Chesterfield Royal Hospital

Updated 26 July 2024

Chesterfield Royal Hospital NHS Foundation Trust (CRHFT) is a district general hospital serving the population of Chesterfield, North Derbyshire and beyond. The catchment population is around 400,000 people. Chesterfield Royal Hospital is situated one mile from Chesterfield town centre (in Calow), opened in 1984 and acquired foundation trust status in 2005. The trust employs around 4000 staff and has approximately 170 volunteers. The trust operates acute hospital services from one main hospital site, Chesterfield Royal Hospital. They provide a full range of acute services plus a 24-hour emergency department, specialist children’s services including a children and adolescent mental health service (CAMHS). There is one community service; community midwifery. There is one community service; community midwifery. There are 19 wards with a total of 500 beds, this includes 18 inpatient beds for paediatric and young people which includes Same Day Emergency Care. Additionally, there are 29-day case chairs. The Trust was last rated Good (published May 2020). The report was published following CQC’s old inspection approach using key lines of enquiry (KLOEs), prompts and ratings characteristics. This assessment has been completed following the Care Quality Commission (CQC) new approach to assessment; Single Assessment Framework (SAF). We carried out our on-site assessment on 13 March 2024. This was a short notice unannounced assessment, which means the provider was told an assessment was going to be starting beforehand. During this assessment we reviewed specific information related to concerns raised by staff within Services for Children and Young People which included the Paediatric Assessment Unit managed by Services for Children and Young People assessment service group (ASG). However assessed under the ASG of Urgent and Emergency Care Services as directed by CQC methodology. During this assessment we looked at 11 quality statements.

Updated 6 February 2024

Chesterfield Royal Hospital NHS Foundation Trust (CRHFT) is a district general hospital serving the population of Chesterfield, North Derbyshire and beyond. The catchment population is around 400,000 people. Chesterfield Royal Hospital is situated one mile from Chesterfield town centre (in Calow), opened in 1984 and acquired foundation trust status in 2005. The trust employs around 4000 staff and has approximately 170 volunteers. The trust operates acute hospital services from one main hospital site, Chesterfield Royal Hospital. They provide a full range of acute services plus a 24-hour emergency department, specialist children’s services including a children and adolescent mental health service (CAMHS). There is one community service; community midwifery. There is one community service; community midwifery. There are 19 wards with a total of 500 beds, this includes 18 inpatient beds for paediatric and young people which includes Same Day Emergency Care. Additionally, there are 29-day case chairs. The Trust was last rated Good (published May 2020). The report was published following CQC’s old inspection approach using key lines of enquiry (KLOEs), prompts and ratings characteristics. This assessment has been completed following the Care Quality Commission (CQC) new approach to assessment; Single Assessment Framework (SAF). We carried out our on-site assessment on 13 March 2024. This was a short notice unannounced assessment, which means the provider was told an assessment was going to be starting beforehand. During this assessment we reviewed specific information related to concerns raised by staff within Services for Children and Young People which included the Paediatric Assessment Unit managed by Services for Children and Young People assessment service group (ASG). However assessed under the ASG of Urgent and Emergency Care Services as directed by CQC methodology. During this assessment we looked at 11 quality statements.

Updated 6 February 2024

Chesterfield Royal Hospital NHS Foundation Trust (CRHFT) is a district general hospital serving the population of Chesterfield, North Derbyshire and beyond. The catchment population is around 400,000 people. Chesterfield Royal Hospital is situated one mile from Chesterfield town centre (in Calow), opened in 1984 and acquired foundation trust status in 2005. The trust employs around 4000 staff and has approximately 170 volunteers. The trust operates acute hospital services from one main hospital site, Chesterfield Royal Hospital. They provide a full range of acute services plus a 24-hour emergency department, specialist children’s services including a children and adolescent mental health service (CAMHS). There is one community service; community midwifery. There is one community service; community midwifery. There are 19 wards with a total of 500 beds, this includes 18 inpatient beds for paediatric and young people which includes Same Day Emergency Care. Additionally, there are 29-day case chairs. The Trust was last rated Good (published May 2020). The report was published following CQC’s old inspection approach using key lines of enquiry (KLOEs), prompts and ratings characteristics. This assessment has been completed following the Care Quality Commission (CQC) new approach to assessment; Single Assessment Framework (SAF). We carried out our on-site assessment on 13 March 2024. This was a short notice unannounced assessment, which means the provider was told an assessment was going to be starting beforehand. During this assessment we reviewed specific information related to concerns raised by staff within Services for Children and Young People which included the Paediatric Assessment Unit managed by Services for Children and Young People assessment service group (ASG). However assessed under the ASG of Urgent and Emergency Care Services as directed by CQC methodology. During this assessment we looked at 11 quality statements.

