Pontefract Hospital

Updated 16 November 2022

Updated 7 December 2018

We previously inspected maternity jointly with gynaecology so we cannot compare our new ratings directly with previous ratings. We rated the service as good because:

• We saw good overall core mandatory training and role specific training completion rates compared to trust targets. Safeguarding training completion rates surpassed trust targets. Staff could clearly describe safeguarding reporting procedures and felt confident making referrals.
• Emergency equipment service checks were in date. Since our last inspection, the service had implemented a comprehensive programme of skills and drills training in all clinical areas.
• There had been no serious incidents reported at maternity services at this location in the 12 months prior to our inspection. We found lessons learned following incident investigations were shared in different formats, and staff were able to describe learning from these incidents.
• Outcomes for women were typically good and outcomes for babies were better than trust targets and regional averages.
• Over a one-year period, maternity services at the location received a comparatively low number of formal complaints (three) and a relatively high number of formal compliments (32). We saw evidence of learning from complaints, which were investigated in a timely manner.
• All staff received an appraisal. Midwifery advisors were on call 24-hours for independent advice and support. Across the trust, there were midwives available for support and guidance and with special interests as part of their role.

However:

• Except for community midwife caseloads, we saw there was sufficient maternity staff within the trust when measured against national guidelines and minimum recommendations. The trust was aware of staffing shortfalls, and there were plans to look at areas of concern. However, we were not assured that staff were allocated properly across the service to meet service need.
• Across the trust, antenatal services experienced difficulty offering women follow-on clinic and day unit review appointments.
• The storage, ordering and disposal of medicines was in line with current guidance and regulations. However, we saw some paper copies of patient group directions, that allowed nurses to administer medicines without a prescription, were out of date.
• At our previous inspection, we found a lack of local audit activity to encourage continuous improvement. At our recent inspection, we saw good progress with prioritisation of activities for completion. However, we noted significant delays with the local maternity audit programme overall.

Updated 7 December 2018

We rated this service as requires improvement because:

• Although the backlog of patients waiting for follow up appointments had improved slightly since our last inspection, there was still a backlog of 18,374 at 22 July 2018.
• There was a process in place for administrative and clinical validation of waiting lists. However, the trust could not provide evidence that clinical validation had taken place on all patients in the backlog.
• Despite specialities having agreed response plans, it was not clear what the trajectories were for clearing the backlogs.
• Referral to treatment times (RTT) were worse than the England overall performance; however there had been a steady increase in performance and there had been an improvement since the last inspection.

However:

• Staff were aware of the processes to follow to report incidents and safeguarding concerns. Learning was shared between teams.
• Staffing levels were flexed to cover clinics and the outpatient departments were staffed by multidisciplinary teams that worked effectively together.
• Patients attending the department received care and treatment that was evidence based and followed national guidance. Staff had access to policies and guidance.
• Staff provided compassionate care to patients and patients were kept informed and given choices in their care.
• The service was well led with leaders who were visible and approachable.
• Staff spoke positively about working for the service, they felt well supported and spoke about good teamwork.
• Leaders were aware of the issues within the service and there were good governance processes in place.

Updated 13 October 2017

Senior nursing staff had daily responsibility for safe and effective nurse staffing levels and staffing guidelines with clear escalation procedures were in place. Appropriate risk assessments were completed accurately for falls, pressure ulcers, National Early Warning Scores (NEWS), sepsis screening and malnutrition. Staff were aware of escalation procedures.

We saw evidence that Root Cause Analysis (RCA) and investigations of serious incidents were comprehensive and highlighted immediate actions taken, chronology of events, findings, care and delivery problems, root causes, recommendations, lessons learned and action plans. We observed the ‘Five Steps to Safer Surgery’ checklist being used appropriately in theatre and saw completed preoperative checklists and consent documentation in patient’s notes.

Patients had good outcomes as they received effective care and treatment to meet their needs. The trust had made changes to the way services are organised to the provision of surgery, concentrating emergency and complex surgery on the Pinderfields Hospital site. This met national guidance of separating planned and urgent care. A trauma dashboard had been developed to monitor overnight admissions across the division and highlight the need for extra bed capacity.

There were clear governance processes in place to monitor the service provided. A clear responsibility and accountability framework had been established. The division handled 97% of complaints within trust timescales (95% target). Leadership at each level was visible, staff had confidence in the leadership and staff and managers were passionate about providing a high quality service for patients with a continual drive to improve the delivery of care.

However:

Medical staff did not meet the trust target for mandatory core training completion, this included safeguarding. Across the division, NEWS audits (March 2017) showed that 59% of observations were recorded which were worse than the 67% compliance rate in the previous audit.

There were 108 medication incidents recorded between March 2016 and February 2017 across the surgical division.

Between February 2016 and January 2017 the trust’s referral to treatment time (RTT) for admitted pathways for surgical services had been worse than the England overall performance.

Updated 7 December 2018

Our overall rating of the service was requires improvement because:

• The unit did not always have enough staff with the right qualifications, skills, experience and training to keep patients safe from avoidable harm. The unit manager was not able to match staffing levels to patient need and was not able to increase staffing when care demands rose.
• Risks within the unit were not clearly identified and we did not see evidence of these being escalated where appropriate.
• We did not receive assurance of performance in clinical audits. There was limited patient outcome data and audits conducted in the department.
• Although there was a streaming and triage process in place in the unit; a clinical review of patients by clinical staff was not always undertaken in a timely way.
• Rooms used for assessment of patients with mental health conditions were not ligature free and did not have access to equipment to summon for help if required.
• Resuscitation equipment was not safely managed. Some equipment was out of date.
• Paper copies of patient group directions (PGD) used in the department for various medicines including ibuprofen, paracetamol, cocodamol etc. had not been reviewed since 2014 and had not been signed by all staff working in the unit. As such medicines were being administered to patients without prescriptions.
• Information we reviewed from the trust showed that the service did not have robust governance procedures in relation to monitoring of the private GP contract, the service did not hold the information on the current level of DBS compliance or training compliance for the GP.
• The division had moved with pace to implement the UTC. However, we did not receive assurance regarding patient outcomes.

However:

• The unit was visibly clean and well organised. Equipment was in good working order and safety tested.
• Staff were caring, compassionate and treated patients with dignity and respect. We spoke with three patients and one relative who were satisfied with the care and treatment they received.
• We were supplied with performance reports for the unit. The reports showed that the UTC performed well against the overall emergency care standard.
• There was good leadership at unit level. Staff we spoke to were aware of the changes in the unit and had been involved in the consultation and planning process.