- NHS hospital
Darlington Memorial Hospital
All Inspections
23 January to 25 January 2024
During an inspection looking at part of the service
The overall summary rating relates to the hospital location rating, which has improved. However, the ratings below relate to maternity services at that location.
Our rating of maternity services at this location improved. We rated it as requires improvement because:
- The service still did not make sure everyone completed mandatory training and essential skills and drills, although compliance had improved since our last inspection.
- Staff did not always complete environmental and emergency equipment safety checks in accordance with trust policy.
- Although there was now a process for documenting arrival times when women and pregnant people attended triage, and formalised, more timely risk assessments were taking place, the new systems in place within the triage unit were not yet fully embedded.
- The service still did not always provide timely inductions of labour to meet clinical need for women, birthing people, and babies. Although data capture and oversight of delays had improved, systems and processes implemented to improve delays were not yet fully embedded.
- The service still did not always have enough senior, experienced midwives on labour wards. Although we found some improvement in terms of numbers of staff and ongoing recruitment, skill mix remained a concern. Systems and processes implemented since our last inspection, to improve staffing were not yet fully embedded.
- Staff did not ensure all medicines and sterile consumable items, were always stored, managed, and replaced timely, prior to expiry dates, in accordance with trust policy and best practice guidance.
- Staff on wards did not always ensure the controlled drug register was completed in accordance with trust policy.
However:
- Staff understood how to protect women from abuse. They controlled infection risk well. Staff assessed risks to women, acted on them and kept good care records.
- There were now fewer missed opportunities for carrying out screening and for managing results of screening and we saw improved recording and escalation of clinical observations.
- The service now had enough cardiotocograph (CTG) equipment and staff were trained to use it.
- We saw improved incident reporting, timelier actions, and systems were now in place to improve shared learning with staff.
- Maternity service now demonstrated better oversight of audit and identified areas for learning and improvement.
- Leaders and staff had strengthened their engagement with service users, staff, equality groups, and local organisations to plan and manage services.
28 and 29 March 2023
During an inspection looking at part of the service
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 Darlington Memorial Hospital (DMH).
We inspected the maternity services at County Durham and Darlington NHS Foundation Trust 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.
We will publish a report of our overall findings when we have completed the national inspection programme.
Darlington Memorial Hospital is one of four sites for maternity services for the trust. Acute maternity services are also provided at University Hospital of North Durham. Outpatient maternity care is also provided at Bishop Auckland and Shotley Bridge Hospitals.
We carried out a short notice unannounced focused inspection of the maternity services at University Hospital of North Durham and Darlington Memorial Hospital, looking only at the safe and well-led key questions.
The inspection was carried out using a data submission and an on-site inspection where we observed the environment, observed care, conducted interviews with patients and staff, reviewed policies, care records, medicines charts and documentation.
Following the site visits, we conducted interviews with specialist staff and senior leaders and reviewed feedback from women and families about the trust. We ran a poster campaign during our inspection to encourage pregnant women and mothers who had used the service to give us feedback regarding care. We analysed the results to identify themes and trends. Feedback included 2 positive and 6 negative experiences. There were some negative comments about clinical decision making and delayed induction of labour.
The service at Darlington Memorial Hospital comprises of a labour ward with a maternity theatre, induction of labour beds and a recovery room. There are antenatal and postnatal wards. There is a separate pregnancy assessment unit. The service also has maternity services at University Hospital of North Durham and pregnancy assessment units at Bishop Auckland Hospital and Shotley Bridge Hospital which provide services to women and birthing people from across the County Durham area. Antenatal and postnatal clinics are also provided at this location.
The trust carried out 4500 deliveries between April 2021 to March 2022, of which about 3000 were carried out at University Hospital of North Durham and 1500 at Darlington Memorial Hospital.
A higher proportion of mothers were in the second (20%), third (16%) and fourth (17%) most deprived deciles at booking compared to the national averages (12% in the second most deprived, 11% in the third and 11% in the fourth).
A lower proportion of mothers were Asian or Asian British (3%) or Black or Black British (1%) compared to the national averages (14%) and (6%) respectively. More women were White, 86% at the trust compared to 67% nationally.
