Bassetlaw District General Hospital

Updated 28 March 2024

Doncaster and Bassetlaw Teaching NHS Foundation Trust provides acute services for 420,000 across South Yorkshire, North Nottinghamshire, and the surrounding areas. The trust employs over 6000 staff.

Bassetlaw Hospital is an acute hospital with over 170 beds, a 24-hour ED and a full range acute clinical services to the local population including:

• Urgent and emergency care
• Medical care (including older people’s care)
• Surgery
• Maternity and gynaecology
• Outpatients and diagnostic imaging
• Critical care
• End of life care
• Children and young people’s services
• Breast care unit

Updated 28 March 2024

Updated 10 July 2018

• We rated safe, effective, caring, responsive and well led as good.
• Care and treatment was based on national guidance and the service monitored the effectiveness of care and treatment.
• Staff cared for patients with kindness and compassion, ensuring they involved patients and their families. Feedback we received about the services from patients and their families was positive.
• The service was responsive to the needs of the individual children and young people who used it.
• There were effective governance systems and processes in place. Regular review of the risk register took place.

However,

• We were not assured that the trust’s safeguarding team were aware of all safeguarding cases. When practitioners made a referral to the local authority, the referral form stated that a copy should be sent to the safeguarding team. However the safeguarding team were unsure whether they were copied in to every safeguarding referral made to the local authority. There was a plan to introduce electronic referrals, which would automatically make a copy to the safeguarding team.
• Staff had no training around mental health conditions and there were no individual risk assessment tools used to ensure the effective management of children and young people with mental health needs.
• When GP trainees were on call they were responsible for covering gynaecology and obstetrics as well as paediatrics. This was identified on the risk register as it could create work pressures at times of high activity and not all consultants could be on site within 30 minutes. However, this was less of a risk than at our previous inspection, due to the closure of the paediatric inpatient ward overnight.
• There appeared to be a disconnect between ward level staff and the service leads. Some staff told us they did not see the management team.
• Although they were waiting for the outcome of a service review being undertaken with the integrated care system (ICS), there was no documented vision or strategy in the interim and staff were unaware of any vision for the children’s service.

Updated 23 October 2015

Overall critical care services at Bassetlaw District General Hospital were judged as good.

Within safety, concerns were identified with regard to the lack of pharmacy staff cover, there were no specifically trained intensivists working within the unit, and there was a lack of dedicated medical out of hours cover provided on the unit. We also identified concerns regarding a lack of delirium and sedation scoring and recording in patient records. However we did not identify any specific concerns regarding the levels of nursing staff on the unit, but some staff did comment that they were often moved to the critical care unit at Doncaster Royal Infirmary.

There were, however, many positive aspects to the unit. Caring was good, patients stated they were well cared for and surveys supported this. Care was effectively delivered by the multidisciplinary team utilising best practice. The service was well led locally, though as a relatively new care group unit, further focus was required on the development of the unit and its future use and links to the unit at Doncaster Royal Infirmary.

Updated 28 March 2024

Updated 23 October 2015

We saw that end of life care services were safe, caring, responsive and well led. However, we saw that improvements were required in order for services to be effective. Mental capacity assessments were not being carried out on patients who were considered to be lacking capacity to be involved in discussions about DNACPR decisions. The trust needed to have a more systematic approach to recording mental capacity assessments in relation to DNACPR decisions where patients were unable to be involved in these discussions.

We observed specialist nurses and medical staff providing specialist support in a timely way that was aimed at developing the skills of non-specialist staff and ensuring the quality of end of life care. Specialist palliative care nurses provided a five day face to face assessment service which was different to the seven day face to face service available at Doncaster. While staff told us the Doncaster on-call nurse could see patients in Bassetlaw if required, this was not widely known by staff at Bassetlaw. There was an agreement by the trust’s corporate investment committee to recruit to a further two end of life care nurses to provide an improved service for patients at Bassetlaw District General Hospital. We were told that staff were caring and compassionate and we saw the service was responsive to patients’ needs. There were prompt referral responses from the specialist palliative care team and a good focus on preferred place of care and fast track discharge for patients at the end of life wishing to be at home.

