County Durham and Darlington NHS Foundation Trust is rated by the Care Quality Commission following comprehensive inspection

England's Chief Inspector of Hospitals has told County Durham and Darlington NHS Foundation Trust that it must make improvements following an inspection by the Care Quality Commission in February 2015.

County Durham and Darlington NHS Foundation Trust was rated as ‘Requires Improvement’ overall. The trust was rated as ‘Good’ for whether its services were caring and responsive and rated as ‘Requires Improvement’ for whether its services were safe, effective and well-led.

Both University Hospital of North Durham and Darlington Memorial Hospital were rated as ‘Requires Improvement’ overall, but the trust’s community services received an overall rating of ‘Good’.

Full reports including ratings for all the trust’s care services are available at www.cqc.org.uk/provider/RXP.

County Durham and Darlington NHS Foundation Trust provides a range of acute and community services a population of approximately 600,000 people across County Durham, Darlington, North Yorkshire, the Tees Valley and South Tyneside.

Inspectors found that staff were caring and compassionate, and treated people with dignity and respect. Patients told inspectors that they were happy with the quality and quantity of food, and were able to access special diets if these were needed.

Inspectors noted that there was effective communication and collaboration between multidisciplinary teams, with multidisciplinary safety discussions and board rounds each morning on all wards. Doctors, nurses and allied health professionals worked well together to provide a holistic approach to patients’ care and treatment.

The trust had a clear vision, with strategies and plans in place for service delivery and future development within the trust. Staff reported that there was a strong culture of learning and improvement and training and development was actively encouraged.

While most areas of the trust visited were clean, with good infection control procedures, inspectors identified some concerns about the cleanliness and monitoring arrangements for infection control within the trusts Accident and Emergency departments. Inspectors have since reviewed this during a separate unannounced inspection and found that action had been taken by the trust to ensure that all equipment in the Accident and Emergency departments were clean.

Across the trust inspectors found examples of patient care records that were not fully completed or kept up to date. Supportive documentation on some wards, such as fluid balance charts and risk assessments, were not consistently completed and pharmacy support to wards and community services was inconsistent. The trust was aware of this issue and was working to address the gaps in pharmacy provision to critical care.

Inspectors raised concerns about staffing levels across a number of services. There was a heavy reliance on bank and agency staff to maintain safe staffing levels. Although the trust was actively recruiting nurses, this remained a challenge. Not all staff working in the community felt fully engaged with the development of services.

CQC’s Chief Inspector of Hospitals, Professor Sir Mike Richards, said:

“Our inspectors found a number of areas of good practice across all sites with services going the extra mile to improve the support that they provided to people. 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. “Since our inspection we have been monitoring the trust and working closely with Monitor and other stakeholders, such as the local Clinical Commissioning Group and NHS England.

“The trust leadership knows what it needs to do to bring about improvement and our inspectors will return at a later date to check on what progress has been made.”

Across the trust, the inspection team found several areas that needed to improve:

• The trust must review current governance processes to ensure they are embedded to ensure consistency across acute and community services.
• The trust must ensure that there are sufficient numbers of suitably skilled, qualified and experienced staff, on medical wards, particularly where patients are receiving non-invasive ventilation (NIV).
• The trust must undertake undertakes a review of the skills, knowledge and capabilities of nurses to complete accurate and timely care plans that meet the needs of patients.
• The trust must ensure that patients are placed on the most appropriate ward to meet their needs.
• The trust must ensure that patient records, including those for patients awaiting discharge, are kept up to date, are patient-centred, contain relevant information about their treatment and care.
• The trust must ensure that medical staff record mental capacity assessments for patients who are unable to participate in decisions about ‘do not attempt cardiopulmonary resuscitation’ (DNACPR).

Inspectors also witnessed several areas of good and practice across the trust, including:

• The critical care service in Darlington Memorial Hospital exceptionally caring. Inspectors observed highly individualised care and attention to detail given to patients and relatives.
• Safety huddles had been implemented on the wards at the University Hospital of North Durham.
• There was consistently positive feedback from patients and relatives about community nursing teams with care being described as excellent.
• The dietetics team was committed to improving nutrition; work it had undertaken had been published and shared nationally.
• The County Durham Rapid Early Specialist Team (CREST) service provided early senior and multidisciplinary assessment for frail older people, which facilitated safe, early supported discharge and managed patients with an anticipated short length of stay.
• There was a family nurse partnership established to provide intensive support for teenage mothers.

CQC’s inspection team informed the trust of its findings immediately after the inspection so that it could take steps to make any improvements.

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.

A team of CQC inspectors and specialists including doctors, nurses, managers and experts by experience spent four days at the trust in February 2015.

Under its inspection model, CQC has given individual ratings to each of the core services at the trust; urgent and emergency services, medical care, surgery, critical care, maternity and gynaecology, services for children and young people, end of life care and outpatients and diagnostic imaging. Community services were also given overall ratings.

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