North Tees and Hartlepool NHS Foundation Trust

Updated 16 September 2022

North Tees NHS Foundation Trust provides acute and community health services to over 400,000 people in the immediate locality of Hartlepool, Stockton and parts of County Durham, as well as offering some specialist services more widely across the North East. There are two main hospital sites, University Hospital of North Tees, based at Stockton-on-Tees, and University Hospital of Hartlepool. The trust also operates a smaller, community hospital at Peterlee, and delivers community services at Lawson Street, Stockton, and One Life Centre, Hartlepool.

The trust provides urgent and emergency care, medical care, surgery, critical care, maternity, gynaecology, children and young people’s services, end of life and outpatient services alongside a range of community services delivered in people’s homes and small community settings.

We carried out this unannounced inspection of North Tees and Hartlepool Hospitals NHS Foundation Trust as part of our continual checks on the safety and quality of healthcare services. At our last inspection we rated the trust overall as good. Our inspection was prompted by concerns about the quality and safety of services. We also inspected the well-led key question for the trust overall.

We inspected maternity services at Hartlepool and North Tees hospitals, and services for children and young people at North Tees, from 3 to 5 May 2022.

We did not inspect medicine, surgery, urgent and emergency care, critical care, end of life care, outpatients or diagnostics at this trust during this inspection. We continue to monitor the quality of these services and may re-inspect if and when appropriate.

At this inspection, we found that ratings in maternity, had gone down to requires improvement since we last inspected them in 2018 when they were rated as good. At this inspection, we found the ratings in services for children and young people stayed the same, and we rated them as good overall.

Due to the ratings given at this inspection, the trust’s overall ratings of good across all domains changed to requires improvement in safe, effective and well-led. This meant that the trust’s overall rating changed from good to requires improvement.

In rating the trust, we took into account the current ratings of medicine, surgery, urgent and emergency care, critical care, end of life, outpatients and community services including community health services for adults, children and young people, end of life and dental services which were not inspected this time.

At this inspection, we rated the core services of maternity requires improvement overall and services for children and young people as good overall.

Our rating of services went down. We rated them as requires improvement because:

• The trust had interim arrangements in place for several key roles, and there was a lack of united leadership and succession planning. Most strategies were in draft, incomplete and not complementary.
• Senior and executive leaders did not always operate effective governance systems to manage risks and issues within the service. Governance arrangements were complex and the board did not always have sufficient oversight and focus on operational risks.
• The trust did not have enough medical and midwifery staff in the areas we inspected to care for patients and keep them safe. Medical staff did not all have regular, up to date appraisals.
• The trust had not engaged with its local community to find out what people wanted and needed. Engagement strategies were not existent, or in development, and had not included consultation with the wider community, equality groups, the public or other local organisations.
• The trust did not always discharge its responsibilities fully under Duty of Candour regulations and did not audit compliance. Complaints were not being handled in line with the trust’s complaints policy.

However:

• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients and their families.
• Staff understood how to protect patients from abuse, and generally controlled infection risk well.
• Leaders and teams managed risk effectively and escalated risk where appropriate, and information systems supported staff to collect and store reliable data.

Updated 3 February 2016

Overall we rated safety as good. There were systems in place to report incidents and staff told us they knew how to report incidents and received feedback from these. Staff were able to give examples on how they had learnt from incidents and how improvements were implemented. We found there were sufficient numbers of staff to make sure that care was delivered to meet patient needs and sickness rates were below the trust target of 6%. Staff had undertaken relevant mandatory training and safeguarding training and compliance rates were above 92%.

We rated effective as good. The trust monitored and identified whether they followed appropriate NICE guidance relevant to the services they provided. The service worked in conjunction with other colleagues in the trust to develop integrated care pathways in order to facilitate the delivery of care closer to home and reduce the length of time a patient needs to remain as an inpatient. Within the therapy service patient specific outcome measures were widely used to monitor and demonstrate effective care delivery and outcomes. However, within community nursing services we found there was no formalised process for clinical supervision in place. Staff told us there were differences across the trust in how this was implemented. Some staff told us they accessed clinical supervision regularly and it worked well whereas other staff told us there was no system to access supervision.

We rated the caring domain as good. We observed care being delivered and listened to staff speaking to patients and relatives on the telephone. In order to gain an understanding of people’s experiences of care, we talked to patients and their relatives who used services. During our visit we saw that patients and relatives were treated with respect, dignity and compassion and we saw caring and compassionate care being delivered. Staff were seen to be very reassuring towards patients, their relatives and other people. People we spoke with during the inspection told us they had been involved in the planning of their care.

Overall we rated the service as good as being responsive to people’s needs. The trust had a range of specialist services to meet the different needs of people which included teams for diabetes, heart failure, continence, falls and neurophysiotherapy. The dementia strategy supported the specific needs of patients; the dementia strategy covered both inpatient hospital care and patients in the community. Analysis of data showed that since April 2014 the trust achieved the referral to treatment (RTT) targets of 95% for musculoskeletal (MSK) services and podiatry services. We saw evidence the service monitored these monthly and between April and June 2015 the services continued to achieve above the 95% target. The trust had in place a concerns and complaints policy and procedure. We saw there was complaints information available within the areas we visited. Learning from complaints was shared where improvements had been identified. The outcome of the investigation was shared with the patient and an action plan was prepared that senior staff shared with their teams.

