All inspections: Chesterfield Royal Hospital

Community & mental health inspection reports for Chesterfield Royal Hospital can be found at Chesterfield Royal Hospital NHS Foundation Trust.

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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.

Pages 1 and 2 of this report relate to the hospital and the ratings of that location, from page 3 the ratings and information relate to maternity services based at Chesterfield Royal Hospital.

We inspected the maternity service at Chesterfield Royal Hospital as part of our national maternity inspection programme. The programme aims to give an up-to-date view of hospital maternity care across the country and help us understand what is working well to support learning and improvement at a local and national level.

We will publish a report of our overall findings when we have completed the national inspection programme.

We carried out an announced focused inspection of the maternity service, looking only at the safe and well-led key questions.

The maternity department at Chesterfield Royal Hospital comprises of the Birth Centre with consultant led and midwife led beds, a combined antenatal and postnatal ward, a bereavement suite, pregnancy assessment centre, antenatal clinic and scanning services.

We did not review the rating of the location therefore our rating of this hospital stayed the same

Chesterfield Royal Hospital is rated Requires Improvement overall.

Our reports are here: https://www.cqc.org.uk/location/RFSDA

How we carried out the inspection

During our inspection of maternity services at Chesterfield Royal Hospital NHS Foundation Trust we spoke with 30 staff including leaders, obstetricians, midwives, and maternity support workers.

We visited all areas of the unit including the antenatal clinic, pregnancy assessment unit, the birth centre and the ante and postnatal ward. We reviewed the environment, maternity policies while on site as well as reviewing 9 maternity records. Following the inspection, we reviewed data we had requested from the service to inform our judgements.

We ran a poster campaign during our inspection to encourage pregnant women and mothers who had used the service to give us feedback regarding care. We received feedback from over 230 women and birthing people in response to the campaign. Comments were generally positive about the birthing experience, but less so about care on the postnatal ward. Women and birthing people commented that staff did not always have the time to provide support, especially with breastfeeding whilst on the ward.

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

Our rating of services went down. We rated it them as requires improvement because:

We rated safe and effective as requires improvement and caring, responsive and well led as good.
In rating the hospital, we took into account the current ratings of the services not inspected this time.
Mandatory training compliance was monitored but was not completed by all staff in medical care (including older people’s care) and maternity.
Records were not always securely stored across three of the four core services we inspected at this time.
Outcomes for patients did not always meet national standards in three of the four core services we inspected at this time.
People could not always access the service when they needed it and did not always receive the right care promptly. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were not always in line with national standards across all four core services we inspected at this time.

However:

All staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
Services mostly 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.
Most staff identified and quickly acted upon patients at risk of deterioration.
Staff, across all four core services treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
Services were inclusive and took account of patients’ individual needs and preferences.
Leaders had the skills and abilities to run the services. They understood and managed the priorities and issues services faced. They were visible and approachable in the services for patients and staff. They supported staff to develop their skills and take on more senior roles.

Chesterfield Royal Hospital NHS Foundation Trust provides acute services from Chesterfield Royal Hospital. The trust provides a full range of acute services plus a 24-hour emergency department service including critical care.

Chesterfield Royal Hospital emergency department supports the treatment of patients presenting with minor, major and traumatic injuries, as well as patients who are ill or seriously ill.

We carried out an unannounced focused inspection of the emergency department (ED) at Chesterfield Royal Hospital on 19 August 2019. Concerning information received by CQC before this inspection suggested that patients may not have been identified quickly when their condition deteriorated, and that safeguarding concerns were not always followed up appropriately.

We did not inspect any other core service or wards at this hospital or any other locations provided by Chesterfield Royal Hospital. During this inspection we inspected using our focused inspection methodology. We did not cover all key lines of enquiry and we did not rate this service at this inspection. However, the ratings for the service overall and the five key questions remain good overall.

