Sheffield Teaching Hospitals NHS Foundation Trust

Updated 22 December 2022

Sheffield Teaching Hospitals NHS Foundation Trust provides acute and community health services to a population of 640,000 people in Sheffield and the surrounding areas. The trust provides specialist services for the populations of Yorkshire & Humber, parts of Mid-Yorkshire and North Derbyshire. The trust delivers services from sixteen locations:

• Beech Hill
• Central Health Clinic
• Firth Park Clinic
• Heeley Dental Clinic
• Jessop Wing
• Jordanthorpe Health Centre
• Limbrick Dental Clinic
• Manor Clinic
• Norfolk Park Dental Clinic
• Northern General Hospital
• Royal Hallamshire Hospital
• Sheffield Dialysis Unit
• Talbot Dental Clinic
• The Charles Clifford Dental Hospital
• Weston Park Hospital
• Wheata Place Dental Clinic

We carried out this unannounced inspection of six of the acute services provided by this trust to check that the trust had made improvements since our last inspection.

We looked at all key lines of enquiry in the core services we inspected. We checked that the trust had taken action to comply with the Warning Notice we served under Section 29A of the Health and Social Care Act following the last inspection which told the trust to make significant improvements in the quality of healthcare provided. We also carried out an inspection of the well-led question which focussed on the specific areas of concern for the trust overall which were identified in the Warning Notice.

We inspected the trust’s medical wards (including services for older people) and surgery at the Royal Hallamshire Hospital and Northern General Hospital. We inspected urgent and emergency care at Northern General Hospital and maternity services at the Jessop Wing.

We did not inspect services provided by the trust which were not cited as a concern in the Warning Notice we served following our last inspection. We are monitoring the progress of improvements to all of the trust’s services and will re-inspect them as appropriate.

Our rating of services improved. We rated them as requires improvement because:

• There was further improvement required to ensure services were consistently safe. In surgery and medicine, the trust had not identified and addressed environmental risks including risks presented through unsafe storage of equipment, cleaning supplies and medical gases. Equipment was not clearly identified as being clean or appropriately maintained and serviced. In surgery, the trust had continued to experience never events and had not implemented a consistent approach to ensure staff learn and share lessons learnt from these incidents. In urgent and emergency services, intentional rounding was not always recorded and did not always occur with the consistency required.
• The trust had not trained sufficient numbers of staff to ensure physical restraint was undertaken safely and appropriately. The trust continued to rely on untrained staff to restrain patients when needed. Staff did not consistently undertake and record the required physical health monitoring after administering rapid tranquilisation to keep patients safe.
• There continued to be inconsistencies in practice in relation to the Mental Capacity Act. In medicine, patients subject to the Deprivation of Liberty Safeguards did not always have a recorded capacity assessment and/or decision recorded in their best interest.
• The trust did not always provide care which was responsive to the needs of people who used services. People could not always access services when they needed them and receive the right care promptly.
• There remained risks in services which had not been identified. In some instances we found leaders had not acted to reduce the impact of risks, and risks were not always reviewed in a timely manner. The trust had not made significant improvement in identifying and reporting serious incidents. There remained a backlog of serious incidents requiring investigation.

However:

• Although there was more to do to sustain and embed improvements, the trust had complied with the requirements of the Section 29A Warning Notice by making significant improvements in the quality of healthcare provided to people who used services within the timeframe specified by our notice.
• Our overall rating for safe improved from inadequate to requires improvement. Our overall ratings for effective and caring improved from requires improvement to good. Whilst our rating of well-led stayed the same because we did not undertake a full review of the well-led key question, we found some improvements since our last inspection.
• The improvements we found meant that none of the trust’s services were now rated as inadequate for safe, effective, caring, responsive or well-led. Our ratings for urgent and emergency care, medicine at Royal Hallamshire Hospital and maternity at Jessop Wing improved from inadequate to requires improvement. Our ratings for effective and caring improved in several services from inadequate or requires improvement to good.
• In rating the trust, we took into account the current ratings of critical care, end of life, outpatients. community services including community nursing, end of life, dental and services delivered at Beech Hill, Sheffield Dialysis Unit, The Charles Clifford Dental Hospital and Weston Park Hospital which were not inspected this time.
• Staff had the training to keep people safe including training in how to recognise and respond to abuse. Staff assessed and managed the risk to patients including the risks presenting due to deterioration in patients’ physical or mental health. Staff managed the risk of falls appropriately. Medicines were mostly managed safely, and the risk of infection was controlled and managed. Most services had enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment.
• The trust now provided effective care which achieved good outcomes, promoted a good quality of life, and was based on good practice. Managers ensured staff were competent and supported. Staff worked together as a team to benefit patients. Most key services were available seven days a week to support timely care. The trust had implemented new and regular audits and reviews to ensure care met fundamental standards.
• Staff were caring. We saw staff treating patients with compassion and kindness. Staff respected patients’ privacy and dignity and took account of their individual needs. Staff supported and involved patients, families, and carers to understand their conditions.
• Services were planned to meet the needs of local people and took account of patients’ individual needs. It was easy in most services for people to give feedback and raise concerns about care they received.
• Leaders had reviewed and improved governance systems and oversight of risk, issues and performance in frontline services. Fit and proper person checks were now in place for all directors.
• The trust had implemented systems to identify incidents involving restrictive interventions including restraint and rapid tranquilisation.
• The trust had also worked to improve culture in services and most staff told us they felt respected, supported, and valued. Staff and managers demonstrated consistent awareness of the improvements made to services and the areas requiring further improvement.

