Rotherham General Hospital

Updated 10 June 2022

The Rotherham NHS Foundation Trust was awarded foundation status in 2005 and provides a wide range of acute and community health services to the people of Rotherham (population approximately 242,160). The trust provides the full range of services expected of a district general hospital including urgent and emergency care, maternity, paediatrics, surgery, medicine, critical care and community services for both children and adults.

The Trust employs approximately 4000 staff who predominantly work in either the main hospital site or in one of the community locations. The trust has close connections with a number of educational providers including Rotherham College, Sheffield Hallam University and is an Associate Teaching Hospital of the University of Sheffield. Services are predominantly commissioned for the people of Rotherham by NHS Rotherham Clinical Commissioning Group, who also act as lead commissioner for other Clinical Commissioning Groups. There are a small number of services commissioned by NHS England. The trust works in close partnership with Rotherham Metropolitan Borough Council, NHS Rotherham Clinical Commissioning Group and Rotherham, Doncaster and South Humber NHS Foundation Trust on developing and implementing the health element of the Rotherham Place Plan and with other health organisations across South Yorkshire and Bassetlaw as part of the Integrated Care System.

From March 2020 to February 2021, there were 74,618 attendances in the emergency department. From April 2020 to March 2021, there were 51,760 inpatient admissions, 283,051 patients attended the outpatient department, and 2,273 deliveries in the maternity department.

Updated 29 September 2021

Updated 29 September 2021

Updated 2 March 2017

We found there was a culture where patients were at the centre of activities. There was a clear process for escalation, investigation and feedback of incidents. Lessons learnt were shared with staff to minimise them reoccurring. Staff received training in vulnerable adult and children protection. They were confident in safeguarding patients.

Outcomes for patients using this critical care service were measured against similar services; this unit were better in some areas and similar in others. Staff were appropriately qualified.

Staff understood and were able to verbalise the principles of mental capacity act, duty of candour and the unit vision and aims.

At our request at the inspection, the trust took immediate action to ensure the fire evacuation arrangement in place for intensive care unit was fit for purpose. We confirmed this during our unannounced inspection. We also wrote to the trust and they confirmed that fire safety advisors were satisfied with the arrangements in place.

However, due to staff shortages, the nurse coordinator on shift was unable to fulfil their duty of managing, supervising and supporting staff to ensure safety. There was also a lack of a designated pharmacist on the unit.

Patients’ notes were not stored securely within the units to maintain patient confidentiality.

The governance arrangements including maintenance of a risk register and the review process did not promote effective risk control.

Updated 14 July 2015

Overall, we rated the End of Life service as good.

We checked 35 DNA CPR forms on wards throughout the hospital and found they were completed inconsistently. This mainly related to how the capacity of patients unable to make decisions about DNA CPR was assessed.

The trust had replaced the Liverpool Care Pathway for delivering end of life care with individualised care plans for patients.

Patients approaching the end of life were identified appropriately and care was delivered according to their personal care plan, including effective pain relief and other symptoms which were regularly reviewed. Patients in the last days of life were identified in a timely way and appropriate action was taken. Patients’ pain was well-managed and appropriate prescribing was in place to manage symptoms such as nausea and vomiting or agitation.

We saw that patients were treated with compassion, dignity and respect. Patients and their representatives spoke positively about their care and told us they felt included in their care planning. We also observed a caring approach by the mortuary and bereavement staff.

The trust did not have a rapid response policy for end of life care patients who preferred to die at home. However, we were told that this could be facilitated within two to three hours with the support of the hospice rapid response team, the trusts specialist palliative care team and the continuing healthcare team.  The trust did not collect this data so we were unable to corroborate this. Data from the trust stated that 93% of patients on the end of life care pathway had died in their preferred place in the last year.

There was a multi-faith prayer room, with screens to separate men and women to accommodate those of Muslim faith. The responsiveness of mortuary and bereavement staff to the needs of parents who had lost children or babies was an example of good practice.

There was a vision and strategy for the end of life care service. There was an increase in investment and staff to support a seven-day, face-to-face service by the specialist palliative care team (SPCT). The trust had a specialist palliative care clinical governance group which provided a forum for clinical governance development, implementation and monitoring across the hospital’s specialist palliative care services. There was an executive director who was the lead for end of life care.

Risk management and quality assurance processes were in place at a local level. The end of life service held governance and patient safety meetings and records showed that risks were escalated, included on risk registers and monitored each month.

Staff within the SPCT spoke positively about the service they provided for patients and were passionate about their work. The mortuary and bereavement staff culture was very positive and enthusiastic about the provision of care at the end of a person’s life. This was demonstrated through their approach to patient care.

There were no specific consultation groups for patients and the public to contribute to the development of end of life care services in the trust. The SPCT acknowledged that there was work to be done to improve end of life care services throughout the trust and had compiled a five-year plan to address this.

Updated 29 September 2021

Updated 14 July 2015

Overall we found that outpatients and diagnostic and imaging departments as good.

We found that safety was good, incidents were reported and risks to patients were assessed. Processes and procedures were in place according to national guidance and regulations. Infection control and cleanliness of equipment was of a good standard. However there were challenges regarding staffing in outpatients and diagnostic imaging, but plans were in place to respond accordingly. Data from the trust showed that there were low completion rates for safeguarding and mandatory training were low. There was little evidence that Mental Capacity Act training had taken place.

Staff were able to demonstrate evidenced- based care and treatment, monitoring of patient outcomes and there was good multi-disciplinary team working. Staff were caring and we saw positive interactions between staff and patients. There were good initiatives and care pathways for patients and services were responsive to people’s needs. Referrals were managed well by booking staff, however, we saw that some patients had been waiting nearly two years for follow- up appointments.

The environment presented significant challenges for outpatient and diagnostic imaging departments. Patient flow between departments was affected by a lack of space and other departments being situated on different floors. Waiting areas were small in main outpatients and staff said that they had “outgrown” the space they were in. However, there were plans were in place to address this through the estate’s strategy and staff worked well and used the space as best they could.

Services were well- led at department level. Staff felt supported by their managers. There was a positive view of the chief executive and the majority of staff shared the management visions for the services. There was a new governance arrangement which was evolving, and there was a positive culture which encouraged teamwork and collaboration. However, there were concerns regarding escalating issues to senior management, bureaucracy and the lack of response to issues.

Updated 2 March 2017

The trust had taken action on some of the issues raised in the 2015 inspection, for example, staff were confident in reporting incidents and received feedback from incidents. The World Health Organisation (WHO) safer surgery checklist was embedded in practice and additional staff had been recruited. The management of medical outliers was in line with trust policy, there had been no mixed sex accommodation breaches and access and flow had improved in fracture clinic.

Systems and processes for infection control and medicines management were reliable and appropriate.

Senior staff planned and reviewed staffing levels and skill mix to keep people safe from avoidable harm. All wards used an early warning scoring system for the management of deteriorating patients.

Patients’ needs were met through the way services were organised and delivered. The trust’s referral to treatment performance was better than the England average between June 2015 and May 2016.

However, the trust did not have a Hospital at Night team and out of hours senior doctors were not always resident on site to support junior doctors and advanced nurse practitioners.

Updated 29 September 2021