Our key findings were as follows;

We found that staff were unaware of safeguarding risks relating to potential access to medicines and sharps by patients who were being treated for mental health conditions.
We saw that the environment was visibly unclean with soiling to floors and walls. There were bags of clinical waste in treatment rooms and waiting areas.
Cubicles were not quickly prepared when patients had left them. Several were left with bloodied and soiled sheets for some time. Trolleys were not always cleaned between uses, however, sheets were changed.
A patient with a confirmed infection was not cared for in isolation. Staff were observed entering and leaving without appropriate personal protection equipment and without washing their hands. This was not in line with National Institute for Health and Care Excellence (NICE) guidelines for hand decontamination. Some hand gel dispensers were found to be empty.
Sharps were not always disposed of correctly. Sharps bins were not all correctly dated in line with the trust’s policy for managing sharps.
We were not assured that the minors area was well supervised. We observed children left unattended in close proximity to adult patients, including a patient in police custody. There were no call bells in these cubicles.
We found unsecured medical gases on corridor areas. These included oxygen and other medical gas cylinders. This presented a risk of harm to patients and staff as they could cause injury if they fell over. There was also a risk of misuse of a pain relieving gas as it was freely available in public areas.
We found equipment unsecured and freely available to patients and the public in unlocked treatment rooms. These items included sharps and injectable medicines.
The main department was severely overcrowded with patients being cared for on trolleys outside rooms which blocked the doorways to cubicles. This led to a risk in the case of a medical emergency, evacuation or fire. Access to emergency resuscitation equipment was not available in the corridor.
The nearest resuscitation equipment was in the resuscitation room. This meant that in the event of a medical emergency, there was a risk of delay in accessing emergency equipment for patients in cubicles.
There was poor visibility of some patients across all areas of the department. Due to overcrowding of the corridor we saw that patients in the cubicles were not visible or easily accessible.
The department had a sepsis pathway which followed national guidelines. It was robust and included clear instructions on flags and actions to take. The pathway was not known well in the department and staff were not aware of the triggers and flags contained in the pathway. We saw examples of this pathway not being followed despite patients meeting the criteria.
The adult resuscitation room was easily accessible to patients and the public when not in use. The fridge was unlocked and contained many medications including insulin, intravenous (IV) sedation, and anaesthetic drugs. All of these medications if ingested or used incorrectly could result in severe harm or death.
Staff were not always aware of changes or learning shared from recent incidents, complaints and mortality reviews.

However, we also found areas of good practice;

There was effective working between the urgent care centre (UCC) streaming nurse and the ED. This ensured safe and efficient transfer of ambulatory patients from the urgent care centre to the ED.
There was active management of the triage queue by senior nurses and doctors to prioritise patients with high risk conditions.
There was good compliance with completing initial physiological observations, and in all cases this was within 15 minutes of the patient’s arrival.
Nurse and medical leaders worked well with the active transfer team from outside the ED to move patients on to appropriate areas which freed up space in the ED for other patients. The ED leaders utilised an ‘early bed booking’ system to prioritise beds for patients who needed them. Risks and issues were shared at regular ‘huddles’ during the shift.

Following this inspection, we wrote to the trust with details of the most significant concerns and asked them to tell us how they intended to improve these. The trust responded with a detailed plan of actions to address the most significant concerns. They told us they had carried out remedial work within 24 hours of receiving notification of our concerns.

We also told the trust that it must take some actions to comply with the regulations that had been breached and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with two requirement notices to help the service improve.

Details are at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals

Our rating of services stayed the same. We rated them as good because:

Caring, effective, responsive and well led were rated as good and safe was rated as requires improvement. During this inspection we inspected the core services of medicine, surgery children and young people, end of life care and child and adolescent mental health services.

Chesterfield Royal Hospital NHS Foundation Trust was one of the first hospitals in the country to become a Foundation Trust in January 2005, and serves a population of around 441,000 across the Bolsover, Chesterfield, Derbyshire Dales and North Amber Valley, High Peak and North East Derbyshire districts.Chesterfield Royal Hospital is a medium sized District General Hospital based a mile outside the centre of Chesterfield in an area known as Calow. The hospital is the town’s largest employer with a workforce in excess of 3,500 staff and has a total revenue of £221.2 million.Chesterfield Royal Hospitals NHS Foundation Trust is registered to provide the following Regulated Activities:

Assessment or medical treatment for persons detained under the Mental Health Act 1983
Diagnostic and screening procedures
Family Planning
Management of supply of blood and blood derived products
Maternity and midwifery services
Surgical Procedures
Termination of pregnancies
Treatment of disease, disorder or injury

Chesterfield Royal Hospital NHS Foundation Trust were inspected between 13-14 July 2016. Unannounced visits were carried out on 20 July 2016. This inspection is a focused follow up inspection following a comprehensive inspection in April 2015. The purpose of this focused follow up inspection was to inspect domains that had previously been deemed to require improvement.We did not rate the trust overall. We looked at domains that had previously been rated as less than good. We made judgements about seven services across the trust as well as making judgements about the five key questions that we ask.

