Castle Hill Hospital

Updated 23 March 2023

Castle Hill Hospital (CHH) provides a range of acute services to the residents of Hull and the East Riding of Yorkshire, as well as specialist services to North Yorkshire, North and North East Lincolnshire. The trust has approximately 1,160 inpatient beds across the two main hospitals and employs over 7,000 whole time equivalent staff to deliver its services. Castle Hill Hospital has the regional Queen’s Centre for oncology and haematology and provides cardiac and elective surgery facilities, medical research teaching and day surgery facilities in the Daisy Building.

Updated 23 March 2023

Updated 24 June 2020

• We rated safe, effective, caring and responsive as good. We rated well led as requires improvement.
• The service provided mandatory training in key skills to all staff and made sure most staff completed it. Staff understood how to protect patients from abuse. Staff kept equipment and the premises visibly clean. Staff managed clinical waste well. Staff completed and updated risk assessments for each patient. The critical care units had enough nursing and medical staff with the right qualifications, skills, training and experience to keep patients safe. Records were clear, up to date and easily available to all staff providing care. The service used systems and processes to safely prescribe, administer, record and store medicines. The service managed patient safety incidents well.
• Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way. Staff monitored the effectiveness of care and treatment. The service made sure most staff were competent for their roles. Most key services were available seven days a week to support timely patient care. Staff supported patients to make informed decisions about their care and treatment.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. Staff provided emotional support to patients, families and carers to minimise their distress. They understood patients personal, cultural and religious needs. Staff supported patients, families and carers to understand their condition and make decisions about their care and treatment.
• The service planned and provided care in a way that met the needs of local people and the communities served. It also worked with others in the wider system and local organisations to plan care. The service was inclusive and took account of patients’ individual needs and preferences. Bedside diaries were used to support patients and their families during critical illness. People could access the service when they needed it and received the right care promptly.
• Leaders had the skills and abilities to run the service. The service had a vision for what it wanted to achieve and a strategy to turn it into action. Staff felt respected, supported and valued. The service had an open culture where patients, their families and staff could raise concerns without fear. Staff had regular opportunities to meet. The service collected reliable data and analysed it.

However:

• Castle Hill Intensive care unit 2 (CICU 2) did not meet the most recent health building note guidance in terms of the environment.
• Whilst there had been some improvement, to the numbers of staff in the critical care outreach team, this was still not adequately staffed out of hours and at weekends. The service did not have enough allied health professionals with the right qualifications, skills, training and experience.
• We were concerned that care and treatment might not always be based on national guidance and best practice. at the time of our inspection. Not all staff had an up to date appraisal. The trust were not meeting the GPICS standard for the number of registered nurses with a post registration critical care award.
• The service was still not providing a formal follow up clinic in line with GPICS standards and the National Institute of Health and Care Excellence (NICE) CG83 best practice guidance.
• Leaders did not always operate effective governance processes. We were concerned about the lack of oversight in relation to the review of policies and procedures relevant to the units. There had been a lack of pace to address risks on the risk register. For example, we were told a business case to address the isolation facilities had been submitted for consideration but this had not been approved consistently.

Updated 15 February 2017

The last comprehensive inspection of End of life care services at the hospital was in February 2014, when we found the service to be good. During this inspection we rated this core service as ‘good’ overall because;

• Patients were protected from avoidable harm and abuse. Staff understood and fulfilled their responsibilities to raise concerns and report incidents and managers shared the learning from incidents. Mandatory training across most services was above the trust targets and medicines were prescribed and administered safely in line with policy and staffing levels were appropriate for the services provided.
• People’s care and treatment was planned and delivered in line with current evidence-based guidance. Information about people’s care and treatment, and their outcomes, were routinely collected and monitored. Staff providing care at the end of life were highly skilled and competent. There was evidence of multidisciplinary working across all teams. The trust had recently employed more resources to provide seven-day specialist palliative care nursing availability. Consent to care and treatment was obtained in line with legislation and guidance.
• Feedback we received from patients was consistently positive about the way staff treated them. We observed a number of staff and patient interactions during our inspection. We observed consistently caring and compassionate staff. Patients and their families were supported emotionally. We saw an initiative that had been implemented by the bereavement team that we thought was outstanding.
• Services were planned and delivered in a way that meets the needs of the local population. All teams involved in caring for patients at the end of life were highly responsive to the needs of the patients in their care and those close to them. Care and treatment was coordinated with other services and other providers to ensure that specialist teams saw patients in a timely manner and patients’ choice in relation to where their care was delivered was achieved. We saw evidence that staff were responsive to meeting the needs of vulnerable patients including those living with dementia.
• All teams were aware of the trust vision and values. Whilst there was no trust end of life strategy at the time of our inspection, the Specialist Palliative Care Team (SPCT) were working collaboratively with other providers and using the national End of Life Care strategy to benchmark and influence the care and treatment they provided to patients. Robust governance, risk management and quality measurement processes were embedded. Staff told us that senior staff were visible and supportive. There was a lead consultant for end of life care and a director who provided representation at the trust board. We found that staff in all teams were consistently positive, friendly, helpful and approachable in all areas we visited. All staff were team focused and we saw examples of innovation, improvement and sustainability.

Updated 1 June 2018

We previously inspected outpatients jointly with diagnostic imaging so we cannot compare our new ratings directly with previous ratings. We rated the service as good because:

• The previous inspection identified a lack of effective governance processes within outpatients. At this inspection we saw the trust had strengthened these processes by introducing performance reports, performance and access meetings and a trustwide outpatients governance committee.
• Staff we spoke with knew how to report incidents and about learning lessons from incidents within the individual health groups.
• All staff we spoke with felt positive about the new management changes and the future of outpatients.
• Some work had been undertaken to look at staff skills and develop training specific to the needs of individual staff.
• Most patients we spoke with told us that staff were caring and friendly.
• Complaints were investigated thoroughly and in a timely manner.
• Mandatory training compliance figures were high.

However:

• Some problems with the storage of patient records remained. Patient records were not always stored securely in some clinics visited.
• The trust was not meeting its internal appraisal standard.
• The previous inspection found issues with waiting times for patients and referral to treatment indicators not always being met. During this inspection, we found that referral to treatment indicators were still not always met.
• We saw high numbers of patients waiting for first and follow up appointments across several outpatient areas, resulting in backlogs. This issue was also identified within the previous inspection report.

Updated 23 March 2023