All inspections: South Tyneside District Hospital

Community & mental health inspection reports for South Tyneside District Hospital can be found at South Tyneside NHS Foundation Trust.

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Our rating of services stayed the same. We rated it them as requires improvement because:

Although staff were aware of incident reporting procedures, they did not always report all incidents. Some staff expressed concerns about lack of reporting because of lack of feedback or perceived action.
Compliance with the World Health Organisation (WHO) surgical safety checklist was variable. We also found some concerns in relation to medicine fridges in surgical services.
There was low compliance in some mandatory training modules in all the services we inspected.
Some appraisal completion rates were below the trust’s target of 90%. In surgery completion rates were worse than the previous year and particularly low in theatres at 44%. We were not aware of any plans to address this.
We found that some patient pathways in the medicine core service were out-of-date and did not have any references to nationally-recognised, evidence-based, best-practice guidance.
The critical care unit lacked ITU-specific clinical guidelines and staff did not consistently monitor the effectiveness of care and treatment through continuous local and national audits.
We found low compliance in the completion of the risk of malnutrition screening tools.
We did not see individualised, patient-centred plans of care, and in some areas we raised concern about the security of care records, although, following our inspection we gained assurance that the trust was taking action to address record security.
There was a lack of seven-day consultant cover on most medical and elderly-care wards.
We saw limited information about how to make a complaint displayed throughout the hospital. Patient information leaflets were not readily available.
We saw that some risks in the medicine core service had remained on the risk register as moderate or high for more than three years. Some risks in relation to patient records had not been recognised prior to our inspection
There had been some improvement with regards to the culture in theatre. Processes and trust guidance was being followed more consistently to manage issues. However we were still provided with examples of inappropriate behaviour and not all staff felt able to report this.
Although the surgical services directorate had a governance structure, there were no local governance arrangements within critical care and communication was informal.
The ward manager of the surgical centre inpatient unit did not have dedicated non-clinical time to fulfil leadership and management responsibilities. This was evidenced with gaps in monthly audit data collection.
The critical care ward manager did not have dedicated non-clinical time to fulfil leadership and management responsibilities. This affected their ability to maintain a robust oversight of incidents and the overall effectiveness of the unit.

However:

All areas we visited were predominantly clean and well-maintained.
Staff provided compassionate care to patients and respected patient privacy and dignity. Patients we spoke with were positive about the service, their relatives told us that they were involved in planning their care and that communication with staff was good.
Services were planned to meet the needs of local people and referral-to-treatment times were better than the England average. The number of bed moves at night and the numbers of medical patients cared for on surgical wards showed an improving picture.
Issues from the previous inspection in surgery had been significantly improved with regards to patients being cared for in recovery and the impact of medical boarders on surgical wards. Referral to treatment times and cancelled operations were better than England averages. We found patient care to be individualised.
Performance indicators for the emergency department were mostly positive, and the trust had achieved the 95% four hour standard for the previous seven months.
Staff were aware of the trust’s vision and values, their morale was generally good and they told us they were proud to work at the trust.

We previously carried out a focussed inspection at South Tyneside District Hospital in July 2016 to review processes, procedures, and practices for safeguarding children and young people. We looked at areas within the safe and well-led domains. Following our visit, we issued a warning notice because:

The trust’s safeguarding children processes, procedures and practices did not support the identification and protection of children who may be at risk.
There was insufficient management oversight and governance of safeguarding children and young people.

We carried out a focussed follow-up inspection on 11 and 12 July 2017 to review the action taken by the trust in response to the warning notice. We did not rate the service.

Our key findings were as follows:

The trust had a good understanding of its strengths and areas for development in relation to safeguarding children and young people. It had developed a robust action plan, which managers frequently reviewed and there was significant senior management oversight of the whole process.
The trust had reviewed its systems to ensure managers had a more robust oversight of training. Compliance levels for safeguarding children training had improved since our last visit.
Governance arrangements at senior level and at the frontline in the adult and paediatric emergency departments were sufficiently robust to identify sub-optimal or poor practice quickly, enabling managers to address this promptly with individual practitioners and staff groups.
The trust had strengthened its safeguarding team by appointing an assistant director safeguarding, a dedicated named nurse safeguarding children for acute services and a safeguarding children advisor, who was based in South Tyneside District Hospital.
Safeguarding children was a standard agenda item at departmental meetings and the director of nursing chaired monthly safeguarding assurance group meetings, the membership of which included key leads from across all services.
The trust had revised the paperwork in the paediatric and adult emergency departments. The medical safeguarding children proforma was also compliant with the recommendations from the Royal College of Paediatrics and Child Health.
The safeguarding children advisor reviewed all attendances of children and young people under the age of 18. The trust had also improved its recording and monitoring of children who had previously attended the emergency department.
Staff spoke positively about the changes the trust had implemented since our last visit. They felt these changes had contributed to a shift in the culture to ensure safeguarding children was everyone’s responsibility. Although some cultural challenges remained, it was evident staff and senior managers would continue to work collaboratively to ensure children and young people were safe and protected from risk of harm.