Our key findings were as follows:

There was an effective incident reporting system. However, there were incidents that had not been closed on the reporting system. There was an open and honest culture, and people who used the service were told when something went wrong.
The environment where care was delivered was visibly clean. There were systems, processes and procedures in place for infection prevention and control which were adhered to by the majority of staff.
The day time ward staffing levels were planned in line with the National Quality Board guidance published in 2013 and 2016.
There was ongoing, and on occasions, significant numbers of bank and agency staff being used.
Generally systems were in place to assess and respond to risks where patients were identified as deteriorating.
There was no critical care outreach team within the hospital, although one was being established.
Medications were stored appropriately and administered safely.
An assessment tool was used to assess patient’s pain. Where patients experienced pain this was managed well.
Most equipment, including resuscitation equipment was checked, serviced and safe for use, however some resuscitation equipment was not checked in line with trust policy.
The trust had recently introduced a new system for staff to access and record their training activities. At the time of the inspection the trust was experiencing difficulties accessing current accurate data of the number of staff who had attended their mandatory training, therefore the trust was not certain on how many staff were currently trained.
Patient care and treatment was planned and delivered in line with current evidence based guidance, standards, best practice and legislation.
There were a significant number of patients being moved between wards in the hospital and moves routinely happened after 10pm. These were predominantly from the initial assessment wards to inpatient wards.
Since our last inspection in April 2015 the trust had achieved the appropriate level of suitably qualified nursing staff per shift with the European paediatric life support (EPLS) qualification.
There was effective multidisciplinary working to deliver patient care.
Patients were supported, treated with dignity and respect. Relatives and friends were involved in patients care. We saw staff carrying out care with a kind, caring and compassionate attitude.
Systems were in place to acknowledge complaints within three days. A triage system was in place to establish response times to complaints depending on the complexity. Response times to complaints had improved since our last visit after an action plan was put in place.
Concerns resolved at ward level were not reported on the incident reporting system; therefore opportunities for learning could be missed however a pilot was taking place to start capturing this information.
High bed occupancy levels above the trust target was identified as an operational risk with the potential to impact on staffing levels and the quality of patient care. This was being managed on the trust’s risk register and a weekly report was being prepared for the commissioners.
Staff we spoke with were aware of, and understood, the vision and values of the trust. Staff identified the “proud to care” initiative to look after patients.

We saw several areas of outstanding practice including:

The neonatal gentamicin prescription sheet that had been produced because of lessons learnt from gentamicin medication errors was outstanding. This has reduced the number of incidents to zero within the department and ensured that all patients received the correct management.
“Toolbox talks”- had been developed and trialled amongst porters with the aim of increasing knowledge of end of life care. “Toolbox talks” were short talks developed and delivered to the porter service manager who then delivered this to their teams. There was a plan in place to roll this out to other non-clinical staff within the trust.
Members of staff on Markham Ward had written a poem to provide support to relatives of end of life patients. “The palliative approach” poem was sensitively written and described how the ward would care for relatives and their loved ones on the ward.
Markham Ward had created a “comfort tin” for relatives of patients in the last days or hours of life which included biscuits and tissues had been developed.
A “comfort tin” for relatives of patients in the last days or hours of life, which included biscuits and tissues, had been developed. We also saw the use of “comfort packs” , which included essential toiletries, such as toothbrushes and cleansing wipes.

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

The trust must ensure the resuscitation equipment provides a full range of equipment to meet all sizes of children, young people and adults.
The trust must ensure that in areas where children are treated, appropriate safeguarding measures and staff training are in place.
The trust must ensure nursing staff who deliver end of life care are familiar with and receive training in the Mental Capacity Act (2005).

