Corbett Hospital Scheduled Report

The Dudley Group NHS Foundation Trust Russells Hall Hospital including Corbett and Dudley Guest Quality Report Russells Hall Hospital, Pensnett Road, Dudley, West Midlands, DY1 2HQ Corbett Hospital, Vicarage Road, Stourbridge, West Midlands,, DY8 4HZP Tel: 01384 456111 Date of inspection visit: 26 and 27 March 2014 Website: www.dgh.nhs.uk Date of publication: 03/12/2014 This report describes our judgement of the quality of care at this hospital. It is based on a combination of what we found when we inspected, information from our ‘Intelligent Monitoring’ system, and information given to us from patients, the public and other organisations. Ratings Overall rating for this hospital Requires improvement ––– Accident and emergency Requires improvement ––– Medical care Good ––– Surgery Good ––– Critical care Requires improvement ––– Maternity and family planning Requires improvement ––– Services for children and young people Good ––– End of life care Good ––– Outpatients Good ––– 1 Russells Hall Hospital including Corbett and Dudley Guest Quality Report 03/12/2014 Summary of findings Letter from the Chief Inspector of Hospitals We carried out this comprehensive inspection as part of the new hospital inspection programme and as a follow up to the Keogh review which took place in 2013. Of the 14 trusts inspected under the Keogh review for the quality and safety of their services, The Dudley Group NHS Foundation Trust was one of only three trusts that were not put into special measures. That review identified concerns regarding: • governance arrangements • the need to embed a culture of learning from incidents • how the trust uses and reviews mortality data • the system for bed management and patient flows • embedding patient experience in the organisation’s learning and strategy • staffing levels and skills mix • safety and equipment checks • pressure ulcer care. Before the inspection conducted in March 2014, the Trust was identified in CQC’s intelligent monitoring system as a priority band 4 Trust. There are six bands within the monitoring system so this Trust had a relatively lower risk. We noted that the trust’s action plan to address the concerns following the Keogh review had been put into place and signed off. Our inspection of The Dudley Group NHS Foundation Trust included Russells Hall Hospital, Corbett Outpatient Centre and Dudley Guest Outpatient Centre. The announced inspection took place between 26 and 27 March 2014, and unannounced inspection visits took place in the two weeks following this visit. Overall, this trust was found to require improvement, although we rated it good in terms of having caring staff, and effective services. We saw much support for the trust, both from the public and from the local health economy. We saw a trust that was a considerable way along its improvement journey and saw many areas of strong development. Whilst some of the core service areas within the trust required improvements in leadership, we found the executive team and the trust board had a clear focus on improvement and as such we rated this trust as good for its overall leadership. The improvements required by the trust were within the grasp of the trust and its leaders. We were confident that these could be achieved quickly.Key findings related to the following: • The trust’s staff are seen as highly caring by many of the patients we spoke to and praised the staff for ‘going the extra mile’. • The trust’s leadership team is seen as highly effective by the staff; and is recognised to be clearly in touch with the experience of patients and the work of the staff. • Staff value the Dudley Group as a place to work and a team spirit is clearly evident. • The trust has responded well to the Keogh review in 2013. • There are a number of areas of good practice in the trust, which should be encouraged. Staff feel able to develop their own ideas and have confidence that the trust will support them. • The emergency department (A&E) is busy and overstretched. There remain challenges in the flow of patients, but much of this relates to flow across the rest of the hospital. Only a small proportion relates to the emergency department itself. 2 Russells Hall Hospital including Corbett and Dudley Guest Quality Report 03/12/2014 Summary of findings • The trust does not always follow its own policy in relation to DNACPR (do not attempt resuscitation) notices. • The ophthalmology clinics require review to ensure that all patients are followed up as required and that there is capacity for these clinics. • The trust must review its capacity in phlebotomy clinics as this is seen as insufficient. Professor Sir Mike Richards Chief Inspector of Hospitals 3 Russells Hall Hospital including Corbett and Dudley Guest Quality Report 03/12/2014 Summar y of findings Summary of findings Our judgements about each of the main services Service Rating Why have we given this rating? Accident Requires improvement ––– The Trust