Grantham and District Hospital

Updated 3 July 2018

Grantham and District Hospital serves the communities of Grantham and the local area. It provides ambulatory paediatric and accident and emergency services as well as medicine, surgery and end of life care.

For the period October 2016 to September 2017 there were 13,628 inpatient admissions to this hospital and 130, 786 outpatient attendances.

We inspected Medicine and Surgery at this inspection.

Updated 3 July 2018

Our rating of services stayed the same. We rated it them as good because:

A summary of this hospital appears in the overall summary above.

Updated 3 July 2018

Our rating of this service stayed the same. We rated it as good because:

• The service demonstrated an improved culture of learning from incidents, including never events.
• Staff consistently treated patients and their relatives with kindness and respect. Patients and carers were involved in care decisions, gave positive feedback and felt supported by staff.
• We saw effective multi-disciplinary working to support evidence based care.
• There was safe provision of equipment, including equipment to be used in an emergency.
• There were effective processes in place to assess and escalate deteriorating patients.
• Improvements had been made to ensure patients living with a learning disability or dementia were identified more easily.
• There had been improvements to governance arrangements, with a number of new initiatives introduced to monitor clinical practice and identify and assess risks to patients.
• There were effective systems for infection prevention and control (IPC), and the management of sepsis.
• Staff understood their roles and responsibilities under the Mental Health Act 1983, and the Mental Capacity Act 2005.
• Risks to people were assessed, managed, and monitored on a day to day basis.
• Staff understood their responsibilities and actions required in identifying patients at risk of deterioration, harm and abuse, and associated reporting.
• Staff were qualified and had the skills to carry out their roles effectively and in line with best practice. However, compliance with mandatory training rates did not meet the trust targets in all areas.
• Patients’ care was planned and delivered in line with national evidence-based guidance and supported by local guidelines and standard operating procedures.

However, we also found:

• At times of pressure extra bed capacity on medical wards was provided without a corresponding escalation in staffing levels.
• Numbers of nursing and medical staff were below those required by the trust.
• Compliance with mandatory training rates did not meet the trust targets in all areas.
• There were limited systems for identifying and managing expired medicines. The policy for this was not explicit in determining responsibilities.
• The average referral to treatment (RTT) was worse than the England average. Although mitigating actions were in place.
• The average length of stay for non-elective patients in cardiology and geriatric medicine was higher than the England average.
• Appraisals had not been completed for all staff.

Updated 27 March 2015

The unit provided safe and effective care, with a good safety record and outcomes for people. There were suitable numbers of staff to meet people’s needs, and they had received training, which prepared them for working within the specialist environment. Staff were caring and compassionate, maintaining people’s dignity and privacy. There were positive interaction between staff and patients, and their relatives.

While there was good access to the service, in 2014 we noted that the use of manual beds rather than electric profiling beds required improvement in order to meet people’s needs. However, in 2015 we noted that the unit had been supplied with electric profiling beds, two of which could weigh patients whilst they were on the bed.

The service was well-led. Staff reported feeling supported by managers in the department, and that senior leaders in the organisation were more visible and accessible. While performance on the staff survey in 2013 had been poor for many questions, all staff we spoke with told us that things had improved in the last year.

Updated 27 March 2015

Updated 10 July 2014

This service does not have facilities for babies to be born at this hospital. However, the trust was still advertising a birthing facility that had closed in February 2014.  This was following a review of the service and public consultation by commissioners. We spoke with 17 members of staff, including midwives, student midwives, maternity support workers and administration staff. We also spoke with three women who used the service and three family members.

We were not assured learning from incidents and complaints were being cascaded to staff. Some staff were unaware of the monthly quality report, which detailed all relevant quality issues for the service.

Not all equipment was fit for purpose or repaired in a timely manner.

