Walkergate Park

Updated 1 September 2016

Walkergate Park Hospital is one of the hospitals providing care as part of Northumberland, Tyne and Wear NHS Foundation Trust. This hospital provides rehabilitation and assessment services on an inpatient, outpatient or community basis, for people with a disability caused by injury or disease affecting the brain, spinal cord or muscles. Walkergate Park Hospital does not provide accident and emergency services, surgery, critical care, children and young people services and diagnostic imaging services.

Northumberland, Tyneand Wear NHS Foundation Trust is one of the largest mental health and disability Trusts in England employing more than 6,000 staff, serving a population of approximately 1.4 million, providing services across an area totaling 2,200 square miles. It has a budget of over £300 million.

The trust provides care from over 60 sites across Northumberland, Newcastle, North Tyneside, Gateshead, South Tyneside and Sunderland. It also has a number of regional and national specialist services. Walkergate Park Hospital is one of the regional specialist services offered. It has 65 beds. The hospital is the only specialist tertiary care neuropsychiatry and neuro rehabilitation service in the northern region. It provides level 1 tertiary specialised rehabilitation services, which provide for patients with highly complex rehabilitation needs that are beyond the scope of their local, and district specialist services.

Walkergate Park Hospital has in patient wards which offer post-acute rehabilitation care and all admissions are planned and the patients are medically stable in order that they are able to engage in their individually tailored rehabilitation programme. There are five wards within the hospital. These are Wards 1a and 1b (neurobehavioural) providing a service for patients who present with a range of physical, cognitive and emotional problems, and who are also exhibiting challenging behaviour. Ward 2 (neuro-psychiatry) provides a comprehensive resource for the assessment, investigation and treatment of specialist care for patients suffering from psychiatric, cognitive and emotional problems because of acquired brain injury or due to other organic and genetic neurological disorders. Ward 3 and Ward 4 (neurorehabilitation) provide a service for patients who have an acquired brain injury or another neurological condition.

Outpatient clinics within Walkergate Park Hospital were run by consultants, allied health professionals or were nurse led. The service provided clinics at this hospital and outreach clinics in Penrith, Durham and Sunderland. Outpatients provided clinics for continence, dystonia, medical and neuro-rehabilitation, sex and relationship clinic, multiple sclerosis, orthotics, splinting, hand hygiene, neuropsychiatry and spasticity.

The hospital did not provide diagnostic imaging services.

The trust also provided other services within the outpatients. These included the north east driving mobility services, community acquired brain injury services, Northumberland head injuries service , community multiple sclerosis team, regional communication aid service, regional disability team and the regional environmental control service.

We inspected Walkergate Park Hospital as part of the comprehensive inspection of Northumberland, Tyne and Wear NHS Foundation Trust. We inspected Walkergate Park Hospital between 6 and 9 June 2016.

Updated 1 September 2016

Walkergate Park Hospital is one of the hospitals providing care as part of Northumberland, Tyne and Wear NHS Foundation Trust. It is a neuro rehabilitation and neuro psychiatry centre located in Newcastle Upon Tyne. This hospital provides rehabilitation and assessment services on an inpatient, outpatient or community basis, for people with a disability caused by injury or disease affecting the brain, spinal cord or muscles. Walkergate Park Hospital does not provide accident and emergency services, surgery, critical care, children and young people services and diagnostic imaging services.

Northumberland, Tyne and Wear NHS Foundation trust serves a population of approximately 1.4 million, providing services across an area totaling 2,200 square miles and has 832 beds. The trust has operated as a foundation trust since December 2009. Walkergate Park Hospital has 65 beds.

We inspected Walkergate Park Hospital as part of the comprehensive inspection of Northumberland, Tyne and Wear NHS Foundation Trust, which included over 60 sites across Northumberland, Newcastle, North Tyneside, Gateshead, South Tyneside and Sunderland. In addition, the trust provides a number of regional and national specialist services. We inspected Walkergate Park Hospital between 6 and 9 June 2016.

Overall, we rated Walkergate Park Hospital as outstanding. We rated it outstanding for being effective, caring, responsive and well-led, and good in providing safe care.

We rated medical care and outpatient services as outstanding.

Our key findings were as follows:

• The trust had a clear vision, strategic goals and core values to maintain the Centre for Neurorehabilitation and Neuropsychiatry as a centre of excellence, putting patients first in a service focused on safety, quality and pride in the care and treatment provided.
• The service has a very person centred focus and culture. Staff worked in partnership with patients, their families, carers and other stakeholders to ensure that individual needs were met to enable them to be as independent as possible.

• Staff took the time to meet the individual needs of patients and we were given examples of where staff had gone ‘the extra mile’ to make patients’ hospital stay a positive experience. All patient feedback was extremely positive.

• Very effective multidisciplinary working (MDT) in the assessment, planning and delivery of patient care was apparent across services within the hospital.