Updated 29 May 2020

Our rating of this service went down. We rated it as requires improvement because:

• Staff did not always follow infection control principles including the use of personal protective equipment (PPE).
• Nursing and medical staff received but did not keep up-to-date with their mandatory training.
• The trust set a target of 90% for completion of safeguarding training. Not all nursing and medical staff had received training specific for their role on how to recognise and report abuse.
• The design of the environment did not always follow the Health Building Note guidance. For example, across most medical wards we visited we found the environment cramped with equipment stored on corridors.
• Staff did not always escalate deteriorating patients in a timely manner. We found inconsistencies with national early warning sign escalation in five out of nine electronic records we looked at.
• Records were not always stored securely. We found some patient records left unattended on trolleys across most wards and records were not always kept in locked trolleys to maintain confidentiality.
• The service participated in relevant national clinical audits. Outcomes for patients were not always positive, consistent or met expectations, such as national standards.
• There were inconsistencies in the decision-making processes for Deprivation of Liberty Safeguards (DoLS).

However,

• All staff knew what incidents to report and how to report them.
• Managers monitored waiting times and made sure patients could access services when needed and received treatment within agreed timeframes and national targets.
• Patients said staff treated them well and with kindness.
• The senior matron and all matrons were visible on the wards.

Updated 17 May 2017

This was a follow up focussed inspection and therefore we did not rate the critical care service overall. We inspected the safe domain only and rated the critical care provision at Chesterfield Royal NHS Foundation Trust as good for safe. We found there had been improvements to the service since our previous inspection in 2015.

Staff knew how to use the trust electronic incident reporting system, could demonstrate learning form incidents and understood the principles of duty of candour. However, staff told us they did not always receive feedback from reported incidents.

Patient records were legible, signed and dated in accordance with General Medical Council (GMC) guidance and included a comprehensive range of patient assessments. Care plans were clear and we saw evidence of staff working with them.

Staff adhered to trust policies on infection control and hygiene and both ITU and HDU had positive infection control audit results. Equipment was well maintained. There was access to resuscitation equipment, which was checked regularly and ready for use. Staff were trained in safeguarding and were confident about escalating any concerns.

A key improvement since our last inspection was patients were reviewed in a timely manner and the service had established systems to audit and challenge the timeliness of response by medical staff. There was a plan to move to a new model of critical care in September 2016, which meant HDU patients would be managed by critical care consultants. The service had escalation procedures for managing deteriorating patients and for discharging patients to wards. The service had introduced new procedures for monitoring and managing patient discharges which was audited.

Staffing levels met recommended guidelines and handovers for medical and nursing staff were effective.

However, issues identified were critical care consultants did not receive feedback from mortality and morbidity meetings and staff were frequently moved to support staff shortages in other areas of the hospital, resulting in a risk ofstaff not working to recommended guidelines and staffing ratios.

There was no critical care outreach team, although recruitment was taking place in preparation for commencing this service in September 2016.

Updated 25 January 2019

Our rating of this service improved. We rated it as good because:

• Staff had a good understanding of how to protect patients from abuse and could describe what safeguarding was and the process to refer alerts.
• Staff were aware of the trusts whistleblowing procedures and what action to take if they had

concerns.

• There were comprehensive risk assessments completed in the medical and nursing notes. These were commenced on admission and there was evidence that risk assessments continued throughout the patients stay in hospital.
• We saw good examples of good multi-disciplinary working and involvement of other agencies and support services.
• Staff cared for patients with compassion. We saw several examples of staff from all disciplines being supportive and kind to patients and their relatives.
• Most patients and their relatives told us they were fully included in discussions around their plan of care.
• From July 2017 to June 2018, the trust reported no incidents classified as never events within end of life care.
• During our last inspection in 2016 we found the trust did not have a process for identifying non-cancer patients requiring end of life or palliative care support. During this inspection we saw the service had added a category to the palliative care team referral document identifying non-cancer patients
• There were systems in place to ensure that staff affected by the experience of caring for patient at end of life were supported. For example, members of the Hospital Palliative Care Team had access to counselling, through a self-referral system as well as a psychologist who provided clinical supervision to individuals or groups, as required.

However

• The majority, (49%) of Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders we viewed were not completed properly and reflected the information included in the patient’s mental capacity assessment.

Updated 26 July 2023

Updated 17 May 2017

We rated outpatient and diagnostic imaging services as good overall.

Staff reported patient safety incidents and there was evidence of learning from incidents and patient complaints. Senior staff had oversight of risks in their areas. Emergency equipment and resuscitation trolleys were not consistently checked. The patient waiting areas were attended by staff so patients could be observed.

Outpatient departments appeared visibly clean and staff used personal protective equipment (PPE), such as gloves and aprons. Patients care and treatment was delivered in line with current national standards and legislation. Staff demonstrated a commitment to patient-centred care. Patients were treated with dignity and respect and spoke highly of the staff. Patient input and feedback was actively sought and several areas had established patient focus and support groups.

There were some areas that provided a proactive service to patients which included several one-stop clinics which provided efficient co-ordinated care. Quality governance knowledge was shared amongst staff at team meetings. Staff felt supported by immediate line managers and clinicians. They said they were listened to and able to raise concerns.

Updated 29 May 2020

Our rating of this service stayed the same. We rated it as good because:

• The service mostly had enough staff to care for patients and keep them safe. Training was available in key skills, staff 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.
• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However:

• Not all staff were up to date with their mandatory training.
• Some serious incidents were not reported within the trusts target of 14 days.
• Outcomes for patients were generally similar to or better when compared to other trusts but did not always meet national standards.
• The percentage of last-minute cancellations at the trust where the patient was not treated within 28 days was higher than the England average.