In addition the trust should:

The trust should ensure all DNACPR order forms are completed accurately and in line with trust policy.
The trust should improve infection control training within the medical division.
The trust should ensure there are consistent processes in place to assure cleanliness of equipment including the birthing pools within maternity and gynaecology services.
The trust should ensure cleaning records are maintained for the milk fridges within maternity and gynaecology services.
The trust should ensure all staff are compliant with trust targets and intercollegiate standards in regards to safeguarding level three training.
The trust should ensure there is a consistent process for assuring the safety of electrical items and they are clearly marked with details of when safety checks are next required. It should be ensured staff are aware to the process for ensuring equipment is checked and safe to use.
The trust should ensure there is a formalised risk assessment produced for the paediatric resuscitation trolley on Nightingale Ward remaining unlocked.
The trust should ensure all investigations involving a child or young person should have representation from the Women and Children’s division.
The trust should ensure the sepsis management of children and young people is fully embedded within the service.
The trust should ensure they work closely with the local hospice in finalising the service level agreement.
The trust should ensure they continue with the plan to monitor how rapidly patients are discharged from hospitals once identified for “fast track”.
The trust should ensure they audit the achievement of patient's preferred place of death.
The trust should ensure the legal process of the Mental Capacity Act 2005 is followed where a patient lacks the capacity to make decisions, particularly in relation to ‘Do Not Attempt Cardio Pulmonary Resuscitation’ (DNACPR) orders.
The trust should consider reviewing the process for transferring obese deceased patients to the mortuary.
Consider the environment in Hollywell Day Case Unit to ensure the environment where trolleys are located and equipment is washed is suitable to ensure effective infection prevention and control measures can be adhered to.
Ensure that all ward and department staff receive information on the policy for the monitoring and recording drug fridge temperatures including details of any actions they are accountable for.
The trust should continue to prioritise reviewing the open incidents, ensure actions are taken to minimise risk ,and ensure actions are completed, learning is shared and records updated.
Should ensure that the surgical department morbidity and mortality quarterly meetings are established and that there is a robust system is in place to secure attendance and enable learning to be shared.
Ensure all staff receive annual appraisals.
Ensure all staff attend mandatory training days.
Ensure all staff complete safeguarding training suitable to their role and grade.
The trust should ensure there is a consistent process for assuring the safety of electrical items and they are clearly marked with details of when safety checks are next required. It should be ensured staff are aware to the process for ensuring equipment is checked and safe to use.
Ensure where resuscitation trolleys are shared between two wards both wards carry out and document the checks as per the trust policy.
Ensure VIP scores are recorded in a consistent manner and that there is no duplication of information.
Ensure data is captured when complaints/concerns are resolved at ward level, and ensure that learning is shared.
Ensure patient transfers are effectively managed to minimise the number of patients transferred after 10pm.
Ensure sufficient medical staffing is available to meet periods of increased demand and to cover staff absences.
Ensure the safer steps to surgery check list is fully completed and audit monthly to achieve 100% compliance.
Ensure the safer steps to surgery check list is used for invasive procedures.
Ensure all of the divisions have shared governance structures which are consistent and collective.

Professor Sir Mike Richards

Chief Inspector of Hospitals

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Chesterfield Royal Hospital was built in the 1980s and became a foundation trust in 2005. The hospital serves five local districts with a population of approximately 441,000. There is a small ethnic minority population, with over 96% of the population belonging to a white ethnic group. Life expectancy for both men and women in two districts (Chesterfield and Bolsover) is worse than the England average.

The hospital provides 682 inpatient beds and employs over 3,500 staff. In the year 2013-14, there were more than 71,000 inpatient admissions and 257,000 outpatient attendances; over 67,000 patients attended the accident and emergency department.

We inspected this trust as part of our in-depth hospital inspection programme. The trust was selected as it was an example of a low risk trust according to our new intelligent monitoring model. Our inspection was carried out in two parts: the announced visit, which took place on the 21,22,23 and 24th April 2015; and the unannounced visit which took place during the evening of the 2 May 2015.

Our key findings were as follows:

All of the services we inspected were found to be caring. Staff were kind and caring towards patients, and treated patients with dignity and respect. Most patients and visitors we spoke with were complimentary about the care they were receiving.

Overall we observed the hospital and clinic environments were visibly clean, hygienic and well-maintained. Improvements were needed in relation to the storage of clinical waste in the Eye Centre, within the Outpatients service. Patients told us they were impressed with the standards of cleanliness. There had been 30 cases of C difficile (a bacteria which causes diarrhoea) infection in the year up to February 2015 which was worse than the England average. Fifteen of the 23 (65%) confirmed patients with C difficile had one or more lapses in the quality of care identified as part of the investigation process. There had been two cases of Methicillin Resistant Staphylococcus Aureus (MRSA) reported between April 2013 to Nov 2014, both occurring in 2013. The trust had 17 cases of Methicillin-Susceptible Staphylococcus Aureus (MSSA) throughout the same period but this was similar to the England average. MRSA and MSSA are types of bacteria that can cause infections. We found there were systems in place to deal with infection prevention, and control and we observed staff to be following the trust guidelines.