• Services within the hospital had engaged and worked with a number of third sector organisations and agencies in order to develop their services or offer further information patients and carers. The services had close links with a number of charities.

• Clinics and services were developed to meet individual needs of people. The services were responsive to the needs of patients and carers and involved patients and carers in the care being provided. Outpatients had introduced a number of outreach services in response to patient need. Outreach clinics were either nurse led, consultant led or led by allied health professionals.

• A number of services provided vocational rehabilitation to patients to help them return to employment.

• Service leads and managers were available, visible within the hospital and approachable; leadership of the service was effective, there was excellent staff morale and they felt supported at ward level.

• Staff and patient engagement was seen as a priority with several systems in place to obtain feedback. The hospital had an effective and well established Service User and Carer Forum.

• The hospital was accredited as a specialised level 1 rehabilitation service.

• The hospital had infection prevention and control policies in place, which were accessible, understood and used by staff.
• Patients received care in a clean, hygienic and suitably maintained environment.
• There was adequate personal protective equipment (PPE) such as aprons and masks available to staff. We routinely saw staff using this equipment during our inspection. Patients and carers told us that staff washed their hands and used gloves and aprons.
• The hospital routinely monitored staff hand hygiene procedures and compliance at the time of inspection was high.
• Patients were assessed regarding their nutritional needs using the Malnutrition Universal Screening Tool (MUST). Where necessary patients were referred to a dietician.

• There were effective arrangements for safely managing medicines, including medicines prescribed ‘as required’ and controlled drugs.

• No patient deaths had occurred within the last three years at this hospital. There were review processes in place should a death occur.

We saw several areas of outstanding practice including:

• A well established Service Users and Carers Forum was in place and social activities for service users and their families had been established with the Headway Charity.
• The hospital had established a Brain Injury Group providing opportunities for discussion of a variety of issues such as brain injury and sleep monitoring.
• The Social Therapeutic and Recreational Rehabilitation Team (STARRT) had been developed to promote independence and increase the quality of life of patients through taking part in social and leisure activities.
• The service had adopted best practice in support of the provision of care and treatment, for example ‘Reducing the risk of deep vein thrombosis (DVT) for patients in hospital’, functional independence measure (FIM) and functional assessment measure (FAM) scores.
• The establishment of a spasticity management clinic for individuals with spasticity following a neurological injury.
• The North East Drive and Mobility Service had worked with a number of external agencies to develop the services to service users, for example the Driver and Licensing Authority and the local police.
• Staff in outpatients had worked with a local university to develop a short course on the holistic management of spasticity and hypertonia. This was developed because a need for training was identified by staff.
• The hand hygiene clinic was a service developed in response to patient need and research by the outpatients department. The development of this work had led to additional support services available for patients with hand hygiene and contributed to staff development in outpatients.
• As part of the caring hands project, the trust had provided an additional two training sessions to home care managers and care staff in Newcastle. Information provided by the trust highlighted that they developing the education programme further.

However, there were also some areas of practice where the trust should make improvements.

The trust should:

• Ensure a consistent approach to displaying NHS safety thermometer data on wards at this hospital. This would assure patients that the hospital was improving practice, based on experience and information.
• Consider implementation of regular record audits within the outpatient department.
• Consider governance leads within the outpatients department.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Updated 1 September 2016

We rated medical care as outstanding because:

• Evidence-based techniques and technologies were used to support the delivery of high quality care, such as NICE Guidance on Urinary Continence Problems in Neurorehabilitation Inpatients, functional independence and functional assessment measures and a ‘Modified Rivermead Mobility Index tool’.

• Patients were treated based on national guidance from the National Institute of Health and Care Excellence (NICE) and local policies were written in line with national guidelines and updated if national guidance changed. The group reviewed patient outcomes through a number of audits and also through the UK Rehabilitation Outcome Collaborative (UK ROC).

• The service has a very person centred focus and culture. All patients and family members said therapeutic input was relevant, co-ordinated and resulted in improvements. Staff took the time to meet the individual needs of patients and we were given examples of where staff had gone ‘the extra mile’ to make patients’ hospital stay a positive experience.

• All patients who responded to the Friends and Family Test (FFT) said they would recommend the service. We were told that care had been individualised to ensure effectiveness and staff were ‘…fabulous’, ‘...amazing’ and ‘…conscientious’.

• Patients and family members had been involved in discharge processes. Staff had been to individual’s homes to undertake assessments, gave full explanations and kept patients involved.

• Each patient received a welcome pack to ‘Walkergate Park Centre for Neurorehabilitation and Neuropsychiatry’. A ‘Patient Rehabilitation Journey Booklet’ was also available for patients to complete and the centre produced a ‘Resources for Carers’ booklet that gave details of information available from the trust, carers resources and mental health resources.

