Chief Inspector of Hospitals publishes report on the quality of care provided by South Tees Hospitals NHS Foundation Trust

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

A team of 45 inspectors has found that the trust provided services that were caring, responsive and well led. But the trust required improvement for providing safe and effective care.

The team of inspectors and specialists including doctors, nurses, managers and experts by experience, visited James Cook University Hospital, the Friarage Hospital and a range of community health services provided by the trust in December.

CQC rated both acute hospitals as Requires Improvement overall. End of life care at both hospitals was rated as Requires Improvement but all other core services were rated as Good. Community services were rated as Good overall.

Full reports including ratings for all of the provider’s core services are available at www.cqc.org.uk/provider/RTR.

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

“I know that South Tees Hospitals NHS Foundation Trust is going through significant period of change to re-structure services and our inspectors saw the trust was engaging staff, local commissioners and the public as part of this development.

“We came across numerous examples of excellent care and patients and their relatives were happy with their experience of care and treatment. Staff at every level were positive about working for the trust and the quality of care they provided.

“However, I am concerned that shortages of staff in some departments may affect patient care. While there have been moves to improve the recruitment process, the trust must continue to make this a priority.

“People are entitled to receive treatment and care in services which are consistently safe, effective, caring and responsive to their needs. The trust has told us they have listened to our inspectors’ findings and have begun to take action where it is required. We will return in due course to check that the improvements needed have been made.”

Inspectors identified a number of areas of excellent practice being provided by the trust, particularly within the trust’s maternity services, which were managed by a strong, cohesive leadership team.

Inspectors found that all the services they inspected across the trust were caring. Staff supported people in a compassionate way, and patients and their families spoke highly of the care they had received.

At the time of the inspection the trust was in the process of implementing a significant programme of change to restructure services in order to operate more effectively. The senior leadership team was consulting staff about the changes and staff told inspectors that they felt encouraged to introduce innovative ideas to improve service delivery and development.

Across all wards and within the community services effective arrangements were in place to manage and monitor the prevention and control of infection and all areas inspected were visibly clean. However, inspectors found nursing staff shortages across a number of wards and departments particularly in urgent and emergency care and children’s services at the trust’s two acute hospitals. Staff attendance at mandatory training and subject specific training was low in some areas.

The inspection found a number of areas where the trust must make improvements, including:

• The trust must ensure that there are enough qualified and experienced staff at both hospitals particularly in the A&E departments and medical and surgical wards.
• The trust must ensure that staff receive appropriate training and support through appraisal and the completion of mandatory training, particularly the relevant level of safeguarding and mental capacity training so that they are working to the latest up to date guidance and practice.
• The trust must ensure that patients’ records are appropriately updated and stored to ensure confidentiality is maintained at all times in line with legislative requirements.
• The trust must ensure that, where a patient is identified as lacking the mental capacity to make a decision or be involved in a discussion around resuscitation, a mental capacity assessment is carried out and recorded in the patient’s file in accordance with national guidance.
• The trust must review arrangements for the recording of do not attempt cardio-pulmonary resuscitation decisions, including records of discussions with patients and their relatives to ensure that they are in accordance with national guidance.

The reports highlight several areas of outstanding practice including:

• At James Cook University Hospital in medical care services, a team of trained therapeutic volunteers led by a therapeutic nursing sister had been created to support patients who may be living with dementia or other illnesses which affected their behaviour. This included engaging with patients, such as playing board games or other interests patients may have. They also supported patients who required help with eating or wanted to explore their environment.
• In maternity services at both hospitals the families and birth forum was involved in the design of the induction of labour suite and in championing the take-up of breastfeeding rates through the use of peer supporters, as well as improving information to raise awareness and promote the service to women when they had left the hospital.
• A ‘baby buddy’ mobile phone app was being piloted by the community midwives to inform women of pregnancy issues, common ailments and reasons to seek advice.
• Diabetes specialist nurses provided telephone support and advice and clinic sessions for patients with diabetes supported by a dietician and ran the DESMOND (Diabetes Education and Self-Management for On-going and Newly Diagnosed) programme which was accessible to patients with diabetes or the risk of developing Type 2 diabetes to provide learning and support for the patient and the health care professionals involved with them.

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 CQC has 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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