We also identified areas where the trust needed to make improvements. Importantly, the trust should:

Continue to take appropriate action to mitigate the risk in relation to the named doctor provision at South Tyneside District Hospital.
Continue to ensure effective peer review meetings are held every 4-6 weeks, with a rotating chairperson. The minutes should include evidence of debate and critical analysis as outlined in the RCPCH intercollegiate document.
Continue to embed good child safeguarding practice and exercise professional curiosity. This includes effective risk assessment and the completion of safeguarding templates/tools.

Professor Edward Baker

Chief Inspector of Hospitals

We carried out a focussed inspection at South Tyneside District Hospital on 27 and 28 July 2016 to review processes, procedures and practices for safeguarding children and young people. We looked at areas within the safe and well-led domains.

Our key findings were as follows:

Staff understood their responsibilities for safeguarding children and young people. However, the trust safeguarding children processes, procedures and practices did not adequately support the identification and protection of children and young people who may be at risk.
Limitations with the patient recording system in the emergency department meant clinical managers did not have an effective means of gathering data for an overview of the cohort of hidden children linked to adult’s attending the emergency department for treatment. As a result, there was limited oversight and accountability to the Executive Management Team and Trust Board.
There was a lack of information included in the emergency department records to determine triggers about existing children in the household, self-harming behaviour or exploration of a child or young person’s social circumstances.
There was limited management oversight and governance of safeguarding children and young people. There was no formally established supervision or effective peer review process.
Training systems did not provide accurate recording and identification of healthcare staff compliance with safeguarding training across the trust.

The trust safeguarding children policy stated all referrals should be copied to the safeguarding team for oversight and follow- up however we found this was not adhered to consistently.
There was some learning and changes made from a serious case review in maternity.
There was insufficient audit activity to monitor the quality and effectiveness of safeguarding processes against current national guidelines and standards.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

Ensure that formal supervision processes for safeguarding children are in place in maternity, paediatrics and the emergency department.
Ensure that formal peer review processes are in place.
Ensure that the training data is accurate so that the trust has oversight of safeguarding children’s training levels by staff group.
Ensure that referral processes are consistent with trust policy.
Ensure that records used for safeguarding children contain sufficient information to determine triggers about existing children in the household, self-harming behaviours and social circumstances.
Ensure that documentation meets the requirements recommended by the Royal College of Paediatrics and Child Health.
Ensure processes are in place for attendees under 18 to be reviewed to ensure all vulnerabilities and safeguarding risks are identified.
Ensure there is sufficient audit activity to monitor the quality and effectiveness of safeguarding processes against current national guidelines and quality standards.
Review the culture in the paediatric department and ensure that staff accountability, roles and responsibilities for safeguarding children are clear.

Professor Sir Mike Richards

Chief Inspector of Hospitals

South Tyneside District Hospital provides acute services for South Tyneside NHS Foundation Trust.

The trust gained foundation status in January 2005. From the 1st July 2011, community health services in Gateshead, South Tyneside and Sunderland transferred to South Tyneside NHS Foundation Trust from NHS South of Tyne and Wear as part of the Government’s Transforming Community Services programme. The trust has a workforce of approximately 5000 staff and serves a population of around 154,000 in South Tyneside, 275,700 in Sunderland and 191,000 in Gateshead. South Tyneside District Hospital provided medical services, surgical services, critical care services, maternity services, and children and young people’s services and has 321 beds.

We inspected South Tyneside District Hospital as part of the comprehensive inspection of South Tyneside NHS Foundation Trust, which included this hospital and community services on 5 to 8 May and 3 June 2015.

Overall, we rated South Tyneside District Hospital as ‘requires improvement’. We rated it ‘good’ for being caring, but it required improvement in providing safe, effective, responsive and well-led care.

We rated maternity and gynaecology, end of life care and outpatient and diagnostic imaging services as ‘good’, with emergency & urgent care, medical care, surgery, services for children and young people and critical care as ‘requires improvement’.

