Updated 23 February 2022
We carried out an unannounced inspection of three of the acute core services provided by this trust because the trust was in special measures. We carried out a comprehensive inspection of critical care and medical care and a focused inspection of urgent and emergency care services.
We also inspected the well-led key question for the trust overall.
We did not inspect several core services that had previously been rated as requires improvement because this inspection was focused on services where we had concerns. We are monitoring the progress of improvements to these services and will re-inspect them as appropriate. As we inspected three out of nine core services, this meant due to aggregation, the rating of requires improvement at location level would not have changed. Services previously rated as requires improvement and not inspected this time include:
- Surgery
- Maternity
- Gynaecology
- End of life care
- Outpatients
- Diagnostic Imaging
Our rating of this trust improved. We rated it as requires improvement and the chief inspector of hospitals has recommended to NHS England and NHS Improvement (NHSEI) that it be removed from the Recovery Support Programme.
- The trust has made marked improvement on those issues that led to it being placed in the Recovery Support Programme (which was then called Special Measures).
- We rated effective, caring and well-led as good, and safe and responsive as requires improvement. Well-led is the overall trust-wide rating, not an aggregation of services ratings.
- We rated all three of the services we inspected as good overall. In rating the trust, we took into account the current ratings of the seven services we did not inspect this time.
- Mandatory training, including safeguarding training compliance for medical staff was below the trust target. Staff did not consistently complete daily and weekly safety checks on resuscitation equipment. Critical care did not have a dedicated pharmacist to support the service. Patient records were not always stored securely. The service did not always use systems and processes to safely prescribe, administer, record and store medicines.
- People could not always access the services when they needed it. Waiting times from referral to treatment were not always in line with national standards.
However:
- Most services had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. The service managed safety incidents well and learned lessons from them.
- Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
- Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
- The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback.
- Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.
How we carried out the inspection
We carried out this inspection on various days throughout December 2021 and January 2022. We visited areas relevant to each of the core services inspected and spoke with a number of patients and staff, as well as holding focus groups. During the inspection we visited critical care, all ward areas for medical services except Stanhoe ward as patients with COVID-19 were being treated on this ward, and all areas of the adult and children’s emergency department, except those restricted due to COVID-19 for urgent and emergency care. We spoke with 76 staff members of various specialty and profession including, consultants, doctors, nurses, healthcare support workers, pharmacists, domestic staff, therapists, support staff, governance and educational staff and senior managers. We spoke with 13 patients throughout the departments and reviewed 36 patient records.
You can find further information about how we carry out our inspections on our website: www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.