The CQC report published today (Tuesday 10 July) recognised a number of areas of quality care and practice at the Trust. Overall, 72 per cent of the services inspected at Doncaster Royal Infirmary and 77 per cent at Bassetlaw Hospital were judged to be ‘Good’ with no service at DBTH rated as ‘Inadequate’.
The CQC assessed whether the Trust’s services were safe, effective, caring, responsive and well-led across the four core services of Urgent and Emergency Care, Medical Care, Children and Young People and Maternity Services.
The visits were undertaken during a period of increasing winter pressures and attendance, which saw the CQC suspend inspections nationally in January 2018. Despite this, inspectors highlighted a number of positives, with ‘Medical Care’ coming in for particular praise. The inspectors found this service within DBTH to be ‘Good’ across the five domains, pointing to an emphasis on infection control, patient assessment and seven day service, all of which are supported by a culture of staff development.
The organisation’s leadership team were also the recipients of praise, with the report evidencing a strong working relationship between the Trust’s Chief Executive and Chair. The inspectors also pointed to training and development opportunities for leaders within DBTH with a goal to further improve patient care and treatment.
Ultimately, the core services inspected have not changed the overall Trust rating of ‘Requires Improvement’ from the previous inspection which took place in 2015. Since the last visit, the Trust has made a number of improvements, highlighted within the report:
- Services were planned to meet the needs of local people
- Good examples of multidisciplinary working, with the Trust performing better than the national average in a number of national audits
- Staff provide emotional support to patients
- Staff are aware of when incidents should be reported and robust processes are in place for reviewing, sharing and learning about incidents
- All areas visited were clean and well-maintained.
Mr Sewa Singh, Medical Director at DBTH, said: “On behalf of the Trust, I welcome the CQC’s scrutiny of our services and we are pleased that they have recognised good practice and the fantastic work which takes place here. We also recognise that there are areas where we could improve further and have started work to deliver this.
“Our patients told inspectors that members of Team DBTH are caring, compassionate and communicate well. Importantly, those staying with us expressed a feeling of safety as well as involvement within their care and treatment, and this is very important to us as an organisation.”
Alongside positives, the report highlights some areas of improvement, including staffing levels which remains a national challenge, as well as ensuring certain standards are met, such as one-to-one care during labour for 90% of women – something which has subsequently been achieved at Bassetlaw Hospital since the report was written and continues to improve at Doncaster Royal Infirmary. The report also found issue with Statutory and Essential Training (SET) and appraisal rates within the Trust, both of which have improved in recent months now standing completed by staff at 80% and 70% respectively.
Visiting at the busiest time of the year, inspectors also highlighted a need for improvement within the organisation’s Emergency Departments (ED). Steps have since been taken to improve ‘booking-in’ arrangements to reduce queues, in addition to improving staffing levels as required after the 2015 inspection. To sustain continued development within Urgent and Emergency Care, an innovative system called ‘Smart-ER’ has recently been implemented which makes diagnosis much more efficient, while further development bids are also being explored to complement the service, which is often the highest performing of its kind in the region.
The inspection came at a time when the local hospitals have made significant strides in financial control. For 2017/18, DBTH ended the year £5.2m ahead of plan with cost savings of over £11 million delivered. In May 2018, NHS Improvement (NHSI) confirmed that significant improvements had been made by DBTH in response to the financial governance issues that had arisen during 2015. These actions alongside the strengthening of board and management capacity and capability has led to the regulator removing the breach of licence, imposed three years earlier, acknowledging the increased confidence in the Trust in providing financially sustainable high quality services for patients.
Reflecting upon a year of good performance in both finance and patient care, the Trust has also reported record lows of preventable harms such as pressure ulcers and falls with significant harm. These achievements are further complimented by sustained improvements in relation to meeting national targets for Clostridium Difficile infection rates, as well as maintaining a better than average performance in the organisation’s Hospital Standardised Mortality Ratio (an indicator of safety) to 87.42, well within the expected range of 100.
Mr Singh continued: “We accept the recommendations from the CQC, and, with the creation of a detailed action plan, we will be taking the required steps to make further improvements to our service as well as address the issues highlighted by the inspection teams. I would also like to express my thanks to our staff who work tirelessly each and every day caring for patients.”
“Over the past number of years, the Trust has been on an improvement journey. The next 12 months will bring with it another set of challenges, and it’s paramount that, as an organisation, we remain focused upon our goals, ensuring that our patients remain at the centre of all we do, that our staff remain focused on continuous improvement and that as an organisation we make the best use of public money. We have a fantastic team at DBTH and I believe we will only continue to make good progress to become an outstanding organisation.”
The reports published today (10 July) by the CQC are based on a combination of its inspection findings, information from the CQC’s Insights (intelligence monitoring system), and information provided by patients, the public, Trust staff and other organisations.
The reports are published on the CQC website at https://www.cqc.org.uk/provider/RP5