Nursing staffing levels had been reviewed and there had been an increase in nursing and midwifery staff. We found the day time staffing levels were in line with national guidance and generally, both the day and night time staffing was in line with the numbers of staff the trust had identified they needed. There was an escalation process in place so that staff could flag if they were concerned about the staffing levels on each shift. In some areas, particularly within medicine, staff didn’t feel there were always enough staff on duty overnight. Some of the staff told us they didn’t report their concerns about the night staffing levels through the incident reporting system. We raised this with the trust and they took action straight away to review their staffing levels at night. There was a reliance on bank and agency nursing staff in some areas and like many trusts, they faced difficulties recruiting nurses.

There had been an increase in the number of midwives, and although the trust was not meeting national recommendations for birth to midwife ratios, staffing was comparable with other maternity services across the region. The trust was not able to provide a band six registered children’s nurse to be on duty at all times. This was due to difficulties in recruiting suitably experienced children’s nurses.

Medical staffing was at safe levels in most of the services we inspected; however in some areas there were vacant posts and reliance on locum medical staff.

Patients were provided with the assistance they needed to eat and drink and the risk of malnutrition or dehydration was assessed. Speech and language therapists provided support to ward areas to carry out swallowing assessments, and dieticians provided nutritional advice.

Patients’ pain was assessed and generally well managed. There were no specialised tools in place to assess pain in those with a cognitive impairment such as a learning disability or those living with dementia. Women in labour were given a choice of pain relief and provided with non-pharmacological options such as aromatherapy and the use of a birthing pool. Epidural pain relief was available on request, and the waiting time for this was within an acceptable 30 minute timeframe.

Monitoring by the Care Quality Commission had not identified any areas where medical care would be considered a statistical outlier when compared with other hospitals. The trust reported data for mortality indicators, the summary hospital-level mortality indicator (SHMI) and hospital standardised mortality ratio (HSMR). These indicate if more patients were dying than would be expected given the characteristics of the patients treated there. The figures for the trust were as expected. Information about patients’ outcomes was monitored. The trust participated in all of the national audits it was eligible for. Where improvements were identified, the trust was responding and was making progress implementing its action plans in order to improve the quality of care they were providing.

Like many trusts in England, the hospital was busy and the trust had faced challenges in access and flow, especially during the winter months. Bed occupancy in the hospital had been consistently over 90% which was above the England average of 88%. In the medical division, bed occupancy was 95.5% in February 2015. It is generally accepted that when bed occupancy goes over 85% it can start to affect the quality of care provided to patients and the running of the hospital. Due to issues with patient flow, medical patients were transferred or admitted to beds that were designated for other specialities.

The trust had a clear vision and a set of values which the vast majority of staff understood. This had been developed alongside staff and other stakeholders. There were a number of strategies in place and these all had clear goals which were measurable. All actions from the working strategies were being monitored. This allowed performance to be closely monitored.

The trust worked on a divisional structure which was clinically led, the chief executive described how this empowered clinical staff. There was recognition however, that this was more developed in some areas than in others, and more time was needed for this structure to become embedded.

The senior leaders in the trust had been working to increase the level of staff engagement. This was work in progress and we found evidence to suggest this was improving, but the staff survey results had been disappointing for the trust. Many staff told us they felt the organisation had changed over the past two years and was now one which had a real focus on the quality of care for patients.

We saw several areas of outstanding practice including:

Staff in the x-ray department were able to view the electronic patient information screen held in the emergency department. This meant they knew when patients were awaiting x-ray and responded promptly, usually within 20 minutes of the request being entered into the system.

Staff working for the local mental health trust which provides care for people with mental health problems, were able to view the electronic information screen held in the emergency department. This meant they knew when patients were awaiting review and responded promptly, usually within 60 minutes.

Locum doctors working in the emergency department received quarterly reviews with an educational supervisor.

The multidisciplinary huddle within the emergency department was informative and effective and valued by the team and wider trust staff.