Our rating of this hospital went down because:
Our rating of the maternity service impacted on the rating for the hospital location overall. As a result ratings for safe and well-led went down to requires improvement and services at Darlington Memorial Hospital are rated as requires improvement overall.
We also inspected the maternity service at University Hospital of North Durham run by County Durham and Darlington NHS Trust.
Following the Care Quality Commission (CQC) inspection of both County Durham Hospital and Darlington Memorial Hospital the CQC issued the Trust with a warning notice on 28/04/2023. This notice is served to the trust under Section 29A of the Health and Social Care Act 2008. Where it identified that the trust is required to make significant improvements.
How we carried out the inspection
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.
02 July to 04 Jul 2019
During a routine inspection
Our rating of services improved. We rated it them as good because:
- We rated safe, effective, caring, responsive and well led as good.
- Urgent and emergency care and surgery core service ratings improved by one rating to good and end of life care improved by two ratings to outstanding.
- At the previous inspection we found that the service did not have enough staff. At this inspection we saw that the service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
- Leaders had the skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff.
- Operating theatres were fully established against the ‘Association for Perioperative Practice’ (AfPP staffing recommendations). This was an improvement since the last inspection.
- The service managed patient safety incidents well. Staff recognised and reported incidents and near misses. Managers investigated incidents and shared lessons learned with the whole team and the wider service. Improvements in practice were effectively embedded with continuous development to support continued awareness and learning surrounding serious incidents and never events.
- End of life care had systems and processes in place to ensure that the needs of local people were considered when planning the service delivery.
- The service had a vision for what it wanted to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community.
However,
- Whilst improvement had been made in terms of access and flow, challenges still remained which impacted on wait times in the department for patients.
- In surgery, mandatory training for nursing and medical staff failed to meet the trust target. In surgery, the targets were met for three of the nine mandatory training modules for which qualified nursing staff were eligible and three of the eleven mandatory training modules were met for which medical staff were eligible.
- In Surgery, medical and nursing staff failed to meet the trust target for safeguarding children training (level 2).
- In Surgery, medical staff failed to meet the trust target for Mental Capacity Act and Deprivation of Liberty Safeguards (level 2).
- Oxygen was not always prescribed or administered in line with national guidance.
- Syringe driver safety checks were not completed in accordance with trust policy (‘Policy for the administration of subcutaneous medication’). We were not assured training in the specific syringe devices used throughout the trust was followed up or monitored at ward level.
12 Sept to 20 Oct 2017
During a routine inspection
Our rating of services stayed the same. We rated it them as requires improvement because:
- We rated safe and well led as requires improvement; effective, caring, and responsive were rated as good.
- Overall, urgent and emergency care, medical care and surgery stayed the same since our last inspection. Maternity services had improved.
- Seven never events had occurred between May and October 2016. The trust took actions to address this. However a further four never events occurred at the trust between November 2016 and May 2017. The trust took further action but despite this two further never events occurred after September 2017.
- The department was having difficulty meeting the four hour target. Between October 2016 and September 2017 the department had only met the monthly 95% four hour target once.
- The hospital did not meet targets for Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards training.
- There were poor levels of overall compliance with mandatory training.
- Staff satisfaction was mixed according the staff survey. Staff did not always feel actively engaged or empowered. Equality and diversity were not consistently promoted and the causes of workforce inequality were not always identified or adequately addressed.
However:
- In most areas nurse staffing had improved.
- Care and treatment of patients requiring non-invasive ventilation (NIV) had improved since the last inspection.
- Staff investigated incidents quickly, and shared lessons learned and changes in practice with staff.
- Wards and department areas were clean and equipment well maintained. Staff followed infection control policies that managers monitored to improve practice.
- Staff provided care and treatment based on national guidance and evidence and used this to develop new policies and procedures.
- Staff cared for patients with compassion, treating them with dignity and respect.
- Patients, families and carers gave positive feedback about their care.
- The hospital escalation policy and procedure guidance was followed during busy times.
