17 May to 5 July 2023
During a routine inspection
Medical care (including older people's care)
Our rating of this location stayed the same. We rated it as requires improvement because:
- The service did not ensure staff at all levels completed the necessary mandatory and statutory training to enable them to carry out the duties they are employed to perform.
- The service did not always have enough staff to care for patients. Staff did not always make sure equipment, such as resuscitation trolleys, were accurately checked and safe to use.
- The service did not ensure systems and processes to mitigate risk including fire safety, infection prevention and control and patients’ privacy and dignity; relating to the environment, premises, and equipment, were safe.
- The service did not ensure systems and processes to monitor cleanliness of the environment and equipment were sufficient to reduce infection prevention and control risk and staff did not always follow the infection prevention and control policy. Managers monitored the effectiveness of the service but did not always ensure staff were competent.
- Staff did not always complete patient risk assessments on admission to medical wards. Managers did not always feed back incident outcomes to staff and staff did not always report near misses or potential harms.
- The service did not always ensure they communicated effectively with patients when making decisions about patient care.
- The service did not always ensure chemicals that are hazardous to health were stored safely and securely. The service did not always keep patient records secure.
- Not all leaders ran services well and information systems were not reliable and did not always support staff to develop their skills.
However:
- Staff understood how to protect patients from abuse. Staff acted on risks to patients and kept good care records.
- Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. 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. Most key services were available seven days a week.
- Staff mostly treated patients with compassion and kindness, 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.
- Staff were involved in developing the service’s vision and values. Most 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 engaged well with patients and the community to plan and manage services and all staff were committed to continually improving services.
Services for children and young people
Our rating of this location went down. We rated it as requires improvement because:
- Staff had varied compliance with training in key skills. Medicines were not always managed well. Safeguarding training was below the trust targets for medical staff. Agency staff did not consistently have an induction.
- Managers did not ensure staff were competent in key skills and did not fully monitor the effectiveness of the service. Staff did not always receive appraisals and clinical supervision was not available for nursing staff. Key services were not available and there was no plan to address this at the time of inspection.
- The service did not always consider the individual needs of children and young people receiving treatment and care.
- Leaders ran services well using reliable information systems but did not support staff to develop their skills. Leaders did not always recognise and escalate concerns within the department.
However:
- The service had enough staff to care for children and young people and keep them safe. The service understood how to protect children and young people from avoidable harm, and managed safety well. The service managed infection risks well. Staff assessed risks to children and young people, acted on them and kept good care records. The service managed safety incidents well and learned lessons from them.
- Staff gave children and young people enough to eat and drink and gave them pain relief when they needed it. Staff worked well together for the benefit of children and young people and supported them to make decisions about their care. They had access to information to help them provide treatment and care safely.
- Staff treated children and young people with compassion and kindness. They respected their privacy and dignity and helped them understand their conditions. Staff provided emotional support to children and young people, families and carers.
- The service 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.
- 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 children and young people receiving care. Staff were clear about their roles and accountabilities. The service engaged well with children, young people and the community to plan and manage services.
Urgent and emergency services
Our rating of this location stayed the same. We rated it as requires improvement because:
- Safeguarding training was below trust targets for medical staff. Managers did not ensure staff were competent in key skills and did not fully monitor the effectiveness of the service. Staff did not always receive appraisals and there was limited clinical supervision was in place for nursing staff.
- The service did not have enough staff to care for patients and keep them safe. Staff assessed risks to patients, acted on them however they did not always re-assess patients or maintain good care records. Staff did not always report incidents or near misses in line with trust policy.
- Overcrowded departments meant patients privacy and dignity could not always be respected.
- Leaders of the service described a disconnect between the emergency department and services within the hospital. They described a lack of trust-wide ownership of the challenges faced by the emergency department.
- The lack of patient flow into and out of the emergency department, and into the hospital, had a significant impact on both staff and patients.
However:
- Doctors, nurses and other healthcare professionals within the emergency department worked together as a team to benefit patients.
- The service planned care to meet the needs of local people, took account of individual needs, and made it easy for people to give feedback.
- Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service promoted equality and diversity in daily work.