Doncaster and Bassetlaw Hospitals NHS Foundation Trust is rated Requires Improvement by the Care Quality Commission

England's Chief Inspector of Hospitals has told Doncaster and Bassetlaw Hospitals NHS Foundation Trust that it must make improvements following inspections by the Care Quality Commission.

Overall Doncaster and Bassetlaw Hospitals NHS Foundation Trust York was rated as ‘Requires Improvement’. The trust was rated as Good for whether its services were caring and well-led and rated as Requires Improvement for whether its services were safe, effective, responsive.    

Full reports including ratings for all the trust’s core services are available on the CQC website. 

Doncaster and Bassetlaw Hospitals NHS Foundation Trust provides a wide range of health services across four hospitals (Bassetlaw District General Hospital in Worksop, Doncaster Royal Infirmary, Montagu Hospital, Mexborough and Retford Hospital), as well as community locations including Chequer Road Clinic. The trust serves a population of around 420,000 people.

The inspection team included CQC inspectors and a variety of specialists: consultant paediatrician, consultant obstetrician, consultant anaesthetist, midwife, senior nurses and managers, student nurse and experts by experience. They inspected the trust between the 14 and 17 April 2015. CQC undertook an unannounced inspection on the 29 April 2015.

There were concerns regarding staff levels in many areas across the trust. The trust was taking action to recruit, and was in the process of undertaking further overseas recruitment for nursing staff; however across both nursing and medical staffing, vacancies continued to cause concern amongst staff with high levels of agency and bank staff in some areas.

Staff in maternity services held ‘afterthoughts’ sessions where they held debriefing and resolution meetings with women to discuss any concerns relating to their care and treatment, and made any necessary referrals to counselling or other specialist services where required.

The majority of areas inspected were clean, however inspectors did identify concerns in the critical care unit at Doncaster Royal Infirmary, the sterile supplies departments at both Doncaster Royal Infirmary and Bassetlaw District General Hospital, and the minor injuries unit at Montagu Hospital.

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

“We spoke with patients, carers and relatives who did not indicate any specific concerns. Patients felt involved in their care and the majority of relatives felt that they were informed. Overall, Doncaster and Bassetlaw Hospitals NHS Foundation Trust has been rated as ‘Requires Improvement’.

“During the inspection concerns were identified in respect of staffing in some areas. The inspection team noted that the trust was undertaking a recruitment drive, including nurses from overseas.

“I applaud the trust for its endeavours in the treatment of dementia. Their award - National Dementia Care Award for the Best Dementia Friendly Hospital, is a great example of those living with the condition being reviewed by clinicians skilled in their management at the earliest opportunity.

“People are entitled to receive treatment and care in services which are consistently safe, effective, caring and responsive to their needs. I am hopeful that when we next visit I will be able to report significant improvement.”

Across the trust, the inspection team found several areas where the trust must take action.

Importantly, the trust must as a provider:

• Ensure that staff receive an effective appraisal.
• Ensure that staff receive mandatory training including adult and child safeguarding training.

Additionally at Doncaster Royal Infirmary the trust must:

• Review arrangements for the initial assessment of patients, including the use of streaming and triage, and add streaming / triage to the risk register.
• Ensure appropriate numbers of medical, nursing and support staff of the required skill mix are available in the emergency department.
• Ensure patient waiting times are reduced to ensure the 95% target for patients seen within four hours is met and maintained.

At Bassetlaw District General Hospital the trust must:

• Review nurse staffing of the children’s inpatient wards to ensure there are adequate numbers of registered children’s nurses and medical staff available at all times to meet the needs of children, young people and parents.
• Ensure that a clean and appropriate environment is maintained throughout the theatre sterile supply unit that facilitates the prevention and control of infection.

At Montagu Hospital the trust must:

• Ensure the minor injuries unit is clean and well maintained.
• Ensure that medicines are safely managed within outpatients and diagnostics.

At Retford Hospital the trust must:

• Audit the Radiation Exposures. Diagnostic reference levels (DRL’s) were used as an aid to optimisation in medical exposure. The trust policy was to audit radiation exposure against the DRL’s, however this was not occurring, and at Montagu Hospital had not taken place since 2002.

Inspectors saw several areas of outstanding practice including:

• The trust managed the Abdominal Aortic Aneurysm (AAA) screening programme across South Yorkshire and Bassetlaw as part of the drive to reduce the number of people who die from the condition.
• Gina’s story arose from an incident at the trust, where the trust learnt and shared learning working with patients in an open and honest way. This work was recognised, locally, regionally and nationally and a local University was using the Human Factors and shared learning work from Gina’s story into one of their programmes.
• The trust was awarded the 4th National Dementia Care Award for the Best Dementia Friendly Hospital. In addition Stirling Ward was developed as the frailty assessment unit to ensure that people living with dementia were reviewed by clinicians skilled in their management at the earliest opportunity.
•  The trust was working with Sheffield University in developing specialty specific training for rehabilitation nurses from Band 2 to 7.

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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