7-9 September 2016
During an inspection looking at part of the service
We carried out this inspection 7 – 9 September 2016. This was a focussed unannounced inspection in response to external reviews carried out at the trust looking at serious incidents and concerns around the culture within maternity services. The external reviews were initiated by the trust following heightened scrutiny of maternity services and monitoring of the service internally. We looked at areas within the safe and well-led domains.
Our key findings were as follows:
- There was an ongoing review of governance structures and quality assurance processes. The Trust had identified the need to enhance governance in the service and had appointed a new leadership team who were revising current practice. Actions were agreed with external partners, some having recently been implemented, but were not yet embedded.
- Following work the trust had undertaken with the support of occupational psychologists and the more recent external reviews, there was some improvement in clinical behaviours but there continued to be issues relating to the cohesiveness of certain groups of medical staff. Certain elements of the obstetrics team remained dysfunctional with a lack of clinical engagement and support. The trust was continuing to work with the relevant members of staff and external partners to resolve current issues.
- Assurance processes to ensure guidelines and practice was followed was not clear which led to confusion amongst staff and women. The assessment, compliance and approval of guidelines were included in the governance review.
- Although weekly risk meetings were held to discuss incidents and key message bulletins were produced to inform all staff of lessons learned, some staff felt that these processes could be stronger.
- The completion of the World Health Organisation surgical safety checklist was not meeting trust targets in all except one domain.
- The antenatal clinic relied upon a paper-based logbook to record blood test results. This was a potential risk to patient confidentiality and loss of data.
- There was a lack of space for handover on the delivery suite to take place.
- There was a newly formed senior leadership team in maternity. The team was cohesive and there was a real drive to improve the quality of the service. The team were aware of the challenges and were able to articulate the actions required to take the service forward.
- Staff spoke positively about the leadership team and told us the head of midwifery was supportive and approachable. Plans were in place to strengthen clinical leadership.
- Staff were aware of the process to follow to report incidents.
- Recommended midwifery to birth ratios and consultant presence on the labour ward were met
- Results from the NHS safety thermometer showed that women had received harm free care over the last 12 months.
- Records relating to women’s care were detailed enough to identify individual needs and to inform staff of any risk and how they were to be managed. There were appropriate escalation procedures for women requiring an emergency response. The early warning score for assessing risks had improved.
- The service had an action plan in response to the Morecambe Bay Investigation recommendations. The majority of these were completed with a few still partially completed due to ongoing re-organisation of the trust.
However, there were also areas of poor practice where the trust needs to make improvements.
Importantly, the trust must:
- Ensure that action continues to be taken to address poor behaviours and performance that is inconsistent with vision and values.
- Ensure that the recent improvements to the governance framework are fully embedded to support the delivery of high quality care, including assessment, approval and compliance of guidelines.
- Improve compliance against the WHO surgical safety checklist.
In addition the trust should:
- Continue to implement the recommendations identified in the review of midwifery staffing to ensure the appropriate deployment of staff in the correct areas.
- Review the process for recording of blood test results in the antenatal clinic.
- Improve the environment for handover on delivery suite to ensure it is fit for purpose.
Professor Sir Mike Richards
Chief Inspector of Hospitals
5 and 6 February 2015
During a routine inspection
Darlington Memorial was one of two acute hospitals forming County Durham and Darlington NHS Foundation Trust. This trust was one of the largest hospital and community healthcare providers in the NHS. It served around 600,000 people across County Durham, Darlington, North Yorkshire, the Tees Valley and South Tyneside services including health and wellbeing services, community based services and acute and planned hospital services.
In total, the trust had 1,331 beds across two acute hospitals and the community, and employed around 7555 staff. Darlington Memorial Hospital had 410 beds.
Darlington Memorial Hospital provided medical, surgical, critical care and maternity services, and services for children and young people, for people in County Durham, Darlington, North Yorkshire, the Tees Valley and South Tyneside. The hospital also provided emergency and urgent care (A&E) and outpatient services.
We inspected Darlington Memorial Hospital as part of the comprehensive inspection of County Durham and Darlington NHS Foundation Trust, which included this hospital, University Hospital of North Durham and the trust's community services. We inspected Darlington Memorial Hospital on 5 and 6 February 2015.
Overall, we rated Darlington Memorial as ‘requires improvement’. We rated it ‘good’ for being caring, effective and responsive, but it required improvement in providing safe and well-led care.
