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The Newcastle Upon Tyne Hospitals NHS Foundation Trust The Newcastle upon Tyne Hospitals NHS Foundation Trust Quality Report Freeman Hospital Freeman Road High Heaton Newcastle upon Tyne NE7 7DN Date of inspection visit: 19 – 22 January 2016 and 5 Tel: 0191 233 6161 February 2016 Website: www.newcastle-hospitals.org.uk Date of publication: 06/06/2016 This report describes our judgement of the quality of care at this trust. 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 trust Outstanding – Are services at this trust safe? Good ––– Are services at this trust effective? Outstanding – Are services at this trust caring? Outstanding – Are services at this trust responsive? Outstanding – Are services at this trust well-led? Outstanding – 1 The Newcastle upon Tyne Hospitals NHS Foundation Trust Quality Report 06/06/2016 Summary of findings Letter from the Chief Inspector of Hospitals We inspected the trust from 19 to 22 January 2016 and • The trust promoted a positive incident reporting undertook an unannounced inspection on 5 February culture. Processes were in place for being open and 2016. We carried out this inspection as part of the CQC’s honest when things went wrong and patients given an comprehensive inspection programme. apology and explanation when incidents occurred. • Patient outcome measures showed the trust We included the following locations as part of the performed mostly within or better than national inspection: averages when compared with other hospitals. Stroke • Royal Victoria Infirmary incorporating the Great North pathways and long-term cancer outcomes were Childrens Hospital particularly effective. Death rates were within expected • The Freeman Hospital levels. • Dental Hospital • There were clearly defined and embedded systems • Centre for Ageing and Vitality and processes to ensure staffing levels were safe. The • Community services including adult community trust had challenges due to national shortages services, community services for children, young however; it was actively addressing this through a people and families, community dentists and range of initiatives including the development of new community end of life care and enhanced roles, and overseas recruitment. There were particular challenges in staffing in the neonatal We inspected the following core services: unit and provision of consultant to patient ratios and • Emergency & Urgent Care pharmacy cover in critical care. • Medical Care • The trust was meeting its waiting time targets for • Surgery urgent and routine appointments. The trust was • Critical Care effectively meeting its four-hour waiting time targets in • Maternity & Gynaecology the Emergency Care Department. • Services for Children and Young People • The diagnostic imaging department inpatient and • End of Life Care emergency image reporting turnaround times did not • Outpatients & Diagnostic Imaging meet nationally recognised best practice standards or Overall, we rated the trust as outstanding. We rated trust targets effective, caring, responsive and well led as outstanding • Systems and processes on some wards for the storage and safe was rated as good. We rated the Royal Victoria of medicine and the checking of resuscitation Infirmary, Freeman Hospital and the Dental Hospital as equipment did not comply with trust policy and outstanding and community services as good. guidance. • Information written in clinical notes about the care Our key findings were as follows: patients received in the Emergency Department and • The trust had infection prevention and control some wards were minimal. policies, which were accessible, and used by staff. • Although improvements had been made to ensure Across both acute and community services patients patients received antibiotics within one hour to treat received care in a clean, hygienic and suitably sepsis, the latest audit showed a compliance of 55%, maintained environment. However, there were some which was still low. infection control issues in the Emergency Care • There were some issues with the environment and Department. facilities in critical care (ward 38) at the RVI. This was • Patients were able to access suitable nutrition and highlighted in the critical care risk register and in a hydration, including special diets, and they reported trust gap analysis report to the Trust Board in 2015. that, overall, they were content with the quality and However, the service was managing risks consistently quantity of food. well in this area to ensure safe care. 2 The Newcastle upon Tyne Hospitals NHS Foundation Trust Quality Report 06/06/2016 Summary of findings • Feedback from patients, those close to them and treatment. The team had worked with other trusts stakeholders was consistently positive about the way across the country, as many patients lived outside of staff treated people. There were many examples of the local area, to ensure a smooth transition. exceptional care where staff at all levels went the extra Feedback from families about the passport was very mile to meet patient needs. positive • The trust used innovative and pioneering approaches • The Allied Health Professionals (AHP) Specialist to deliver care and treatment. This included new Palliative Care Service was a four-year project currently evidence-based techniques and technologies. Staff funded by Macmillan, which embedded AHPs into the were actively encouraged to participate in existing Acute Specialist Palliative Care Service. The benchmarking, peer review, accreditation and primary outcomes being to improve patient research. experience, manage symptoms, maximise, and • The trust worked hard to ensure it met the needs of increase well-being and quality of life. local people and considered their opinions when • There was an integrated model where palliative trying to make improvements or develop services. It specialists joined the cystic fibrosis team to provide was clear that the opinion of patients and relatives palliative care in parallel with standard care. Specialist was a top priority and highly valued. palliative care staff saw all patients with advanced • There was a proactive approach to understanding the disease including those on the transplant waiting lists. needs of different patients. This included patients who • The trust had an Older Peoples Medicine Specialist were in vulnerable circumstances and those who had Nurse led in-reach service into the emergency complex needs. department. In addition, there was an Elderly • There were strong governance structures and a Assessment Team at weekends which included a systematic approach to considering risk and quality social worker and specialist nurse. management. Senior and local site management was • The critical care pressure ulcer surveillance and visible to staff. Staff were proud to work in the prevention group had developed a critical care organisation and spoke highly of the quality of care dashboard for pressure ulcer incidence. A new provided. pressure ulcer assessment tool was developed and • There were consistently high levels of constructive implemented this had led to a major reduction in engagement with patients and staff, including all pressure injury. equality groups. • The Newcastle Breast Centre was at the forefront of treating breast cancer. The trust was the first unit in We saw several areas of outstanding practice including: the UK to offer'iodine seed localisation' in breast Royal Victoria Infirmary conservation surgery. Many breast cancer patients were given the chance totake partin national and • The home ventilation service delivered care to around international breast cancer treatment trials, as well as 500 patients in their own home. The service led the reconstruction studies. way for patients who needed total management of • In cardiology, the service had developed a new their respiratory failure at home with carers. The team pathway for patients requiring urgent cardiac pacing. offered diagnostics, extensive training and patient This was a 24/7 consultant led service and reduced support. The team had written the national curriculum patients length of stay. for specialist consultant training. The domiciliary visits • Eye clinic liaison staff had worked with the Action for covered the whole of the North of England, up to the Blind People charity to improve links between medical Scottish border, West Coast and Teesside. and social care. Studies showed that there had been a • The liaison team from the bone marrow transplant reduction in patient falls and consultations. unit had developed an open access pathway so post- transplant patients could access urgent care quickly The Freeman Hospital and safely. Children and young people presented their • There was an integrated model of care between the unique passport upon arrival in A&E, which included Specialist Palliative Care Team and the Cardiothoracic all information about their condition and any ongoing 3 The Newcastle upon Tyne Hospitals NHS Foundation Trust Quality Report 06/06/2016 Summary of findings Transplant Team. The teams worked alongside • The service had introduced computer based virtual patients with advanced disease including those surgery in the planning of jaw excision and waiting for transplant and those with ventricular assist reconstruction. The dental hospital was considered devices. the leaders in this field with experience in using this • A sleep checklist was developed for patients in
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