CQC finds Yeovil District Hospital Good for Caring, but overall trust requires improvement

England's Chief Inspector of Hospitals has rated the services provided by Yeovil District Hospital in Somerset as Requires Improvement following an inspection by the Care Quality Commission.

A team of CQC inspectors and specialist advisors spent three days inspecting Yeovil District Hospital NHS Foundation Trust during March this year. Full reports of the inspection including ratings for all core services are available at www.cqc.org.uk/provider/RA4

At the time of the inspection the hospital was on black alert - which meant that services were extremely busy and capacity was stretched in every area. This affected the care delivered in some areas. P

Professor Ted Baker, Deputy Chief Inspector of Hospitals, said:

“During the inspection we found that Yeovil District Hospital NHS Foundation Trust was working hard with other organisations to improve the services offered to the local community.

“We found a highly committed workforce who put their patients at the centre of care. We saw some examples of very good practice which included the stroke buddying group and the ways in which maternity staff were involving vulnerable young women in maternity care.

“However we also found an emergency department which was not responsive to the needs of patients when it was under pressure. We were also concerned to find that young adult patients were placed on a young persons’ unit within the children’s ward - so much so that we needed to raise this during the inspection.

“We found that the trust were responsive to our concerns and they made immediate arrangements to ensure that children were properly safeguarded.

"Although the trust needs to ensure that there are enough staff to meet the needs of patients at periods of high demand, it is for the Board of the trust to determine whether this is best achieved through additional recruitment, or it can be achieved through changes to the existing model of care. In planning for the future, the trust must continue to work closely with primary care services and the wider healthcare economy to ensure that people living in the Yeovil area get consistently high quality care - whether in hospital or at home.”

The inspection team found that staff were caring, respectful and considerate. Staff were proud to work at Yeovil as part of a hospital-based community in which staff worked together to try to meet the needs of patients.

The emergency department was experiencing continued pressure and services had not kept pace with the demand. Some patients had to wait too long for an initial clinical assessment.

Overall there were proportionately fewer senior consultants than the average for hospitals in England. There was a shortage of nurses in some specialist areas. Some patients were waiting too long for surgery; referral to treatment times did not meet national standards in four of the six surgical areas.

Most areas of the hospital were visibly clean although equipment was not always stored in a way which reduced the risk of infection.

At the time, CQC was concerned at arrangements to protect children on Ward 10 from the risk of abuse. The ward includes a unit which had been designed for young people in transition to adult services. Although it was intended to be used by young people with complex medical conditions, other patients were admitted and there was no way of preventing adults from having access to young children. Following the inspection, the trust agreed to ensure patients meet the criteria on admissions and to commission a review of the service.

The report identifies a number of areas of outstanding practice including:

• The development of a hospital garden for use by patients, including those living with dementia.
• At the foot of every bed space in the critical care unit there is a clock, with the date and a clear sign which says: "You are in intensive care, you are in Yeovil Hospital." This had been provided in response to patient feedback to help orientate patients.
• The critical care outreach team had produced a patient assessment document to help the early recognition of sepsis. A staff badge has been introduced to acknowledge staff who had used the tool to identify and manage a patient with sepsis.
• In maternity and gynaecology services, the Acorn team provide specialist care for women who are vulnerable, known to be at risk of domestic abuse, who smoke or are prone to substance abuse.
• Services for children and young people have a school based within the children’s outpatients department for patients who had been in hospital for long periods.

The inspection has identified a number of areas for improvement that include:

• The trust must ensure equipment is stored appropriately and in a way that reduces the risk of infection.
• Resuscitation equipment must be routinely checked. Children’s resuscitation equipment must be available in the children’s assessment area in the emergency department.
• The trust must ensure medical and nursing staffing is sufficient to meet the needs of patients.
• The trust must ensure there are enough medical and nursing staff to meet the operational and staffing standards for intensive care units.
• The emergency department must ensure patients receive initial assessment by a qualified clinical member of staff within 15 minutes of arrival.
• The trust must ensure young adults (patients between the ages 18 to 24) meet the criteria for admission onto the Young Persons Unit. The trust must review the physical environment of Ward 10 and explore options to ensure patients over the age of 18 do not have access to children.

The Care Quality Commission will present 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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