As a pilot fixed term project, a pharmacist worked in the department to support all aspects of medicines management. Data showed this was beneficial to patients and speeded up admission processes.

The trust had a clear vision of how its clinical environments could be made dementia friendly. They had realised this vision in the refurbishment of the discharge lounge.

Each clinical area had its own improvement plan . This meant ward matrons and their staff were clear about the various quality and safety improvement initiatives in progress, how they would be achieved, and how they were inter-related.

The trust had reacted positively to audit data and had embarked on a local health and social care economy project to produce and implement a dementia and delirium patient treatment pathway. Manvers ward had introduced patient based communication folders which allowed written requests for information to be made and responded to within 24 hours.

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

Action the hospital MUST take to improve

Ensure there is appropriate and timely monitoring of deteriorating patients within the HDU department.
Ensure ward staff are supported to identify and manage very sick or deteriorating patients in ward areas.
Ensure that people who may lack capacity to make decisions about their care have an adequate assessment of their mental capacity, and that decisions about DNACPR are taken in line with the requirements of the Mental Capacity Act (2005).
Ensure that an accurate record is kept for each baby, child, and young person which includes appropriate information and documents the care and treatment provided.
Ensure all DNACPR order forms are completed accurately and in line with trust policy.
Ensure that numbers of registered nurses meet national guidance, and meet the needs of patients at all times, including throughout the night.
Ensure that an experienced, senior children’s nurse is available during the 24-hour period to provide the necessary support to the nursing team.
Ensure that there are sufficient numbers of staff to provide the dermatology outpatient service.
Ensure that at least one nurse per shift in each clinical area (ward / department) within the children’s and young people’s service is trained in advanced paediatric life support or European paediatric life support.
Ensure all staff involved in caring for patients at the end of life receives adequate training in end of life care.
Ensure the resuscitation trolleys and their equipment are checked, properly maintained, and fit for purpose in all clinical areas.
Ensure there are robust waste management procedures in place.

Action the hospital SHOULD take to improve:

The trust should ensure sufficient cover in the accident and emergency department to allow all staff to attend necessary training sessions.
The trust should consider the effectiveness of signage in the emergency department reception area to advise patients when their condition requires them to proceed to the front of the queue.
The trust should ensure safe and effective processes for the disposal of clinical and chemical waste.
The trust should review its medical bed capacity to ensure that the majority of patients are cared for in the correct speciality bed for the duration of their hospital admission. It should also review its arrangements for the management of patients outlying in non-speciality beds to ensure the quality and safety of their care is not compromised.
The trust should review its arrangements for quality assuring Root Cause Analyses, and for monitoring the implementation and efficacy of any associated action plans to ensure that RCA’s identify remedial actions that are fully implemented and evaluated.
The trust should review its arrangements for ensuring the monitoring of in-dwelling intravenous devices in line with “Saving Lives” guidance.
The trust should review the provision of the continuous piped oxygen and suction issue in the cardiac catheter laboratory and associated recovery areas.
The trust should ensure that all confidential patient records in clinical areas, and confidential waste, are securely stored to minimise the risk of unauthorised access.
The trust should review how it can provide both rehabilitation and follow up for patients who are discharged from intensive care to meet NICE guidance.
The trust should take steps to reduce the number of patients being discharged from the critical care unit overnight.
The providers should ensure suitable storage in the critical care unit is available so that equipment can be plugged in when being stored.
The trust should ensure intravenous fluids are stored safely in the critical care unit.
The trust should ensure that staff in the fracture clinic where children and young people are seen, understand their roles and individual responsibilities to prevent, identify and report abuse when providing care and treatment.
The trust should ensure that they have written formal arrangements in place with the children and adolescent mental health team so that the needs of children and young people with mental health problems are met.
The trust should ensure that agreed care pathways and written guidance are in place to guide staff when caring for children and young people who have mental health conditions.
The trust should ensure there is an effective link nurse structure to enable local support and guidance in end of life care in the absence of the specialist palliative care team.
The trust should review the hours of service provided by the specialist palliative care team to include a face-to-face specialist palliative care service from at least 9am to 5pm, seven days per week.
The trust should consider reviewing their local and national audit activity in order to monitor the effectiveness of end of life care services and benchmark against end of life services nationally.
The trust should review the storage of patient property following a patient’s death.
The trust should ensure a risk assessment is undertaken for those patients who are waiting within outpatient areas with no clinical oversight.
The trust should ensure a clearly defined governance structure across the entire outpatient services. There should be more monitoring of patient outcomes and performance such as waiting times within clinics.
The trust should ensure that there is a clear process for triaging of test results in Dermatology outpatients. by appropriately trained staff to ensure patient safety.
The trust should review the environment within dermatology outpatients to ensure the privacy and dignity of patients.
The trust should ensure that medical records are stored securely within outpatients.
The trust should ensure staff leading on serious investigations working in the maternity service are appropriately trained in investigatory processes and report writing.
The trust should strengthen the investigation of serious incidents within maternity services to include multidisciplinary involvement, the development of SMART action plans, and senior review and approval, in line with the Serious Incident Guidance, March 2015.
The trust should ensure women who have undergone a termination of pregnancy are cared for in an area that provides them with dignity and respect.
The trust should ensure staff working in the maternity service are given feedback on complaints received identifying themes and preventative actions.
The trust should review its complaints handling procedures to ensure that patient complaints are responded to in a timely manner. It should also ensure that staff understand the role and function of the Patient Advice and Liaison service.