Our key findings were as follows:

Across the acute hospital arrangements were in place to manage and monitor the prevention and control of infection. There was a dedicated infection control team to support staff and ensure policies and procedures were implemented and adhered to. We found that the areas we visited were clean. Infection rates for Methicillin Resistant Staphylococcus Aureus (MRSA) and Clostridium Difficile (C Difficile) were within an acceptable range for this size of 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 staffing shortages in some areas across both nursing and medical professions with some wards unable to meet the safer staffing requirements. The trust used agency nurses and locum doctors to address the staffing requirements.
There were processes for implementing and monitoring the use of evidence based guidelines and standards to meet the needs of differing patient groups across both the hospital and community services.
There were processes in place from ward and department level through to Board level for the reporting of incidents.
There were long waits in the Emergency Department through the winter period with patients being cared for in the department. It was noted that patients were placed on a bed after being in the department for six hours.
There was on occasion a lack of critical care capacity which resulted in patients being cared for in the theatre recovery unit rather than in the intensive care unit.
Governance processes were not fully developed or embedded across the divisions.
The staff engagement was set out in the overarching trust strategy and we saw examples of staff engagement such as team brief and the Chief Executive ‘cheer up Friday’ email message.
There was a clear strategic development plan which included both community and hospital services.
There were concerns regarding leadership of some services.

We saw several areas of outstanding practice including:

The children’s diabetic team used a computer system that allowed uploading of information from glucose meters, insulin pumps, and mobile apps. The system consolidated and presented the information in reports which allowed the clinicians to see a more accurate picture of the patient’s health over a period of time.
The staff from the Endoscopy Unit won the 2015 ‘Study Team of the Year’ category awarded by the National Institute for Health Research North East and North Cumbria Clinical Research Network.
The Endoscopy Unit had participated in an international programme ‘Endo-live’ where live investigations were carried out and transmitted via satellite to conferences. The event in 2014 was opened by a professor from the endoscopy unit at South Tyneside District Hospital.
Ward 19 had received a quality mark in 2014 from the Royal College of Psychiatrists as a result of positive work in the delivery of good quality, essential care for older people.
The IT department is working collaboratively with the community IT team to ensure both the acute and community electronic patient systems will be compatible.
Maternity services used a telehealth system (the delivery of health information using telecommunications technology). This system enabled women to monitor their blood glucose levels and blood pressure in their own homes, avoiding unnecessary visits to the clinic.
A new form of renal replacement therapy which improved outcomes for patients with renal failure and meant that they could be stabilised prior to transfer to a hospital with a renal service (South Tyneside does not have a renal service).

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

Review compliance with mandatory training and in particular training in safeguarding, medical device management, medicines management and Mental Capacity Act and Deprivation of Liberty Safeguards.
Ensure that medical staff receive mandatory training including on fire prevention and child and adult safeguarding.
Ensure all necessary patient risk assessments for example, venous thromboembolism (VTE) and early warning scores for deteriorating patients are completed and recorded appropriately.
Ensure assurance processes are in place to confirm the five steps to safer surgery (part of the WHO surgical safety checklist) is being consistently completed.
Review the policy, processes, procedures, training, and support arrangements for the safe care and treatment of medical ‘boarders’ within surgical wards and the impact on services.
Review the arrangements for the provision of a care pathway and formal medical rota for the management of patients with gastrointestinal bleeds.
Review how the flow of patients is managed through the emergency department (ED) and ensure that there is a documented escalation plan that is implemented when required to deal with patients waiting for more than four hours for transfer to a ward. This should include action to avoid patients staying in ED for longer than 12 hours.
Review the quality of record keeping in the emergency department to ensure that records accurately reflect the standard of care provided including risk assessments, nutrition and hydration and provision of nursing care.
Ensure that when patients complain about their care, there is an effective process in place for staff to receive feedback and learning.
Conduct a full environmental risk assessment for the Intensive Therapy / High Dependency Unit (ITU) and take action to mitigate the risks posed by lack of storage space.
Develop and implement an escalation plan approved by the operating theatre and critical care nursing and clinical leads that ensures that appropriate support systems are available on a timely basis if critical care patients are nursed in the recovery room
Ensure that all theatre staff caring for Level 2 and Level 3 ITU patients have received the appropriate training and that training records are retained.
Implement dedicated pharmacy support for ITU.
Ensure appropriate staffing on all children’s inpatient areas particularly the special care baby unit.
Ensure that all medical devices receive portable appliance testing as required.
Ensure that COSHH risk assessments are completed for all areas storing substances hazardous to health to ensure that these are stored securely.
Ensure that effective control measures are in place to monitor exposure levels of nitrous oxide and the checking of ventilation and scavenging systems on the delivery suite.
Ensure resuscitation equipment checks are carried out regularly and consistently across all areas of the department.
Ensure that all employees receive an annual appraisal.
Ensure that there is a formal strategy for maternity and gynaecology services which sets out how the service is to achieve its priorities and that staff understand their role in achieving service objectives