How we carried out the inspection

The inspections of the trust’s core services and the focussed inspection of the trust’s well-led key question was overseen by Sarah Dronsfield CQC Head of Hospitals Inspection and supported by two CQC inspection managers, eight CQC inspectors, a CQC assistant inspector, a CQC inspection planner and seven specialist professional advisors.

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.

Updated 14 November 2018

Updated 14 November 2018

Updated 9 June 2016

Overall rating for this core service Outstanding

Overall we found services for community adults to be outstanding.

There were robust methods of reporting, investigating and learning from incidents and near misses that staff understood and embedded in their daily work. There was a risk register in place that ensured potential risks were known, assessed and appropriate controls were implemented. Pharmacists worked with community teams and had written and reviewed standard operating procedures to improve safety around medicines.Compliance with mandatory training was generally high and we observed good infection control practices. We found that staffing levels met the needs of patients.

We found care and treatment was evidenced based with pathways of care based on National Institute of Clinical Excellence (NICE) guidelines. There were excellent examples of multi-professional teams working closely together for the benefit of patients. Referrals to community services were managed by the Single Point of Access (SPA) service, which established the most appropriate service for the patient. Staff had good access to records using laptops with 4G and used an electronic patient record system allowing information to be shared between professionals. Staff we spoke to had a good level of knowledge about the Mental Capacity Act and Deprivation of Liberty Safeguards.

Caring was good. We found staff were genuinely caring and passionate about the care they provided to patients. Patients we spoke to all said they were extremely happy with the care they received and felt they were always treated with compassion. Patient’s relatives said they thought the care provided had been excellent and staff had been caring and responsive. We observed staff treating patients with dignity and respect. Patients and their relatives were involved in their care. We observed treatment and support options being discussed with patients and their families before gaining consent and agreement. Emotional support was made available for example; mental health services aligned to the active recovery team provided talking therapies for patients and could signpost patients to other agencies. We saw staff putting on overshoes when entering patients home in wet weather. We thought this was extremely considerate.

Community services were exceptionally responsive. There was close working with commissioners to provide services along coordinated pathways of care. We saw good examples of community services working closely and planning services with the acute hospitals to provide integrated care to patients. The active recovery team had redesigned the traditional model of assessing to discharge to the more patient centred approach of discharge to assess. The first ward to implement discharge to assess had a sustained reduction in length of stay of 7 days. Access to services via the single point of access was excellent, ensuring patients were seen by the right professional at the right time at a venue of their choice. Staff were aware of cultural differences. Patient information leaflets were available in different languages and there was good access to interpreting services. Community nursing teams had a dedicated member of staff who was the dementia link. Staff we spoke to had completed dementia training and could describe how they would provide extra support for patients living with dementia. There was shared learning from complaints and we saw evidence that changes were made in response to complaints.

Community services were extremely well led. Senior managers could articulate their vison and strategy and shared this with staff. There was strong leadership at both senior and local level. Staff spoke highly of their managers and felt well supported and listened too. Senior managers were often seen and staff said they were approachable. Staff engagement was outstanding. The trust used different methods of engaging the staff such as the ‘listening into action’ events and ‘you said we did’ initiatives. Staff were consulted with and encouraged to lead on service development and change and they felt empowered and valued. There was a positive culture of service improvement and we found innovative services along pathways of care, which reached across both hospitals, and community services.

