Stockport NHS Foundation Trust

Updated 15 May 2020

Stockport NHS Foundation Trust provide services for children and adults across Stockport and the High Peak area, as well as community health services for Stockport. The trust operates from three hospital locations, 24 community locations across Stockport and their staff also provide care in people’s homes. Stepping Hill Hospital is the trust’s main acute site, which provides emergency, critical care, surgery, children’s and young people services, end of life care and medical services. The medical services provided at the hospital include general medicine, endoscopy, cardiology, geriatric medicine, endocrinology, gastroenterology, rehabilitation, respiratory and stroke medicine. The trust also offers a specialist `hub` centre for emergency and high-risk general surgery, one of only four in Greater Manchester and covering the south-east sector of the region. The other hospital locations, Devonshire Centre for Neuro-rehabilitation and Bluebell Ward – The Meadows, deliver non-acute services.

The trust had 692 beds in November 2019. The trust had increased bed capacity during the winter period and had approximately an additional 60 beds open at the time of inspection. The trust holds approximately 1880 outpatient clinic appointments and 791 community clinic appointments each week. Stockport NHS Foundation Trust has a designated critical care unit with 13 beds for both level 2 and 3 patients. They provide midwifery care to 3,100 women and their families each year throughout the pregnancy within both hospital and community settings.

Between January 2019 and December 2019, there were 100,520 type one attendances at the department. Type one emergency departments provide full major emergency services and have resuscitation facilities. Between January 2019 and March 2019, there were a further 1,808 type three attendances at the service. Type three departments are for walk-in attendances for minor illness or injury.

The trust employs over 5,400 staff who work across a number of premises to deliver hospital and community-based services.

We have previously inspected Stockport NHS Foundation Trust. We inspected the trust in January 2016. It was rated as requires improvement. We carried out an unannounced focused inspection of Stepping Hill Hospital in March 2017. We carried out this inspection to particularly look at the care and treatment received by patients within urgent and emergency care and patients receiving medical care at the hospital.

The trust was last inspected in October and November 2018. It was rated as requires improvement. The use of resources was rated as inadequate.

Updated 15 May 2020

• We rated safe, effective, responsive and well-led as requires improvement. We rated caring as good. We rated three of the trust’s 13 services as requires improvement, one as inadequate and nine as good. In rating the trust, we took into account the current ratings of the nine services not inspected this time.
• We rated well-led for the trust overall as requires improvement.
• We rated urgent and emergency care as inadequate. We rated medical care, maternity and children and young people’s services as requires improvement.
• Within urgent and emergency care, people were not always kept safe and were at high risk of avoidable harm during periods of heavy demand on the service.
• Risk assessments for patients with mental health needs were not being completed, meaning that opportunities to prevent or minimise harm were missed. We raised this with the trust and they took immediate action to address this.
• There was a lack of consistency in the effectiveness of the care, treatment and support that people received in some areas.
• There were significant issues with the flow of patients through the emergency department and the hospital so that patients were assessed, treated, admitted and discharged in a safe, timely manner. Emergency care was consistently unable to be provided in a timely way. Women could not always access the maternity service of their choice when they needed it. High numbers of patients were medically optimised and awaiting transfer or discharge.
• Governance and risk management systems were not always effective. There was a lack of oversight of key performance areas in the services.

However:

• There had been improvements, particularly within medical care, regarding staff knowing how to support patients who lacked capacity to make their own decisions or those who were experiencing mental ill health.
• We rated caring as good in medical care, maternity and services for children and young people.
• There was improved compliance with the Fit and Proper Persons Requirement (Regulation 5 of the Health and Social Care Act (Regulated Activities) Regulations 2014).

Updated 15 May 2020

Updated 15 May 2020

Updated 21 December 2018

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

• There were high compliance rates of mandatory training and most mandatory training module targets had been met.
• Services had suitable premises and equipment. They were kept clean to minimise the risk of infection.
• There were enough staff, with the right qualifications, skills and training to meet key performance indicators so that patients were seen and assessed in a timely way and within the prescribed targets.
• The service provided care and treatment based on national guidance. There were processes in place to ensure that guidance was promptly reviewed, disseminated and embedded.
• The effectiveness of care and treatment was monitored regularly and reported to the trust board. Services were involved in the annual clinical audit programme. Audit results and patient outcome monitoring were used to drive improvements.
• Staff received regular supervision and role-specific training. They were encouraged to take up external training courses that were relevant to their roles.
• Staff worked collaboratively with the acute hospital, GPs and local authority to deliver effective care and treatment and support people to live healthier lives and manage their own conditions.
• Staff cared for patients with compassion and respected their privacy and dignity. They offered adequate emotional support and involved patients and their carers in decisions about patients’ care and treatment.
• Complaints and concerns were treated seriously and lessons were learned and shared with staff.
• The service had a vision for what it wanted to achieve and workable plans to turn it into action. The views of staff and patients were used to drive improvements.
• Staff were valued and supported by managers and a positive culture and the wellbeing of staff was promoted.

