Updated 23 March 2023
This report describes our judgement of the quality of care provided by this trust. We base it on a combination of what we found when we inspected and other information available to us. It includes information given to us from staff at the trust, people who use the service, the public and other organisations.
We rated well-led (leadership) from our inspection of trust management, taking into account what we found about leadership in individual services. We rated other key questions by combining the service ratings and using our professional judgement.
We carried out this unannounced inspection of three acute services provided by this trust as part of our continual checks on the safety and quality of healthcare services
We also inspected the well-led key question for the trust overall.
Overall summary
- Hull University Teaching Hospitals NHS Trust (HUTH) offered a comprehensive secondary care service portfolio covering the major medical and surgical specialties, routine and specialist diagnostic services and other clinical support services. These services were primarily provided to a catchment population of approximately 600,000 in Hull and the East Riding.
- HUTH provided specialist and tertiary services to a population of 1-1.25m people, this covered the area from Scarborough in North Yorkshire to Grimsby and Scunthorpe in North East and North Lincolnshire.
- HUTH was also a designated centre for:
- Cancer
- Cardiology
- Vascular
- Major trauma
- The only major services not provided by HUTH were:
- Transplant Surgery
- Major Burns
- Some Specialist paediatric services
- The organisation sat within the Humber and North Yorkshire Integrated Care System (ICS).
- HUTH was situated in the geographical area of Kingston upon Hull and the East Riding of Yorkshire. The two main sites being Hull Royal Infirmary and Castle Hill Hospital.
- The Trust was established in October 1999 and on 1st March 2019 changed its name to Hull University Teaching Hospitals NHS Trust to strengthen links with Hull University, particularly around teaching and academic opportunities.
We inspected Emergency and Urgent Care, Medicine and Surgery. We also inspected the well-led key question for the trust overall. We did not inspect maternity, critical care, children and young people services, outpatients and end of life services at this inspection.
At our last inspection in 2020 we rated the trust overall as requires improvement. CQC temporarily suspended all routine inspections on 16 March 2020 to support and reduce the pressure on health and social care services during the COVID-19 pandemic. This inspection, in terms of core services, was already underway at the time of the suspension and therefore could not be completed in the usual way. The report included the findings from the completed service level inspections, but the well-led inspection was not completed. We did complete a well led inspection as part of this inspection.
Our rating of services stayed the same. We rated them as requires improvement because:
- Overall, we rated safe as inadequate, effective and responsive as requires improvement and caring as good. We rated well-led as requires improvement.
- We rated Emergency and Urgent Care as inadequate. We rated safe, effective, responsive and well-led as inadequate. We rated caring as requires improvement.
- We rated Medicine as requires improvement. We rated safe, effective, responsive and well-led as requires improvement and rated caring as good.
- We rated Surgery as requires improvement. We rated safe as inadequate, effective, responsive and well-led as requires improvement and rated caring as good.
- In rating the trust, we took into account the current ratings of the other core services that were not inspected this time.
What we found
Our rating of services stayed the same. We rated them as requires improvement because:
- Senior Leaders understood and managed the priorities and issues the service faced. However, whilst they were aware of the issues and significant challenges, they did not always manage services with timely and decisive action, and this had an impact on patient care. Although, they used systems to manage performance effectively, they did not always operate effective governance processes to escalate relevant risks and issues, and identify actions to reduce their impact. There were significant challenges in some key areas that were not addressed timely and in a way that had the required impact on patient care.
- Services we inspected did not have enough staff to keep patients safe. Staff did not always assess risks to patients and failed to identify risks and could not evidence how these risks were acted upon. Care records were incomplete. The service did not always manage safety incidents well or learn lessons from them.
- The service did not always provide care and treatment based on national guidance and evidence-based practice. Managers did not always monitor the effectiveness of the service. Staff did not always support patients to make informed decisions about their care and treatment. They did not always follow national guidance to gain patients’ consent. They did not always support patients who lacked capacity to make their own decisions or who were experiencing mental ill health.
- Staff did not always respect people’s privacy and dignity, and take account of their individual needs.
- People could not always access the service when they needed it and did not always receive the right care promptly. People did not always receive the right care promptly due to pressures on bed capacity. There were significant numbers of patients unable to leave the hospital as they were waiting for onward care packages resulting in some patients needing longer stays while they awaited treatment and discharge. There were significant challenges with performance and patient flow across the trust which had not yet been fully addressed.
- During our inspection we found that local leadership at core service level varied. In the most recent NHS Staff Survey, scores for ‘Staff Engagement’ and ‘Morale’ were similar to the sector average but had significantly declined since the last inspection. Some staff did not always feel respected, supported and valued.
However:
- Staff treated people with compassion and kindness.
- The service had a good understanding of quality improvement methods and the skills to use them. Leaders encouraged innovation and participation in research.
- Leaders and staff actively and openly engaged with patients, staff, equality groups, the public and local organisations to plan and manage services.
How we carried out the inspection
The team that carried out the well led inspection included one inspection manager, 6 inspectors, one assistant inspector and an inspection planner. In addition, there was an executive reviewer plus four specialist advisors experienced in executive leadership of NHS trusts. The inspection team was overseen by Sarah Dronsfield, Head of Hospital Inspection.
You can find further information about how we carry out our inspections on our website: www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.