The Care Quality Commission (CQC) has found significant improvements in the quality of care at South Tees Hospitals NHS Foundation Trust, following inspections in November and January that see their overall rating move up from requires improvement to good.
The unannounced inspection was carried out to check on the progress of improvements they were told to make following a previous inspection in February last year, in which the trust were issued with a warning notice to make rapid and widespread changes.
This inspection looked at critical care services and urgent and emergency care at The James Cook University Hospital, and medical wards (including services for older people) and surgery at both this hospital and Friarage Hospital. CQC also looked at how well-led the trust was overall.
As well as the overall rating for the trust improving from requires improvement to good, so have how safe, effective and well-led the trust is. How caring and responsive the trust is, has again been rated as good.
For the individual services inspected:
- Critical care at The James Cook University Hospital has improved from requires improvement to good. How effective, responsive and well-led it is has also moved from requires improvement to good. Safety has improved from inadequate to good, and caring was again rated as good
- Urgent and emergency services at The James Cook University Hospital was again rated as good overall, and for how effective, caring and well-led the service is. How safe the service is has also improved from requires improvement to good, however how responsive the service is, moves down from good to requires improvement
- Medical care at both hospitals was again rated as requires improvement. Caring, responsive and well-led were again rated as good, safe and effective were again rated as requires improvement
- Surgery was again rated as good overall at both hospitals with how well-led the services were improving from requires improvement to good. The service at both hospitals was again rated as good for being safe, effective, caring, and responsive.
All well as the overall trust rating improving, this inspection sees the overall rating for Friarage Hospital and The James Cook University Hospital improve from requires improvement to good overall. Both hospitals are now rated as good in all five key questions of safe, effective, caring, responsive and well-led, where previously they both requires improvement for safe, effective and well-led.
The trust had also made enough improvement to meet the requirements of the warning notice they were issued in February 2022 which is no longer active.
Sarah Dronsfield, CQC deputy director of operations in the north, said:
“When we returned to South Tees, we found an effective leadership team who had made significant and widespread improvements since our last inspection. This is reflected in their overall rating change from requires improvement to good, of which all their staff should feel very proud.
“Our inspectors saw much more effective processes, and management of services which was having a direct positive impact on the quality of care people were receiving. For example, these systems were used to identify risks to people and implement actions to reduce the impact of them, meaning they were much safer, and receiving more effective care.
“This was most evident in critical care which was unrecognisable from our last inspection. It was most impressive, they were able to do this during the COVID-19 pandemic.
“Staff across all the services we visited were well engaged and committed to continually learning and improving people’s care. It was also very impressive that leaders engaged staff to contribute to decision-making, for example to help avoid financial pressures compromising the quality of care.
“However, there are pockets of improvements that still need to be made, particularly around making sure all staff are completing mandatory training to have the skills to keep people safe and provide effective care.
“The trust has worked hard to improve the quality and safety of services they are providing to people, and other organisations should look at this report as an example of how to deliver high standards of care.
“Leaders should continue to build on the good work they’ve already done, and apply their learning to other areas in the trust. We’ll continue to monitor the trust and return to inspect their other services to ensure people receive care that meets standards they have a right to expect.”
Inspectors found the following:
- Leaders ran services well, understanding the issues faced, and making plans to tackle them. They also supported staff to develop their skills and take on more senior roles
- Staff felt respected, supported and valued, and were focused on the needs of people using services
- The service promoted equality and diversity in daily work and provided opportunities for career development
- The service had an open culture where people using services, their families and staff could raise concerns without fear
- Leaders and staff actively and openly engaged with people using services, those closest to them, staff and the public to plan and manage services
- To nurture a culture of compassionate leadership, the trust had developed a leadership, improvement and safety academy. The trust had presented nationally on the significant improvements in their national staff survey data by putting civility first as part of this culture, which is aimed at preventing bullying.
However:
- In medical care, there was not always enough nursing staff to care for people and keep them safe
- In the emergency and urgent care service, there was no clear flagging system for risks associated with people experiencing mental health crisis and people couldn’t always access the service when they needed it
- The trust faced ongoing challenges with access and flow in the emergency department, which meant that they couldn’t ensure people were able to access the department and receive the right care promptly. Despite these pressures, staff worked hard to keep people safe. The introduction of the frailty team pilot in January 2022 had helped to play a role in addressing access and flow with 54% of people reviewed by the team avoiding admission to hospital altogether.