Professor Sir Mike Richards

Chief Inspector of Hospitals

We visited three inpatient wards and one outpatients department in the hospital over two days. We spoke with a total of 61 people using the service and 18 of their representatives. We spoke with 29 staff, including clinical and care staff and senior managers.

We found that the provider had taken action since our last inspection in relation to ensuring the privacy and dignity of people using the service. We found many examples of people using the service being treated with consideration and respect. People told us, 'I've had nothing other than kindness and a great deal of patience.' and, 'They (the staff) draw the curtains around you if you need anything doing or if they want to talk to you.' However, this was not consistent. People on one ward told us they had to wait a long time for help to get washed and dressed and to use the commode. People using the outpatients clinic said some of the doctors did not treat them with respect.

Most people we spoke with told us they had been given appropriate information in relation to their care and treatment. A visitor said, 'The doctors don't use too much technical language, so you understand what they're saying.' Some people using the outpatients department told us they did not always get all the information they needed.

We found that the provider's systems for assessing and monitoring the quality of the services provided were not effective. Areas for improvement were identified but action taken in response was not always effective in making the necessary changes.

We found that the provider had taken action since our last inspection to ensure that people's personal records were accurate and up to date. The records we looked at generally had sufficient information in relation to the care and treatment of people using the service.

We visited three wards in the hospital and spoke with people using the service and visitors on each ward. We spoke with the matrons for the three wards and also with nurses, health care assistants, doctors, a dietitian, catering and domestic staff. We found that the provider had made changes since our last inspection to protect people using the service from the risks of inadequate nutrition.

People we spoke with were satisfied with the choice, quality and quantity of the food provided. One person told us, 'You get a choice of food for every meal and there's always something I like.' We found that the menus had been expanded to provide more choice and variety.

We found that new guidance and procedures had been introduced throughout the hospital to ensure that people had the right support to eat and drink. We saw that the guidance and procedures were followed in practice on the wards we visited. One person told us, 'There's always a nurse around at mealtimes', and we observed staff providing unhurried and sensitive help to people who needed it. Staff we spoke with felt that the new procedures made mealtimes better organised and ensured people's nutritional needs were met.

We saw that each ward now had a designated Nutrition Champion, a qualified nurse with responsibility for ensuring that people's nutritional and hydration needs were met. Staff we spoke with felt the Nutrition Champions had made a positive difference to the experience of people using the service.

We visited four wards in the hospital over two days. One was a medical ward designated as caring for older people and one was a specialist unit for the treatment and rehabilitation of people who had suffered a stroke. Two of the wards were for people having assessment of their needs before being transferred to other wards or being discharged home. We spoke with people using the service and their representatives. We spoke with staff including clinical, care, ancillary and therapy staff and senior managers.

We found that the provider had taken action and had addressed some of the concerns from our previous inspection in August 2012. However, we found that the provider had not achieved compliance in any of the three standards we looked at.

People we spoke with told us they were involved in decisions made about their care and treatment and they understood the choices available to them. We found many examples of good practice where people's privacy, dignity, independence and personal views were taken into account. However, we also found examples where people's privacy and dignity were not well promoted. People's views were sought, but it was not always clear what action had been taken or was planned to address issues raised.

