Newark Hospital

Updated 14 May 2020

Newark Hospital is located in the Newark and Sherwood area of Nottinghamshire. It provides surgery, outpatient services, inpatient medical services, endo of life services and an urgent care service.

The Urgent Care Centre is open 24 hours a day to treat urgent but not life-threatening conditions in adults and children.

The trust provides medical care services for patients. At the hospital, there is an endoscopy unit and 36 inpatient beds across two wards. Sconce Ward is a sub-acute/rehabilitation ward that sees patients across various specialities. The Fernwood Unit is a 12 bed, GP led ward for patients with low-level rehabilitation needs. The hospital offers end of life services on both these wards.

The hospital has a Minster day case minor operations suite with 20 beds consisting of 12 beds and eight trollies. Day cases are performed Monday to Friday and the service offers day case surgical procedures for gynaecology, dermatology, plastics and ophthalmology orthopaedics, podiatric surgery, breast, general surgery and urology. There are two day case theatres, one with laminar flow. The service also provides a pre operative assessment service.

We inspected surgery and end of life services on this inspection.

Updated 14 May 2020

Our rating of services improved. We rated it them as good because:

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

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, 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 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;

• The surgical service was not holding simulation drills directly on the unit to be able to assess what went well and where improvement was needed specifically for theatres and the ward to improve future drills on the unit and staff response to emergencies.
• The surgical service was not storing intravenous fluids in locked cupboards in theatres in line with best practice guidelines from the Royal Pharmaceutical Society and the National Institute for Health and Care Excellence (NICE).
• The service was not conducting sufficient local audits to be able to assess patient care and outcomes more clearly at Newark hospital.
• The trust was unable to provide any data prior to the inspection for the Newark Hospital site only. All information in the report is from staff but without data to corroborate it unless specifically mentioned in the report.
• The endo of life service did not provide a seven-day week 24 hour a day end of life or specialist palliative care team.
• The trust did not consistently collect, audit, analyse, and use information to support all its activities. Internal audit processes across the service were minimal and audit outcomes were not used to improve quality and performance of the service.
• Staff did not know their roles and responsibilities under the Mental Capacity Act 2005 to support patients that lacked the capacity to make decisions about their care.
• There were several of governance issues which indicated the trust did not have full oversight of issues relating to the end of life care service at Newark hospital.

Updated 15 August 2018

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

• There were good processes in place to prevent avoidable harm.
• Patient risk assessments were routinely completed and nursing records were clear and comprehensive.
• Care and treatment was delivered in line with evidence based, best practice guidance.
• There was a positive multi-disciplinary team (MDT) approach on the wards and departments we visited.
• Consent was well managed and staff understood their responsibilities in relation to the Mental Capacity Act and associated Deprivation of Liberties Safeguards (DoLS).
• Staff demonstrated a kind and caring approach towards patients and their families. It was obvious that staff had positive relationships with patients and we saw them spend time talking to patients and their families and friends.
• Staff took their time to respond to the individual needs of patients, including those living with a cognitive impairment such as dementia and those living with a learning disability.
• Services were in place to support patients with spiritual and cultural needs.
• All staff we spoke with were enthusiastic and passionate about the work they did.
• There was evidence of clinical governance procedures and quality measurement processes.

However;

• Patients’ medical records were not always clear or legible and it was difficult to find and follow the latest episode of care.
• Some staff we spoke with at the time of the inspection were still unsure of the direction of travel for this hospital. In addition, some staff were unclear about the plans for the Fernwood Unit.

Updated 14 May 2020

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

• The trust was unable to provide any data prior to the inspection for the Newark Hospital site only. All information in the report is from staff but without data to corroborate it unless specifically mentioned in the report.
• The service did not provide a seven-day week 24 hour a day end of life or specialist palliative care team.
• The trust did not consistently collect, audit, analyse, and use information to support all its activities. Internal audit processes across the service were minimal and audit outcomes were not used to improve quality and performance of the service.
• Staff did not know their roles and responsibilities under the Mental Capacity Act 2005 to support patients that lacked the capacity to make decisions about their care.
• We looked at six Do not resuscitate orders (DNACPR) orders out of the six, four were incorrect (80%).
• There were several of governance issues which indicated the trust did not have full oversight of issues relating to the end of life care service at Newark hospital. Prior to our inspection, the trust were unable to supply any data requested specifically for Newark hospital. The reason given for was the data could not be separated from the main Kingsmill site. This has meant all data requested and provided after our inspection and in the report is not specific to Newark hospital and therefore cannot be reviewed on that basis.

