University Hospital of Hartlepool

The University Hospital of Hartlepool is part of North Tees and Hartlepool NHS Foundation Trust and has 88 beds. It provides a wide range of diagnostic services, outpatient clinics, maternity services and day case and low risk surgery,

The trust gained foundation status in 2007. It has a workforce of approximately 4660 staff and serves a population of around 400,000 in Hartlepool, Stockton and parts of County Durham. The trust also provides services in a number of community facilities across the areas supported, including Peterlee Community Hospital and the One Life Centre, Hartlepool.

We inspected University Hospital Hartlepool as part of the comprehensive inspection of North Tees and Hartlepool NHS Foundation Trust and inspected University Hospital Hartlepool on 7-10 July and 29 July 2015.

Overall, we rated University Hospital Hartlepool as requires improvement. We rated it good for safe, caring and responsive, but it required improvement in providing effective and well-led care.

We rated surgical services, children’s and young people services and outpatient and diagnostic imaging services as good and medical care and maternity and gynaecology services as requires improvement.

Our key findings were as follows:

• Arrangements were in place to manage and monitor the prevention and control of infection. There was a dedicated infection control team to support staff and ensure policies and procedures were implemented and adhered to. We found that areas we visited were clean. On Holdforth Unit we saw that infection control procedures were not always being followed.
• There were low rates of infection in the hospital, with no confirmed MRSA infections, two confirmed cases of Clostridium Difficile and one confirmed case of Escherichia Coli (E. Coli).
• Patients were able to access suitable nutrition and hydration, including special diets and they reported that they were content with the quality and quantity of food.
• There were staffing shortages with one ward unable to meet the safer staffing requirements. The trust used NHS Professionals or agency nurses to address the staffing requirements. We discussed this concern with the trust and we noted that beds had been closed on the ward to improve staffing ratios on our follow-up unannounced inspection.
• We reviewed a significant number of policies on the intranet for medicine and maternity services that were out of date and required updating.
• There were processes in place for the reporting of incidents and there was evidence of learning from incidents. However, governance processes were not fully developed or embedded and there were concerns in some areas regarding the maintenance and use of risk registers.
• There were concerns regarding leadership of Holdforth Unit however the trust had addressed these concerns in part by the time of the unannounced inspection.

We saw several areas of good practice including:

• The development of advanced nurse practitioners had enabled the hospital to respond to patients’ needs appropriately and mitigated difficulties in recruiting junior doctors.
• The bariatric service had been developed as part of a consortium arrangement with neighbouring NHS trusts to ensure the local population had access to this service.
• Staff had produced posters and delivered presentations at the International Society of Orthopaedic and Trauma Nursing international conference on the development of virtual fracture clinics and on the roles of speciality nurses.
• The trust told us that a number of staff within the departments had completed modules on service improvement and that one current project was working to improve the staff engagement and sustainability in clinical supervision.
• A project in conjunction with Hartlepool Council was initiated to improve health care for people living with learning disabilities. When a patient with learning disabilities was admitted to the hospital, an alert was generated and they were admitted to a virtual ward managed by the learning disabilities lead nurse. This ensured that the trust was able to respond to their needs in an appropriate and timely manner.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the hospital must:

• Ensure there are systems and processes in place to minimise the likelihood of risks by completing the 5 Steps to Safer Surgery checklist.
• Ensure staff follow trust policies and procedures for managing medicines, including controlled drugs.
• Ensure that risk assessments are documented along with personal care and support needs and evidence that a capacity assessment has been carried out where required.
• Ensure effective systems are in place which enable staff to assess, monitor and mitigate risks relating to the health, safety and welfare of people who use the service.
• Ensure that all policies and procedures in the In-Hospital Care directorate are reviewed and brought up to date.
• Ensure midwifery policies, guidelines and procedural documents are up to date and evidence based.
• Ensure there are always sufficient numbers of suitably qualified, skilled and experienced staff to deliver safe care in a timely manner.
• Ensure that all annual reviews for midwives take place on a timely basis.
• Ensure all staff attend the relevant resuscitation training.

In addition, the hospital should:

• Ensure the processes and documentation used for appraisal of non-medical staff meets their personal development needs in children and young people services.
• Ensure that formal drugs audits and stock checks are carried out regularly in outpatients.
• Ensure that clinic planning, room utilisation and staffing is effectively managed and controlled for outpatient clinics including those hosted by the trust.
• Ensure that established models of regular nursing clinical supervision are implemented for all staff involved in patient care.
• Ensure that strategy and management plans regarding transforming the outpatients departments are communicated to all staff.
• Have a competency based framework in place for all grades of midwives.
• Have systems in place to achieve the nationally recommended ratio of 1:15 for supervision of midwives.
• Indicate benchmark data on the maternity performance dashboard to measure performance.
• Ensure the availability of a diabetes specialist midwife.
• Provide simulation training to prevent the abduction of an infant.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Professor Sir Mike Richards

Chief Inspector of Hospitals