South Tees Hospitals NHS Foundation Trust

Updated 24 May 2023

We plan our next inspections based on everything we know about services, including whether they appear to be getting better or worse. Each report explains the reason for the inspection.

This report describes our judgement of the quality of care provided by this trust. We base it on a combination of what we found when we inspected and other information available to us. It includes information given to us from staff at the trust, people who use the service, the public and other organisations.

We rated well-led (leadership) from our inspection of trust management, taking into account what we found about leadership in individual services. We rated other key questions by combining the service ratings and using our professional judgement.

Overall summary

South Tees NHS Foundation Trust provides acute and community health services to a population of around 1.5 million people living in Middlesbrough, Northallerton and surrounding areas. There are two main hospital sites, The James Cook University Hospital, a regional major trauma centre and tertiary hospital offering a wide range of specialist services, and Friarage Hospital, a busy acute hospital serving a mainly rural population of 135,000. The trust also operates from several primary care hospitals and community locations.

The trust provides urgent and emergency care, medical care, surgery, critical care, maternity, gynaecology, children and young people’s services, end of life and outpatient services alongside a range of community services delivered in people’s homes and local community settings.

We carried out this unannounced inspection of four of the acute services provided by this trust to check that the trust had made improvements since our last inspection in February 2022. We looked at all key lines of enquiry in the core services we inspected. We checked that the trust had taken action to comply with the Warning Notice we served under Section 29A of the Health and Social Care Act following the last inspection which told the trust to make significant improvements in the quality of healthcare provided.

We inspected urgent and emergency care and critical care services at The James Cook University Hospital, and medical wards (including services for older people) and surgery at both The James Cook University Hospital and Friarage Hospital. We also inspected the well-led key question for the trust overall.

We did not inspect end of life care, maternity, gynaecology, services for children and young people, outpatients, diagnostics, or community services at this trust during this inspection. We are monitoring the progress of improvements to services and will re-inspect them as appropriate.

Our rating of services ​improved​. We rated them as ​good​ because:

Overall, we rated safe, effective, caring, responsive and well led as good. The trust had made significant improvement since the last CQC inspection and throughout the pandemic, particularly in critical care.

We rated emergency and urgent care services as good. We rated safe, effective, caring and well-led as good. We rated responsive as requires improvement.

We rated medical care as requires improvement. We rated safe and effective as requires improvement and rated caring responsive and well-led as good at both hospitals.

We rated surgery as good overall at both hospital sites. We rated safe, effective, caring, responsive and well-led as good at both hospital sites.

We rated critical care as good overall and in all domains. The safe domain had improved significantly since our last inspection.

In rating the trust, we took into account the current ratings of the five services we did not inspect at this time.

What we found

Leaders had the skills and abilities to run the service. They understood the priorities and issues that the trust faced and had plans in place for these. They were visible and approachable in the trust and were well known to staff. They supported staff to develop their skills and take on more senior roles.

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 and provided opportunities for career development. The service had an open culture where patients, their families and staff could raise concerns without fear.

Leaders operated largely effective governance processes, throughout the service and with partner organisations, although there was more to do to strengthen this. Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service.

Leaders and teams used systems to manage performance effectively. They identified and escalated relevant risks and issues and identified risks had actions taken to reduce their impact. They had plans to cope with unexpected events. Staff contributed to decision-making to help avoid financial pressures compromising the quality of care.

Leaders and staff actively and openly engaged with patients and those closest to them, staff and the public to plan and manage services. They acknowledged that wider engagement with equality groups, the public and local organisations was needed. They collaborated with partner organisations to help improve services for patients.

All staff were committed to continually learning and improving services. They had a good understanding of quality improvement methods and the skills to use them. Leaders encouraged innovation and participation in research.

However:

In medical care, there was not always enough nursing staff to care for patients and keep them safe.

In the emergency and urgent care service, there was no clear flagging system for risks associated with patients experiencing mental health crisis and people could not always access the service when they needed it and could experience long delays waiting for treatment.

The trust faced ongoing challenges with access and flow in the emergency department, which meant that they could not ensure people were able to access the department and receive the right care promptly. Despite these pressures, staff worked hard to keep patients safe.

Whilst the trust provided mandatory training in key skills, medical staff compliance was below the trust target.

Substances hazardous to health were not always stored securely in areas where there were vulnerable people.

How we carried out the inspection

The team that carried out the inspection included two inspection managers, 11 inspectors, one assistant inspector and an inspection planner. In addition, there was an executive reviewer plus three specialist advisors experienced in executive leadership of NHS trusts, including the CQC national professional advisor for ambulance services. The inspection team was overseen by Sarah Dronsfield, Deputy Director of Operations.

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

Updated 2 July 2019

Updated 2 July 2019

Updated 10 June 2015

Community health services for children, young people and families at this trust had well-established systems for incident reporting and analysis using the Datix healthcare software system. Staff told us, and we saw evidence in team meeting notes, that incidents were analysed at a local level and learning was discussed within teams. Staff understood their responsibilities to raise concerns, and report incidents and near misses.