We rated medical care, surgical services, critical care, services for children and young people, maternity and gynaecology, and outpatient and diagnostic imaging services as ‘good’, with A&E, and end of life care as ‘requires improvement’.
Our key findings were as follows:
- Arrangements were in place to manage and monitor the prevention and control of infection, with a dedicated team to support staff and ensure policies and procedures were implemented. We found that all areas we visited were clean. Rates of Methicillin-resistant staphylococcus aureus (MRSA) and Clostridium difficile (C. difficile) were within an acceptable range for the size of the trust.
- Patients were able to access suitable nutrition and hydration, including special diets, and they reported that, on the whole, they were content with the quality and quantity of food.
- There were processes for implementing and monitoring the use of evidence-based guidelines and standards to meet patients’ care needs.
- There was effective communication and collaboration between multidisciplinary teams.
- There were staff shortages, particularly on some medical wards, mainly due to vacancies for nursing and medical staff. The trust was actively recruiting following a review of nursing establishments. In the meantime, bank, agency and locum staff were being used to fill any deficits in staff numbers, and staff were working flexibly, including working overtime.
- Mortality rates were within acceptable limits for a hospital of this size.
There were areas of poor practice where the trust needs to make improvements.
Importantly, the trust must:
- Review the achievements and actions taken to address the targets set nationally within A&E.
- Review consultant levels against CEM guidance.
- Ensure that the A&E department meets cleanliness, infection control and hygiene standards, particularly relating to high and low level dust, blood stains, equipment and floors.
- Ensure that the area outside the accident and emergency decontamination facility is free from dirt, litter and debris.
- Be able to demonstrate that all toys are cleaned properly to reduce the risk of infection within the A&E department.
- Ensure that staff regularly check all resuscitation drugs and equipment within the A&E department.
- Ensure medicine fridges are locked and temperatures are checked regularly within the A&E department; this will include recording maximum and minimum fridge temperatures.
- Ensure that medical gases are stored in a secure facility within the A&E department.
- Ensure that there are sufficient numbers of suitably skilled, qualified and experienced staff on medical wards, in line with best practice and national guidance; taking into account patients’ dependency levels, particularly where patients are receiving non-invasive ventilation (NIV) and require Level 2 intervention. Also, ensure that actual staffing levels meet planned staffing levels.
- Ensure that patients are placed on the most appropriate ward to meet their needs, including a review of the care of patients requiring NIV to ensure that they are admitted to a suitable ward with appropriately skilled and experienced staff, in line with best practice guidance.
- Ensure that patient records, including those for patients awaiting discharge, are maintained and up to date, are patient-centred, contain the relevant information about their treatment and care, and serve to eliminate unnecessary delays.
- Ensure that staff are conversant with the syringe driver policy and carrying out/recording syringe driver checks in line with this policy.
- Add audits of syringe driver administration safety checks to the annual end of life audit programme.
- Ensure that medical staff record mental capacity assessments for patients who are unable to participate in decisions about do not attempt cardiopulmonary resuscitation (DNACPR).
- Ensure that audits of mental capacity assessments are incorporated into audits of DNACPR forms.
- Ensure robust implementation of structural changes to the specialist palliative care team to support the development of the end of life care services.
- Ensure that data is available to identify and demonstrate the effectiveness of the end of life service.
In addition the trust should:
- Continue to review College of Emergency Medicine (CEM) audit data to ensure patient outcomes are met.
- Direct medical staff to check resuscitation equipment and drugs before the start of their shift even when nursing staff have completed the checks within the A&E department.
- Extend its safeguarding assessment processes and consider child sexual exploitation for all age appropriate children.
- Encourage all relevant staff within the A&E department to attend violence and aggression training.
- Ensure that patients have their medicines reconciled in accordance with trust targets.
- Review access to patient information in languages other than English.
- Review dedicated management time allocated to ward managers.
- Review the patient flow of higher dependency patients through the hospital to ensure care is given in the most appropriate setting.
- Consider ways of improving engagement between staff and managers within the care closer to home directorate, with a view to achieving a joined up approach within maternity and gynaecology services. Also, consider ways of improving responsiveness and efficiency in respect to service level decisions within this service.