However:

• The crisis response team was not carrying out the expected nursing assessments required for patients which was particularly important given their role as the first response. We found that records were incomplete.
• The crisis response team were not operating in line with their terms of reference and did not have a clear exclusion policy. They were not measuring expected key performance indicators such as bed days saved due to the intervention of the team and whether patients were admitted to hospital when patients were discharged from the service.
• The security arrangements in Kingsgate House could be improved with addition of secure doors between patient waiting areas and clinic room corridors.
• The arrangements for meeting individual patient needs and access to information could be improved. For example, it was difficult to establish from the trust website what community services were offered, where those services were and a choice of methods to contact the services.
• Most services did not have information leaflets printed in different languages, easy read or pictorial versions.

Updated 11 August 2016

We gave an overall rating of outstanding to the community children’s, young people and families service. Services were safe and lessons were learned from incidents. Staff were aware of the duty of candour. Safeguarding processes were robust and there was effective leadership and partnership working in this service. There was one to one safeguarding supervision for staff. Records were securely stored and were comprehensive, accurate and complete.

Staffing was adequate and there had been an increase in staffing establishment in a number of areas. Recruitment was in progress to address the vacancies and there was good skill mix in teams.

There was an audit programme and the results of the audits were used to change and improve services. Services were evidence based and outcome focused. Staff worked with different agencies and other health professionals to improve health and social care outcomes for children, young people and families.

There was a focus on positive mental health and well-being and a preventative approach to services that required a high level of input for children in their pre-school years. The most vulnerable children and young people were intensively supported to help them to achieve their outcomes.

Services were caring and children with complex health needs were supported from birth through their school years and work was ongoing to support young people through transition. The trust worked with children and their families to develop and improve services.

Targets were met by the trust and the relationships with other agencies, including commissioners was positive. This partnership working supported children and young people in their development.

The leadership at all levels of the trust was effective and robust. Governance, quality and risk management structures were in place and there was two way communication between the senior management team and the staff in community clinics. Staff enjoyed working at the trust and felt that they did a good job.

Updated 11 August 2016

Overall rating for this core service GOOD

We rated community inpatient services as good in the safe, effective, responsive, caring and well led domain because:

• The ward areas were fit for purpose, clean and spacious.

• Staff followed good hygiene practices and there were good systems for handling and disposing of medicines.

• There was good evidence of multidisciplinary team working with regular meetings held to review patient’s ongoing development and needs.

• Staffing levels were adequate although agency staff and staff from the ward would work extra shifts to fill some shifts. Recruitment was ongoing to fill current vacancies

• Compliance with mandatory training was mainly above target for most staff.

• Incidents were reported through effective systems and lessons learnt or improvements made following investigations were shared.

• Staff were aware of their role and responsibilities around the Mental Capacity Act (2005) and Depravation of Liberty Safeguards.

• Staff had access to information they required, for example diagnostic tests and risk assessments.

• Best practice guidance in relation to care and treatment was followed across the service.

• The service participated in national and local audits and action plans were formulated following the results of audits.

• The care provided by the service was patient centred and patients were involved in their care and planning individual goals.

• Patients were observed receiving compassionate care and their privacy and dignity were maintained.

• There was strong local and service level leadership across the service.

• Staff said they felt supported, that morale was good and they felt part of the team.

Updated 11 August 2016

Overall rating for this core service GOOD O

The specialist palliative care team worked as part of a multidisciplinary team covering the acute and community based services, with specific team members dedicated to providing the community element of specialist care. Their role was to assess, support, deliver, monitor and evaluate end of life and palliative care provided by the trust within Stockport, Tameside and Glossop.

The specialist palliative care team provided safe, co-ordinated care and had patients as the focus of their work. Patients were discharged quickly from hospital and equipment and services were put in place within the community to meet their needs.

There was excellent team working between the trust and other services to provide holistic patient care. General Practitioners, social services and community district nurse services all worked alongside the specialist team ensuring patients were a priority. The trust worked to national standards such as the Gold Standards Framework, and were working towards accreditation, and provided excellent educational programmes[DW1] for specialist staff and other clinical staff that may participate in end of life care as part of their role.

In twelve months between 31st March 2014 and 1st April 2015, 918 people had been referred to the community specialist palliative care team. This was less than the previous year. Of those patients 92% (844) had a cancer diagnosis.

Implementation of alternative documentation for the Liverpool Care Pathway[DW2] 2014 (LCP) had been slow. The service had used guidance and key action documents in the interim, to ensure individualised care planning had taken place and the introduction of the Individualised Plan of Care was still being rolled out at the time of inspection.

Patients and relatives we spoke with told us the care they received was delivered with an attentive and considerate manner. They felt involved in their treatment and felt their wishes were followed Patients were treated with dignity and respect.

There was good communication between the specialist palliative care management team and the executive team. Senior staff told us they felt supported and there was non-executive director representation on the trust board. Communication through the community teams, however, could be improved. Some staff told us they felt disconnected from the community and hospital senior leadership teams.

Plans were in place to merge services as part of the Healthier Together and Greater Manchester devolution programmes which would enhance service provision in the area.

Training took place at local level and the business group managed the outcomes from the two areas separately. Separate MDT meetings took place weekly in each area and although the trust had a specialist palliative care consultant in the community, they were only responsible for patients in the Stockport area. Patients in Tameside and Glossop were treated by their GP and any clinical advice was obtained from the local hospice.