Archived: Danetre Hospital

Updated 27 March 2014

The services on the inpatient ward at Danetre Hospital were provided by Northampton General Hospital NHS Trust (NGH). The inpatient ward was a 29-bedded ward and provided a programme of rehabilitation from a specialist therapy team for people with clinical needs requiring 24-hour nursing and medical care. In addition, the ward provided nursing care for patients with subacute medical and end of life care. There were six beds dedicated to stroke rehabilitation and six beds for palliative care.

The ward provided continuing support and care closer to home, offering help with rehabilitation and recovery from stroke. The aim was to provide care closer to home for patients fit for discharge from the acute hospital, with a clinical need for medical rehabilitation, offering a ‘step-down’ facility or had subacute medical needs. The ward also offered care to patients referred directly from the community with the aim of providing care and treatment, in order to prevent the need for admission to the acute hospital, so providing a ‘step-up’ facility. The ward was supported by a multidisciplinary team including nursing, medical and therapy staff.

Updated 27 March 2014

Danetre Hospital was one of three community hospital sites where Northampton General Hospital NHS Trust provided services on an inpatient ward. Danetre Hospital Inpatient Ward was a 28-bedded ward providing rehabilitation following discharge from Northampton General Hospital. The hospital also provided palliative care, dedicated stroke care and a service for patients who needed an enhanced level of care that could not be provided at home.

Northampton General Hospital NHS Trust was an acute trust with 800 consultant led-beds, and provided general acute services for a population of 380,000. It also provided hyperacute stroke, vascular and renal services to people living throughout the whole of Northamptonshire, which had a population of 691,952. The trust was an accredited cancer centre and provided cancer services to a wider population of 880,000 who lived in Northamptonshire and parts of Buckinghamshire.

Northampton General Hospital NHS Trust also provided services at Isebrook Hospital and Corby Community Hospital.

We found the medical service on the inpatient ward at Danetre Hospital to be generally safe because there were assessment and reporting systems in place to identify risk, take action and learn lessons from incidents and complaints. Staff felt informed about incidents and able to report concerns. Staff followed national and best practice guidelines. There was good multidisciplinary team working throughout the ward and with trust specialist teams. Outcomes for patients were good.

The ward staff operated in three teams each specialising in a field of care; this enabled staff to develop their knowledge and they continually sought ways to improve patient experience; for instance, one team had achieved the Gold Standard for palliative care.

Nurse staffing and patient dependency levels were assessed using a recognised tool. There were vacancies, which were covered either by staff on the ward doing additional hours or by bank and agency nurses. The trust was in the process of recruiting more staff.

There were arrangements in place for the safe administration and handling, storage and recording of medication. However, there had not been an allocated pharmacist to the ward to oversee and review medicine and prescribing arrangements. This meant that patients were at risk of not receiving appropriate treatment, possible medication errors occurring and necessary reviews of medication not taking place. The trust had employed a locum pharmacist who was due to start by the end of January 2014.

Analysis of infection rates in the trust showed them to be within expected limits. The ward was clean and there were arrangements in place for ward cleaning and decontamination of equipment. We found gels, aprons and gloves were in good supply and waste appropriately dealt with. There were assurance mechanisms in place to identify when standards for cleanliness and infection prevention needed improving.

We sought the views of the public at a listening event prior to the inspection and also checked on a range of patient feedback and survey information. We spoke with patients during the inspections who reported that they were happy with the care and treatment on the ward and staff were kind. We saw examples of compassionate care. The local ward results from the Friends and Family Test were consistently good, but staff were not complacent and continued to seek ways to improve patient experience.

There were clear clinical, organisational, governance and risk management structures in operation. Staff had confidence in the ward managers and felt well supported. However, not all staff had completed their mandatory training or had an appraisal. This meant that the trust could not be assured that staff were up to date with their skills and knowledge to appropriately meet patients’ needs. Issues over the lack of a pharmacist for the ward and non-completion of training and appraisals had been known to the trust for a significant time, with insufficient action taken to address the issues.

We found that the trust had breached Regulation 13 (medication) and Regulation 23 (staff support and training) for the regulated activity treatment of disease, disorder and injury.

Updated 27 March 2014

We found the medical service was safe because there were systems in place to identify risk, take appropriate action and learn lessons from any incidents or areas of poor performance. Staff were confident about how to report incidents and felt well informed. However, we found the medication arrangements had not been reviewed by a pharmacist for about six months. This was because there had been no pharmacist allocated to the ward during this time. A locum pharmacist was expected to start by the end of January 2014.

Staffing levels were calculated using a nationally recognised tool, the Hurst Nursing Workforce Planning Tool, to assess need. It had been noted that not all shifts achieved the recommended skill mix, and recruitment was taking place to address this. Three general practices provided medical support; each held a lead role for the three specialist teams on the ward. External specialist teams from across the trust and the local hospice provided additional support and advice.

The ward was clean, well maintained and appropriately equipped. Arrangements were in place for cleaning the ward and individual items of equipment. Staff knew how to decontaminate medical equipment, and we observed this in practice. Hand gels, aprons and gloves were in good supply. Quality assurance systems ensured ward cleanliness, and equipment met appropriate guidelines and standards.

Services were effective, and designed to meet the needs of patients on the ward. Staff followed national and best practice guidelines. There was good multidisciplinary team working throughout the ward and with trust specialist teams. Outcomes for patients were good. The ward operated in three teams each specialising in a field of care; this enabled staff to develop their knowledge and apply it to patient care. They continually sought ways to improve patient experience: for instance, one team had achieved the Gold Standard for palliative care.

Patients were positive about their experience and found staff kind and caring. We saw several examples of compassionate care. Patients reported they liked the food and we saw positive interactions between patients and staff. The local ward results from the Friends and Family Test were consistently good, but staff were not complacent and continued to seek ways to improve patient experience. They had specialised within three teams, so that they could concentrate on recognising and meeting patients’ particular care and treatment needs.

The services on the ward responded to the needs of the local population by providing a ‘step-up’ facility with enhanced care to patients from the community, in order to reduce the need for admission to the acute hospital, Northampton General Hospital. Similarly, a ‘step-down’ facility provided rehabilitation services for patients needing nursing and medical support after discharge from the acute hospital. In addition, the ward provided subacute medical care and had designated palliative care beds for end of life care. We found that there were no formal arrangements in place for spiritual or multifaith provision. Local ministers supported the ward but their support was not always appropriate and staff had to ask individual patients and their families where to obtain the help needed for their particular faith. There was no bereavement support in place. Staff would give support as part of the care provided, but there were no arrangements or links to external bereavement services.

There were clear clinical, organisational, governance and risk management structures in operation. There was an open culture of reporting incidents and learning from incident investigations and complaints. Staff had confidence in the ward managers and felt well supported. They were given the opportunity to develop their specialist knowledge and skills, which encouraged innovation and motivation. The trust had introduced new documentation and tools, including observation charts, to monitor patients. However, staff were experiencing difficulty because some aspects of the care documentation were designed for use in an acute setting rather than in a community hospital. Some aspects of audit data showed poor performance and staff felt scores on performance did not always reflect practice. The lack of dedicated pharmacy support, poor levels of attendance at mandatory training and a failure to complete appraisals had been known to the trust for a significant time but insufficient action had been taken to address these issues.