Many of the people we spoke with were satisfied with the quality of the food provided. We found that people were not always offered a suitable choice of food. As at our previous inspection, we found that some people did not get the support they needed to eat enough for their needs.

We found that accurate records were not always maintained for people using the service. This meant that people were not fully protected against the risks of unsafe or inappropriate care.

People told us what it was like to be a patient in Chesterfield Royal Hospital. They described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people in hospitals were treated with dignity and respect and whether their nutritional needs were met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by an "expert by experience" (people who have experience of using services and who can provide that perspective), and a practising professional. We visited two wards, both designated as primarily caring for older people receiving medical care and treatment. The provider delivered the regulated activities 'Treatment of disease, disorder or injury' and 'Diagnostic and screening procedures' on these two wards. Each ward had 31 patients on the day of our visit. We spoke with 16 patients, three relatives, and eight staff across a range of roles.

Most patients told us they felt staff respected their privacy and dignity. We observed positive and respectful interactions between staff and patients on both wards we visited. However, we also saw examples of patients' privacy, dignity and independence not being upheld or maintained.

Patients had mixed views about the food provided. Some patients were satisfied while others wanted more variety or wanted meals to meet their specific needs. We saw that patients had a choice of meals and the food provided looked appetising. We found that patients did not always have enough support to ensure they had adequate nutrition and fluids.

Patients told us they felt safe and felt able to report any concerns to staff. We saw that staff carried out assessments to determine if patients were at risk of falling and took action to reduce this risk.

Most patients told us that staff were very good but some patients had mixed experiences and told us some staff were not as helpful as others. For example, one patient said, "It's a difference between shifts, on one nothing's too much trouble, next shift it's 'in a minute' ". We saw that although both wards were very busy on the day of our visit and staff were continually occupied, most patients said their needs were met.

We found that patients had access to their nursing care records, though none of the patients we spoke with had looked at them. We saw that nursing care records were not always accurate or fully completed and often lacked detail.

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.

Most people told us they felt involved in decisions about their care and treatment. Parents of children admitted to the hospital told us that they were given sufficient information and the child was also involved as much as possible where this was appropriate.

People we spoke with said that staff respected their privacy and dignity. One person said 'they always make sure the curtains are closed for privacy and they're very polite and friendly'.

People told us they were generally happy with the care and support they received. They said 'I've been well looked after', and said the staff were 'so kind' 'they do everything willingly and cheerfully'. One person told us they appreciated the helpfulness and straightforward approach of the stoma nurse so the person now knew how to manage their stoma care independently.

The people we spoke with had mixed views about the food provided. Some people said the food was good whilst others said that the food did not meet their needs and preferences. One person was pleased with the choice available for their gluten free diet. Other people said the food was tasteless and could be better presented. One person said 'it all tastes the same' and another commented that the food was 'abysmal'.

People told us that maintaining cleanliness and hygiene appeared to be a high priority on the wards. They said 'They are in my room every couple of hours mopping and cleaning, this room is spotless', 'the cleaning routine is extremely thorough', and 'staff are always washing their hands'.

People on the new wards said they were pleased with the facilities such as the spacious bays and the toilets and shower rooms in each bay.

Most people told us there were enough staff available to meet their needs. They said 'there's always staff around when I need them' and 'they're always coming to check I'm ok'. Two people on one ward said that they sometimes had to wait for assistance as there were not always enough staff around.

Chesterfield Royal Hospital

All Inspections

Other CQC inspections of services

During an assessment of Services for children & young people

During an assessment of Urgent and emergency services

During an assessment of the hospital overall

10 May 2023

During an inspection looking at part of the service

04 Feb to 02 Apr 2020

During a routine inspection

19 August 2019

During an inspection looking at part of the service

6 Sept to 8 Nov 2018

During a routine inspection

13, 14 & 20 July 2016

During a routine inspection

Professor Sir Mike Richards

21 April 2015

During an inspection of this service

21-24 April 2015

During a routine inspection

26, 27 November 2013

During an inspection looking at part of the service

8 August 2013

During an inspection looking at part of the service

5, 6 June 2013

During an inspection looking at part of the service

11 August 2012

During a themed inspection looking at Dignity and Nutrition

21 March 2012

During a themed inspection looking at Termination of Pregnancy Services

17 May 2011

During a routine inspection