• All patients had a care plan and all were appropriately individualised from core standards and current to the needs of the patient. Patients and relatives informed us they felt involved in care options, decision making and planned treatment.

• Patients reported staff spent time with them and staff recognised the importance of time to care and support patients emotional needs. Care plans highlighted the assessment of patients emotional, spiritual and mental health needs.

• Staff said service leads and managers were available, visible within the division and approachable; leadership of the service was effective, there was excellent staff morale and they felt supported at ward level. Staff spoke very positively about the service they provided for patients and emphasised quality and patient experience as a priority and everyone’s responsibility.

• Research and audit projects were being carried out for, for example the self-management of long term neurological conditions, speech and language therapy outcome measures, evaluation of current therapist to patient ratio and intensity of therapy intervention and spasticity management standards. A spasticity management clinic for individuals with spasticity following a neurological injury was provided for residents in the North East.

• We reviewed handover meetings and sheets used by ward staff and escalation documentation, which was effective in communication and decision making for those patients at risk of deterioration.

• The trust had formal nurse staffing review processes in place and the group had a funded establishment in place. The centre was accredited as a specialised level 1 rehabilitation service.

• The trust had a designated lead for safeguarding, a safeguarding strategy and held regular safeguarding board meetings. Staff understood their responsibilities and discussed safeguarding policies and procedures confidently and competently.

• Planning meetings to co-ordinate therapeutic input in to a patient’s care and treatment were held each week.

• Continued Professional Development Forums were in place on wards to assist in meeting training needs for speciality training. Education meetings took place each week and an education programme had been developed.

• We observed multidisciplinary working (MDT) in the assessment, planning and delivery of patient care on all wards and we observed effective interactions between various different teams and services.

• The group had developed a Social Therapeutic and Recreational Rehabilitation Team (STARRT) to promote independence and increase the quality of life of patients. The centre had developed work with the Headway Charity, the Brain Injury Group and the Service User and Carer Forum.

• The service designed wards in such a way to make optimum use of space to deliver patient care. Facilities and premises were designed for the access and availability of the specific patient profile using the centre. We observed the layout of the centre enabled patients to exercise within the corridors to aid their rehabilitation.

• There were examples of services planned in response to patient need e.g. a protocol for the management of foot-drop in patients with neurological conditions, specific protocols for all patients with acute pain and the prevention and management of harm from pressure ulcers, falls, and catheter associated UTIs.

• However, although all wards collected information relevant to the NHS safety thermometer, a consistent approach to display this data was not in place; wards displayed some information or no information at all. This would have assured people using the service that the ward was improving practice based on experience and information.

Updated 1 September 2016

Overall, we rated this service as outstanding. We found that outpatients for safe was good, with caring, responsive and well led rated as outstanding because:

• There was very effective and clear multidisciplinary team working throughout the services visited and staff could describe working with a number of different professionals and external services to enhance services and patient outcomes. There was excellent access to a number of additional services within Walkergate Park Hospital and staff could sign post patients and carers to other services if required.

• Patient feedback for the services visited was consistently positive, friends and family test results were positive and patients felt supported. Confidentiality, dignity and privacy was respected by staff. The service provided strong person centred care that met people’s individual needs.

• Clinics and services were developed to meet individual needs of people. The services were responsive to the needs of patients and carers and involved patients and carers in the care being provided.

• Outpatients had introduced a number of outreach services in response to patient need. Outreach clinics were either nurse led, consultant led or led by allied health professionals.

• A number of services visited had close links with third sector organisations to develop the service they offered and help provide further support to patients and carers.

• A number of services provided vocational rehabilitation to patients to help them return to employment.

• Staff we spoke with could describe the values of the trust. There was a clear leadership structure in place and staff felt supported by management. Staff were positive about working in their services and were proud of the service they provided to patients. There was a culture of staff completing training and development opportunities.

• Staff used evidence based care and treatment using National Institute for Health and Care Excellence guidelines (NICE) and local and national guidelines were in use. There were care pathways in place in the services visited and patient risk assessments and goal setting was in place for patients.

• We found staff to be competent in their roles and a number of staff had completed further training and development. Staff could describe consent, the mental capacity act and deprivation of liberty standards.

• There was a commitment to supporting carers. Outpatients had a carer’s charter in place. The services had been developed in response to patient need and developed to provide person centred care.

• Strong and effective governance processes were in place and management could describe how risks were escalated and managed. Risk registers were in place at the services visited which were proactively reviewed.

• The services visited had been involved in a number of innovative service developments.

• Staff we spoke with had a good understanding of how to report incidents and safeguarding concerns.

• All areas visited were visibly clean and tidy. Staff had access to personal protective equipment and hand gel dispensers were available in areas visited.

• Medicines were securely stored. Patient group directions were in place and signed. Records were found to be managed securely. Staffing levels were good and in line with trust planned levels in the services visited.