We rated the service as requires improvement for well-led. We saw the service had a risk register which identified the risk rating and what control measures the service had put in place. However, on review of the risk registers the reasons why some of the risks had been put on the risk register were unclear. Some risks were classed as generic, such as the risk of dermatitis due to allergy and exposure to skin irritants and the risk of needle stick injury. These would usually be identified on an individual basis rather than as a service risk under the relevant health and safety policy / procedure. Following the inspection, the trust told us these had been put on the risk register in response to specific incidents in the HPV (Human Papilloma Virus) immunisation team and in the GP services where unsheathed needles had been used. 

Staff told us on the whole they felt well supported by their managers and the senior management team within the directorate. Staff also reported they felt listened to and their managers were approachable. However, some staff told us whilst they felt supported by their direct line manager they felt management teams above them did not understand the pressures within the service. We found some staff were unclear about the nursing leadership for the district nursing service at the trust. We found reporting incidents was embedded across the service and we saw evidence of staff receiving feedback and learning was shared.  We found action plans were developed following serious incidents and the actions and progress had been monitored.

Updated 3 February 2016

Overall, we rated community health services for children, young people and families as good.

Children and young people’s services were safe. Staff knew how to manage and report incidents and we saw there had been learning following a serious case review. There were good safeguarding processes in place and staff received regular formal supervision. Staffing levels and caseloads were manageable and recruitment plans were in place to ensure health visiting vacancies were filled. In addition, the clinics and children’s centres we visited were clean.

Children and young people’s services were effective. Although some performance measures were being missed, care and treatment was evidence based and staff were competent. The trust had also successfully implemented evidence based programmes, such as the family nurse partnership programme. There were policies and procedures in place to support staff and ensure that services were delivered effectively and efficiently. There was good evidence of multidisciplinary and multi-agency working across the services.

Children and young people’s services were very caring. Staff were passionate about delivering high quality care and were very dedicated to their patients.

Children and young people’s services were responsive. Services were planned and delivered to meet the needs of the local population in line with the commissioning framework of the trust. Staff worked hard to meet the needs of children and families in vulnerable circumstances and there were support networks in place to ensure children and young people were protected.

Children and young people’s services were well-led. The majority of staff we spoke with understood the vision and strategy for their own service and also the wider trust. There were issues with some aspects of the leadership structure due to the prolonged absence of a senior member of the team. However, plans were in place to address the shortfall. We found the culture was open and transparent and there was strong evidence of collaborative team working across all services.

Updated 3 February 2016

Overall rating for this core service Good l

Overall we found that the community dental service at North Tees and Hartlepool NHS Foundation Trust provided safe and effective care. Patients were protected from abuse and avoidable harm and there were systems in place for identifying, investigating and learning from incidents, accidents and complaints. Overall we rated the service good.

At the time of the inspection, we judged that the service was safe and people were protected from abuse and physical harm.

We judged the service was effective and that people’s care, treatment and support achieved good outcomes for them. Treatments were based on the best available evidence and the service provided good health promotion.

We judged that people were involved in their care, and were treated with compassion, kindness, dignity and respect. The service was responsive to people’s needs, specifically meeting the needs of patients who were predominantly vulnerable and had complex needs. The service was well-led in that the leadership and management of the service provided a platform on which a holistic pattern of oral health care could be provided.

In coming to these judgements we spoke with patients and carers, staff who worked in the community dental clinics and the oral health promotion team. We inspected the facilities in five clinics (100% of the trusts dental locations) at Eston Clinic, Guisborough Primary Care Hospital, the One Life Centre in Hartlepool, North Ormesby Health Village and Lawson Street Health Centre. We spoke to 5 service users, 10 relatives or carers and observed 9 patients receiving dental treatments. We examined 20 clinical patient records and spoke to 14 members of staff.

Updated 3 February 2016

Overall rating for this core service Good

The Specialist Palliative Care team worked as part of a multidisciplinary team covering the acute and community based services, with specific team members dedicated to providing the community element of specialist care. Their role was to assess, support, deliver, monitor and evaluate end of life and palliative care provided by the trust. Services provided safe, co-ordinated care and we saw that staff were focused on continual learning and service development. Equipment used for patients at the end of life was easily accessible in the community and staff told us they felt they had the resources they needed to deliver quality care.

End of life care within the trust was influenced by national guidance such as the ‘Gold Standards Framework’ and we saw that good multidisciplinary working was in operation with the needs of the patient at the centre of all care activities. Patients and relatives we spoke with told us the care they received was delivered with care and compassion and that they were respected and treated with dignity. The trust was working towards a seven day specialist palliative care service and we saw that the needs of the local population were considered when reviewing the service provided. Improvements had been made to fast-track the discharge of people at the end of life and all staff were aware of and involved in, supporting patients to be cared for in their preferred place of care.

The specialist palliative care and end of life care services were well-led with both medical and nursing staff working to ensure the service meets the needs of patients. However, there was limited evidence that the end of life care strategy and service development had pro-active involvement at board level. In addition, in their support of the community inpatient service at University Hospital Hartlepool, the specialist palliative care team operated within a reactive rather than pro-active framework.