Action had been taken against the issues identified in audits including the National Care of the Dying Audit. The implementation of the last days of life individual plan of care (IPOC) had been closely monitored by the end of life care coordinator with continuous reviews and feedback in place to develop this. A business case had been developed to increase the capacity of the end of life care/specialist palliative care service and the trust board had committed investment in improving the service as a result. The trust had a clear vision and strategy for end of life care services and participated in regional discussions and collaboration in relation to strategic planning and delivery of services to improve end of life care in the region.

Updated 28 March 2024

Updated 19 February 2020

• The service provided mandatory training to all staff and controlled infection risk well. Equipment and the premises were visibly clean. Staff managed clinical waste well. There were enough staff to keep patients safe and provide the right care and treatment.
• Staff kept records of patients’ care and treatment. Records were up to date and easily available to staff providing care. The service prescribed, administered, recorded and stored medicines safely.
• Staff recognised incidents and reported them appropriately. Managers shared lessons learned locally with the team.
• The service based care and treatment on national guidance and individual specialities managed NICE guidance compliance rates within departments. Medical staff prescribed and administered pain relief for minor procedures.
• Staff worked together as a team to benefit patients and provide good care and were competent for their roles. All staff had completed their appraisal. Staff knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health.
• The service provided outpatient clinics between 9am and 5pm, Monday to Friday. Some clinics were provided in the evenings to meet demand. People could access food and drink. The service had relevant information promoting healthy lifestyles and support.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
• Staff provided emotional support to patients, families and carers to minimise their distress.
• Staff supported patients, families and carers to understand their condition.
• The service planned and provided care to meet the needs of local people. The service was inclusive and took account of patients’ individual needs and preferences.
• People could access the service when they needed it. Although some specialties struggled to meet demand, most waiting times from referral to treatment and arrangements to admit, treat and discharge patients were in line with national standards. Staff treated concerns seriously, investigated them and managers shared lessons learned with staff.
• Local managers were visible and approachable for patients and staff. They supported staff across the department. The service and senior leaders had a vision for what it wanted to achieve and a strategy to turn it into action.
• Staff felt respected, supported and valued, and focused on the needs of patients. The service provided opportunities for career development with an open culture where staff could raise concerns without fear.
• Although the ‘did not attend’ rate was higher than the England average at all of the trust’s sites, a new text reminder and respond system had been implemented. Managers and booking centre staff told us the trust had been able to reduce the rate significantly over two full months prior to our inspection.
• Leaders operated effective governance processes. Managers worked with partner organisations. Staff at all levels were clear about their roles.
• Leaders managed performance effectively. Environmental risks were identified and recorded.
• The service collected data to understand performance, make decisions and improvements. The information systems were integrated and secure.
• Leaders and staff engaged with patients, staff, and local organisations to plan and manage services. They collaborated with partner organisations to help improve services for patients.
• Leaders encouraged innovation and participation in research.

However:

• Cleaning checklists were not always completed.
• Records were not always clear, and staff did not always adhere to professional record keeping standards.
• Learning from never events was not shared widely across different outpatients departments at the trust although staff in ophthalmology were aware of the events and actions taken as a result of investigation and reporting within the specialty.
• The trust did not display information for patients on how to make a complaint.
• There was a waiting list for review patients in ophthalmology and an incident had occurred where a patient had not received the right care promptly. Patient review appointments were managed centrally by the trust bookings team and managers said their processes were robust and would not allow a backlog of review appointments. However, the incident investigation had identified over 700 patients in ophthalmology had no review appointments. Following the inspection, staff told us the trust, with the CCG, had commissioned an external review of all waiting lists. They told us all ophthalmology patients on the review list had their appointments brought forward.
• Information provided by the trust prior to our inspection showed no clinics were cancelled. However, they later provided information to show 20% of all outpatient clinics were cancelled.
• Some staff were unaware who executive leaders were.
• Although staff were aware of departmental plans relevant to their own area, not all staff were aware of how they linked in with the overarching trust strategy.
• Risk registers did not include all risks and reviews of actions taken were not documented.
• Senior leadership operated at directorate level and outpatients departments worked separately from each other. It was not clear if leaders had an overview of the outpatients department as a whole.

Updated 28 March 2024

Updated 28 March 2024