Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust

The inspection of Doncaster and Bassetlaw Hospitals NHS Foundation Trust took place between the 14 and 17 April 2015. We undertook an unannounced inspection on the 29 April 2015. During the inspection we inspected clinical services at Doncaster Royal Infirmary, Bassetlaw District General Hospital, Retford Hospital and Montagu Hospital.

The inspection was part of CQC’s scheduled inspection programme.

Overall we judged the trust as requires improvement. Across the 5 key questions, we rated safety, effectiveness and responsiveness as requires improvement; caring and well-led were rated as good. Within these overall ratings there was variation across different clinical services, across different hospital locations.

Our key findings were as follows:

• Staffing levels vary across services. The trust is actively recruiting, but vacancies are impacting on the quality of service provided in some instances.
• Not all staff have received an appraisal or have accessed mandatory training. The trusts systems for recording these also require development.
• The majority of areas we inspected were clean, however we did identify concerns in the critical care unit at Doncaster Royal Infirmary, the sterile supplies departments at both Doncaster Royal Infirmary and Bassetlaw District General Hospital, and the minor injuries unit at Montagu Hospital.
• The majority of staff followed correct infection prevention processes, and hand washing techniques. We did identify some concerns regarding infection prevention practices in the critical care unit at Doncaster Royal Infirmary with regard to nursing patients with infections.
• Patients received appropriate nutrition and hydration whilst an inpatient.

We saw several areas of outstanding practice including:

• The trust managed the Abdominal Aortic Aneurysm (AAA) screening programme across South Yorkshire and Bassetlaw as part of the drive to reduce the number of people who die from the condition.
• Gina’s story arose from an incident at the trust, where the trust learnt and shared learning working with patients in an open and honest way. This work was recognised, locally, regionally and nationally and a local University was using the Human Factors and shared learning work from Gina’s story into one of their programmes.
• The trust was awarded the 4th National Dementia Care Award for the Best Dementia Friendly Hospital. In addition Stirling Ward was developed as the frailty assessment unit to ensure that people living with dementia were reviewed by clinicians skilled in their management at the earliest opportunity.
• The trust was working with Sheffield University in developing specialty specific training for rehabilitation nurses from Band 2 to 7.

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

Importantly, the trust must as a provider:

• Ensure that the public are protected from unnecessary radiation exposure.
• Ensure that staff receive an effective appraisal.
• Ensure that staff receive mandatory training including adult and child safeguarding training

Additionally at Doncaster Royal Infirmary the trust must:

• Review arrangements for the initial assessment of patients, including the use of streaming and triage, and add streaming / triage to the risk register
• Ensure appropriate numbers of medical, nursing and support staff of the required skill mix are available in the emergency department
• Ensure patient waiting times are reduced to ensure the 95% target for patients seen within four hours is met and maintained
• Ensure patients’ pain symptoms are assessed, and pain relief administered promptly for all groups of patients.
• Review nurse staffing of the children’s inpatient wards to ensure there are adequate numbers of registered children’s nurses and medical staff available at all times to meet the needs of children, young people and parents.
• Ensure that a clean and appropriate environment is maintained throughout the theatre sterile supply unit, emergency department and critical care unit that facilitates the prevention and control of infection.

At Bassetlaw District General Hospital the trust must:

• Review nurse staffing of the children’s inpatient wards to ensure there are adequate numbers of registered children’s nurses and medical staff available at all times to meet the needs of children, young people and parents.
• Ensure that a clean and appropriate environment is maintained throughout the theatre sterile supply unit that facilitates the prevention and control of infection.

At Montagu Hospital the trust must:

• Ensure the minor injuries unit is clean and well-maintained.
• Ensure that medicines are safely managed within outpatients and diagnostics.

At Retford Hospital the trust must:

• Audit the Radiation Exposure/ DRLs.

Professor Sir Mike Richards

Chief Inspector of Hospitals