- Consider ways in which it can identify the required standards within the maternity service dashboard.
- Consider timelines for review and achievement within the maternity and gynaecology services clinical and quality strategy for 2014–16 .
- Consider ways of developing a coherent plan for joint working on improvements to maternity and gynaecology services.
- Consider ways for improving timely and responsive human resource management processes, including personnel issues that affect service delivery in maternity and gynaecology services.
- Ensure that the paediatric high dependency room has specific standard operating procedures or protocols available to guide the suitably trained staff required to deliver high dependency care.
- Ensure that advanced paediatric nurse practitioners have a set of standard operating procedures available to guide their practice and care.
- Formally nominate an executive or non-executive director to represent children at board level. This should be separate from the safeguarding children executive lead role.
- Review access and security arrangements to theatres and recovery areas.
- Review the servicing of all equipment within the theatre and recovery areas to ensure maintenance and service arrangements are within required timescales.
- Improve the systems in place to remove out of date stock or stock no longer used from store cupboards in the outpatient department.
- Ensure that actions against the ‘National care of the dying’ audit and other identified actions to develop the service are carried out in a planned and timely way with continued evaluation.
- Ensure that systems support ways of identifying when incidents and complaints relate to end of life care so that specialist input can be provided and recorded in terms of investigation and learning.
Professor Sir Mike Richards
Chief Inspector of Hospitals
22, 23, 24 October 2013
During a routine inspection
We visited A&E and wards 14, 21, 31, 33, 34, 44, 51 and 52. We spoke with 50 patients and / or relatives during the inspection; 30 in A&E and 20 on the hospital wards and reviewed the records of more than 20 patients. We spoke with ward sisters, nurses, healthcare assistants, catering and domestic cleaning staff. We spoke at length with the trust's lead managers involved in infection prevention and control. This included the Director of Infection Prevention and Control (DIPC) and the infection prevention and control lead nurse. We also spoke with senior staff within facilities, estates, endoscopy, sterile services, theatres, catering, microbiology and pharmacy.
We found the A&E department appeared calm and well-ordered on the days we were there. Overall we observed patients were treated with dignity and respect by the nursing and medical staff on the days of inspection. This was reflected in the comments we received from patients, both within A&E and from patients who had been admitted onto the wards.
Comments from the patients we spoke with in A&E about how well they'd been kept informed were mixed. Some patients within the minor injuries streams said they'd been kept well informed about how their treatment was progressing, whereas others said they weren't aware of the different systems operating within the department. Comments included 'We have had triage sorted out, been seen and just been discharged'.We have had plenty of information and understand what is wrong. We have been treated with respect; the whole experience has been very good' and 'Not been informed by anyone from the department as to what is happening.' Comments from patients within the major injuries stream were largely positive and included 'They (the staff) are polite and very pleasant' and 'My experience here has been marvellous.'
We found patients had their health care needs assessed and received appropriate treatment to meet them; both within A&E and on the hospital wards. Patients told us staff were friendly and helpful. Comments included 'I rang the buzzer during the night as the man opposite was confused and trying to get out of bed. They (the staff) came directly no problem', 'I think the staff are well trained to do their job' and 'I am happy with the care I have received.'
The overall structure and governance in relation to infection prevention and control was judged to be positive. We found there were effective systems in place to reduce the risk and spread of infection. We saw clinical and patient areas were kept clean. We saw domestic staff were cleaning across all areas during our inspection. We saw staff regularly washed their hands and used disinfecting hand cleaner. We saw dispensers of hand cleaner at the entrance to the wards and at the entrances to bays and side rooms. We saw people who entered the wards for treatment or to visit people were encouraged to use these cleaners to help prevent the spread of germs.
7 November 2012
During a routine inspection
Patients care records were written in a clear and easy to understand way. The assessments and care plans contained within each person's record detailed how staff should support each individual in the person's preferred way.
The provider had sufficient numbers of staff with the right competencies, knowledge, skills and experience to meet the needs of patients.
The provider had clear procedures in place, which were followed in practice, for receiving, handling and responding to complaints.