Russells Hall Hospital

Updated 22 November 2023

Russells Hall hospital is part of The Dudley Group NHS Foundation Trust. The trust is the main provider of hospital and adult community services to the populations of Dudley, significant parts of the Sandwell borough and smaller, but growing, communities in South Staffordshire and Wyre Forest. The trust serves a population of around 450,000 people from 3 hospital sites at Russells Hall Hospital, Guest Outpatient Centre in Dudley and Corbett Outpatient Centre in Stourbridge. The trust provides the full range of secondary care services and some specialist services for the wider populations of the Black Country and West Midlands region. The trust also provides specialist adult community-based care in patients’ homes and in more than 40 centres in the Dudley Metropolitan Borough Council community.

We carried out unannounced inspection of the following acute services provided by the trust at Russells Hall hospital.

• Services for children and young people.
• Urgent and Emergency care.

We did not inspect any other services.

How we carried out the inspection

Urgent and Emergency care at Russells Hall Hospital

We inspected this service on 17 and 18 May 2023. This was an unannounced full core service inspection looking at urgent and emergency care. We visited all areas of the urgent and emergency care (U&E) department including the waiting rooms, triage, resuscitation, minors, majors, and children’s urgent and emergency care (U&E) department.

The team that inspected the service comprised 1 CQC hospitals inspector, 1 CQC children's service inspector and 2 specialist advisors with expertise in emergency medicine and children’s emergency medical care.

During our inspection we spoke with 24 staff members including nursing staff, safeguarding leads, healthcare assistants, ambulance staff, cleaners, doctors and managers. We spoke to 15 patients, and we reviewed 5 adult patient records, 5 children’s patient records, 5 medication charts and we reviewed 11 previous case files for children’s paediatric care.

Childrens and young people's services at Russells Hall Hospital

We carried out an unannounced full core service inspection of the Children and Young People’s service on the 7 and 8 June 2023.

During the inspection, we looked at all 5 key lines of enquiry which were safe, effective, caring, responsive and well-led.

The team that inspected the service comprised of 1 CQC hospitals inspector, 1 CQC children service inspector and 2 specialist advisors with expertise in children's and neonatal services.

We spoke with 32 staff including senior leaders, matrons, doctors, nurses, health care assistants, porters, infection control leads, safeguarding leads and the transitional lead. We spoke with 7 families and 2 young people. We also looked at 65 patient records.

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.

Updated 18 April 2018

• Medical care wards were designed to ensure access, flow and discharge was effective while keeping good patient outcomes and safety in mind.
• The department had good systems and processes in place to manage sepsis by introducing bundles, sepsis leads and direct dial numbers to contact the right people who were required to intervene.
• Staff had maintained their caring and supportive approach when dealing with patients despite significant increases in pressure as a result of staffing pressures. Feedback from people who used medical care wards was overwhelmingly positive.
• Manager’s, senior nursing staff and clinicians worked closely together to identify areas where the service and patient experience could improve.
• Staff worked well as teams and felt supported by managers and felt valued by the trust as employees.
• There were quality boards throughout medical care and quality information shared with teams, patients and relatives to keep them up to date with what was happening on the wards.

However:

• Staffing remained an issue and there were a significant number of vacancies and bank and agency work across medical care wards. However, this was managed well and bank staff were well inducted into all areas were they worked.
• The trust did not always engage with national audits. There was evidence of how the service had reviewed local audit results and implemented changes to improve performance.
• Staff did not always meet targets for completion of mandatory training.
• Staff did not always carry out full safety checks in the catheter laboratory of all countable items during operative procedures. For example, they carried sharps checks but did not swab count which would be good practice.
• Patient medicines were not always appropriately disposed of to avoid harm

Updated 22 November 2023

Updated 12 July 2019

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

• The service provided mandatory training in key skills to all staff and made sure everyone completed it.
• Staff understood how to protect patients from abuse. Staff had training on how to recognise and report abuse and they knew how to apply it.
• The service had enough nursing staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment
• Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date and easily available to all staff providing care.
• The service followed best practice when prescribing, giving, recording and storing medicines. Patients received the right medication at the right dose at the right time.
• The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service.
• The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.
• Staff assessed and monitored patients regularly to see if they were in pain. They supported those unable to communicate using suitable assessment tools and gave additional pain relief to ease pain.
• Managers monitored the effectiveness of care and treatment and used the findings to improve them. They compared local results with those of other services to learn from them.
• Intensive Care National Audit Research Centre (ICNARC) data from quarter 1 April to June 2018 report showed the risk adjusted mortality rate was 1.41 for the ITU and SHDU, and for the MHDU 1.48, which was within the expected range.

