Durham Diagnostics and Treatment Centre

Updated 10 June 2020

Durham Diagnostics and Treatment Centre (DDTC) opened in 2018 to provide a specialist hub for patients in the Durham area requiring surgical services in urology and oral and maxillofacial surgery. Renal, outpatients and some ophthalmology services were also provided within the location. Surgical services were provided under a consultant led day case service.

There was one operating theatre on site, this was currently being used for urology and oral and maxillofacial surgery only. There were no overnight inpatient beds. Pre-assessment facilities were available onsite.

Outpatient clinics were provided in suites of rooms on the ground floor. There was a range of consultation, examination and treatment rooms and some minor procedures were carried out by specialty medical and nursing staff. The department had access to an x-ray room which was staffed by radiology staff from the main hospital radiology department. There was an endoscope decontamination suite with separate clean and dirty areas.

We were unable to rate effective and caring within surgery due to lack of activity at the time of inspection.

Updated 10 June 2020

• We rated outpatients as good. We rated surgery as requires improvement.
• The service provided mandatory training in key skills to all staff and made sure everyone completed it. Staff understood how to protect patients from abuse. Staff had training on how to recognise and report abuse and they knew how to apply it. The service controlled infection risk well. They kept equipment and the premises visibly clean. The service had enough staff with the right qualifications, skills, training and experience. The service used systems and processes to safely prescribe, administer, record and store medicines. The service managed patient safety incidents well.
• There was insufficient activity for us to rate effective in surgery at the time of the inspection. In addition, the service did not provide any information to show us how they monitored the effectiveness of surgical care and treatment.
• We do not currently rate effective in outpatients. However, the service provided care and treatment based on national guidance and evidence-based practice. The service made sure staff were competent for their roles. Staff supported patients to make informed decisions about their care and treatment.
• There was insufficient activity for us to rate caring in surgery at the time of the inspection. However, in outpatients we found staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. Staff provided emotional support to patients, families and carers to minimise their distress. They understood patient's personal, cultural and religious needs.
• In outpatients the service planned and provided care in a way that met the needs of local people and the communities served. The service was inclusive and took account of patients’ individual needs and preferences. People could access the service when they needed it and received the right care promptly. It was easy for people to give feedback and raise concerns about care received. In both services waiting times from referral to treatment and arrangements to admit, treat and discharge patients were in line with national standards.
• Leaders understood and managed the priorities and issues the service faced. The service had a vision for what it wanted to achieve and a strategy to turn it into action. Staff felt respected, supported and valued. Leaders operated governance processes. Leaders and teams used systems to manage performance effectively. They identified and escalated relevant risks and issues. The service collected data and analysed it. Leaders and staff engaged with patients, staff and the public to plan and manage services.

However:

• Outpatients was underutilised and had capacity to provide more clinics. At the time of our inspection, it was not clear how the trust intended to proceed to improve this. No formal outpatient service clinical governance meetings had taken place since the trust merger. We were made aware that speciality governance meetings took place. Leaders acknowledged the need to embed the governance systems further across the service.
• In surgery leaders and staff did not always actively engage with patients, staff, equality groups to plan and manage services. Despite there being systems to monitor and manage activity, these were not utilised effectively to make an impact on performance and theatre utilisation.

Updated 10 June 2020

• The service provided mandatory training in key skills to all staff and made sure everyone completed it.
• Staff understood how to protect patients from abuse, staff had training on how to recognise and report abuse, and they knew how to apply it.
• The service controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean.
• The design, maintenance and use of facilities, premises and equipment kept people safe. Staff were trained to use them. Staff managed clinical waste well.
• Staff completed and updated risk assessments and removed or minimised risks. Staff identified and quickly acted upon patients at risk of deterioration.
• The service had enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment.
• Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date, stored securely and easily available to all staff providing care.
• The service used systems and processes to safely prescribe, administer, record and store medicines.
• 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.
• Staff always had access to up-to-date, accurate and comprehensive information on patients’ care and treatment. All staff had access to an electronic records system that they could all update.
• The service provided care and treatment based on national guidance and evidence-based practice.
• Specialty staff monitored the effectiveness of care and treatment.
• The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and development.
• Doctors, nurses and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care.
• Key services were available five days a week with some weekend and evening clinics to support timely patient care.
• Staff gave patients practical support and advice to lead healthier lives.
• Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent. They knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
• Staff provided emotional support to patients, families and carers to minimise their distress. They understood patient's personal, cultural and religious needs.
• Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.
• The service planned and provided care in a way that met the needs of local people and the communities served. It also worked with others in the wider system and local organisations to plan care.
• The service was inclusive and took account of patients’ individual needs and preferences. Staff made reasonable adjustments to help patients access services. They coordinated care with other services and providers.
• People could access the service when they needed it and received the right care promptly. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were in line with national standards.
• It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff.
• Leaders understood and managed the priorities and issues the service faced. Senior leaders were visible and approachable in the service for patients and staff. They supported staff to develop their skills and take on more senior roles.
• The service had a vision for what it wanted to achieve and a strategy to turn it into action.
• Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service promoted and provided opportunities for career development.
• Leaders operated governance processes, throughout the service and with partner organisations. 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 actions to reduce their impact.
• The service collected data and analysed it. Staff could find the data they needed, in easily accessible formats, to understand performance, make decisions and improvements. The information systems were integrated and secure.
• Leaders and staff engaged with patients, staff and the public to plan and manage services.
• 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.

However, we also found:

• Patients told us some appointments were rearranged with short notice and at a different site from their original appointment. Some patients had difficulty travelling long distances to DDTC.
• There was a list of patients overdue a review appointment extending to 14,844 patients across all specialties and sites within the trust.
• Some staff felt senior managers from the theatres directorate could be more engaged, supportive and available to staff.
• Although staff told us they knew DDTC was underused and had capacity to provide more clinics, at the time of our inspection, it was not clear to all staff how the trust intended to proceed to improve utilisation of DDTC.
• Although some staff within the department were not aware of an overall strategy for outpatients they told us the plan for the future was to work more closely as a department across all sites.
• Although clinical governance activities were carried out and the leadership team could describe full details of these activities, no formal outpatient service clinical governance meetings had taken place since the trust merger. We were made aware that speciality governance meetings took place. Leaders acknowledged the need to embed the governance systems further across outpatients and were working to do this starting with the planned governance meetings.

Updated 10 June 2020

• Leaders and teams did not consistently use systems to manage theatre utilisation effectively.
• Leaders and staff did not continually actively engage with patients, staff, equality groups, the public and local organisations to plan and manage services.
• The service did not supply any information on how they monitored surgical site infections, surgical safety checklists.
• Due to the lack of surgical activity we were not able to rate caring or effective. We were unable to observe any care and treatment.

However:

• The trust had enough nursing and support staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Medical and nursing staff attended the unit specifically to deliver the surgical list and care for the patient from admission to discharge.
• Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were in line with national standards.
• 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.
• Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service had an open culture where patients, their families and staff could raise concerns without fear.