There were effective arrangements in place to manage and monitor the prevention and control of infection, and safeguard people from abuse.

Outcome monitoring for children, young people and their families using the service varied. Staff assessed and delivered treatment in line with current legislation, standards and recognised evidence-based guidance. There was evidence that performance was reviewed and actions were in place to improve outcomes.

The service followed local policies and national guidance to achieve the best outcomes for young people using the service. The service was actively engaged with regional and national networks. Staff were trained and competent to give specialist advice and treatments.

Health promotion work and advice was given to young people to assist them in making safe choices and keeping themselves safe.

Children, young people and their carers said they were treated with compassion, dignity and respect and they were involved in care and treatment decisions. Information was provided to help children and young people understand the care available to them.

Children, young people and their carers were treated with kindness and respect, ensuring that confidentiality was maintained.

Children, young people and their carers felt included in decision-making. They were listened to and able to express their opinions, which they felt were taken into account.

People were able to access care and treatment close to home in local clinics and treatment centres.

Services were flexible and worked across professional and organisational boundaries.

There were systems within all teams for learning from experiences, concerns and complaints.

Staff knew the vision, strategy and objectives for the trust. There were service and team meetings which included items on risk, safety and quality. There were systems for recording and managing risks; managers were approachable and visible.

Staff and teams worked collaboratively to deliver quality care. The services sought out and acted on feedback from patients.

Updated 28 October 2016

At our last inspection in December 2014, we identified concerns around staff not receiving appropriate training and support through the completion of mandatory training, particularly the relevant level of safeguarding training. Additionally we found that patient records were not always accurate and complete.

During this inspection risks to patients were assessed and managed to ensure safe delivery of care.

Staff responded appropriately to safeguarding concerns. There were systems and processes for the monitoring of medicines and infection control.

Staffing levels were adequate to meet patient demands; staffing was monitored and reviewed daily.

Staff had received appropriate training and support through the completion of mandatory training, so that they were working to the latest up to date guidance and practices, with appropriate records maintained.

Staff understood their responsibilities to raise concerns and to record safety incidents. There were systems for reporting and learning from incidents.

Opportunities were available to learn from investigations and the service was aware of areas in which it needed to improve.

Updated 10 June 2015

Staff reported incidents and processes were in place to ensure that lessons were learned.

Trust-wide, evidence-based guidance was available on the trust’s intranet; however, there was limited information on evidence-based care and treatment specific to urgent care. We saw hard copies of policies and standard operating procedures for the urgent care centres that had not been reviewed for several years. We were informed that guidance was being updated, but was not yet available.

There was limited audit undertaken to monitor quality and patients’ outcomes.

We were informed that 64% of staff were compliant with mandatory training. We saw that staff had been booked to attend update training.

Staff had received training in relation to urgent care and were supported to develop their skills further. The emergency care practitioners received informal supervision. There were no formal clinical supervision sessions held with staff, including those working on their own.

Appropriate systems ensured that staff were made aware of safeguarding concerns and that information was shared with other professionals. Medicines and equipment were managed appropriately.

We saw that patients and their relatives were treated with dignity and respect. Information about who was suitable to be seen at urgent care centres was displayed on site and on the trust’s website.

Patients at all centres were seen within four hours.

The management and leadership of the urgent care centres had moved to the trauma and theatres clinical centre as part of the trust’s reorganisation in April 2014. There were plans to amalgamate the three urgent care centres to one location at Redcar Primary Care Hospital from April 2015. The intention was to develop the service once on one site, however the current focus was on amalgamating the service.

The governance and risk management of the urgent care centres was managed through the trust’s trauma and theatres clinical centre. There was limited management information or quality review undertaken to enable the leadership to fully understand and develop the service.

Updated 10 June 2015

The community specialist palliative care service is part of an integrated service working together with the hospital service provided at the James Cook University Hospital as part of the South Tees Hospitals NHS Foundation Trust.

We found the community specialist palliative care teams provided a safe, high-quality service for people with a life-limiting illness or at the end of life.

The service followed evidence-based guidelines which had been developed by the Specialist Palliative Care Multidisciplinary Team (SPCMDT) and the North of England Cancer Network. The guidelines incorporated the latest guidance from the National Institute for Health and Care Excellence (NICE) and other professional organisations.

There were effective arrangements in place for managing people’s pain and the service had made improvements, for example, monitoring people’s hydration and nutrition.

Staff were competent and well-qualified to meet people’s needs. All staff had completed advanced communications skills training, were able to support people’s psychological needs and provide access to services which specialised in helping people cope with the psychological aspects of their condition.

The community specialised palliative teams had developed good working relationships with GP practices, community nurses and nursing homes. In addition to caring for people, staff provided palliative care training for other healthcare professionals.

Throughout our visit we observed that the service was well-led. Staff we spoke with were clear about the development priorities for the service. They told us they felt involved in shaping the future direction of the service and were encouraged to contribute ideas for service development and innovation.