There were no specialist midwives for bereavement, substance misuse or safeguarding. When questioned, staff explained to us these specialist posts were needed to meet the needs of the women using the service. There was inequality in the ultrasound scanning facilities offered to women. The head of midwifery post had been vacant for three months. Staff were unaware that a plan had been put into place to ensure the head of midwifery post was temporarily covered until a replacement head of midwifery employed. The majority of staff told us they felt isolated from the trust and felt decisions were made without consultation.

Updated 27 March 2015

Updated 3 July 2018

Our rating of the service at this inspection stayed the same. We rated it as good because:

• The service had a positive incident reporting culture, demonstrating learning and sharing both locally and across the trust.
• There was a robust system within pre-operative assessment with a clear admission criterion, comprehensive infection control and prevention screening and risk assessments for all patients.
• There was access to equipment, including emergency equipment with in-house medical physics support.
• Staff understood their roles and responsibilities under the Mental Health Act 1983, and the Mental Capacity Act 2005.
• Risks to people were assessed, managed, and monitored on a day-to-day basis.
• Surgical services at Grantham and District hospital (GDH) provided cared to patients in line with local and national guidance.
• Staff were competent and appropriately trained to undertake the role for which they were employed, had equal opportunities for professional development and were up to date with annual appraisals.
• The trust had a five-year strategy for all clinical services for 2014 to 2019 to support the delivery of good quality patient care. This underpinned the trusts values.
• Staff were aware of the trust values which were displayed within the departments and told us they enjoyed working at GDH and felt valued in their work.

However, we also found:

• Some items of equipment were out of date for servicing schedules. This was escalated at the time of identification and corrected prior to completion of the inspection.
• Some medicines were found to be out of date. This was escalated at the time of identification and corrected prior to completion of the inspection.

Updated 11 April 2017

Overall, we rated urgent and emergency services as good.

We rated safe as requires improvement, effective, caring, responsive and well-led as good because:

Care and treatment provided by the department was in line with current evidence based guidance, standards and best practice. The department assessed patients throughout their care pathway in line with ‘National Institute of Health and Care Excellence’ (NICE) quality standards and College of Emergency Medicine (CEM) guidelines.

The department collected information about patients’ care, treatment and outcomes; the department used these to improve patient care.

Staff treated patients with dignity, respect and kindness during all interactions we observed.

Staff helped people and those close to them cope emotionally with their care and treatment.

Staff respected patients’ rights to make choices about their care.

Waiting times and delays were minimal and managed appropriately. Care and treatment was coordinated with other services and providers.

There were systems in place to support vulnerable patients.

There was an effective governance framework in place. The department monitored quality, risks and performance issues through monthly clinical governance meetings and there was a good feedback loop.

We saw an effective system in place to ensure patients received appropriate initial assessment by appropriately qualified clinical staff within 15 minutes of arrival to ED in line with best practice.

Emergency preparedness plans were in place and staff knew of these.

Staff gave sufficient priority to safeguarding vulnerable adults and children.

However;

There was not a robust system in place for checking availability of life saving equipment.

We found staff had not checked resuscitation equipment in line with trust policy. Several single-use items in the paediatric resuscitation trolley were out of date.

There were not sufficient numbers of children’s nurses in the department and four out a possible 20 (20%) adult nurses had completed paediatric competencies.

There were insufficient numbers of nurses and doctors trained in paediatric resuscitation.

Nurses and doctors told us the department was not big enough for the number of patients now accessing the department. We saw doctors bringing patients into the department to cubicles, which were already in use. There was no dedicated receiving area for patients arriving by ambulance.

Staff allocated ambulance stretchers to the corridor until a cubicle was available. There was a risk to safety as it would be difficult to evacuate the area in an emergency or to assess and treat a patient who became unwell.

Patients could not always access the right care at the right time due to the department’s overnight closure, especially those with urgent care needs.

There was a mixed morale amongst staff in the department, some staff described the overnight closure as worrying and wondered if the department would ever re-open overnight. Some said they liked it as staffing levels had improved during the day. Consultants said morale was low; they felt they were unable to provide the service they wanted to the local population of Grantham.