was experiencing an increased number of and patients admitted to the ED. This had a negative emergency impact on the Trust meeting the national target of admitting, transferring or discharging patients within four hours of their arrival in the department. We saw when patients arrived by ambulance they were assessed in a corridor, and at times they were kept in this area until a cubicle was free. Staff told us they were aware the practice was not ideal for patients. Patients were observed until they were placed on a trolley, which was as soon as possible after entering the department. The ED was struggling to manage the flow of patients through the department. Much of the challenge related to the ability of the ED to identify beds in the hospital for those patients who needed to be admitted. Delays in moving patients from the ED were impacted by general blockages across the system. This in part also related to the lack of capacity outside the hospital to facilitate a prompt discharge for patients. There were some initiatives in place to avoid unnecessary admissions (where admission isn’t clinically required) and to speed up the discharge of patients but waiting times for patients were not improving. The Trust told us they were aware of the key risks within the organisation but there appeared to be no clear communication or action taken between Trust wide managers and the frontline staff within the ED. The reality for the staff of the day-to-day pressure was immense and the staff felt that this was being overlooked. The staff were committed to trying out new initiatives, learning and wanted to improve. They told us senior leaders were less responsive to supporting them. Although there was some monitoring of quality taking place it was not carried out in a structured or formalised way. We found that the ED staff were enthusiastic and caring. Relatives and patients told us they found the staff very kind and caring. Patients told us they felt 4 Russells Hall Hospital including Corbett and Dudley Guest Quality Report 03/12/2014 Summar y of findings Summary of findings safe and they had been informed about their treatment. They told us they would recommend the hospital to friends and family. The ED was running at full capacity. During our inspection, we found the department staffed with medical and nursing staff in sufficient numbers to meet the needs of patients. We observed patients in the Minors and Majors areas being prioritised or triaged by a ‘triage trained’ nurse. This process ensured that the most appropriate plan of care was organised to meet their needs. Children were triaged in the separate paediatric department from 11am to 11pm. This meant that they were seen by specialist nurses and doctors during those hours. Medical Good ––– We found that all of the areas we visited on the care medical care directorate were clean and hygienic, which helped to protect patients from hospital-acquired infection. We saw that all areas were well maintained and free of clutter. We saw that staff had completed mandatory training and received annual appraisals of their performance. All staff received mental health awareness training and de-escalation training had commenced for nursing staff. We found that lead nurses were well informed about de-escalation techniques and challenging behaviour. We saw that staff received training on how to report incidents, such as falls, and complaints. Staff told us that they received regular feedback on these. We saw that lessons learned from incidents, and actions for any improvements, were discussed in team meetings. We found that medicines management was safe and patients received timely and appropriate pain medication as needed. We saw that staffing levels had improved and the Trust was in the process of recruiting additional trained nurses and medical staff. We saw that staff worked in partnership with other colleagues and partners to achieve the right outcomes for patients. Throughout the inspection we observed positive interaction between staff and patients. All of the patients we spoke with said the staff were very good. They told us that they were treated with respect and dignity. 5 Russells Hall Hospital including Corbett and Dudley Guest Quality Report 03/12/2014 Summar y of findings Summary of findings We were concerned about the delays in the flow of patients through the hospital. We saw that some patients had to wait for long periods and were subjected to multiple moves in the directorate. We are aware that this is an ongoing problem and actions have been taken to improve this situation with the introduction of the frail elderly short stay unit. However, this remains an area of improvement for the Trust. A dementia care bundle – a small set of evidence-based practices and processes to improve care – had been piloted, but this must be implemented across the directorate to provide the best outcomes for people living with dementia.

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