Updated 9 June 2016

We rated the community dental services at this trust as outstanding. This was because:

• Staff protected patients from abuse and avoidable harm. A specialist dentist working in the service had contributed to the development of theresource website ‘child protection and the dental team’, initially funded by the Department of Health and now hosted by the British Dental Association. This resource is used nationally by general dental practice teams for the effective management of safeguarding children in dental practice. Systems for identifying, investigating and learning from patient safety incidents were in place. Infection control procedures were in place. The environment and equipment were clean and well maintained and medicines and emergency equipment was available at each site we visited to deal with medical emergencies. However, due to the age and design of the Manor clinic the delivery of optimal care to patients who were confined to a wheelchair was difficult.

• The dental services were effective and focused on patients’ and their oral health care. We saw several examples of innovative care approaches including the provision of care to the most vulnerable members of society. Those vulnerable members included Sheffield’s homeless community who were treated through the The service could meet patients’ needs because of the flexible attitude of all service members. In collaboration with commissioners of dental services and dental public health consultants, Sheffield community dental service developed a domiciliary service called Residential Oral Care Sheffield (ROCS). Senior dentists and the oral health promotion team in the service work in partnership with local general dental practitioners to deliver effective dental care to 90 care homes in Sheffield.

• Patients, relatives and carers said they had positive experiences of care within the service. We saw good examples of staff providing compassionate and effective care. We also saw effective interactions taking place between individual staff members. We found staff to be hard working, caring and committed to the care and treatment they provided. Staff spoke with passion about their work and conveyed their dedication to what they did.

• Staff responded to patients’ needs at each clinic we visited. The service kept treatment delays for routine dental treatment within reasonable limits through effective resource management. Effective multidisciplinary team working ensured the service provided patients with care that met their needs and at the right time. We saw specialist dental teams delivering dental care to mental health services, the homeless of Sheffield, the spinal injuries unit and special schools.

• The community dental service was well led. Organisational, governance and risk management structures were in place. The service’s operational management team was visible and the working culture appeared open and transparent. Staff were aware of ‘PROUD’ and the organisation’s vision and way forward and they said they felt well supported and that they could raise any concerns.

• The Sheffield community dental service had achieved national profile status in community dentistry through a number of innovative projects. The clinical lead was instrumental in developing a ‘case mix’ tool kit that is used to describe the complexity of the patients treated in the community dental services. Commissioners of dental services when commissioning community dental services use this tool kit as a national benchmark. Commissioners also use the tool kit as a key performance indicator when judging the effectiveness of a community dental service.

Updated 5 April 2022

Updated 14 November 2018

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

• We rated safe, effective, caring, responsive and well-led as good.
• Staff caring for patients at the end of their life were aware of how and when to report incidents, including safeguarding concerns. We saw that staff received feedback and lessons learned were shared.
• Staff practiced safe infection control techniques.
• Staff caring for patients at the end of their life assessed patients and escalated their care to the specialist team when necessary.
• Guidelines, pathways and policies were produced in line with national best practice guidelines and recommendations.
• There was sufficient numbers of skilled staff to care for patients at the end of their life. The service was available seven days a week 24 hours a day.
• Staff understood the importance of seeking patient consent before providing care and treatment and showed a good understanding of the mental capacity act and deprivation of liberty safeguards.
• Relatives we spoke with gave consistently positive feedback. Staff spoke about the patients they cared for in a caring, compassionate and respectful way.
• Patients and their relatives told us that they were involved in planning their care and that communication with staff was good.
• Staff provided emotional support to patients and their loved ones.
• Services were planned in conjunction with external partners, across the whole of the health system to meet the needs of local people.
• We saw numerous positive examples of initiatives to meet the individual needs of patients at the end of their life.
• There was a clear leadership structure and strategy for end of life care. Staff told us that their line managers were visible, approachable and supportive.
• Local governance arrangements were robust and the team was aware of the risks to their service.
• We saw numerous examples of engagement, improvements and innovation.

However:

• The trust had implemented processes to record whether patients preferred place of death was achieved and if not why not, they had not completed any audits of this data. Therefore, whilst a system was now in place the trust was still not measuring if patients achieved their wishes. However, we found establishing patients’ preferred place of care was seen as a priority.