to implement this role but the Board were keen to ensure that this happened.

Updated 19 January 2024

Updated 28 October 2016

We rated safe for outpatients and diagnostic services as good because:

There had been improvements in all areas identified during the 2014 inspection. There were processes to ensure that resuscitation equipment was checked each day. Staff had enough personal protective equipment in all the areas and staff knew how to dispose of items safely and within guidelines.

There were sufficient staff of all specialties and grades to provide a good standard of care in the departments we visited.

There were processes to ensure medicines were managed safely. Practices were monitored and improvements made where required. Staff identified and responded appropriately to changing risks to patients, including deteriorating health and medical emergencies.

Updated 24 May 2023

Updated 24 May 2023