• The service made sure staff were competent for their roles. Managers appraised staff’s work performance to provide support and monitor the effectiveness of the service.
• Staff of different kinds worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.
• Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.
• Staff provided emotional support to patients to minimise their distress.
• Staff involved patients and those close to them in decisions about their care and treatment.
• The critical care service planned and provided services in a way that met the needs of local people.
• The service took account of patient’s individual needs.
• Managers at all levels in the critical care service had the right skills and abilities to run a service providing high-quality sustainable care.
• The service had a vision and strategy for the critical care services reflected the trusts vision and strategy to provide the best possible patient experience and workable plans to turn it into action.
• Managers across the critical care service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
• The critical care service used a systematic approach to continually improve the quality of its services.
• The critical care service collected, analysed, managed and used information well to support all its activities, using secure electronic systems with security safeguards.
• The critical care service engaged well with patients, staff, the public and local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively.
• The trust was committed to improving services by learning from when things went well and when they went wrong, promoting training, research and innovation

However:

• The service controlled infection risk well and staff kept themselves, equipment and the premises clean. However, monthly hand hygiene audits did not include a large enough sample to provide assurance.
• Staff completed and updated risk assessments for each patient. They kept clear records and asked for support when necessary. But not all patients had venous thromboembolism (VTE) assessments.
• The service had suitable premises and equipment and looked after them well. But the SHDU did not have a resuscitation trolley based on the unit.
• Staff gave patients enough food and drink to meet their needs and improve their health. However, the service did not have a dedicated dietitian and was not meeting the Guidelines for the Provision of Intensive Care Services (GPICS) for dietician’s staff.
• Staff understood how and when to assess whether a patient had the capacity to make decisions about their care, but compliance for mental health law training for medical staff was below the trust target of 90%.
• The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with all staff. However, complaints were not managed in line with the trusts complaints policy
• People could access the service when they needed it. However, patients discharged on the MHDU were delayed more than eight hours, this was worse than other similar units.
• The service had effective systems for identifying risks, planning to eliminate or reduce them. However, the service risk register did not clearly document the date of entry for risks or when they had last been reviewed.

Updated 12 July 2019

• People were not safe or at high risk of avoidable harm. Some regulations were not met.
• People were at risk of not receiving effective care or treatment. There was risk of lack of consistency in the effectiveness of the care, treatment and support that people received. Some regulations were not met.
• There were times when people did not feel well supported or cared for and their dignity was not maintained. The service was not always caring. Some regulations were not met.
• Services did not always meet people’s needs. Some regulations were not met.
• The delivery of high quality care was not assured by the leadership, governance or culture. Some regulations were not met.

Updated 12 July 2019

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

• The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately.
• The trust had suitable premises and equipment which were well maintained.
• The service provided care and treatment based on national guidance. Where the organisation did not meet clinical indicators, there were actions in place to improve.
• Staff in the SPCT monitored their response times, preferred place of death and preferred place of care and audited this data.
• Staff treated patients with compassion, dignity and respect. Feedback from patients and relatives confirmed that staff treated them well and with kindness. Staff were keen to ease patients and relatives’ distress as much as possible. Staff had introduced activity boxes as a distraction for children who became upset while visiting a loved one.
• Staff involved patients and those close to them in decisions about their care and treatment. The service had open visiting hours, enabling relatives and carers to stay overnight.
• Staff supported people to engage in activities which they knew were important to them such as visits from their favourite pets, arranging weddings and the renewal of marriage vows.
• Staff provided emotional support for patients and their relatives to minimise their distress. The trust gave patients and carers information on what to expect following the death of a loved one, and sign posted families to relevant information and support, including counselling services.
• The trust planned and provided services in a way that met the needs of local people.
• The service treated concerns and complaints seriously. Complaints relating to end of life care were reviewed by the SPCT and discussed at the end of life steering group meeting. Staff were aware of themes in complaints around end of life care and could identify areas of learning.
• The end of life care service had a strong person-centred culture. Staff were highly motivated and inspired to offer care that was kind and promoted people’s dignity. We found strong caring, respectful and supportive relationships between people who used the service, those close to them and staff.

However:

• The nurse staffing for the specialist palliative care team (SPCT) was not in line with national guidance.
• The consultant staffing for the SPCT was not in line with national guidance.
• The SPCT did not offer a seven-day service

Updated 29 June 2023

Updated 12 July 2019

We rated it as requires improvement because:

• Staff did not always use control measures to prevent the spread of infection.
• Risks to people were not always adequately assessed and were not always managed safely.
• Records were not always available to all staff providing care.
• In the ophthalmology department local rules and risk assessments were out of date and this had not been identified by leaders.
• There were issues with the tracking of patient notes which were transported between the department and centre file where records were being stored. This had not yet been resolved.
• There were examples of ineffective governance systems in some areas such as risk registers and audits.

However:

• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
• Staff kept themselves, equipment and the premises clean.
• Managers monitored the effectiveness of care and treatment and used the findings to improve them. They compared local results with those of other services to learn from them.
• The service made sure staff were competent for their roles. Managers appraised staff’s work performance.

