Barnsley NHS Foundation Trust provides a range of acute hospital health services at Barnsley Hospital. The trust serves the Barnsley area which has an estimated population of 236,000. In total the trust had 359 beds. Barnsley is in the 20% most deprived areas in the country.
We inspected Barnsley NHS Foundation Trust as part of our comprehensive inspection programme. We carried out an announced inspection of hospital between 14 -17 and July 2015. In addition, an unannounced inspection was carried out on 26 July 2015. The purpose of the unannounced inspection was to look at the emergency department and medical wards at the weekend.
Overall, we rated this trust as requires improvement and we noted some outstanding practice and innovation.
However, improvements were needed to ensure that services were safe and well-led.
Our key findings were as follows:
• Staffing levels were planned and monitored. There were some shortages; most notably there was a shortage of children’s nurses at the trust.
• There had been no cases of hospital acquired MRSA since 2008. The rate of hospital acquired C.difficile was within the trust’s trajectory.
• The adjusted mortality rates had reduced significantly in the trust over the past year. Analysis across a range of indicators showed there was no evidence of risk regarding mortality.
• The trust performed mostly above the 95% standard for percentage of patients waiting to be seen within four hours since May 2014, with the exception of December 2014 and May 2015.
• Assessments of patient’s nutritional needs were recorded. Across the trust, we found patients were supported to eat and drink.
• Following transfer to a new IT appointment system, the trust had discovered a backlog of outpatients who potentially needed a follow-up appointment. Work was underway to clinically validate the list and ensure all relevant patients were offered a review appointment by 31 January 2016.
• Leadership at the trust had been subject to significant change over the last 20 months. Staff spoke positively about the trust leadership.
We saw several areas of outstanding practice including:
• The uro-gynaecology nurse specialist had introduced “percutaneous tibial nerve stimulation for overactive bladders” following a successful business case to the trust. This improved symptoms for patients and made cost savings for the trust. Audit data from 2014 demonstrated improved outcomes for women.
• The dermatology service described a tele-dermatology project they were providing in conjunction with the local Clinical Commissioning Group whereby some GP practices could send in pictures of patient problems and receive an electronic treatment plan within three days. The service had also recently been approved to provide private cosmetic procedures (such as Botox) and was seeking to use these as a revenue generator for the trust.
• We saw that staff in the breast clinic had developed a simple tool for patients to remind them to take their medication. The staff had developed a card, covered in a picture of brightly coloured tablets that could be hung from a door handle at their home such as a kitchen cupboard. This had been shared at an internal nursing conference and staff in other areas of the trust were using for their patients.
• A midwife had won the prestigious 2015 Royal College of Midwifery’s (RCM) Philips AVENT National Award for Innovation in Midwifery. They created a secure staff social networking site called ‘Ward-book’ which was used by midwifery staff at the hospital to communicate important messages across the department. Each week the Head of Midwifery wrote a departmental update which gave staff the opportunity to feedback in real-time and this was posted on the system. The Ward-book was used as a virtual notice board. It helped communication between managers and staff and helped improve the outcomes for patient care.
• Pharmacy robots had been introduced at the trust in July 2014. This has reduced errors and increased staff capacity.
However, there were also areas of poor practice where the trust needs to make improvements.
Importantly, the trust must:
• ensure all patients attending the emergency department, have an initial assessment undertaken by a suitably qualified healthcare professional in accordance with national guidance.
• ensure that children attending the hospital are cared for by nursing staff who have the qualifications, competence, skill and experience to do so safely.
• ensure oxygen is prescribed in line with national guidance.
• ensure that medicines reconciliation is completed in 24hrs and meets local and NICE guidance.
• ensure compliance with the five steps for safer surgery.
• ensure suitable patients are offered laparoscopic colorectal surgery in accordance with NICE guidance.
• address the backlog of outpatient follow-ups.
Professor Sir Mike Richards
Chief Inspector of Hospitals