Chief Inspector of Hospitals finds that South Tyneside NHS Foundation Trust requires improvement

England’s Chief Inspector of Hospitals has rated South Tyneside NHS Foundation Trust as Requires Improvement following a comprehensive inspection by the Care Quality Commission.

A team of inspectors has found that the trust provided services that were outstanding for being caring, but that the trust required improvement for providing safe, effective, responsive and well led services.

During the inspection in May and June 2015, a team of inspectors and specialists including doctors, nurses, managers and experts by experience, visited South Tyneside District Hospital and the trust’s community services provided across South Tyneside, Sunderland and Gateshead. Full reports including ratings for all of the core services will be available from 00:01 on Tuesday 1 December at: www.cqc.org.uk/provider/RE9.

At South Tyneside District Hospital, maternity and gynaecology services, end of life care, and outpatients and diagnostic imaging were rated as Good. Medical care, services for children and young people, critical care, surgery, and urgent and emergency services were rated as Requires Improvement. Community health services were rated Good overall, and in particular were rated as Outstanding for being caring.

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

“When we inspected the services run by South Tyneside NHS Foundation Trust, we found that staff were universally committed to delivering compassionate person centered care to patients and this is reflected in the Outstanding rating awarded to the trust for caring services. We were particularly impressed by the trust’s approach to end of life care where staff worked closely with patients and their relatives to coordinate and plan the care for patients at the end of their life.

“However the pressure on beds has been affecting the quality of care. I am concerned that at times patients needing intensive care were being cared for in other areas. Patients have had to wait too long in Accident and Emergency before they are admitted to the wards. These are areas which must be addressed to ensure that patients’ needs are met at all times.

“The trust must also continue the work to tackle staff shortages and to address concerns around gaps in staff training. I know that the senior managers have acknowledged the importance of these challenges. I believe that the trust has considerable potential to improve their services along these lines, and I will watch their progress with interest.”

During the inspection, CQC identified a lack of capacity in the intensive care unit. On a number of occasions patients requiring admission to the unit had to be cared for in the theatre recovery unit. At the time of the inspection plans to increase the number of beds in the intensive care unit were awaiting approval by the executive board.

There had been a recent increase in nursing staff on some wards. However, there were not enough doctors and on some wards the number of nurses was below safe levels. The trust was using agency nurses and locum doctors to address their staffing requirements.

In both the hospital and community services inspectors found that arrangements were in place to manage the prevention and control of infection. All areas visited by the inspection team were clean.

Inspectors found that staff were caring and compassionate, and treated people with dignity and respect. Patients told inspectors that they were happy with the care and treatment they received and that staff listened to their views and those of their family members. Care for people receiving end of life services was rated as Outstanding within South Tyneside District Hospital and in the community. Care for children receiving community services were also rated as outstanding.

Dental services had excellent local leadership and were rated as outstanding.

Learning from incidents was widely shared across the trust and staff recognised the importance of reporting incidents to ensure patient safety.

The inspection identified a number of areas where the trust must improve including:

• The trust must review compliance with mandatory training, particularly training in safeguarding, medical device management, medicines management and Mental Capacity Act and Deprivation of Liberty Safeguards.
• The trust must ensure the consistent use of the World Health Organisation’s surgical safety checklist.
• The trust must review how the flow of patients is managed through the emergency department including how they deal with patients waiting for more than four hours for transfer to a ward.
• The trust must implement an escalation plan approved by operating theatre and critical care nursing and clinical leads that ensures that appropriate support systems are available on a timely basis if critical care patients are nursed in the recovery room.
• There must be appropriate staffing on all children’s inpatient areas particularly the special care baby unit.

The reports highlight several areas of outstanding practice:

• A national survey of the experience of cancer patients had found the trust to be the best performing hospital in England. Areas of excellent performance in the survey included emotional support from nursing and medical staff, clear explanations of what was wrong and what to expect, involvement of family members and easy contact with the cancer specialist nurse. There was a bereavement ward specialist nurse who held bereavement meetings and the chaplain, a trained psychotherapist provided support to patients and their family.
• The community dental service had developed a video to help prepare Learning Disability patients for visits to the dentist.
• An outstanding level of care and compassion for patients and their relatives using community end of life care services. Patients and relatives felt truly respected and valued as individuals and empowered as partners in their care.
• The trust’s services to support older people won the value in healthcare ward in the Health Service Journal national awards. The service supports people who are malnourished to ensure they are receiving the right, high quality care regarding their diet.

A training programme was also set up in local care homes, resulting in more than 1,000 carers being trained to ensure residents receive a high energy, high protein diet. The trust provides a range of community services across South Tyneside, Gateshead and Sunderland, and hospital services in South Tyneside for a population of around 153,000 people.

The reports which CQC publish today 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 including Healthwatch.

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.

Ends

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