England's Chief Inspector of Hospitals has told Barnsley Hospital NHS Foundation Trust that it must make improvements to some services following an inspection by the Care Quality Commission.
Overall Barnsley Hospital NHS Foundation Trust was rated as Requires Improvement. The trust was rated as Good for whether its services were caring, responsive and effective and rated as Requires Improvement for whether its services were safe, and well-led. End of life care services were rated as Outstanding for being Caring.
Full reports including ratings for all the trust’s core services are available on this website.
A team of inspectors, including specialist advisors visited spent several days at Barnsley Hospital in July 2015. A subsequent unannounced visit also took place later in the month as part of the inspection.
The Chief Inspector of Hospitals, Professor Sir Mike Richards, said: “I was encouraged to learn that we found many examples where staff went beyond their roles to provide compassionate care for patients, particularly in end of life care where we found the whole team whatever their role to be providing an Outstanding service.
“Generally, the outcomes for patients are better than the national average – although we found that emergency care, surgery and children’s and young people’s services needed to improve further.
"While staffing levels were being managed closely, I note that some shortages were having an impact; most notably in the shortage of children’s nurses.
“While it is a matter of concern that there is a backlog of outpatients who may need a follow-up appointment, we saw that work was underway to check the list and ensure that all relevant patients are offered a review appointment by 31 January.
“People are entitled to receive treatment and care in services which are consistently safe, effective, caring and responsive to their needs. I believe that the trust has potential to improve further and I will watch their progress with interest.”
Inspectors found that staff were caring and compassionate, and treated people with dignity and respect. The trust employed a full time learning disability liaison nurse and a dementia specialist nurse to support staff to meet patients’ individual needs.
Care was delivered according to best practice guidelines, patient outcomes were good across most clinical services, and there was a strong multidisciplinary team working throughout the trust.
Although staffing levels were planned and monitored, inspectors raised concerns about staffing shortages on some wards. There was a shortage of children’s nurses on the children’s ward and in the emergency department. The recruitment of suitable nurses and doctors remained an on-going challenge, but the trust had a rolling programme of recruitment and was taking action to address shortfalls.
The emergency department operated a triage system to assess patients arriving by ambulance. However, they did not have a system for triage or initial assessment of patients who did not arrive by ambulance in accordance with national guidance.
Checks to ensure patients continued to receive the medicines they were taking before admission did not always take place within 24 hours of admission and arrangements for storing and accounting for medicines in the theatres were not adequate - although there were plans in place to address this.
There had been some changes to leadership at the trust in the period prior to the inspection. Although the trust had made progress to strengthen risk management arrangements, further work was needed to fully embed these changes across the organisation.
The inspection team found several areas where the trust must take action including:
- All patients attending the emergency department must have an initial assessment undertaken by a healthcare professional in accordance with national guidance.
- The trust must make sure that children attending the hospital are cared for by appropriate nursing staff.
- Suitable Patients must be offered laparoscopic colorectal surgery in accordance with NICE guidance.
- The trust must address the backlog of outpatient follow-ups.
There were also several areas of outstanding practice, including:
- A Midwife had won the 2015 Royal College of Midwifery’s national award for innovation in midwifery. The trust had created a secure staff social networking site called ‘Ward-book’, which was used by midwifery staff at the hospital to communicate important messages across the department.
- The uro-gynaecology nurse specialist had introduced “percutaneous tibial nerve stimulation for overactive bladder” which improves symptoms for patients and reduced costs for the trust. Audit data from 2014 demonstrated improved outcomes for women.
- The Dermatology service described a teledermatology project they were providing in conjunction with the local clinical commissioning group whereby some GP practices could send in pictures of patient problems and receive an electronic treatment plan within 3 days.
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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