In addition the trust should:

Review the concerns raised by staff of bullying and harassment and the difficult working environment within theatres.
Review the concerns raised by medical staff from the trauma and orthopaedics department about individual bullying and harassment leading to concerns about patient care.
Develop a strategy to support dedicated educational support for critical care staff.
Develop a formal process for safeguarding supervision in maternity services.
Develop processes to ensure that there is an audit trail for submission of HSA4 (abortion notification) forms to the Department of Health.
Consider improving facilities for children waiting within the main outpatients department.

Professor Sir Mike Richards

Chief Inspector of Hospitals

We undertook this visit over three days on site and visited the following areas; Accident and emergency, Children's services, human resources, community nursing at Palmers Hospital, outpatients, the cancer unit, pharmacy, Wards 19 & 20, pathology and mortuary services and customer services. We spent a further two days receiving evidential documents from the Trust. A team of four inspectors were accompanied by two professional advisors and an expert by experience.

We found that patients' needs were assessed and their treatment plans were discussed with them. Patients told us they felt well informed about what was happening with them regarding their care and discharge arrangements. Overall people told us the care and treatment they received was good.

We saw staff were recruited in a safe and effective manner and the human resources department undertook checks to make sure people applying to work for the Trust had appropriate qualifications, checks and references prior to commencing employment.

The hospital was well-led. The hospital had a thorough system of checks to monitor the quality of the care provided at ward level and there was a clear route to ensure that any issues or risks were raised to the executive team.

Some patients said they didn't know how to make a complaint but we saw there was an action plan in place to improve this.Patient records that we viewed were up to date and provided information in relation to the care and treatment provided.

The atmosphere on the wards and departments throughout our visit was calm and controlled. Staff were busy but were able to meet the needs of patients in a timely way. Ward areas appeared clean, well maintained and generally free from clutter.

We found that patients' needs were assessed and their treatment plans were discussed with them. Patients told us they felt well informed about what was happening with them regarding their care and discharge arrangements.

Overall people told us the care and treatment they received was good.

Staff told us they felt supported by their colleagues and management of the hospital and there were systems in place to ensure training and professional development at all levels.

The hospital had a thorough system of checks to monitor the quality of the care provided at ward level and there was a clear route to ensure that any issues were raised to Board of Directors level if required. Complaints were monitored and dealt with systematically.

We did not speak to people who used this service as part of this review. We looked at a random sample of medical records. This was to check that current practice ensured that no treatment for the termination of pregnancy was commenced unless two certificated opinions from doctors had been obtained.

All of the patients and relatives who we met gave positive feedback about how the staff listened to them and involved them in all aspects of their care. They reported that they were treated with respect and that staff made every effort to meet their wishes.

Patient's comments included, 'The staff spend time with me'; 'They always tell me what they are going to do'; 'I am always asked for my view'; 'I am always asked if I need assistance'; 'The staff put me at my ease'; and, 'The staff are very responsive'.

Patients told us that they were satisfied with the care and treatment they received. They said that most staff had treated them with courtesy and respect and that their privacy and dignity had been protected. They said they were given information and had been involved in decisions about their care.

However, some described instances where they felt staff had been abrupt in their manner and lacking in respect.

Patients told us they felt their nutritional needs and dietary preferences were well met. They gave mainly positive feedback about the quality, range and availability of food.

Archived: South Tyneside District Hospital

All Inspections

Other CQC inspections of services

31 October 2017

During a routine inspection

11 – 12 July 2017

During a routine inspection

Professor Edward Baker

27-28 July 2016

During an inspection looking at part of the service

Professor Sir Mike Richards

Date of inspection visit: 5 - 8 May, 23 June 2015

During a routine inspection

Professor Sir Mike Richards

19, 20, 21, 22, 25 November 2013

During a routine inspection

16, 17 October 2012

During a routine inspection

22 March 2012

During a themed inspection looking at Termination of Pregnancy Services

6 October 2011

During an inspection looking at part of the service

18 April 2011

During a themed inspection looking at Dignity and Nutrition