However,

• Staff had training in key skills, 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 also managed medicines well.
• Staff knew how to recognise incidents and report them appropriately
• The service had suitable premises and equipment and controlled infection risk well. Staff kept equipment and the premises clean.
• The service prescribed, gave, recorded and stored medicines well. Patients received the right medication at the right dose at the right time and staff kept clear, up to date and appropriate records of patients’ care and treatment.
• Staff understood how to protect patients from abuse and knew their roles and responsibilities when raising a safeguarding notification
• The service took account of patients’ individual needs. Nursing staff could access translation services for patients who did not speak English as a first language. The trust had facilities for family members to stay with their relative overnight and the mortuary had facilities for bariatric patients.
• The service treated concerns and complaints seriously, investigated them in line with trust policy.
• Portering staff transported deceased patients to the mortuary in a timely manner.
• The EOLC team were proud of the organisation as a place to work and spoke highly of a culture of working together to meet the needs of the patients and their families.
• The hospital had end of life champions on the wards who cascaded information and training from the EOLC team.

Updated 15 August 2018

We rated it as good because:

• Mandatory training including safeguarding adults was higher than the trust target for mandatory training.
• Staffing levels showed minimum vacancies and a low staff turnover rate.
• Medical records were available for over 98% of the time for clinic appointments.
• There was safe handling and storage of medical records.
• There was evidence of shared learning following incidents and there was a positive culture related to incident reporting.
• Care and treatment was given in line with national evidence based guidance.
• There was a range of facilities to meet peoples nutritional and hydration needs.
• Staff were suitably trained and competent to deliver care effectively.
• Appraisal rates were 98% for outpatients services at Newark Hospital
• There were processes in place to obtain consent in line with policies.
• We saw staff providing compassionate care throughout our visit. Patients spoke highly of the care they received from staff.
• Staff and volunteers provided emotional support to patients during visits to outpatient services.
• A variety of services were being offered which supported the local population.
• There was a large active voluntary service which supported patients, families and staff.
• The ‘did not attend’ (DNA) rate was lower than both the national and trust average.
• Patients were offered a choice of appointments and there had been an increase in attendances for both new attendances (7.4%) and follow up appointments (8.8%).
• Clinic utilisation had improved from 77% to 88.9%.
• There was a clear vision and strategy for the hospital which was shared by leaders, staff and the public. There was evidence of progress and delivery of key objectives within the strategy.
• Leaders were visible and changes that had been made in senior leadership had had a positive impact on staff.
• There was a governance structure and processes that enabled the hospital to monitor and measure performance and to manage risks.
• There were high levels of staff satisfaction. Staff were proud of the hospital as a place to work and spoke highly of the culture.
• There was evidence of a continuous learning culture and progressions of innovation to improve outpatients service at Newark Hospital.

Updated 14 May 2020

Updated 15 August 2018

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

• Safety was given a high priority, people were protected from avoidable harm and abuse. Lessons were learnt when things went wrong and staff were open and honest with patients. Performance showed a good track record and steady improvements in safety.
• There were clearly defined and embedded systems, policies and procedures to keep people safe and safeguarded from abuse. Staffing levels and skill mix were planned and reviewed. Patients were assessed appropriately and their condition monitored for signs of deterioration.
• People had good outcomes because they received effective care and treatment that met their needs. There was participation in local and national audits and information was used to improve care. Staff were competent to carry out their roles and had annual appraisals to determine training and development needs.
• There was evidence of good multidisciplinary working particularly when elderly or vulnerable patients were discharged and needed ongoing care.
• Staff had a good understanding of the Mental Capacity Act and consent to care and treatment was obtained in line with legislation and guidance.
• People were treated with dignity and respect and were involved as partners in their care. Staff responded passionately when people needed help and support and helped patients and those close to them to cope emotionally with their care and treatment.
• Services were planned and delivered in a way that met the needs of the local population. Reasonable adjustments had been made and action taken to remove barriers for people who had difficulty using or accessing services. It was easy for patients to complain or raise a concern.
• There was a clear statement of vision and values driven by quality and safety and the strategic objectives were monitored and reported to the board.
• Good governance procedures and structures were in place which interacted with each other appropriately. Risks were managed and understood by all staff.
• Leaders were visible and supportive, staff were complimentary about local leaders. There was a culture of openness and honesty and mechanisms were in place to support staff and promote positive wellbeing.
• There was effective engagement with local stakeholders and staff, staff actively raised concerns and those who did were supported. Staff proactively sought ways to innovate and improve.

However:

• Two nurse call bells in one of the treatment rooms were attached to extension cables which represented a ligature risk.
• There were no local safety standards in place for invasive procedures.
• The controlled drug storage area was shared with the GP out of hours service which could result in stock control errors.
• Staff were still uncertain about the future of Newark Hospital and the UCC.