• Staff of different kinds worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.
• Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.
• People could access the service when they needed it. Most waiting times from referral to treatment and arrangements to admit, treat and discharge patients were in line with good practice, action plans were for those that were not.
• Managers at all levels in the service had the right skills and abilities to run a service providing high-quality sustainable care.

Updated 12 July 2019

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

• The service had planned for enough nursing staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment. Due to an increase in the whole time equivalent allocation of nursing staff numbers in 2018 following a staffing review; some wards were not fully recruited to at the time of inspection. However, shifts were staffed safely and recruitment was active.

• The service had enough medical staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.

• Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date and easily available to all staff providing care.

• The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance. We noted within the risk register specific to surgery services provided in October 2018; that not all surgery staff were adhering to NICE guidelines which meant patients may not receive evidence based care. As a result, an action had been set to monitor this through monthly clinical governance meetings.

• Managers monitored the effectiveness of care and treatment and used the findings to improve them. They compared local results with those of other services to learn from them.

• Staff of different kinds worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.

• Staff consistently cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness. Staff provided emotional support to patients to minimise their distress.

• Staff involved patients and those close to them in decisions about their care and treatment.

• The service took account of patients’ individual needs. Staff could book face to face interpretations for patients who did not speak English to a level to be able to give informed consent to treatment and care. All wards had link nurses who had received additional training and support to work with patients with specific needs. A trust wide mental health team was available to support patients.

• People could access the service when they needed it. Waiting times from referral to treatment and arrangements to admit and treat patients were in line with good practice.

• Managers at all levels in the trust had the right skills and abilities to run a service providing high-quality sustainable care. Managers across the trust promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.

• The trust used a systematic approach to continually improve the quality of its services and safeguarding high standards of care by creating an environment in which excellence in clinical care would flourish.

• The trust was committed to improving services by learning from when things went well and when they went wrong, promoting training, research and innovation.

However, we also found:

• The service provided mandatory training in key skills to all staff. Following the inspection, the trust provided evidence that nursing staff compliance to mandatory training was satisfactory; however medical staff compliance was below the trust target.

• Within theatres, we saw that flammable substances under Control of Substances Hazardous to Health (COSHH) were stored in a locked cupboard. However, all substances were located together and within a wooden cupboard which could pose as a fire risk. We raised this during inspection and the trust responded by saying the wooden cupboards would be replaced by fire-proof ones. The trust later told us they had chosen to remove the cupboards entirely to reduce the risk of fire.

• Where patients were referred with acute conditions to the new surgical ambulatory assessment unit, contained within the surgical assessment unit, a target was to triage them within 30 minutes. We spoke to staff about this. At the time of our inspection; whilst times were written on a patient whiteboard of initial observations and full nurse triages undertaken; there was no formal way to monitor or record this. Therefore, there may have been a risk that some patients were not being seen within the target time slot.

• Staff completed initial assessments for venous thromboembolism (VTE) however we noted in patient records that staff did not always record if this was reviewed after 24 hours post admission. We discussed this with ward staff who told us they encouraged medical staff to complete and record the reviews. We saw that staff undertook preventative measures, such as using compression stockings during surgical procedures, where indicated.

• Sharing of learning following never events had not reached all ward staff.

• Data provided from the trust before our inspection showed that most surgery patients were fasting too long before their surgery. Other concerns identified were patients not having food and fluid within recommended timescales after surgery. However, it was found that no patients reviewed received food inappropriately. A re-audit was scheduled for April 2019 to assess compliance with action plans.

• In surgery the 90% target was not met for the mental health law training module for which medical staff at Russells Hall Hospital were eligible. We requested a more up to date overview of mental health training compliance post inspection. We found that medical staff compliance had dropped further to 40.6%.

• Staff told us that patients were not discharged from longer stay wards after 8.30pm, and ward or bed moves were avoided after 10pm where possible. However, data from the trust showed that from October 2017 to September 2018; 1,899 bed moves happened between 10pm and 8am. The wards with the highest number of night moves were B4 (general surgery and colorectal surgery; 616 moves) and B3 (vascular and general surgery ward; 539 moves). However, we did note that the data showed a reduction in moves per month from June to September 2018 which was more positive.

• Surgical wards were housing medical outliers. On Ward B4, 12 beds were allocated to medical patients over the winter period. This meant that surgical patients were not always able to access the ward most relevant to their specialist needs. For example, we saw trauma and orthopaedic patients located on the urology ward. Despite this, staff worked well to ensure surgical and medical outliers were cared for safely and effectively.

• We noted within the trust risk register submitted in October 2018 that patients with autism may have a compromised experience due to a lack of staff training and awareness. Plans to reduce the impact of this were in place. Conversely; the trust reported in their pre-inspection information that staff were up to date with most recent mandatory training figures which included autism awareness

Updated 22 November 2023