Royal Victoria Infirmary

Updated 24 January 2024

The Royal Victoria Infirmary including the Great North Children’s Hospital provides a full range of acute services including an urgent and emegency care department.

Updated 24 January 2024

Updated 24 January 2024

Updated 6 June 2016

We rated critical care as outstanding for safe, effective, caring, and well led and good for responsive.

Standards for infection prevention and control were good and rates of infections were better than national averages. Ward 18 was a large purpose built critical care unit with excellent facilities, in contrast to the inadequate environment of ward 38, although staff reduced risks and ensured patients received safe care.

Care was led 24 hours a day, seven days a week by a consultant in intensive care medicine. With the exception of pharmacist cover and consultant to patient ratios out of hours, staffing was in line with the Core Standards for Intensive Care (2013).

Critical care services were very well led. A genuine culture of listening, learning and improvement was evident amongst all staff.

Patients and their families had access to a range of support services. It was clear that patients were at the centre of decisions. There were many examples of compassionate care.

The critical care unit performed within or above national averages in governance and performance areas.

Updated 29 May 2019

• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse, and they knew how to apply it.
• The service controlled infection risk well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection.
• The service had suitable premises and equipment and looked after them well.
• The service had enough 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. The service managed patient safety incidents well.
• The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers monitored the effectiveness of care and treatment and used the findings to improve them. Staff of different kinds worked together as a team to benefit patients.
• Staff understood how and when to assess whether a patient had the capacity to make decisions about their 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 service planned and provided services in a way that met the needs of local people. The service took account of patients’ individual needs. People could access the service when they needed it.
• The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with all staff.
• Managers at all levels in the service had the right skills and abilities to run a service providing high-quality sustainable care. The service had a vision for what it wanted to achieve and workable plans to turn it into action.
• Managers across the service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
• The service systematically improved service quality and safeguarded high standards of care by creating an environment for excellent clinical care to flourish.
• The service had good systems to identify risks, plan to eliminate or reduce them, and cope with both the expected and unexpected.
• The service collected, analysed, managed and used information well to support all its activities, using secure electronic systems with security safeguards.
• The service engaged well with patients, staff, the public and local organisations to plan and manage appropriate services and collaborated with partner organisations effectively.
• The service was committed to improving services by learning from when things went well or wrong, promoting training, research and innovation.

However:

• The service did not meet the diagnostic imaging reporting time targets. To assist in addressing challenges with reporting times, the trust had recently started to outsource some MRI and CT elective reporting work.
• The service did not always meet the two-week urgent waiting time targets.
• While mandatory training was provided to all staff and managers told us staff were being asked to complete it, mandatory training compliance rates were not achieving the 95% target the trust set. Mandatory safeguarding training compliance did not achieve the trust target. Mandatory training and safeguarding training compliance was between April 2018 and April 2019 and therefore was expected to improve as the year progressed.
• Resuscitation trolley checks had not been consistently completed between 1 October 2018 and 16 January 2019.
• The service had challenges with paediatric radiologist staffing levels and were under resourced by three paediatric radiologists.
• The interventional radiology department used the World Health Organisation (WHO) safety checklist. However, audit of the checklist had only recently commenced
• While privacy and dignity was maintained in department areas visited, there were occasions during the inspection where patients were waiting to be seen on beds in the corridors on the main x-ray department which did not support a patient’s privacy and dignity whilst in the department.
• During the inspection there was limited evidence staff had access to communication aids to enhance communication with people with additional needs where required.

Updated 29 May 2019

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

• The service had fully implemented the care of the dying patient document and addressed all the issues we previously identified at our last inspection. Additionally, patient care and outcomes had improved, and the team’s thorough education offer to staff on wards had meant that at this inspection, we found that care of the dying really was everyone’s business.
• People were truly respected and valued as individuals. Staff went the extra mile to support their patients and people were positive about their care and treatment. Emotional and spiritual support for patients and their families was second to none.
• The staff team were stable, experienced and committed. The team’s focus on continuous development meant that standards were constantly rising. Topic specific sub groups ensured that any areas in need of improvement remained ‘on the radar’ and progress was regularly checked. Staff were given sufficient time to develop new and innovative ways to improve.
• There was a ‘can-do’ approach to end of life care when it came to people’s individual needs and preferences. The team were proactive in seeking solutions to barriers to fulfilling these and were not afraid to try new things to ensure patients’ care was right for them. People with protected characteristics under the Equality Act (2010) were offered care in a way that was tailored to suit them and empower them to make as many decisions about their care and their death as they wished.
• Safety was a priority that the whole team were engaged with. Incidents were rare, and medicines appropriately managed. Information systems shared with local partners underpinned record keeping with paperless notes and clear audit trails.
• Care and treatment were holistically planned in collaboration with patients and other local providers. Patients were identified earlier than at our last inspection, seen earlier by the specialist team, and discharged home earlier if this was their preference, leading to overall improvements in outcomes.
• Leadership was strong and compassionate. The team’s vision and strategy were well articulated and progress against three-year plans was regularly checked. Ward staff had more awareness of the team’s key documents than at our previous inspection. Staff contributed to research and the development of national guidance and conducted regular audits of their service.

However:

• The service was not meeting the trust’s 90% target for staff receiving an annual appraisal. Medical staff appraisal rates were 62.5% and qualified nursing staff 77% at the time of our inspection.
• Leadership was shared by medical and nursing staff in different directorates. While this was working effectively, the lack of an operations manager had the potential to restrict future development of the service.

Updated 24 January 2024

Updated 6 June 2016

Overall we rated outpatient and diagnostic imaging as good because:

The service had met national targets for urgent and routine appointment waiting times.

Patients were happy with the care they received and found it to be caring and compassionate. Staff worked within nationally agreed guidance to ensure that patients received the most appropriate care and treatment.

There were sufficient staff of all specialties and grades to provide a good standard of care in all departments.

There was good leadership of staff to provide good patient outcomes in the outpatients and diagnostic imaging departments. There were well-organised systems for organising clinics.

The departments learned from complaints and incidents, and developed systems to stop them happening again.

However, diagnostic imaging reporting turnaround times for inpatients and A&E patients did not match national best practice guidance.

Updated 24 January 2024

Updated 24 January 2024