Gateshead Health NHS Foundation Trust

Updated 14 August 2019

Gateshead Health NHS Foundation Trust is a NHS Foundation Trust based in Gateshead in the North East of England. Gateshead Health NHS Foundation Trust was authorised as a Foundation Trust in January 2005. The trust provides secondary and community care and older persons’ mental health services to a population of approximately 200,000. Wider populations are served for specialist screening services, pathology and gynaecology-oncology services, including South of Tyne, Northumberland, Humberside, Cumbria and Lancashire.

The trust provides services from the Queen Elizabeth Hospital, Dunston Hill Day Hospital, Bensham Hospital, Primary Care Centres, GP surgeries, and Patients’ homes. The trust also provides a range of services from Blaydon Primary Care Centre and Washington Primary Care Centre, up until 1 October 2018 a specialist unit in Houghton-le-Spring for patients who require rehabilitation.

The trust delivers some clinical pathways, through hub and spoke arrangements, with neighbouring providers.

The trust is a tertiary centre for gynaecological oncology and a provider of specialist screening services, for breast, bowel and aortic aneurysm.

Trust services were commissioned by Newcastle and Gateshead Clinical Commissioning Group (CCG).

The trust has a revenue turnover of around £250m and employs 4,400 staff.

The trust has 600 hospital beds and employs around 4200 staff across the services. Between 2017/2018 the trust saw 59,355 inpatient admissions, 445,033 outpatient attendances, 121,346 accident and emergency admissions and delivered 1642 babies. There were 1104 in-hospital deaths.

The CQC has carried out a number of inspections of the trust. It was rated as ‘good’ with outstanding care by the CQC in 2015/16. In 2017 Older Persons’ Mental Health Services was rated inadequate for inpatients and ‘requires improvement’ for community-based services.

Updated 14 August 2019

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

• There were systems and processes embedded to keep people safe within acute and community services. Staff received training in safety systems and had a thorough understanding of safeguarding procedures staffing levels were reviewed appropriately and regularly. Any staff shortages were escalated and responded to well. The trust had a strong track record of safety which was supported timely and accurate performance information. There were robust medicines management processes in place. When incidents occurred the trust demonstrated lessons were learnt and communicated to widely to staff.
• Patients received effective evidence based care and treatment which met their needs. The trust ensured there was consistency of practice through the review of evidence based guidance, best practice standards, legislation and technologies. Staff and volunteers were appropriately qualified for their role. New staff were afforded a comprehensive induction and were supported to consolidate their skills as required. People were supported to make decisions and, where appropriate, their mental capacity was assessed and recorded. When people aged 16 and over lacked the mental capacity to make a decision, best interests decisions were made in accordance with legislation.
• Patients and their families who received care at the trust were truly respected and empowered as partners in their care. Feedback from those receiving care was positive. We observed staff were highly motivated and offered care which was kind and promoted dignity. We found staff built strong relationships which were caring and respectful, and these were valued and promoted by leaders.
• We found the needs of people were met and prioritised in the way in which services were configured and delivered. Patients and their families were given informed choice and continuity of care. Patients and their families could access the right care at the right time. Waiting times, delays and cancellations were minimal and managed appropriately. People were kept informed of any disruption to their care or treatment. The trust used learning from complaints and concerns as an opportunity for improvement.
• There was a positive culture within the organisation which drove improvement and governance to support the delivery of high quality person centre care. Leaders from all levels within the organisation were visible and approachable. Service leaders actively promoted and empowered staff to drive improvement. Innovation was celebrated and quality improvement was embedded within the trust.

However:

• We found a ward environment which was not clutter free, this could mean that patients were at risk for falling. In addition we were concerned with the storage of substances hazardous to health.
• On the wards for older people with mental health problems we found patient records were not easily accessible for staff during the recent migration from paper to electronic system and some items were missing. This meant that staff were not always updating risk assessments following incidents of falls. Following the inspection the Trust provided information to confirm all missing documents had been located and added to the records. They also audited the records. Staff had followed the trusts falls protocol however, the risk assessment had not been updated or reviewed. In addition staffing levels had fluctuated requiring increased use of bank and agency staff.
• We found the Sunniside Unit did not comply with guidance on eliminating mixed sex accommodation. This impacted on patient’s privacy and dignity. The trust did not have any general mitigation in place relating to the privacy and dignity of patients using dormitories and individual risk assessments had not been completed to identify and manage the risks. However, the trust has since confirmed all patients will have an individual risk assessment regarding the safe use of dormitories and it has plans in place to ensure full compliance with the Mental Health Act Code of Practice, 2015 in the future.

Updated 14 August 2019

Updated 14 August 2019

Updated 14 August 2019

We rated this service as good because:

• The service 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. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• 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. People could access the service when they needed it and did not have to wait too long for treatment.
• 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.
• The service had used its transformation programme to move focus from management of individual conditions to the overall, holistic wellbeing of patients.

Updated 14 August 2019

Our rating of this service improved. We rated it as good because:

• The service provided safe care. Clinical premises where patients were seen were safe and clean. The number of patients on the caseload of the teams, and of individual members of staff, was not too high to prevent staff from giving each patient the time they needed. Staff managed waiting lists well to ensure that patients who required urgent care were seen promptly. Staff assessed and managed risk well and followed good practice with respect to safeguarding.
• Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment and in collaboration with families and carers. They provided a range of treatments that were informed by best-practice guidance and suitable to the needs of the patients. Staff engaged in clinical audit to evaluate the quality of care they provided.
• The teams included or had access to the full range of specialists required to meet the needs of the patients. Managers ensured that these staff received training, supervision and appraisal. Staff worked well together as a multidisciplinary team and with relevant services outside the organisation.
• Most staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
• The service was easy to access. Staff assessed and treated patients who required urgent care promptly and those who did not require urgent care did not wait too long to start treatment. The criteria for referral to the service did not exclude people who would have benefited from care.
• The service was well led and the governance processes ensured that procedures relating to the work of the service ran smoothly.

However:

• The occupational therapy team had not received training in the Mental Health Act 1983 or the Mental Capacity Act 2005.
• There were limited opportunities for patients who used the service and those close to them to provide feedback on the service.

Updated 14 August 2019

Our rating of this service improved. We rated it as requires improvement because:

• Systems and processes in place were not effective to ensure care records were complete, up to date and contemporaneous.
• Sunniside Unit did not comply with guidance on eliminating mixed sex accommodation. An action plan was in place to eliminate the use of dormitories however, this did not address all issues regarding patients’ privacy and dignity.
• At the time of inspection, staff were not completing individual risk assessments for patients in dormitory accommodation on Sunniside Unit and there were no plans as to how the risks were managed.

However:

• The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received training, supervision and appraisal. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
• The staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice. A good range of activities for patients were also available.
• Staff were caring, compassionate and professional in their interactions with patients, and understood the individual needs. They actively involved patients and families and carers in care decisions.
• The service managed beds well so that a bed was always available locally to a person who would benefit from admission and patients were discharged promptly once their condition warranted this.