Doncaster Royal Infirmary

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.

Doncaster Royal Infirmary (DRI) is one of the acute hospitals forming part of Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust. There are more than 500 beds. It provides a full range of 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

Updated 28 March 2024

Updated 10 July 2018

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

• We rated effective, caring, responsive and well led as good. Safe was rated as requires improvement.
• Sepsis screening tools were used and all the records of patients we saw with suspected sepsis were managed appropriately.
• 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.
• Children’s services were actively involved with the Integrated Care System (ICS) to plan care to reflect the needs of the local population.
• There were effective governance systems and processes in place. Regular review of the risk register took place.

However:

• Safeguarding training rates were below the trust target.
• There were no individual risk assessment tools to ensure the effective management of children and young people with mental health needs. Not all staff had received training in caring for children and adolescents with mental health conditions, but this had started to be addressed.
• Actual staffing levels did not meet planned levels and the nurse to patient ratio exceeded the Royal College of Nursing (RCN) guidance (2013).
• We observed that staff were not always using personal protective equipment or following appropriate hand hygiene practices.
• There were environment issues, such as out of order shower cubicles on the children’s unit, water damaged ceiling tiles and protruding wires on the neonatal unit and condemned televisions were being stored in the adolescent room on the children’s ward.
• We observed medicines left unattended.

Updated 23 October 2015

Overall critical care services at Doncaster Royal Infirmary were judged as good.

There were 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 overall, though as a relatively new care group unit further focus was required on the development of the unit in terms of space and facilities.

The service met the individual needs of patients whilst they were on the unit. Early discharges and out-of-hours discharges were similar to other units, and out of hours discharges to the ward were slightly above that of other similar units. There were some concerns regarding patients being discharged from the critical care unit delayed by over four hours.

Within safety, concerns were identified with regard to the environment and the risks associated with evacuation in the event of a fire and distance from other services that were required for the effective functioning of the unit. The poor use of storage and the impact this had on infection prevention risks and the practices for nursing patients with infections.

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. Hotel services staff were not adequately trained or supported in the receipt of bodies to the mortuary and we were not assured by the trust’s arrangements for the storage of bodies in the mortuary in a way that respected the dignity of patient’s after death. 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 seven day face to face assessment service. 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. The development of an electronic referral/alert system had seen an increase in referrals to the end of life care team in a timely manner. A business case had been developed as a result and the trust board had committed investment in expanding the end of life 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

We previously inspected outpatients jointly with diagnostic imaging, so we cannot compare our new ratings directly with previous ratings.

We rated this service as good because:

• The service provided mandatory training to all staff. 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 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 or weekends 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. Staff made reasonable adjustments to help patients access services.
• 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:

• Some outpatients staff did not follow trust policy regarding security of paper prescriptions.
• There was not always an indication on equipment that it had been cleaned and 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 outpatient departments at the trust.
• 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.
• Although the trust told us there was a system in place to identify and record patients waiting for long periods within clinics, we did not see this being followed in practice in all outpatient areas during our inspection. There were some long waiting times within clinics and not all departments informed patients on arrival how long they would need to wait or the reason for any delay.
• 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 and specialties 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