York Teaching Hospital NHS Foundation Trust is rated Requires Improvement by the Care Quality Commission

England's Chief Inspector of Hospitals has told York Teaching Hospital NHS Foundation Trust that it must make improvements following inspections by the Care Quality Commission.

Overall York Teaching Hospital NHS Foundation Trust was rated as ‘Requires Improvement’. The trust was rated as Good for whether its services were caring and effective and rated as Requires Improvement for whether its services were safe, responsive and well-led.

Full reports including ratings for all the trust’s core services are available on the CQC website.

York Teaching Hospital NHS Foundation Trust provides a range of acute hospital and specialist healthcare services to a population of approximately 530,000 people living in and around York, North Yorkshire, North East Yorkshire and Ryedale. The trust provides community-based services for people living in Selby, York, Scarborough, Whitby and Ryedale.

A team of inspectors, including specialist advisors visited York, Scarborough and Bridlington hospitals during March and May 2015.

The hospitals were visibly clean, with hand-washing facilities and hand cleaning gels available throughout. Inspectors saw good examples of hand hygiene by all staff. Inspectors found that staff were caring and compassionate, and treated people with dignity and respect. Patients were able to access suitable nutrition and hydration, including special diets.

The culture within the trust was, in the main, positive and open. Staff wanted to work more collaboratively across the three acute hospitals and community and felt that this area was improving.

The provider was unable to consistently provide safe staffing levels across the trust. There were shortages of nursing staff on medical and some surgical wards; consultant cover within A & E; and community inpatient staff. The trust was actively trying to recruit to the majority of these roles.

Patients were often waiting too long for treatment. The national targets for A & E, referral-to-treatment, and cancer waiting times were not being achieved. Inspectors noted that patients arriving in both A & E departments at York and Scarborough hospitals sometimes had to wait too long for a clinical assessment of their condition.

The Chief Inspector of Hospitals, Professor Sir Mike Richards, said:

“We have rated services provided by York Teaching Hospitals as good for delivering effective care. Policies and pathways were based on best practice, in line with NICE guidelines. My inspectors witnessed strong and respectful multidisciplinary teams working across the various disciplines.

“We found a number of areas of outstanding practice across all sites with services going the extra mile to improve the support that they provided to people – it is encouraging to report that the Child and Adolescent Mental Health Services (CAMHS) in York were providing much-needed inpatient support. However, we saw other services where more needed to be done to make sure that care and treatment consistently met the required standard.

“People are entitled to receive treatment and care in services which are consistently safe, effective, caring and responsive to their needs.”

Across the trust, the inspection team found several areas where the trust must take action including:

• The trust must ensure there are sufficient numbers of suitably skilled, qualified and experienced staff on duty at all times in line with best practice and national guidance.

At York and Scarborough Hospital:

• The trust must ensure all patients have an initial assessment of their condition carried out by clinical staff within 15 minutes of the arrival at the Accident and Emergency Department.

At Scarborough Hospital:

• The trust must ensure that patient flow into and out of critical care is improved, specifically in relation to delayed discharges, delayed admissions, running at high capacity and non-clinical transfers out of the unit.
• Staff must complete their mandatory training especially within medicine, outpatients and diagnostics and critical care, and have access to other necessary training.

At Bridlington Hospital and across community services:

• The trust must review the uptake and monitoring of training, and ensure that staff are compliant with mandatory training requirements.

There were also several areas of outstanding practice, including:

• The appointment of a senior paediatric specialty trainee ‘quality improvement fellow’ for one year. This has led to improvements such as the use of technology in handover sessions, and further plans for the development of electronic recording of clinical observations.
• Positive partnership working within the Child and Adolescent Mental Health Services (CAMHS) in York, which ensured that the acute inpatient wards had seven-day support. The community nursing team also had a CAMHS nurse specialist allocated to the team who provided psychological support for families and staff.
• The trust employed innovative methods to monitor central venous lines, which included a central line clinical pathway. Ward 25, an integrated orthopaedic and geriatric ward, worked closely with the A&E department. It identified older patients with a fractured neck of femur, to speed up flow to the ward and on to theatre, leading to fasterrehabilitation and reduced length of stay in hospital.

The reports published today by the CQC are based on a combination of its inspection findings, information from CQC’s Intelligent Monitoring system, and information provided by patients, the public and other organisations.

The Care Quality Commission has already presented its findings to a local Quality Summit, including NHS commissioners, providers, regulators and other public bodies. The purpose of the Quality Summit is to develop a plan of action and recommendations based on the inspection team’s findings.

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